Cancer

1. The client frequently finds lumps in her breasts, especially around her menstrual period. Which information should the nurse teach the client regarding breast self-care? 1. This is a benign process, which does not require follow-up. 2. The client should eliminate chocolate and caffeine from the diet. 3. The client should practice breast selfexamination monthly. 4. This is the way breast cancer begins and the client needs surgery. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

1. 1. This is symptomatic of benign fibrocystic disease, but follow-up is always needed if the lumps do not go away when the hormone levels change. 2. Some practitioners suggest eliminating caffeine and chocolate from the diet if the breasts become tender from the changes, but there is no research supporting this to be effective in controlling the discomfort associated with fibrocystic breasts. 3. The American Cancer Society no longer recommends breast self-examination (BSE) for all women, but it is advisable for women with known breast conditions to perform BSE monthly to detect potential cancer. 4. The client may need a breast biopsy for potential breast cancer at some point, but breast cancer develops when there is an alteration in the DNA of a cell. TEST-TAKING HINT: The test taker could eliminate option "1" because of the clause "does not require follow-up." The question is asking about self-care, and only two (2) options—"2" and "3"—involve the client doing something. The test taker should choose between these. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 409). F.A. Davis Company. Kindle Edition. 3

1. The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented? 1. Hold all venipuncture sites for at least five (5) minutes. 2. Limit fresh fruits and flowers. 3. Place all clients in reverse isolation. 4. Have the clients use a soft-bristle toothbrush. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

1. 1. This would be done for thrombocytopenia (low platelets), not neutropenia (low white blood cells). 2. Fresh fruits and flowers may carry bacteria or insects on the skin of the fruit or dirt on the flowers and leaves, so they are restricted around clients with low white blood cell counts. 3. Clients with severe neutropenia may be placed in reverse isolation, but not all clients with neutropenia will be placed in reverse isolation. Clients are at a greater risk for infecting themselves from endogenous fungi and bacteria than from being exposed to noninfectious individuals. 4. This is an intervention for thrombocytopenia. TEST-TAKING HINT: The test taker must match the problem with the answer option. Options "1" and "4" would probably be implemented for the client with a bleeding disorder. Option "3" has the word "all" in it, which would make the test taker not select this option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 159). F.A. Davis Company. Kindle Edition. 2

1. The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Protection from ultraviolet light d. Regular examination of reproductive organs Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

1. a. Lung cancer is the leading cause of cancer deaths in the United States for both women and men and smoking cessation is one of the most important cancer prevention behaviors. Approximately one half of cancer-related deaths in the U.S. are related to tobacco use, unhealthy diet, physical inactivity, and obesity. Cancers of the reproductive organs are the second leading cause of cancer deaths. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

10. The nurse is teaching a class to older women concerning cancer of the uterus. Which situation is a risk factor for developing endometrial cancer? 1. Age 40 years or younger. 2. Perimenopausal bleeding. 3. Progesterone given with estrogen. 4. Truncal obesity. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 431). F.A. Davis Company. Kindle Edition.

10. 1. Clients at risk for uterine cancer are usually 55 years old or older. 2. Postmenopausal bleeding places the client at risk, but perimenopausal bleeding is expected as the ovaries begin to slow production of eggs. 3. Unopposed estrogen replacement therapy predisposes women to developing uterine cancer, but progesterone offsets the risk. 4. Truncal obesity is one of the risk factors for developing endometrial cancer, although it has not been determined how this occurs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 435). F.A. Davis Company. Kindle Edition. 4

10. Which clinical manifestation would the nurse assess in the client newly diagnosed with intrinsic lung cancer? 1. Dysphagia. 2. Foul-smelling breath. 3. Hoarseness. 4. Weight loss. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 233). F.A. Davis Company. Kindle Edition.

10. 1. Dysphagia is a late sign of intrinsic lung cancer. 2. Foul-smelling breath is a late sign of intrinsic lung cancer. 3. Hoarseness is an early clinical manifestation of intrinsic lung cancer. "Intrinsic" means the tumor is on the vocal cord. 4. Weight loss is a late sign of most types of cancers, not just intrinsic lung cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 240). F.A. Davis Company. Kindle Edition. 3

10. The client is being discharged after a left wedge resection. Which discharge instructions should the nurse include? Select all that apply. 1. Notify the HCP of a temperature of 100°F. 2. Carry large purses and bundles with the right hand. 3. Do not go to church or anywhere with crowds. 4. Try to keep the arm as still as possible until seen by the HCP. 5. Have a mammogram of the right and left breasts yearly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 399). F.A. Davis Company. Kindle Edition.

10. 1. It is a common instruction for any client who has had surgery to notify the HCP if a fever develops. This could indicate a postoperative infection. 2. The client who has had a mastectomy is at risk for lymphedema in the affected arm because the lymph nodes are removed during the surgery. The client should protect the arm from injury and carry heavy objects with the opposite arm. 3. The client can attend church services and large gatherings. This client had surgery, not chemotherapy, which would make the client immunosuppressed. 4. The client should be taught arm-climbing exercises before leaving the hospital to facilitate maintaining range of motion. 5. The client has developed a malignancy in one breast and is at a higher risk for developing another tumor in the remaining breast area. TEST-TAKING HINT: The test taker must determine if the option of keeping the arm still is recommended. Most postoperative recommendations require the client to move as much as possible. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 411). F.A. Davis Company. Kindle Edition. 1,2,5

10. The nurse and the licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? 1. The client newly diagnosed with chronic lymphocytic leukemia. 2. The client who is four (4) hours postprocedure bone marrow biopsy. 3. The client who received two (2) units of (PRBCs) on the previous shift. 4. The client who is receiving multiple intravenous piggyback medications. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

10. 1. The newly diagnosed client will need to be taught about the disease and about treatment options. The registered nurse cannot delegate teaching to an LPN. 2. This client is postprocedure and could be cared for by the LPN. 3. This client has already received the blood products; this client requires routine monitoring, which the LPN could perform. 4. The LPN can administer antibiotic medications. TEST-TAKING HINT: The nurse cannot assign assessment, teaching, or evaluation. The clients in options "2," "3," and "4" are stable or have expected situations. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 1

10. What is the name of a tumor from the embryonal mesoderm tissue of origin located in the anatomic site of the meninges that has malignant behavior? a. Meningitis b. Meningioma c. Meningocele d. Meningeal sarcoma Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

10. d. Meningeal sarcoma is from the embryonal mesoderm, is located in the meninges, and is malignant. A meningioma has the same tissue of origin and anatomic site but it is benign. Meningitis is inflammation or infection of the meninges. Meningocele is a hernia cyst filled with cerebrospinal fluid. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

11. Which priority intervention should the nurse implement for the client diagnosed with coal workers' pneumoconiosis? 1. Monitor the client's intake and output. 2. Assess for black-streaked sputum. 3. Monitor the white blood cell count daily. 4. Assess the client's activity level every shift. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 234). F.A. Davis Company. Kindle Edition.

11. 1. Fluids should be encouraged to help to liquefy sputum; therefore, intake and output should be monitored, but this is not the priority intervention. 2. Black-streaked sputum is a classic sign of coal workers' pneumoconiosis (black lung), and the sputum should be assessed for color and amount. Remember Maslow's hierarchy of needs when answering priority questions. 3. The client's white blood cells should be monitored to assess for infection, but it is not priority and is not done daily. 4. Activity tolerance is important to assess for clients with all respiratory diseases, but it is not the priority intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 240). F.A. Davis Company. Kindle Edition. 2

11. The nurse is caring for a client diagnosed with uterine cancer who has received afterload intracavitary radiation. Which precaution should the nurse implement? 1. Wear rubber gloves to protect the nurse from all exposure. 2. Allow any visitor the client wishes to see. 3. Minimize the amount of time spent with the client. 4. Encourage the client to ambulate in the hallway. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 431). F.A. Davis Company. Kindle Edition.

11. 1. Rubber gloves should be worn to dispose of any soiled material, but they will not protect the nurse from sealed radiation sources. 2. Visitors who may be pregnant or who are younger than 18 years old should not be allowed in the client's room. 3. Afterload intracavitary radiation therapy treatments are completed in the client's room after prepared applicators are placed in surgery. This minimizes exposure of the health-care workers to radiation. The nurse should plan care to minimize exposure to the client and the radiation. 4. The client is placed in a room at the far end of the hallway, and in some facilities clients on either side of the client's room may have to be moved to limit exposure to radiation. The client is not allowed to leave the room until the radiation safety department clears the client for discharge. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 435). F.A. Davis Company. Kindle Edition. 3

11. The client who has had a mastectomy tells the nurse, "My husband will leave me now since I am not a whole woman anymore." Which response by the nurse is most therapeutic? 1. "You're afraid your husband will not find you sexually appealing?" 2. "Your husband should be grateful you will be able to live and be with him." 3. "Maybe your husband would like to attend a support group for spouses." 4. "You don't know that is true. You need to give him a chance." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 399). F.A. Davis Company. Kindle Edition.

11. 1. This is restating the client's feelings and is a therapeutic response. 2. This is not recognizing the client's concerns and putting the nurse's expectations on the spouse. 3. This is problem-solving and could be offered, but the therapeutic response is to restate the client's feeling and encourage a conversation. 4. The client may know this is true. The nurse is telling the client she has no reason for her feelings. Feelings are what they are and should be accepted as such. TEST-TAKING HINT: When the question asks for a therapeutic response, the test taker should choose an option encouraging the client to ventilate her feelings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 411). F.A. Davis Company. Kindle Edition. 1

11. The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? 1. Infection. 2. Anemia. 3. Nutrition. 4. Grieving. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

11. 1. Treating infections, which require HCP orders for cultures and antibiotics, is a collaborative problem. 2. The treatment of anemia is a collaborative problem. 3. The provision of adequate nutrition requires collaboration among the nurse, HCP, and dietitian. 4. Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration. TEST-TAKING HINT: The stem of the question asks for an independent intervention. If the test taker understands the problem and the treatment needs, options "1," "2," and "3" can be eliminated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 4

11. A patient's breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastases. What is the best description of this tumor? a. Sarcoma, grade II, T3 N4 M0 b. Leukemia, grade I, T1 N2 M1 c. Carcinoma, grade II, T1 N1 M0 d. Lymphoma, grade III, T1 N0 M Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

11. c. The breast cancer origination gives it the anatomic classification of a carcinoma. Grade II has moderate abnormal cells with moderate differentiation. T1 N1 M0 represents a small tumor with only minimal regional spread to the lymph nodes and no metastasis. Sarcomas originate from embryonal mesoderm or connective tissue, muscle, bone, and fat. Leukemias and lymphomas originate from the hematopoietic system. The other histologic grading and TNM classifications do not represent this patient's tumor. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

12. Which statement indicates the client with a total laryngectomy requires more teaching concerning the care of the tracheostomy? 1. "I must avoid hair spray and powders." 2. "I should take a shower instead of a tub bath." 3. "I will need to cleanse around the stoma daily." 4. "I can use an electric larynx to speak." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 234). F.A. Davis Company. Kindle Edition.

12. 1. The client should not let any spray or powder enter the stoma because it goes directly into the lung. 2. The client should not allow water to enter the stoma; therefore, the client should take a tub bath, not a shower. 3. The stoma site should be cleansed to help prevent infection. 4. The client's vocal cords were removed; therefore, the client must use an alternate form of communication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 240). F.A. Davis Company. Kindle Edition. 2

12. The client has been diagnosed with cancer of the breast. Which referral is most important for the nurse to make? 1. The hospital social worker. 2. CanSurmount. 3. Reach to Recovery. 4. I CanCope. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 399). F.A. Davis Company. Kindle Edition.

12. 1. The social worker assists clients in finding nursing home placement and financial arrangements and does some work with clients to discuss feelings, but this is not the best referral. 2. CanSurmount volunteers work with all types of clients diagnosed with cancer, not just clients with breast cancer. 3. Reach to Recovery is a specific referral program for clients diagnosed with breast cancer. 4. I CanCope is a cancer education program for all clients diagnosed with cancer and their significant others. TEST-TAKING HINT: The question asks for the most appropriate referral, and the test taker should choose the one specific to breast cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 411). F.A. Davis Company. Kindle Edition. 3

12. The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate intervention? 1. T 99, P 102, R 22, and BP 132/68. 2. Hyperplasia of the gums. 3. Weakness and fatigue. 4. Pain in the left upper quadrant. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

12. 1. These vital signs are not alarming. The vital signs are slightly elevated and indicate monitoring at intervals, but they do not indicate an immediate need. 2. Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency. 3. Weakness and fatigue are symptoms of the disease and are expected. 4. Pain is expected, but it is a priority, and pain control measures should be implemented. TEST-TAKING HINT: If all the answer options contain expected events, the test taker must decide which is priority—and pain is a priority need. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 4

12. The client is diagnosed with a brain abscess. Which sign/symptom is the most common? 1. Projectile vomiting. 2. Disoriented behavior. 3. Headaches, worse in the morning. 4. Petit mal seizure activity. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 58). F.A. Davis Company. Kindle Edition.

12. 1. Vomiting may occur, but it is not projectile and it is not the most common. 2. Disoriented behavior may occur, but it is not the most common. 3. The most common and prevailing symptom of a brain abscess is a headache that is worse in the morning because of increased intracranial pressure as a result of lying flat (gravity). 4. The client with a brain abscess may have seizure activity, but it is usually tonic-clonic (grand mal) and it is not the most common. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 64). F.A. Davis Company. Kindle Edition. 3

12. The nurse is counseling a group of individuals over the age of 50 with average risk for cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal exam Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

12. b. Healthy men and women should have a colonoscopy every 10 years, an annual fecal occult blood test, or a barium enema every 5 years. These frequencies may change depending on the results. Annual PSA and digital rectal exams screen for prostate problems, although the decision to test is made by the patient with his health care provider. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

125. The concept of intracranial regulation is identified for a client diagnosed with a brain tumor. Which intervention should the nurse include in the client's plan of care? 1. Tell the client to remain on bedrest. 2. Maintain the intravenous rate at 150 mL/hour. 3. Provide a soft, bland diet with three (3) snacks per day. 4. Place the client on seizure precautions. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 23). F.A. Davis Company. Kindle Edition.

125. 1. The client can be up as he/she wishes but the nurse should assess this and determine if the client has the functional ability to be able to accomplish this without assistance. 2. A client with a brain tumor would be at risk for increased intracranial pressure (ICP). Fluids should be limited to decrease the amount of cerebrospinal fluids produced by the body. 3. The client can have the diet of choice. The tumor occupies space and increases the pressure on the brain, which can cause vomiting. This vomiting is not associated with the diet; it is caused by the pressure. 4. Clients with brain issues are at risk for electrical misfiring of the neurons, a seizure. The nurse should institute measures to protect the client during a seizure. TEST TAKING HINT: The test taker should remember that basic nursing care is appropriate for client protection. Maslow's hierarchy of needs lists safety in the second highest priority tier. Physiological needs that involve life-threatening or life-altering complications are the only things that are more important than safety. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 54). F.A. Davis Company. Kindle Edition. 4

13. The occupational nurse for a mining company is planning a class on the risks of working with toxic substances to comply with the "Right to Know" law. Which information should the nurse include in the presentation? Select all that apply. 1. A client who smokes cigarettes has a drastically increased risk for lung cancer. 2. Floors need to be clean and dust needs to be wet to prevent transfer of dust. 3. The air needs to be monitored at specific times to evaluate for exposure. 4. Surface areas need to be painted every year to prevent the accumulation of dust. 5. Employees should wear the appropriate personal protective equipment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 234). F.A. Davis Company. Kindle Edition.

13. 1. Clients who smoke cigarettes and work with toxic substances have increased risk of lung cancer because many of the substances are carcinogenic. 2. When floors and surfaces are kept clean, toxic dust particles, such as asbestos and silica, are controlled and this decreases exposure. Covering areas with water controls dust. 3. The quality of air is monitored to determine what toxic substances are present and in what amount. The information is then used in efforts to minimize the amount of exposure. 4. Applying paint to a surface does not eliminate or minimize exposure and can trap more dust. 5. Employees must wear protective coverings, goggles, and other equipment needed to eliminate exposure to the toxic substances. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 240). F.A. Davis Company. Kindle Edition. 1,2,3,5

13. The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

13. 1. The scan detects abnormalities in the lymphatic system, not the vascular system. 2. Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days. 3. Cardiac angiograms are performed through the femoral or brachial arteries and are completed in one session. 4. The test takes 30 minutes to one (1) hour and then is repeated at intervals. TEST-TAKING HINT: The test taker must be aware of diagnostic tests used to diagnose specific diseases. Options "1" and "3" could be eliminated because of the words "vascular" and "cardiac"; these words pertain to the cardiovascular system, not the lymphatic system. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 2

13. The client diagnosed with a brain abscess has become lethargic and difficult to arouse. Which intervention should the nurse implement first? 1. Implement seizure precautions. 2. Assess the client's neurological status. 3. Close the drapes and darken the room. 4. Prepare to administer an IV steroid. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 58). F.A. Davis Company. Kindle Edition.

13. 1. This is an appropriate intervention, but it is not the first. 2. Remember, assessment is the first step of the nursing process and should be implemented first whenever there is a change in the client's behavior. 3. This helps prevent stimulation that could initiate a seizure, but it is not the first intervention. 4. Steroids may be administered to clients with brain abscesses to decrease inflammation, but assessment is the first intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 65). F.A. Davis Company. Kindle Edition. 2

13. A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens in the blood d. CT or positron emission tomography (PET) scan Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

13. b. Although other tests may be used in diagnosing the presence and extent of cancer, biopsy is the only method by which cells can be definitely determined to be malignant. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

14. The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

14. 1. Biopsies are surgical procedures requiring needle aspiration or excision of the area; they are not nuclear medicine scans. 2. The biopsy specimen is sent to the pathology laboratory for the pathologist to determine the type of cell. "Laboratory test" refers to tests of body fluids performed by a laboratory technician. 3. A biopsy is used to determine if the client has cancer and, if so, what kind. However, this response does not answer the client's question. 4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma. TEST-TAKING HINT: Option "1" can be eliminated if the test taker knows what the word "biopsy" means. Option "3" does not answer the question and can be eliminated for this reason. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 162). F.A. Davis Company. Kindle Edition. 4

14. A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

14. a. A simple mastectomy can be done to prevent breast cancer in women with high risk and can be used to control, cure, or provide palliative care for breasts with cancerous tumors. A mastectomy would not be used for biopsy or otherwise to establish a diagnosis of cancer. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

15. The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis? 1. Night sweats and fever without "chills." 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

15. 1. Clients with Hodgkin's disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom. 2. Lymph node enlargement with Hodgkin's disease is in the neck area. 3. Malaise and stomach complaints are not associated with Hodgkin's disease. 4. Pain in the neck area at the site of the cancer occurs in some clients after the ingestion of alcohol. The cause for this is unknown. TEST-TAKING HINT: The test taker must notice the descriptive words, such as "groin" and "fatty," to decide if these options could be correct. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 162). F.A. Davis Company. Kindle Edition. 1

15. Match the surgical procedures with their primary purposes in cancer treatment (answers may be used more than once). a. Mammoplasty b. Bowel resection c. Cordotomy for pain control d. Insertion of feeding tube into stomach e. Colostomy to bypass bowel obstruction f. Placement of a central venous catheter g. Debulking procedure to enhance radiation therapy h. Surgical fixation of bones at risk for pathologic fracture Match to these 1. Cure, control, or both 2. Supportive care 3. Palliation 4. Rehabilitation Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

15. a. 4; b. 1; c. 3; d. 2; e. 3; f. 2; g. 1; h. 2. Mammoplasty is done for rehabilitation post mastectomy. A bowel resection and debulking procedure to enhance radiation therapy are done to cure or control cancer. Cordotomy for pain control and colostomy to bypass bowel obstruction are done for palliation. Supportive care includes insertion of a feeding tube, placement of a central venous catheter, and surgical fixation of bones at risk for pathologic fracture. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

16. The client is diagnosed with leukemia and has leukocytosis. Which laboratory value would the nurse expect to assess? 1. An elevated hemoglobin. 2. A decreased sedimentation rate. 3. A decreased red cell distribution width. 4. An elevated white blood cell count. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 180). F.A. Davis Company. Kindle Edition.

16. 1. Clients with leukemia are usually anemic because of the bone marrow's inability to produce cells or, in this case, the bone marrow, stuck in high gear, producing immature white blood cells that are unable to function normally. 2. Sedimentation rates increase in some diseases, such as rheumatoid arthritis, but there will be no change in leukemia. 3. The red cell distribution width (RDW), shown in the CBC report, reports on the size of the red blood cells. 4. An elevated white blood cell count is what is being described in the term "leukocytosis"—leuko- means "white" and cyto- refers to "cell." Leukocytosis is the opposite of leukopenia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 185). F.A. Davis Company. Kindle Edition. 4

16. Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

16. 1. Long-term steroid use suppresses the immune system and has many side effects, but it is not the highest risk for the development of lymphoma. 2. This client would be considered to be in late-stage breast cancer. Cancers are described by the original cancerous tissue. This client has breast cancer that has metastasized to the lymph system. 3. Clients who have received a transplant must take immunosuppressive medications to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients. 4. A neurogenic bladder is a benign disease; stent placement would not put a client at risk for cancer. TEST-TAKING HINT: To answer this question, the test taker must be aware of the function of the immune system in the body and of the treatments of the disease processes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 162). F.A. Davis Company. Kindle Edition. 3

16. Which patient would be most likely to be cured with chemotherapy as a treatment measure? a. Small cell lung cancer b. New neuroblastoma c. Small tumor of the bone d. Large hepatocellular carcinoma Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

16. b. Neuroblastomas are cured with chemotherapy. A positive response of cancer cells to chemotherapy is most likely in solid or hematopoietic tumors that arise from tissue that has a rapid rate of cellular proliferation and new tumors with cells that are rapidly dividing. A state of optimum health and a positive attitude of the patient will also promote the success of chemotherapy. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

17. The client is placed on neutropenia precautions. Which information should the nurse teach the client? 1. Shave with an electric razor and use a soft toothbrush. 2. Eat plenty of fresh fruits and vegetables. 3. Perform perineal care after every bowel movement. 4. Some blood in the urine is not unusual. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 180). F.A. Davis Company. Kindle Edition.

17. 1. Shaving with an electric razor and using a soft toothbrush are interventions for thrombocytopenia. 2. Fresh fruits and vegetables are limited because they may harbor microbes. 3. Perineal care after each bowel movement, preferably with an antimicrobial soap, is performed to reduce bacteria on the skin. 4. Blood in the urine would indicate a complication and is not expected. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 185). F.A. Davis Company. Kindle Edition. 3

17. The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? 1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

17. 1. Up to 90% of clients respond well to standard treatment with chemotherapy and radiation therapy, and those who relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis. 2. Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's disease because of the expected prognosis with standard therapy. 3. Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred. TEST-TAKING HINT: The test taker must have a basic knowledge of the disease process but could rule out option "2" based on the word "investigational." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 162). F.A. Davis Company. Kindle Edition. 1

17. Which classification of chemotherapy drugs is cell cycle phase-nonspecific, breaks the DNA helix which interferes with DNA replication, and crosses the blood-brain barrier? a. Nitrosureas b. Antimetabolites c. Mitotic inhibitors d. Antitumor antibiotics Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

17. a. Nitrosureas are cell cycle phase-nonspecific, break the DNA helix, and cross the blood-brain barrier. Antimetabolites are cell cycle phase-specific drugs that mimic essential cellular metabolites to interfere with DNA synthesis. Mitotic inhibitors are cell cycle phase-specific drugs that arrest mitosis. Antitumor antibiotics bind with DNA to block RNA production. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

18. The nurse writes the problem of "grieving" for a client diagnosed with non-Hodgkin's lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society's Dialogue group. 4. Have the chaplain visit with the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

18. 1. Encouraging the client to talk about his or her feelings is an independent nursing intervention. 2. Discussing activities that will make pleasant memories and planning a family outing improve the client's quality of life and assist the family in the grieving process after the client dies, but this is an independent nursing intervention. 3. Nurses can and do refer clients diagnosed with cancer to the American Cancer Society- sponsored groups independently. Dialogue is a group support meeting that focuses on dealing with the feelings associated with a cancer diagnosis. 4. Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions. TEST-TAKING HINT: The stem of the question asks for a collaborative intervention, which means that another health-care discipline must be involved. Options "1," "2," and "3" are all interventions the nurse can do without another discipline being involved. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 163). F.A. Davis Company. Kindle Edition. 4

18. The client is diagnosed with chronic myeloid leukemia and leukocytosis. Which signs/ symptoms would the nurse expect to find when assessing this client? 1. Frothy sputum and jugular vein distention. 2. Dyspnea and slight confusion. 3. Right upper quadrant tenderness and nausea. 4. Increased appetite and weight gain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 180). F.A. Davis Company. Kindle Edition.

18. 1. Frothy sputum and jugular vein distention are symptoms of heart failure, which could occur as a complication of anemia. 2. Clients with leukocytosis may be short of breath and somewhat confused as a result of decreased capillary perfusion to the lung and brain from excessive amounts of WBCs inhibiting blood flow through the capillaries. 3. The client may have left upper quadrant pain and tenderness from WBC infiltration of the spleen, but the client will not have right upper quadrant tenderness. 4. The client may be anorectic and lose weight. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 185). F.A. Davis Company. Kindle Edition. 2

18. The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents, primarily to prevent a. septicemia. b. extravasation. c. catheter occlusion. d. anaphylactic shock. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

18. b. One of the major concerns with the IV administration of vesicant chemotherapeutic agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

19. Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

19. 1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes used to monitor the progress of the treatment of Hodgkin's disease, but ESR levels can be elevated in several disease processes. 4. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify ReedSternberg cells for a diagnosis of Hodgkin's disease. TEST-TAKING HINT: The test taker can eliminate the first three (3) answer options based on these tests giving general information on multiple diseases. A biopsy procedure of the involved tissues is the only procedure that provides a definitive diagnosis. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 163). F.A. Davis Company. Kindle Edition. 4

19. For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

19. a. Intravesical regional chemotherapy is administered into the bladder via a urinary catheter. Leukemia is treated with IV chemotherapy. Osteogenic sarcoma is treated with intraarterial chemotherapy via vessels supplying the tumor. Metastasis to the brain is treated with intraventricular or intrathecal chemotherapy via an Ommaya reservoir or lumbar punctures. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

2. The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? 1. Fever and infections. 2. Nausea and vomiting. 3. Excessive energy and high platelet counts. 4. Cervical lymph node enlargement and positive acid-fast bacillus. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

2. 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection. 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia. 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells. In some forms of leukemia, the bone marrow is not producing cells at all, and in others, the bone marrow is stuck producing tens of thousands of immature cells. 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis. TEST-TAKING HINT: Option "3" could be eliminated because of the excessive energy. Illness normally drains energy reserves; it does not increase them. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 159). F.A. Davis Company. Kindle Edition. 1

2. The client is diagnosed with breast cancer and is considering whether to have a lumpectomy or a more invasive procedure, a modified radical mastectomy. Which information should the nurse discuss with the client? 1. Ask if the client is afraid of having general anesthesia. 2. Determine how the client feels about radiation and chemotherapy. 3. Tell the client she will need reconstruction with either procedure. 4. Find out if the client has any history of breast cancer in her family. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

2. 1. General anesthesia is used for either procedure. 2. The client should understand the treatment regimen for follow-up care. A lumpectomy requires follow-up with radiation therapy to the breast and then systemic chemotherapy. If the cancer is in its early stages, this regimen has results equal to those with a modified radical mastectomy. 3. A lumpectomy removes only the tumor and a small amount of tissue surrounding the tumor; reconstruction is not needed. 4. A history of breast cancer in the family is immaterial because this client has breast cancer. TEST-TAKING HINT: The test taker should use the nursing process to answer this question and select an assessment intervention, which eliminates option "3" as a correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 409). F.A. Davis Company. Kindle Edition. 2

2. The nurse is performing the admission assessment on a 78-year-old female client and observes bilateral pendulous breasts with a stringy appearance. Which intervention should the nurse implement? 1. Request a mammogram. 2. Notify the HCP of the finding. 3. Continue with the examination. 4. Assess for peau d'orange skin. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 430). F.A. Davis Company. Kindle Edition.

2. 1. These are normal findings in a postmenopausal breast and do not require a mammogram. The client should have a mammogram yearly. 2. These are normal findings in the postmenopausal breast so there is no need to notify the HCP. 3. These are normal findings in the postmenopausal breast. Glandular tissue is replaced with fibrous tissue, the breasts become pendulous, and the Cooper's ligaments become prominent. 4. Peau d'orange skin occurs in advanced breast cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 434). F.A. Davis Company. Kindle Edition. 3

2. What defect in cellular proliferation is involved in the development of cancer? a. A rate of cell proliferation that is more rapid than that of normal body cells b. Shortened phases of cell life cycles with occasional skipping of G1 or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

2. d. Malignant cells proliferate indiscriminately and continuously and also lose the characteristic of contact inhibition, growing on top of and in between normal cells. Cancer cells usually do not proliferate at a faster rate than normal cells, nor can cell cycles be skipped in proliferation. However, malignant proliferation is continuous, unlike normal cells. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

20. Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin's disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

20. 1. This client is receiving treatments that can have life-threatening side effects; the nurse is not experienced with this type of client. 2. Chemotherapy is administered only by nurses who have received training in chemotherapy medications and their effects on the body and are aware of necessary safety precautions; this nurse is in the first week of orientation. 3. This is expected in a client with leukemia, but it indicates a severely low platelet count; a nurse with more experience should care for this client. 4. This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products. TEST-TAKING HINT: The key to this question is the fact, although the nurse is an experienced medical-surgical nurse, the nurse is not experienced in oncology. The client who could receive a treatment on a medical-surgical floor should be assigned to the nurse. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 163). F.A. Davis Company. Kindle Edition. 4

20. Which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. Intrathecal b. Intraarterial c. Intravenous d. Intraperitoneal Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

20. d. Intraperitoneal regional chemotherapeutic administration is used to treat metastasis from a primary colorectal cancer. Intrathecal administration is used with the spinal cord or the brain. Intraarterial administration is used to deliver chemotherapy to tumors via specific vessels. IV administration is used for systemic administration. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

21. Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin's disease? 1. The client's reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client's menstrual cycle. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

21. 1. This is a false promise. Many clients undergo premature menopause as a result of the cancer therapy. 2. The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the cancer can cause cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to be a precursor to leukemia. A developing fetus would be subjected to the internal conditions of the mother. 3. Some clients—but not all—do become sterile. The client must understand the risks of therapy, but the nurse should give a realistic picture of what the client can expect. It is correct procedure to tell the client the nurse does not know the absolute outcome of therapy. This is the ethical principle of veracity. 4. The therapy may interfere with the client's menses, but it may be temporary. TEST-TAKING HINT: Option "3" can be eliminated on the basis that it says "all" clients; if the test taker can think of one case where "all" does not apply, then the option is incorrect. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 163). F.A. Davis Company. Kindle Edition. 2

21. When teaching the patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety. b. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects. c. Assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening. d. Inform the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong use of wigs. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

21. b. Patients should always be taught what to expect during a course of chemotherapy, including side effects and expected outcome. Side effects of chemotherapy are serious but it is important that patients be informed about what measures can be taken to help them to cope with the side effects of therapy. Hair loss related to chemotherapy is usually reversible and wigs, scarves, or turbans can be used during and following chemotherapy until the hair grows back. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

22. Which clinical manifestation of Stage I nonHodgkin's lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B-cell lymphocytes on the CBC. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

22. 1. Enlarged lymph tissue would occur in Stage III or IV Hodgkin's lymphoma. 2. A tender left upper quadrant would indicate spleen infiltration and occurs at a later stage. 3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma. 4. B-cell lymphocytes are the usual lymphocytes involved in the development of lymphoma, but a serum blood test must be done specifically to detect B cells. They are not tested on a CBC. TEST-TAKING HINT: Most cancers are staged from 0 to IV. Stage 0 is microinvasive and Stage I is minimally invasive, progressing to Stage IV, which is large tumor load or distant disease. If the test taker noted the "Stage I," then choosing the option that presented with the least amount of known disease— option "3"—would be a good choice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 164). F.A. Davis Company. Kindle Edition. 3

22. Which normal tissues manifest early, acute responses to radiation therapy? a. Spleen and liver b. Kidney and nervous tissue c. Bone marrow and gastrointestinal (GI) mucosa d. Hollow organs such as the stomach and bladder Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 57). Elsevier Health Sciences. Kindle Edition.

22. c. Tissue that is actively proliferating, such as GI mucosa, esophageal and oropharyngeal mucosa, and bone marrow, exhibits early acute responses to radiation therapy. Radiation ionization breaks chemical bonds in DNA, which renders cells incapable of surviving mitosis. This loss of proliferative capacity yields cellular death at the time of division for both normal cells and cancer cells but cancer cells are more likely to be dividing because of the loss of control of cellular division. Cartilage, bone, kidney, and nervous tissues that proliferate slowly manifest subacute or late responses. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

23. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the HCP's orders onto the medication administration record (MAR). 4. Determine the client's response to the therapy. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

23. 1. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse. 2. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. 3. This is the responsibility of the ward secretary or the nurse, not the unlicensed assistive personnel. 4. This represents the evaluation portion of the nursing process and cannot be delegated. TEST-TAKING HINT: The test taker must decide what is within the realm of duties of a UAP. Three (3) of the options have the UAP doing some action with medications. This could eliminate all of these. Option "1" did not say monitor or evaluate or decide on a nursing action; this option only says the UAP can take vital signs on a client who is presumably stable because the infusion has been going long enough to reach the hourly time span. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 164). F.A. Davis Company. Kindle Edition. 1

23. The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Moisturize skin with lotion b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

23. d. Avoiding sources of excessive heat and cold will prevent damage to the skin. Only nonmedicated, nonperfumed lotions or creams (e.g., calendula ointment, aloe gel, Aquaphor) are recommended for dry skin. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

24. The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)-year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is the same as for the general population. 4. Have the client talk with the family about funeral arrangements. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 152). F.A. Davis Company. Kindle Edition.

24. 1. The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly. 2. Follow-up appointments should be at least yearly. 3. The client's risk for developing cancer has increased as a result of the therapies undergone for the lymphoma. 4. This client is in remission, and death is not imminent. TEST-TAKING HINT: The test taker should look at the time frames in the answer options. It would be unusual for a client to be told to have a checkup every five (5) years. Option "4" can be eliminated by the stem, which clearly indicates the client is progressing well at the five (5)-year remission mark. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 164). F.A. Davis Company. Kindle Edition. 1

24. When a patient is undergoing brachytherapy, what is it important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment. b. The patient is a source of radiation and personnel must wear film badges during care. c. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

24. b. Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation and in addition to implementing the principles of time, distance, and shielding, film badges should be worn by caregivers to monitor the amount of radiation exposure. Computerized dosimetry and simulation are used in external radiation therapy. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

25. The post-anesthesia care nurse is caring for the client diagnosed with lung cancer who had a thoracotomy and is experiencing frequent premature ventricular contractions (PVCs). Which intervention should the nurse implement first? 1. Request STAT arterial blood gases. 2. Administer lidocaine intravenous push. 3. Assess for possible causes. 4. Request a STAT electrocardiogram. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 235). F.A. Davis Company. Kindle Edition.

25. 1. ABGs may show hypoxia, which is a cause of PVCs, but it is not the first intervention the nurse should implement. 2. Lidocaine is the treatment of choice for PVCs, but it is not the first intervention. 3. The nurse should assess for possible causes of the PVCs; these causes may include hypoxia or hypokalemia. 4. An ECG further evaluates the heart function, but it is not the first intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 243). F.A. Davis Company. Kindle Edition. 3

25. The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included in the teaching? 1. Wear a sunscreen with a protection factor of 10 or less when in the sun. 2. Try to stay out of the sun between 0300 and 0500 daily. 3. Perform a thorough skin check monthly. 4. Remember caps and long sleeves do not help prevent skin cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 478). F.A. Davis Company. Kindle Edition.

25. 1. The lower the SPF number of sunscreen, the less protection. A sunscreen of SPF 15 is a minimum. 2. Clients should avoid sunlight in the afternoon, between 3 p.m. and 5 p.m. "Between 0300 and 0500" refers to morning, the middle of the night. 3. The American Cancer Society recommends a monthly skin check using mirrors to identify any suspicious skin lesion for early detection. 4. Anything that prevents UV rays from reaching the skin helps to prevent skin cancer. Hats with a full brim are preferred to baseball caps, which leave the ears and back of the neck exposed. TEST-TAKING HINT: The test taker must notice time frames. In option "2," the use of "between 0300 and 0500" instead of "between 1500 and 1700" makes this option incorrect. In option "1" the number of the sunscreen makes this option wrong, and in option "4" the word "not" is an absolute word that could eliminate this option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 491). F.A. Davis Company. Kindle Edition. 3

25. To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

25. a. Walking programs scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

26. The client in the gynecology clinic asks the nurse, "What are the risk factors for developing cancer of the cervix?" Which statement is the nurse's best response? 1. "The earlier the age of sexual activity and the more partners, the greater the risk." 2. "Eating fast foods high in fat and taking birth control pills are risk factors." 3. "A Chlamydia trachomatis infection can cause cancer of the cervix." 4. "Having yearly Pap smears will protect you from developing cancer." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 400). F.A. Davis Company. Kindle Edition.

26. 1. Risk factors for cancer of the cervix include sexual activity before the age of 20 years; multiple sexual partners; early childbearing; exposure to the human papillomavirus; HIV infection; smoking; and nutritional deficits of folates, beta carotene, and vitamin C. 2. High-fat diets place clients at risk for some cancers but not for cervical cancer. The use of birth control pills may allow increased sexual freedom because of the protection from pregnancy, but it does not increase the risk for cancer of the cervix. 3. Infections with the human papillomavirus are a risk factor for cancer of the cervix. 4. Having a yearly Pap smear increases the chance of detecting cellular changes early, but it does not decrease the risk for developing cancer. TEST-TAKING HINT: The test taker could discard option "4" as a possible answer because it is a yearly test for the early detection of cervical cancer, not a risk factor. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 414). F.A. Davis Company. Kindle Edition. 1

26. The nurse is caring for the postoperative client diagnosed with lung cancer recovering from a thoracotomy. Which data require immediate intervention by the nurse? 1. The client refuses to perform shoulder exercises. 2. The client complains of a sore throat and is hoarse. 3. The client has crackles that clear with cough. 4. The client is coughing up pink frothy sputum. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 235). F.A. Davis Company. Kindle Edition.

26. 1. The client refusing to perform shoulder exercises is pertinent, but it does not require immediate intervention. 2. Sore throats and hoarseness are common postintubation and would not require immediate intervention. 3. Crackles that clear with coughing would not require immediate intervention. 4. Pink frothy sputum indicates pulmonary edema and would require immediate intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 243). F.A. Davis Company. Kindle Edition. 4

26. The female client admitted for an unrelated diagnosis asks the nurse to check her back because "it itches all the time in that one spot." When the nurse assesses the client's back, the nurse notes an irregular-shaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? 1. Notify the HCP to check the lesion on rounds. 2. Measure the lesion and note the color. 3. Apply lotion to the lesion. 4. Instruct the client to make sure the HCP checks the lesion. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 478). F.A. Davis Company. Kindle Edition.

26. 1. The nurse should complete an assessment of the lesion prior to notifying the HCP to check it. 2. This is part of assessing the lesion and should be completed. The ABCDs of skin cancer detection include the following: (1) Asymmetry—Is the lesion balanced on both sides with an even surface? (2) Borders—Are the borders rounded and smooth or notched and indistinct? (3) Color—Is the color a uniform light brown or is it variegated and darker or reddish purple? (4) Diameter—A diameter exceeding 4 to 6 mm is considered suspicious. 3. This may help as a comfort measure, but it is not the first and most important action. 4. Instructing the client to also notify the HCP to assess the lesion should be done but does not have priority. TEST-TAKING HINT: Assessment is the first step in the nursing process. The test taker should have a systematic decision-making model when determining a priority action. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 491). F.A. Davis Company. Kindle Edition. 2

26. When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

26. b. Alkylating chemotherapeutic agents and high-dose radiation are most likely to cause secondary malignancies as a late effect of treatment. The other conditions are not known to be late effects of radiation or chemotherapy. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

27. The nurse is admitting a client diagnosed with Stage Ia cancer of the cervix to an outpatient surgery center for a conization. Which data would the client most likely report? 1. Diffuse watery discharge. 2. No symptoms. 3. Dyspareunia. 4. Intense itching. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 400). F.A. Davis Company. Kindle Edition.

27. 1. Diffuse, watery, foul-smelling discharge occurs at a much later stage. 2. At this stage the client is asymptomatic and the cancer has been determined by a Pap smear. 3. Dyspareunia is painful sexual intercourse; the client is asymptomatic. 4. Intense itching occurs with vaginal yeast infections. TEST-TAKING HINT: The test taker could either choose option "2" because it is the least presenting symptom or discard it. Staging for all cancers starts with "0" or "1," indicating the least detectable cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 414). F.A. Davis Company. Kindle Edition. 2

27. The nurse is caring for clients in an outpatient surgery clinic. Which client should be assessed first? 1. The client scheduled for a skin biopsy who is crying. 2. The client who had surgery three (3) hours ago and is sleeping. 3. The client who needs to void prior to discharge. 4. The client who has received discharge instructions and is ready to go home. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 478). F.A. Davis Company. Kindle Edition.

27. 1. This client has an unexpected situation occurring and should be assessed before any stable client. 2. This client's surgery was three (3) hours ago and the client should be stable and allowed to rest. 3. This client can be seen after assessing the client in option "1." 4. This client could be escorted to the door by an unlicensed assistive personnel; another nurse has already prepared the client for discharge. TEST-TAKING HINT: Physiological problems usually have priority over psychological ones, but none of the other clients has a lifethreatening or life-altering situation. The only unexpected situation is the client who is crying. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 491). F.A. Davis Company. Kindle Edition. 1

27. What describes a primary use of biologic therapy in cancer treatment? a. Protect normal, rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy b. Prevent the fatigue associated with chemotherapy and high-dose radiation as seen with bone marrow depression c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. Depress the immune system and circulating lymphocytes as well as increase a sense of well-being by replacing central nervous system deficits Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

27. c. Biologic therapies are normal components of the immune system and are used therapeutically to restore, augment, or modulate host immune system mechanisms. They have direct antitumor effects or other biologic effects to assist in immune activity against cancer cells. Virtually all biologic therapies may cause a flu-like syndrome. The other options are not correct. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

28. The client diagnosed with cancer of the uterus is scheduled to have radiation brachytherapy. Which precautions should the nurse implement? Select all that apply. 1. Place the client in a private room. 2. Wear a dosimeter when entering the room. 3. Encourage visitors to come and stay with the client. 4. Plan to spend extended time with the client. 5. Notify the nuclear medicine technician. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 400). F.A. Davis Company. Kindle Edition.

28. 1. Brachytherapy is the direct implantation of radioactive seeds through the vagina into the uterus. The client should be in a private room at the end of the hall to prevent radiation exposure to the rest of the unit. 2. Nurses wear a dosimeter registering the amount of radiation they have been exposed to. When a certain level is reached, the nurse is no longer allowed to care for clients undergoing internal radiation therapy. 3. Visitors are limited while the radiation is in place. 4. In this case, spending extra time with a client is not done. The nurse does only what must be done and leaves the room. 5. The nuclear medicine technician will assist with the placement of the implants and will deliver the implants in a leadlined container. The technician will also scan any items (linens and wastes) leaving the room for radiation contamination. TEST-TAKING HINT: This is an alternate-type question, which requires the test taker to select more than one correct answer. The test taker must select all the correct answers to receive credit for the question. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 414). F.A. Davis Company. Kindle Edition. 1,2,5

28. Which client is at the greatest risk for the development of skin cancer? 1. The African American male who lives in the northeast. 2. The elderly Hispanic female who moved from Mexico as a child. 3. The client who has a family history of basal cell carcinoma. 4. The client with fair complexion who cannot get a tan. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 478). F.A. Davis Company. Kindle Edition.

28. 1. Darker skinned individuals have a lower risk of developing skin cancer. It is living in the southwestern regions of the United States where sun exposure is the greatest that increases skin cancer risk. 2. Hispanic clients have more melanin in the skin than Caucasian clients, and moving from Mexico would have decreased the UV exposure. 3. A family history of malignant melanoma increases the risk of developing malignant melanoma. Basal cell carcinoma is directly related to sun exposure and does not have an increased familial risk. 4. Clients with very little melanin in the skin (fair-skinned) have an increased risk as a result of the UV damage to the underlying membranes. Damage to the underlying membranes never completely reverses itself; a lifetime of damage causes changes at the cellular level that can result in the development of cancer. TEST-TAKING HINT: If the test taker noticed the similarities in the clients in options "1" and "2"—darker skin and living in an area with less sun exposure or moving from an area with greater sun exposure to an area with less—the test taker could eliminate these two (2) options. Based on skin color, the fair-skinned client would be most at risk. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 492). F.A. Davis Company. Kindle Edition. 4

28. Priority Decision: While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for nursing actions related to a. diarrhea. b. grieving. c. risk for infection. d. inadequate nutritional intake. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

28. c. The nadir is the point of the lowest blood counts after chemotherapy is started and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated but they are not the priority. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

29. The middle-aged client has had two (2) lesions diagnosed as basal cell carcinoma removed. Which discharge instruction should the nurse include? 1. Teach the client that there is no more risk for cancer. 2. Refer the client to a prosthesis specialist for prosthesis. 3. Instruct the client how to apply sunscreen to the area. 4. Demonstrate care of the surgical site. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 478). F.A. Davis Company. Kindle Edition.

29. 1. The client should be taught to complete monthly skin checks to detect any future lesions. 2. Basal cell lesions grow slowly and do not metastasize until the lesion has become very large. Prostheses are usually not needed. 3. The area may need to have an antibiotic ointment, but sunscreen should not be applied until after the operative area has healed and then only when the client is going to be in the sun. 4. On discharge, all clients should receive instructions in the care of surgical incisions. TEST-TAKING HINT: If the test taker did not know the specific information regarding this type of cancer surgery, then choosing an answer that is appropriate for all surgeries is a good option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 492). F.A. Davis Company. Kindle Edition. 4

29. An allogenic hematopoietic stem cell transplant is considered as treatment for a patient with acute myelogenous leukemia. What information should the nurse include when teaching the patient about this procedure? a. There is no risk for graft-versus-host disease because the donated marrow is treated to remove cancer cells. b. The patient's bone marrow will be removed, treated, stored, and then reinfused after intensive chemotherapy. c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen (HLA) match with the patient. d. There is no need for posttransplant protective isolation because the stem cells are infused directly into the blood. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

29. c. An allogenic hematopoietic stem cell or bone marrow transplant is one in which peripheral stems cells or bone marrow from an HLA-matched donor is infused into a patient who has received high doses of chemotherapy, with or without radiation, to eradicate cancerous cells. In an autologous bone marrow transplant, the patient's own bone marrow is removed before therapy to destroy the bone marrow. The marrow is treated to remove cancer cells and may be infused shortly after conditioning treatment or frozen and stored for later use. With either source, the new bone marrow will take several weeks to produce new blood cells and protective isolation is necessary during this time. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

3. The client diagnosed with leukemia has central nervous system involvement. Which instruction should the nurse teach? 1. Sleep with the HOB elevated to prevent increased intracranial pressure. 2. Take an analgesic medication for pain only when the pain becomes severe. 3. Explain radiation therapy to the head may result in permanent hair loss. 4. Discuss end-of-life decisions prior to cognitive deterioration. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

3. 1. Sleeping with the head of the bed elevated might relieve some intracranial pressure, but it will not prevent increased intracranial pressure from occurring. 2. Analgesic medications for clients with cancer are given on a scheduled basis with a fast-acting analgesic administered prn for breakthrough pain. 3. Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. Radiation therapy has longer lasting side effects than chemotherapy. If the radiation therapy destroys the hair follicles, the hair will not grow back. 4. Cognitive deterioration does not usually occur. TEST-TAKING HINT: The test taker must be aware of the treatments used for the disease processes to answer this question but might eliminate option "2" because it violates basic principles of pain management. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 159). F.A. Davis Company. Kindle Edition. 3

3. The client has undergone a wedge resection for cancer of the left breast. Which discharge instruction should the nurse teach? 1. Don't lift more than five (5) pounds with the left hand until released by the HCP. 2. The cancer has been totally removed and no follow-up therapy will be required. 3. The client should empty the Hemovac drain about every 12 hours. 4. The client should arrange an appointment with a plastic surgeon for reconstruction. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

3. 1. The client has had surgery on this side of the body. Pressure on the incision should be limited until the client is released by the HCP to perform normal daily activities. 2. This is providing the client false hope. Cancer cells characteristically move easily in the lymph or bloodstream to other parts of the body. Microscopic disease cannot be determined by the naked eye. 3. A client who has a mastectomy might be discharged with a Hemovac drain, but a wedge resection should not require one. 4. The breast has not been removed; reconstruction is not needed. TEST-TAKING HINT: If the test taker did not know this answer, option "1" is information provided to any client who has had surgery on the upper chest or arm. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 409). F.A. Davis Company. Kindle Edition. 1

3. What does the presence of carcinoembryonic antigens (CEAs) and α-fetoprotein (AFP) on cell membranes indicate has happened to the cells? a. They have shifted to more immature metabolic pathways and functions. b. They have spread from areas of original development to different body tissues. c. They produce abnormal toxins or chemicals that indicate abnormal cellular function. d. They have become more differentiated as a result of repression of embryonic functions. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

3. a. Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins, such as carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), on cell membranes that reflect a return to more immature functioning. The other options are unrelated to CEA and AFP. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

30. The client has had a total abdominal hysterectomy for cancer of the uterus. Which discharge instruction should the nurse teach? 1. The client should take HRT every day to prevent bone loss. 2. The client should practice pelvic rest until seen by the HCP. 3. The client can drive a car as soon as she is discharged from the hospital. 4. The client should expect some bleeding after this procedure. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 401). F.A. Davis Company. Kindle Edition.

30. 1. Clients who are diagnosed with cancer of the uterus have the ovaries removed to reduce hormone production. The client will not be taking HRT. 2. Pelvic rest means nothing is placed in the vagina. The client does not need a tampon at this time, but sexual intercourse should be avoided until the vaginal area has healed. 3. The sitting position a client assumes when driving a vehicle places stress on the lower abdomen. The client should wait until the HCP releases her to drive. 4. The client should not have any vaginal bleeding. TEST-TAKING HINT: The test taker should apply basic postoperative concepts when answering questions and realize bleeding is not expected postoperatively and safety should always be addressed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 415). F.A. Davis Company. Kindle Edition. 2

30. The nurse is caring for a client diagnosed with squamous cell skin cancer and writes a psychosocial problem of "fear." Which nursing interventions should be included in the plan of care? 1. Explain to the client that the fears are unfounded. 2. Encourage the client to verbalize the feeling of being afraid. 3. Have the HCP discuss the client's fear with the client. 4. Instruct the client regarding all planned procedures. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

30. 1. The diagnosis of cancer is concerning for clients; this is belittling the client's concerns and gives false reassurance. 2. This is the most commonly written therapeutic communication goal. This addresses the client's concerns. 3. The nurse is capable of discussing the client's concerns. Many clients feel more comfortable discussing fears with the nurse than with the HCP. 4. This should be done but does not directly address the client's problem. TEST-TAKING HINT: The test taker must read the question carefully to decide what the question is asking. The answer must address the problem of fear. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 492). F.A. Davis Company. Kindle Edition. 2

30. During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to a. increase urine output with hydration therapy. b. establish electrocardiographic (ECG) monitoring. c. administer a bisphosphonate such as pamidronate (Aredia). d. restrict fluids and administer hypertonic sodium chloride solution. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 58). Elsevier Health Sciences. Kindle Edition.

30. a. Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim). Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

31. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a dermatology clinic. Which task should not be delegated to the UAP? 1. Stock the rooms with the equipment needed. 2. Weigh the clients and position the clients for the examination. 3. Discuss problems the client has experienced since the previous visit. 4. Take the biopsy specimens to the laboratory. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

31. 1. The UAP can restock rooms. 2. These activities can be performed by a trained UAP. 3. This is part of assessing the client and cannot be delegated. 4. This is appropriate delegation. TEST-TAKING HINT: This is an "except" question. The test taker must be careful to read the words in the stem of the question, such as "not be delegated." All of the answers except one should be activities that the UAP can perform. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 492). F.A. Davis Company. Kindle Edition. 3

31. The client diagnosed with uterine cancer is complaining of lower back pain and unilateral leg edema. Which statement best explains the scientific rationale for these signs/symptoms? 1. This is expected pain for this type of cancer. 2. This means the cancer has spread to other areas of the pelvis. 3. The pain is a result of the treatment of uterine cancer. 4. Radiation treatment always causes some type of pain in the region. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 401). F.A. Davis Company. Kindle Edition.

31. 1. This pain indicates metastasis to the retroperitoneal region. If caught early, a complete hysterectomy is usually the only therapy recommended. This type of pain indicates the cancer is advanced and the prognosis is poor. 2. This pain indicates the cancer is in the retroperitoneal region and the prognosis is poor. 3. Pain is not part of the treatment of cancer. Surgery may cause pain, but most treatments do not. 4. Radiation therapy does not always result in pain; it depends on the area irradiated. TEST-TAKING HINT: Option "4" has the absolute word "always" and should be eliminated as a correct answer. The stem is describing symptoms in regions other than the lower pelvis, so an educated choice is option "2." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 415). F.A. Davis Company. Kindle Edition. 2

31. Priority Decision: The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the first thing the nurse should do for this patient? a. Administer a nonsteroidal antiinflammatory drug. b. Assess the patient's vital signs and behavior to determine the medication to use. c. Have the patient keep a pain diary to better assess the patient's potential addiction. d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 59). Elsevier Health Sciences. Kindle Edition.

31. d. The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

32. The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? 1. The lesion is asymmetrical and has irregular borders. 2. The lesion has a waxy appearance with pearllike borders. 3. The lesion has a thickened and scaly appearance. 4. The lesion appeared as a thickened area after an injury. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

32. 1. Malignant melanomas are the most deadly of the skin cancers. Asymmetry, irregular borders, variegated color, and rapid growth are characteristic of them. 2. A waxy appearance and pearl-like borders are characteristic of basal cell carcinoma. 3. A thickened and scaly appearance describes squamous cell carcinoma. 4. A thickened area after an injury describes a benign condition called a keloid. TEST-TAKING HINT: This is a knowledge-based question, but it does indicate the differences in the types of skin lesions. The test taker should concentrate on the differences when studying for an examination. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 492). F.A. Davis Company. Kindle Edition. 1

32. Which client should the nurse assess first after receiving the shift report? 1. The client diagnosed with a stroke who has right-sided paralysis. 2. The client diagnosed with meningitis who complains of photosensitivity. 3. The client with a brain tumor who has projectile vomiting. 4. The client with epilepsy who complains of tender gums. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 60). F.A. Davis Company. Kindle Edition.

32. 1. Paralysis is an expected occurrence with a client who has had a stroke. 2. Photosensitivity is an expected sign of meningitis. 3. Projectile vomiting indicates that increased intracranial pressure is exerting pressure on the vomiting center of the brain. 4. Tender gums could be secondary to medication given for epilepsy. The client may need to see a dentist, but this client does not need to be assessed first. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 68). F.A. Davis Company. Kindle Edition. 3

32. Which factors will assist a patient in coping positively with having cancer (select all that apply)? a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. A young person will adapt more easily f. Not having had to cope with previous stressful events Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 59). Elsevier Health Sciences. Kindle Edition.

32. a, b, d. Feeling in control, having a strong support system, and the potential of cure or control of the cancer will have a positive effect on coping with the diagnosis. The other options will make coping more difficult for the patient. (See Table 16-19.) Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 340). Elsevier Health Sciences. Kindle Edition.

33. The client has had a squamous cell carcinoma removed from the lip. Which discharge instructions should the nurse provide? 1. Notify the HCP if a nonhealing lesion develops around the mouth. 2. Squamous cell carcinoma tumors do not metastasize. 3. Limit foods to liquid or soft consistency for one (1) month. 4. Apply heat to the area for 20 minutes every four (4) hours. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

33. 1. The client should be aware of symptoms that indicate development of another skin cancer. Squamous cell carcinoma can develop in areas of the skin and mucous membranes. 2. Of deaths from squamous cell carcinomas, 75% occur because of metastasis. Even basal cell carcinoma can metastasize but is usually so slow growing that surgical excision removes the cancer if the client does not delay treatment. 3. The surgery was on the lip, not in the mouth. Food can be of a regular consistency. 4. Applying heat to the area would increase circulation and edema, increasing the client's discomfort. TEST-TAKING HINT: Anatomical positioning ("lip") could eliminate option "3." An HCP should be notified for any nonhealing wound. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 493). F.A. Davis Company. Kindle Edition. 1

34. Which client physiological outcome (goal) is appropriate for a client diagnosed with skin cancer who has had surgery to remove the lesion? 1. The client will express feelings of fear. 2. The client will ask questions about the diagnosis. 3. The client will state a diminished level of pain. 4. The client will demonstrate care of the operative site. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

34. 1. This is a psychological goal, not a physiological goal. 2. This is a knowledge-deficit goal, not a physiological goal. 3. Pain is a physiological problem; this is an appropriate physiological goal. 4. This is a teaching goal, not a physiological goal. TEST-TAKING HINT: The test taker must read the question carefully to determine what the stem is asking. All of the goals are appropriate for the client with skin cancer, but only one is a physiological goal. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 493). F.A. Davis Company. Kindle Edition. 3

35. The male client diagnosed with acquired immunodeficiency syndrome (AIDS) states that he has developed a purple-brown spot on his calf. Which action should the nurse do first? 1. Refer the client to an HCP for a biopsy of the area. 2. Assess the lesion for size, color, and symmetry. 3. Discuss end-of-life decisions with the client. 4. Report the sexually transmitted illness to the health department. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

35. 1. The client may need a biopsy, but the nurse should assess the area before deciding to refer the client. 2. This is the first step in deciding how to help the client. The nurse should assess the lesion to determine if it could be a Kaposi's sarcoma tumor or a healing contusion. 3. This is important for all clients, even those without a chronic illness, but the question asks what should be done first. This is not the priority at this time. 4. AIDS is a reportable disease, but reporting is not the priority intervention. TEST-TAKING HINT: Assessment is the first step in the nursing process. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 493). F.A. Davis Company. Kindle Edition. 2

36. The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? 1. Sunscreen is only needed during the hottest hours of the day. 2. Toddlers should not have sunscreen applied to their skin. 3. Sunscreen does not help prevent skin cancer. 4. The higher the number of the sunscreen, the more it blocks UV rays. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 479). F.A. Davis Company. Kindle Edition.

36. 1. Sunscreen should be used whenever the client is going to be exposed to UV rays. 2. Infants younger than age six (6) months should not be placed in the sun or have sunscreen applied. This does not include the medical uses of a bili-light. 3. Sunscreen blocks absorption of UV rays, which, when allowed to penetrate the skin, cause damage to the layers of the skin. This, in turn, causes cellular changes, which over time can develop into skin cancer. 4. Sunscreen products range in numerical value from 4 to 50; the higher the number of the sunscreen, the greater the UV protection. TEST-TAKING HINT: Option "1" has the absolute word "only" and could be eliminated. "Toddlers" is a key in this option. The test taker must decide if it is appropriate for a toddler to have sunscreen applied to the skin. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 493). F.A. Davis Company. Kindle Edition. 4

36. The nurse is caring for a client diagnosed with uterine cancer who has been receiving systemic therapy for six (6) months. Which intervention should the nurse implement first? 1. Determine which antineoplastic medication the client has received. 2. Ask the client if she has had any problems with mouth ulcers at home. 3. Administer the biologic response modifier filgrastim (Neupogen). 4. Encourage the client to discuss feelings about having cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 401). F.A. Davis Company. Kindle Edition.

36. 1. This can be done to determine specific problems resulting from the specific side effects of the medication, but it is not the first action. The nurse can ask general assessment questions to determine how the client is tolerating the treatments. 2. The systemic side effects of chemotherapy are not always apparent, and the development of stomatitis can be extremely distressing for the client. The nurse should assess the client's tolerance to treatments. 3. This is done if the white blood cell count is low. The nurse assesses the WBC count and then obtains an order from the HCP. 4. This is an appropriate action but not before assessing physical problems. TEST-TAKING HINT: When prioritizing nursing interventions, the test taker should apply the nursing process, and assessment is the first step. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 416). F.A. Davis Company. Kindle Edition.

37. The nurse is assessing a client with complaints of vague upper abdominal pain worse at night but relieved by sitting up and leaning forward. Which assessment question should the nurse ask next? 1. "Have you noticed a yellow haze when you look at things?" 2. "Does the pain get worse when you eat a meal or snack?" 3. "Have you had your amylase and lipase checked recently?" 4. "How much weight have you gained since you saw an HCP?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 317). F.A. Davis Company. Kindle Edition.

37. 1. A yellow haze is a sign of a toxic level of digoxin, with the client seeing through the yellow haze. Seeing a yellow haze is not the same as the client having jaundice. In jaundice, the skin and sclera are yellow, signs of pancreatic cancer. 2. The abdominal pain is often made worse by eating and lying supine in clients diagnosed with cancer of the pancreas. 3. The client does not know these terms, and the HCP should check these laboratory values. 4. Clients diagnosed with cancer of the pancreas lose weight; they do not gain weight. TEST-TAKING HINT: The test taker could arrive at the correct answer by correlating words in the stem of the question and words in the answer options—the abdomen with eating and pain with pain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 333). F.A. Davis Company. Kindle Edition. 2

38. The nurse is caring for a client newly diagnosed with Stage IV ovarian cancer. What is the scientific rationale for detecting the tumors at this stage? 1. The client's ovaries lie deep within the pelvis and early symptoms are vague. 2. The client has regular gynecological examinations and this helps with detection. 3. The client had a history of dysmenorrhea and benign ovarian cysts. 4. The client had a family history of breast cancer and was being checked regularly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 401). F.A. Davis Company. Kindle Edition.

38. 1. The ovaries are anatomically positioned deep within the pelvis, and because of this, signs and symptoms of cancer are vague and nonspecific. Symptoms include increased abdominal girth, pelvic pressure, indigestion, bloating, flatulence, and pelvic and leg pain. Increasing abdomen size as a result of accumulation of fluid is the most common sign. Many women ignore the symptoms because they are so nonspecific. 2. Regular gynecological examinations are recommended, but this is advanced disease. 3. Dysmenorrhea is not a risk factor for developing ovarian cancer. Any enlarged ovary should be evaluated, especially if the client is postmenopausal, when the ovaries shrink in size. 4. A family history of breast cancer is a cause for the client to be assessed regularly for breast and ovarian cancer, but this is late disease. TEST-TAKING HINT: "Stage IV" should help the test taker to eliminate options "2" and "4" because this client has advanced disease and it is hoped regular checkups find problems early. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 417). F.A. Davis Company. Kindle Edition. 1

38. The nurse caring for a client diagnosed with cancer of the pancreas writes the problem of "altered nutrition: less than body requirements." Which collaborative intervention should the nurse include in the plan of care? 1. Continuous feedings via (PEG) tube. 2. Have the family bring in foods from home. 3. Assess for food preferences. 4. Refer to the dietitian. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 317). F.A. Davis Company. Kindle Edition.

38. 1. Tube feedings are collaborative interventions, but the stem did not say the client had a feeding tube. 2. Having family members bring food from home is an independent intervention. 3. Assessment is an independent intervention and the first step in the nursing process. No one should have to tell the nurse to assess the client. 4. A collaborative intervention is to refer to the nutrition expert, the dietitian. TEST-TAKING HINT: The key word in the stem is "collaborative," which means another health-care discipline must be involved. Only options "1" and "4" involve other members of the health-care team. The test taker could eliminate distracter "1" by rereading the stem and realizing the stem did not include the client having a feeding tube. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 333). F.A. Davis Company. Kindle Edition. 4

39. The nurse is planning a program for clients at a health fair regarding the prevention and early detection of cancer of the pancreas. Which self-care activity should the nurse discuss as an example of a primary nursing intervention? 1. Monitor for elevated blood glucose at random intervals. 2. Inspect the skin and sclera of the eyes for a yellow tint. 3. Limit meat in the diet and eat a diet low in fat. 4. Instruct the client with hyperglycemia about insulin injections. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

39. 1. Monitoring the blood glucose at random intervals, as done at a health fair, could identify possible diabetes mellitus or the presence of a pancreatic tumor, but detecting a disease at an early stage is secondary screening, not primary prevention. 2. Inspecting the skin for jaundice is a secondary nursing intervention. 3. Limiting the intake of meat and fats in the diet is an example of primary interventions. Risk factors for the development of cancer of the pancreas are cigarette smoking and eating a high-fat diet. By changing these behaviors, the client could possibly prevent the development of cancer of the pancreas. Other risk factors include genetic predisposition and exposure to industrial chemicals. 4. Instructing a client with hyperglycemia (diabetes mellitus) is an example of tertiary nursing care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 333). F.A. Davis Company. Kindle Edition. 3

4. The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? Select all that apply. 1. Administer high-dose chemotherapy. 2. Teach the client about autologous transfusions. 3. Have the family members' HLA typed. 4. Monitor the complete blood cell count daily. 5. Provide central line care per protocol. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

4. 1. All of the bone marrow cells must be destroyed prior to "implanting" the healthy bone marrow. High-dose chemotherapy and full-body irradiation therapy are used to accomplish this. 2. Autologous transfusions are infusions from the client himself or herself. This client has a cancer involving blood tissue. To reinfuse the client's own tissues would be to purposefully give the client cancer cells. 3. The best bone marrow donor comes from an identical twin; next best comes from a sibling who matches. The most complications occur from a matched unrelated donor (MUD). The client's body recognizes the marrow as foreign and tries to reject it, resulting in graft-versus-host disease (GVHD). 4. The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. 5. Clients will have at least one multipleline central venous access. These clients are seriously ill and require multiple transfusions and antibiotics. TEST-TAKING HINT: If the test taker knows the definition of "autologous," then option "2" could be eliminated. . Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 159). F.A. Davis Company. Kindle Edition. 1,3,4,5

4. Which recommendation is the American Cancer Society's (ACS) 2015 guideline for the early detection of breast cancer? 1. Beginning at age 18, have a biannual clinical breast examination by an HCP. 2. Beginning at age 30, perform monthly breast self-exams. 3. At age 45 through 54, receive a yearly mammogram. 4. Beginning at age 50, have a breast sonogram every five (5) years. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

4. 1. Unless there is a personal history of breast cancer or a strong family history, clinical breast examinations should begin at age 30 years and should be performed yearly. 2. If the client is going to perform breast selfexamination (BSE), it should begin at age 18. The ACS no longer includes monthly BSE as part of its guidelines. 3. The ACS recommends a yearly mammogram for the early detection of breast cancer beginning at age 45 and going to age 55 and approximately every two (2) years after the age of 55. Before age 45 and after age 55 it should be a discussion between the woman and her HCP to determine if more frequent mammograms are warranted. A mammogram can detect disease that will not be large enough to feel. 4. Breast sonograms are performed to diagnose specific breast disease when a screening mammogram has shown a suspicious area. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 409). F.A. Davis Company. Kindle Edition. 3

4. What factor differentiates a malignant tumor from a benign tumor? a. It causes death. b. It grows at a faster rate. c. It is often encapsulated. d. It invades and metastasizes. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

4. d. The major difference between malignant and benign cells is the ability of malignant tumor cells to invade and metastasize. Benign tumors can cause death by expansion into normal tissues and organs. Benign tumors are more often encapsulated and often grow at the same rate as malignant tumors. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

40. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which intervention should the nurse delegate to the UAP? 1. Assist the client with abdominal pain to turn to the side and flex the knees. 2. Monitor the Jackson Pratt drainage tube to ensure it is draining properly. 3. Check to see if the client is sleeping after pain medication is administered. 4. Empty the bedside commode of the client who has been having melena. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

40. 1. The UAP can help a client to turn to the side and assume the fetal position, which decreases some abdominal pain. 2. Monitoring a Jackson Pratt drain is a highlevel nursing intervention, which the UAP is not qualified to implement. 3. Evaluation of the effectiveness of a prn medication must be done by the nurse. 4. The nurse should empty the bedside commode to determine if the client is continuing to pass melena (blood in the stool). TEST-TAKING HINT: There are basic rules to delegation. The nurse cannot delegate assessment, teaching, evaluation, medications, unstable clients, or situations requiring nursing judgment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 333). F.A. Davis Company. Kindle Edition. 1

40. The client has had an exploratory laparotomy to remove an ovarian tumor. The pathology report classifies the tumor as a "low malignancy potential" (LMP) tumor. Which statement explains the scientific rationale for this pathology report? 1. The client does not have cancer but will need adjuvant therapy. 2. The client would have developed cancer if the tumor had not been removed. 3. These borderline tumors resemble ovarian cancer but have better outcomes. 4. The client has a very poor prognosis and has less than six (6) months to live. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

40. 1. The client has a low-grade cancer occurring in approximately 15% of ovarian tumors. The affected ovary usually is removed, and the client may or may not require adjuvant therapy. Women with this type of tumor are usually younger than age 40 years. 2. The tumor is classified as cancer. The followup care is not as extensive because of the characteristics the tumor displays. 3. These tumors are low-grade cancers with fewer propensities for metastasis than most ovarian cancers. 4. This client has a better prognosis than 85% of clients diagnosed with ovarian cancer. TEST-TAKING HINT: The test taker could eliminate option "4" because "low malignancy potential" and "poor prognosis" do not match. The statement in option "1" says the client does not have cancer but will need therapy for cancer, so the test taker could eliminate this option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 417). F.A. Davis Company. Kindle Edition. 3

41. The client diagnosed with cancer of the pancreas is being discharged to start chemotherapy in the HCP's office. Which statement made by the client indicates the client understands the discharge instructions? 1. "I will have to see the HCP every day for six (6) weeks for my treatments." 2. "I should write down all my questions so I can ask them when I see the HCP." 3. "I am sure this is not going to be a serious problem for me to deal with." 4. "The nurse will give me an injection in my leg and I will get to go home." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

41. 1. This is routine for radiation therapy, but chemotherapy is given one (1) to three (3) or four (4) days in a row and then a period of three (3) to four (4) weeks will elapse before the next treatment. This is called intermittent pulse therapy. 2. The most important person in the treatment of the cancer is the client. Research has proved the more involved a client becomes in his or her care, the better the prognosis. Clients should have a chance to ask questions. 3. Cancer of any kind is a serious problem. 4. Most antineoplastic medications are administered intravenously. Many of the medications can cause severe complications if administered intramuscularly. TEST-TAKING HINT: The test taker can eliminate option "3" based on this statement being denial of the problem. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 333). F.A. Davis Company. Kindle Edition. 2

42. The nurse writes a problem of "anticipatory grieving" for a client diagnosed with ovarian cancer. Which nursing intervention is priority for this client? 1. Request the HCP to order an antidepressant medication. 2. Refer the client to a CanSurmount volunteer for counseling. 3. Encourage the client to verbalize feelings about having cancer. 4. Give the client an advance directive form to fill out. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

42. 1. An antidepressant may be needed at some time, but at this point the nurse should offer his or her time and interest and encourage the client to discuss the feeling of having cancer. 2. CanSurmount volunteers are extremely helpful in talking about having cancer with the client, but they do not provide counseling. The programs work based on the fact someone who has had cancer and gone through treatment can relate to the client about to begin treatment. 3. The nurse should plan to spend time with the client and allow the client to discuss the feelings of having cancer, dying, fear of the treatments, and any other concerns. 4. The client will need to complete an advance directive, but this action does not address the client's grieving process. TEST-TAKING HINT: The test taker could eliminate option "2" because a client is not referred to a volunteer for counseling. Only one (1) option directly addresses the problem and requires the nurse to interact with the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 418). F.A. Davis Company. Kindle Edition. 3

42. The client is being admitted to the outpatient department prior to an endoscopic retrograde cholangiopancreatogram (ERCP) to rule out cancer of the pancreas. Which preprocedure instruction should the nurse teach? 1. Prepare to be admitted to the hospital after the procedure for observation. 2. If something happens during the procedure, then emergency surgery will be done. 3. Do not eat or drink anything after midnight the night before the test. 4. If done correctly, this procedure will correct the blockage of the stomach. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

42. 1. The client should stay in the outpatient department after the procedure for observation unless the HCP determines a more extensive work-up should be completed. 2. This is not the type of procedure where the results warrant an emergency surgery. A cardiac catheterization sometimes results in an emergency surgery and the client is prepared for this possibility, but this is not the case with an ERCP. 3. The client should be NPO after midnight to make sure the stomach is empty to reduce the risk of aspiration during the procedure. 4. The possible blockage is of the duodenum, common bile duct, or pancreatic outlet. TEST-TAKING HINT: The nurse should never preface any instruction with "if done correctly" because this sets the nurse, HCP, and facility up for a lawsuit. The client is NPO for any procedure or surgery where the client will receive general or twilight sleep anesthesia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 334). F.A. Davis Company. Kindle Edition. 3

43. The client diagnosed with ovarian cancer has had eight (8) courses of chemotherapy. Which laboratory data warrant immediate intervention by the nurse? 1. Absolute neutrophil count of 3,500. 2. Platelet count of 150 103. 3. Red blood cell count of 5 106. 4. Urinalysis report of 100 WBCs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

43. 1. An absolute neutrophil count of 3,500 indicates the client has sufficient mature white blood cells, or granulocytes, to act as a defense against infections. 2. A platelet count of 150,000 is within normal range (150 103 [1,000] 150,000). Thrombocytopenia is less than 100,000. 3. A red blood cell count of 5,000,000 is within normal limits (5 106 [1,000,000] 5,000,000). 4. A normal urinalysis contains one (1) to two (2) WBCs. A report of 100 WBCs indicates the presence of an infection. A clean voided specimen should be obtained and a urine culture should be done. This client should be prescribed antibiotics immediately. TEST-TAKING HINT: The test taker should memorize normal values for common laboratory tests. Urine will not have a large number of white blood cells unless there is a pathological process occurring. The kidneys filter the blood but do not process the destruction of blood cells. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 418). F.A. Davis Company. Kindle Edition. 4

43. The client is diagnosed with cancer of the head of the pancreas. Which signs and symptoms should the nurse expect to assess? 1. Clay-colored stools and dark urine. 2. Night sweats and fever. 3. Left lower abdominal cramps and tenesmus. 4. Nausea and coffee-ground emesis. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

43. 1. The client will have jaundice, clay-colored stools, and tea-colored urine resulting from blockage of the bile drainage. 2. Night sweats and fevers are associated with lymphoma. 3. Left lower abdominal cramps are associated with diverticulitis, and tenesmus is straining when defecating. 4. Nausea and coffee-ground emesis are symptoms of gastric ulcers. TEST-TAKING HINT: The test taker should remember anatomical placement of organs. This eliminates options "3" and "4." The pancreas empties pancreatic enzymes into the small bowel in close proximity to where the common bile duct enters the intestine to aid in the digestion of carbohydrates and fats. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 334). F.A. Davis Company. Kindle Edition. 1

44. The client diagnosed with cancer of the head of the pancreas is two (2) days postpancreatoduodenectomy (Whipple's procedure). Which nursing problem has the highest priority? 1. Anticipatory grieving. 2. Fluid volume imbalance. 3. Alteration in comfort. 4. Altered nutrition. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

44. 1. Clients diagnosed with cancer of the pancreas have a poor prognosis, but this is not the priority problem at this time. 2. This is a major abdominal surgery, and massive fluid volume shifts occur when this type of trauma is experienced by the body. Maintaining the circulatory system without overloading it requires extremely close monitoring. 3. Pain is a priority but not over fluid volume status. 4. Altered nutrition is an appropriate problem but not priority over fluid volume shift. The client will be NPO with a nasogastric tube to suction and will be receiving total parenteral nutrition. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 334). F.A. Davis Company. Kindle Edition. 2

44. The client diagnosed with ovarian cancer is prescribed radiation therapy for regional control of the disease. Which statement indicates the client requires further teaching? 1. "I will not wash the marks off my abdomen." 2. "I will have a treatment every day for six (6) weeks." 3. "Nausea caused by radiation therapy cannot be controlled." 4. "I need to drink a nutritional shake if I don't feel like eating." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

44. 1. The radiation markings on a client are there to guide the technician to irradiate only the area within the marks. The marks must remain until the client has completed the treatments. 2. Radiation therapy is administered in fractionated (divided) doses to allow for regeneration of normal cells. Cancer cells do not regenerate as rapidly as normal cells. 3. There are many medications prescribed for cancer or treatment-induced nausea. The client should notify the HCP if adequate relief is not obtained. 4. Cancer treatments frequently interfere with the client's appetite, but supporting the nutritional status of the client is important. TEST-TAKING HINT: The question is an "except" question. All options except one (1) will be statements indicating the client does understand the teaching. If the test taker missed the information making this an "except" question, finding two (2) options with correct answers might clue the test taker to reread the stem. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 418). F.A. Davis Company. Kindle Edition. 3

45. The nurse is assessing the client diagnosed with a lung abscess. Which information supports this diagnosis of lung abscess? 1. Tympanic sounds elicited by percussion over the site. 2. Inspiratory and expiratory wheezes heard over the upper lobes. 3. Decreased breath sounds with a pleural friction rub. 4. Asymmetric movement of the chest wall with inspiration. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 237). F.A. Davis Company. Kindle Edition.

45. 1. Dull sounds would be heard over the site of a lung abscess as a result of the solid mass. 2. Crackles may be heard, but wheezes indicate a narrowing of airways, not exudates-filled airways. 3. Diminished or absent sounds are heard with intermittent pleural friction rubs. A lung abscess is the accumulation of pus in an area where pneumonia was present that becomes encapsulated and can extend to the bronchus or pleural space. 4. Even with a lung abscess, the chest should move symmetrically. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 246). F.A. Davis Company. Kindle Edition. 3

45. The client had a total pancreatectomy and splenectomy for cancer of the body of the pancreas. Which discharge instructions should the nurse teach? Select all that apply. 1. Keep a careful record of intake and output. 2. Use a stool softener or bulk laxative regularly. 3. Use correct insulin injection technique. 4. Take the pain medication before the pain gets too bad. 5. Sleep with the head of the bed on blocks. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

45. 1. The client is being discharged. There is no need for the client to continue recording intake and output at home. 2. The client has undergone a radical and extensive surgery and will need narcotic pain medication, and a bowel regimen should be in place to prevent constipation. 3. Removal of the pancreas will create a diabetic state for the client. The client will need insulin and pancreatic enzyme replacement. 4. The client should not allow pain to reach above a "5" before taking pain medication or it will be more difficult to get the pain under control. 5. There is no reason for the client to sleep with the head of the bed elevated. TEST-TAKING HINT: The test taker might choose option "3" by remembering the pancreas secretes insulin. Option "4" is taught to all clients in pain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 334). F.A. Davis Company. Kindle Edition. 2,3,4

45. The female client has a mother who died from ovarian cancer and a sister diagnosed with ovarian cancer. Which recommendations should the nurse make regarding early detection of ovarian cancer? 1. The client should consider having a prophylactic bilateral oophorectomy. 2. The client should have a transvaginal ultrasound and a CA-125 laboratory test every six (6) months. 3. The client should have yearly magnetic resonance imaging (MRI) scans. 4. The client should have a biannual gynecological examination with flexible sigmoidoscopy. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

45. 1. This is appropriate information if the client is in her mid- to late-30s and has completed her family, but this is not discussing early detection of ovarian cancer. 2. A transvaginal ultrasound is a sonogram in which the sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sonogram, can provide information about ovarian cancer for early diagnosis. 3. Yearly MRI scans will not provide the information the two (2) tests will, and every 12 months is too long an interval. 4. A flexible sigmoidoscopy provides the HCP with a visual examination of the sigmoid colon, not the ovaries. TEST-TAKING HINT: The test taker could eliminate option "4" because of the anatomical site and option "3" because of the time factor. The test taker should ask, "If looking for early detection, at what interval should the client see the HCP?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 418). F.A. Davis Company. Kindle Edition. 2

46. The client admitted to rule out pancreatic islet tumors complains of feeling weak, shaky, and sweaty. Which priority intervention should be implemented by the nurse? 1. Start an IV with D5W. 2. Notify the health-care provider. 3. Perform a bedside glucose check. 4. Give the client some orange juice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

46. 1. The client may need IV medication, but in this case if it is needed, it is 50% dextrose. 2. The HCP might be notified, but the nurse needs to assess the client first. 3. These are symptoms of an insulin reaction (hypoglycemia). A bedside glucose check should be done. Pancreatic islet tumors can produce hyperinsulinemia or hypoglycemia. 4. Treating the client is done after the nurse knows the glucose reading. TEST-TAKING HINT: The test taker should remember the function of the pancreas. This leads the test taker to look for interventions for hypoglycemia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 334). F.A. Davis Company. Kindle Edition. 3

46. The client has had a total abdominal hysterectomy for cancer of the ovary. Which diet should the nurse discuss when providing discharge instructions? 1. A low-residue diet without seeds. 2. A low-sodium, low-fat diet with skim milk. 3. A regular diet with fruits and vegetables. 4. A full liquid-only diet with milkshake supplements. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

46. 1. This diet is appropriate for a client diagnosed with diverticulitis. 2. This diet applies to a client with coronary artery disease and hypertension. 3. The client is not placed on a specific diet, but it is always a good recommendation to include fruits and vegetables in the diet. 4. There is no reason to limit the consistency of the foods consumed to full liquids. TEST-TAKING HINT: The test taker should recognize option "3" as a recommended diet for all clients without a specific disease process limiting the types of foods consumed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 419). F.A. Davis Company. Kindle Edition. 3

47. The home health nurse is admitting a client diagnosed with cancer of the pancreas. Which information is the most important for the nurse to discuss with the client? 1. Determine the client's food preferences. 2. Ask the client if there is an advance directive. 3. Find out about insurance/Medicare reimbursement. 4. Explain the client should eat as much as possible. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

47. 1. Food preferences are important for the caregiver to know because this will be the person preparing meals for the client, but it is not the highest priority. 2. Cancer of the pancreas has a poor prognosis; the nurse should determine if the client has executed an advance directive regarding his or her wishes. 3. This is important because of payment issues, but it is not the highest priority. 4. Clients diagnosed with cancer frequently have anorexia, and explaining the client should eat does not mean the client will eat. TEST-TAKING HINT: The test taker needs to know general information about the disease process to answer this question, but option "2" is a good choice for many terminal diseases. Remember to read the questions carefully. The home health nurse is not arranging meals for the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 335). F.A. Davis Company. Kindle Edition. 2

47. The nurse is preparing an educational presentation for women in the community. Which primary nursing intervention should the nurse discuss regarding the development of ovarian cancer? 1. Instruct the clients not to use talcum powder on the perineum. 2. Encourage the clients to consume diets with a high-fat content. 3. Teach the women to have a lower pelvic sonogram yearly. 4. Discuss the need to be aware of the family history of cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 402). F.A. Davis Company. Kindle Edition.

47. 1. Research has shown the use of talcum powder perineally increases the risk for developing ovarian cancer, although there is no explanation known for this occurrence. Other risk factors include a highfat diet, nulliparity, infertility, older age (70 to 80 years) has the greatest incidence, mumps before menarche, and family history of ovarian cancer. 2. Nurses should never encourage a high-fat diet. 3. Only clients in a high-risk category should have routine sonograms. The time frame for the high-risk group of clients is six (6) months. This is not primary intervention; early detection is secondary intervention. 4. This alerts the client to participate in activities detecting cancer early, a secondary intervention. TEST-TAKING HINT: The test taker could eliminate options "3" and "4" because of the word "primary" in the stem. Option "2" could be eliminated because of the recommendation of a high-fat diet. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 419). F.A. Davis Company. Kindle Edition. 1

48. The nurse is caring for a client who is one (1) day postoperative hysterectomy for cancer of the ovary. Which nursing interventions should the nurse implement? Select all that apply. 1. Assess for calf enlargement and tenderness. 2. Turn, cough, and deep breathe every six (6) hours. 3. Assess pain on a 1-to-10 pain scale. 4. Apply sequential compression devices to legs. 5. Assess bowel sounds every four (4) hours. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

48. 1. All clients who have had surgery are at risk for developing deep vein thrombosis (DVT), and an enlarged, tender calf is a sign of DVT. 2. The client should be turned and encouraged to cough and deep breathe at least every two (2) hours. 3. Clients who have had surgery should be assessed for pain on a pain scale and by observing for physiological markers indicating pain. 4. Sequential compression hose are used prophylactically to prevent deep vein thrombosis. 5. The client should be assessed for the return of bowel sounds. TEST-TAKING HINT: Option "2" has a time frame in it, and the test taker should ask if the time frame is correct for the intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 419). F.A. Davis Company. Kindle Edition. 1,3,4,5

48. The nurse caring for a client diagnosed with cancer of the pancreas writes the nursing diagnosis of "risk for altered skin integrity related to pruritus." Which intervention should the nurse implement? 1. Assess tissue turgor. 2. Apply antifungal creams. 3. Monitor bony prominences for breakdown. 4. Have the client keep the fingernails short. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 318). F.A. Davis Company. Kindle Edition.

48. 1. The client is at risk for poor nutrition and malabsorption syndrome for which tissue turgor assessment is appropriate, but the client problem is pruritus, or itching. 2. The itching is associated with the cancer and not a fungus. 3. The client should be monitored for skin breakdown, but pruritus is itching and an intervention is needed to prevent skin problems as a result of scratching. 4. Keeping the fingernails short will reduce the chance of breaks in the skin from scratching. TEST-TAKING HINT: The problem is "risk for skin breakdown." The etiology is "pruritus." Interventions address the etiology. Goals address the problem. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 335). F.A. Davis Company. Kindle Edition. 4

49. The client is being admitted to rule out a brain tumor. Which classic triad of symptoms supports a diagnosis of brain tumor? 1. Nervousness, metastasis to the lungs, and seizures. 2. Headache, vomiting, and papilledema. 3. Hypotension, tachycardia, and tachypnea. 4. Abrupt loss of motor function, diarrhea, and changes in taste. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

49. 1. Nervousness is not a symptom of a brain tumor, and brain tumors rarely metastasize outside of the cranium. Brain tumors kill by occupying space and increasing intracranial pressure. Although seizures are not uncommon with brain tumors, seizures are not part of the classic triad of symptoms. 2. The classic triad of symptoms suggesting a brain tumor includes a headache that is dull, unrelenting, and worse in the morning; vomiting unrelated to food intake; and edema of the optic nerve (papilledema), which occurs in 70% to 75% of clients diagnosed with brain tumors. Papilledema causes visual disturbances such as decreased visual acuity and diplopia. 3. Hypertension and bradycardia, not hypotension and tachycardia, occur with increased intracranial pressure resulting from pressure on the cerebrum. Tachypnea does not occur with brain tumors. 4. Abrupt loss of motor function occurs with a stroke; diarrhea does not occur with a brain tumor, and the client with a brain tumor does not experience a change in taste. TEST TAKING HINT: The test taker can rule out option "4" because of the symptom of diarrhea, which is a gastrointestinal symptom, not a neurological one. Considering the other three possible choices, the symptom of "headache" would make sense for a client with a brain tumor. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 37). F.A. Davis Company. Kindle Edition. 2

49. Which is the American Cancer Society's recommendation for the early detection of cancer of the prostate? 1. A yearly PSA level and DRE beginning at age 50. 2. A biannual rectal examination beginning at age 40. 3. A semiannual alkaline phosphatase level beginning at age 45. 4. A yearly urinalysis to determine the presence of prostatic fluid. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

49. 1. The American Cancer Society recommends all men have a yearly prostate-specific antigen (PSA) blood level, followed by a digital rectal examination (DRE) beginning at age 50. Men in the high-risk group, including all African American men, should begin at age 45. 2. A biannual (every 6 months) examination is not recommended. 3. Alkaline phosphatase levels are performed on men with known prostate cancer to determine bone involvement. This is not a screening test. 4. This test is done if the client has signs and symptoms of prostatitis. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 419). F.A. Davis Company. Kindle Edition. 1

49. The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? 1. The client worked with asbestos for a short time many years ago. 2. The client has no family history for this type of lung cancer. 3. The client has numerous tattoos covering both upper and lower arms. 4. The client has smoked two (2) packs of cigarettes a day for 20 years. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 195). F.A. Davis Company. Kindle Edition.

49. 1. Working with asbestos is significant for mesothelioma of the lung, a cancer with a very poor prognosis, but not for small cell carcinoma. 2. Family history is not the significant risk factor for small cell carcinoma. Smoking is the number-one risk factor. 3. Tattoos may be implicated in the development of blood-borne pathogen disease (if sterile needles were not used), but they do not have any association with cancer. 4. Smoking is the number-one risk factor for developing cancer of the lung. More than 85% of lung cancers are attributable to inhalation of chemicals. There are more than 400 chemicals in each puff of cigarette smoke, 17 of which are known to cause cancer. TEST-TAKING HINT: If the test taker did not know this information, option "3" has no anatomical connection to the lungs and could be eliminated. This information has been widely disseminated in the media for more than 40 years since the Surgeon General's office first warned about the dangers of smoking in the early 1960s. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 216). F.A. Davis Company. Kindle Edition. 4

5. The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? 1. CLL is not serious, and clients die from other causes first. 2. There are no symptoms with this form of leukemia. 3. This is a childhood illness and is self-limiting. 4. In early stages of CLL, the client may be asymptomatic. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

5. 1. All types of leukemia are serious and can cause death. The chronic types of leukemia are more insidious in the onset of symptoms and can have a slower progression of the disease. Chronic types of leukemia are more common in the adult population. 2. The symptoms may have a slower onset, but anemia causing fatigue and weakness and thrombocytopenia causing bleeding can be present (usually in the later stages of the disease). Organ enlargement from infiltration may be present. Secondary symptoms of fever, night sweats, and weight loss may also be present. 3. This disease is usually found in adults. 4. In this form of leukemia, the cells seem to escape apoptosis (programmed cell death), which results in many thousands of mature cells clogging the body. Because the cells are mature, the client may be asymptomatic in the early stages. TEST-TAKING HINT: The test taker can eliminate option "1" based on the words "not serious"; common sense lets the test taker know this is not true. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 160). F.A. Davis Company. Kindle Edition. 4

5. The client had a mastectomy for cancer of the breast and asks the nurse about a TRAM flap procedure. Which information should the nurse explain to the client? 1. The surgeon will insert a saline-filled sac under the skin to simulate a breast. 2. The surgeon will pull the client's own tissue under the skin to create a breast. 3. The surgeon will use tissue from inside the mouth to make a nipple. 4. The surgeon can make the breast any size the client wants the breast to be. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

5. 1. This is done for reconstruction of a breast or augmentation of breast size, but it is not a TRAM flap procedure, which uses the client's own tissue. 2. The TRAM flap procedure is one in which the client's own tissue is used to form the new breast. Abdominal tissue and fat are pulled under the skin with one end left attached to the site of origin to provide circulation until the body builds collateral circulation in the area. 3. The plastic surgeon can rebuild a nipple from pigmented skin donor sites or can tattoo the nipple in place. 4. This is true of saline implants but not of TRAM flaps. TEST-TAKING HINT: If the test taker is taking a standard pencil-and-paper test and is not familiar with this procedure, then skipping the question and returning to it at a later time is advisable. Another question might give a clue about the procedure. This is not possible on the NCLEX-RN computerized examination. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 410). F.A. Davis Company. Kindle Edition. 2

5. A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse likely to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

5. d. Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

50. The client has been diagnosed with a brain tumor. Which presenting signs and symptoms help to localize the tumor position? 1. Widening pulse pressure and bounding pulse. 2. Diplopia and decreased visual acuity. 3. Bradykinesia and scanning speech. 4. Hemiparesis and personality changes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

50. 1. A widening pulse pressure and bounding pulse indicate increased intracranial pressure but do not localize the tumor. 2. Diplopia and decreased visual pressure are symptoms indicating papilledema, a general symptom in the majority of all brain tumors. 3. Bradykinesia is slowed movement, a symptom of Parkinson's disease, and scanning speech is symptomatic of multiple sclerosis. 4. Hemiparesis would localize a tumor to a motor area of the brain, and personality changes localize a tumor to the frontal lobe. TEST TAKING HINT: The test taker could arrive at the correct answer if the test taker realized that specific regions of the brain control motor function and hemiparesis and that other regions are involved in personality changes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 4

50. The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply. 1. Apply O2 via nasal cannula. 2. Have the dietitian plan for six (6) small meals per day. 3. Place the client in respiratory isolation. 4. Assess vital signs for fever. 5. Listen to lung sounds every shift. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 195). F.A. Davis Company. Kindle Edition.

50. 1. Respiratory distress is a common finding in clients diagnosed with lung cancer. As the tumor grows and takes up more space or blocks air movement, the client may need to be taught positioning for lung expansion. The administration of oxygen will help the client to use the lung capacity that is available to get oxygen to the tissues. 2. Clients with lung cancer frequently become fatigued trying to eat. Providing six (6) small meals spaces the amount of food the client eats throughout the day. 3. Cancer is not communicable, so the client does not need to be in isolation. 4. Clients with cancer of the lung are at risk for developing an infection from lowered resistance as a result of treatments or from the tumor blocking secretions in the lung. Therefore, monitoring for the presence of fever, a possible indication of infection, is important. 5. Assessment of the lungs should be completed on a routine and prn basis. TEST-TAKING HINT: This alternative-type question is an all-or-nothing situation. The NCLEX-RN examination requires the test taker to answer each option correctly to receive credit for the question. Each option has the potential to be right or wrong. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 217). F.A. Davis Company. Kindle Edition. 1,2,4,5

50. The client is diagnosed with early cancer of the prostate. Which assessment data would the client report? 1. Urinary urgency and frequency. 2. Retrograde ejaculation during intercourse. 3. Low back and hip pain. 4. No problems have been noticed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

50. 1. Urgency and frequency are obstructive symptoms and are late signs. 2. Retrograde ejaculation occurs when the sperm are ejaculated into the urine; it occurs in some cases of male infertility. 3. Low back pain and hip pain are symptoms of metastasis to the bone and are late symptoms. 4. In early-stage prostate cancer, the man will not be aware of the disease. Early detection is achieved by screening for the cancer. TEST-TAKING HINT: The test taker should notice the word "early" in the stem of the question and choose the option with the least amount of symptoms. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 419). F.A. Davis Company. Kindle Edition. 4

51. The nurse is discussing cancer statistics with a group from the community. Which information about death rates from lung cancer is accurate? 1. Lung cancer has a low mortality rate because of new treatment options. 2. Lung cancer is the number-one cause of cancer deaths in both men and women. 3. Lung cancer deaths are not significant in relation to other cancers. 4. Lung cancer deaths have continued to increase in the male population. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 196). F.A. Davis Company. Kindle Edition.

51. 1. Lung cancer is the number-one cause of cancer deaths in the United States. 2. Lung cancers are responsible for almost twice as many deaths among males as any other cancer and more deaths than breast cancer in females. 3. Lung cancers are the most deadly cancers among the U.S. population. 4. Lung cancer deaths have remained relatively stable among the male population but have continued to steadily increase among females. TEST-TAKING HINT: The nurse must be able to interpret data to the public. The nurse will be asked about incidence and severity of diseases. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 217). F.A. Davis Company. Kindle Edition. 2

51. The 80-year-old male client has been diagnosed with cancer of the prostate. Which treatment should the nurse discuss with the client? 1. Radiation therapy every day for four (4) weeks. 2. Radical prostatectomy with lymph node dissection. 3. Diethylstilbestrol (DES), an estrogen, daily. 4. Penile implants to maintain sexual functioning. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

51. 1. Radiation therapy is considered aggressive therapy and is not recommended for the elderly client unless needed to alleviate pain from bony metastasis. 2. A radical prostatectomy with lymph node dissection is extensive surgery and only recommended for clients with a life expectancy of greater than 10 years. 3. DES is a hormone preparation that suppresses the male hormones and slows the growth of the tumor. Some men with a life expectancy of less than 10 years choose not to treat the cancer at all and will usually die from causes other than prostate cancer. 4. Penile implants do not treat prostate cancer. Sexual functioning may or may not be impaired, depending on whether the client is treated surgically by a radical prostatectomy. If so, then the client may be prescribed Viagra or Cialis. Eighty-year-old men are not candidates for a radical prostatectomy. TEST-TAKING HINT: The test taker should notice the age of the client. When an age is provided in the question, it is significant. The elderly do not tolerate many treatments well, so the test taker should choose the least invasive treatment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 420). F.A. Davis Company. Kindle Edition. 3

51. The male client diagnosed with a brain tumor is scheduled for a magnetic resonance imaging (MRI) scan in the morning. The client tells the nurse that he is scared. Which response by the nurse indicates an appropriate therapeutic response? 1. "MRIs are loud but there will not be any invasive procedure done." 2. "You're scared. Tell me about what is scaring you." 3. "This is the least thing to be scared about— there will be worse." 4. "I can call the MRI tech to come and talk to you about the scan." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

51. 1. This is providing information and is not completely factual. MRIs are loud, but frequently the client will require an IV access (an invasive procedure) to be started for a contrast medium to be injected. 2. This is restating and offering self. Both are therapeutic responses. 3. This statement is belittling the client's feeling. 4. This is not dealing with the client's concerns and is passing the buck. The nurse should explore the client's feeling to determine what is concerning the client. The MRI may or may not be the problem. The client may be afraid of the results of the MRI. TEST TAKING HINT: When the question asks the test taker for a therapeutic response, the test taker should choose the response that directly addresses the client's feelings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 2

52. The client diagnosed with breast cancer has developed metastasis to the brain. Which prophylactic measure should the nurse implement? 1. Institute aspiration precautions. 2. Refer the client to Reach to Recovery. 3. Initiate seizure precautions. 4. Teach the client about mastectomy care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

52. 1. Nothing in the stem indicates the client has a problem with swallowing, so aspiration precautions are not needed. 2. Reach to Recovery is an American Cancer Society-sponsored program for clients with breast cancer, but it is not prophylactic. 3. The client diagnosed with metastatic lesions to the brain is at high risk for seizures. 4. Teaching about mastectomy care is not prophylactic, and the stem did not indicate whether the client had a mastectomy. TEST TAKING HINT: The test taker should not read into a question—for example, about mastectomy care. The test taker should be careful to read the descriptive words in the stem; in this case, "prophylactic" is the key to answering the question correctly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 3

52. The nurse writes a client problem of urinary retention for a client diagnosed with Stage IV cancer of the prostate. Which intervention should the nurse implement first? 1. Catheterize the client to determine the amount of residual. 2. Encourage the client to assume a normal position for urinating. 3. Teach the client to use the Valsalva maneuver to empty the bladder. 4. Determine the client's normal voiding pattern. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

52. 1. The nurse should assess the client's normal voiding pattern before taking any action. 2. This is a good intervention, but it comes after assessment. 3. The Valsalva maneuver will help the client to empty the bladder, but assessment comes before teaching. 4. Determining the client's normal voiding patterns provides a baseline for the nurse and client to use when setting goals. TEST-TAKING HINT: Assessment is the first step of the nursing process. In any question requiring the test taker to choose the first action, an answer option with the words "check," "assess," or "determine" should be considered as a possible answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 420). F.A. Davis Company. Kindle Edition. 4

52. The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse? 1. The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup. 2. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table. 3. The client receiving Procrit, a biologic response modifier, has a T 99.2˚F, P 68, R 24, and BP of 198/102. 4. The client receiving prednisone, a steroid, is complaining of an upset stomach after eating breakfast. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

52. 1. This is expected from this client and does not warrant immediate attention. 2. This is called a three (3)-point stance. It is a position many clients with lung disease will assume because it assists in the expansion of the lung. 3. Biologic response modifiers stimulate the bone marrow and can increase the client's blood pressure to dangerous levels. This BP is high and warrants immediate attention. 4. This client can be seen after taking care of the client in "3." The nurse should intervene, but it is not a life-threatening situation. TEST-TAKING HINT: Even if the test taker did not know the side effects of Procrit, a BP Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 217). F.A. Davis Company. Kindle Edition. 3

53. The significant other of a client diagnosed with a brain tumor asks the nurse for help identifying resources. Which would be the most appropriate referral for the nurse to make? 1. Social worker. 2. Chaplain. 3. Health-care provider. 4. Occupational therapist. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

53. 1. A social worker is qualified to assist the client with referrals to any agency or personnel that is needed. 2. The chaplain should be referred if spiritual guidance is required, but the stem did not specify this need. 3. The HCP also can refer to the social worker, but the nurse can make this referral independently. 4. The occupational therapist assists with cognitive functioning, activities of daily living (ADLs), and modification of the home, but the stem did not define these needs. TEST TAKING HINT: The test taker must decide what each discipline has to offer the client; an SW has the broadest range of referral capabilities. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 1

53. The client has undergone a bilateral orchiectomy for cancer of the prostate. Which intervention should the nurse implement? 1. Support the scrotal sac with a towel and apply ice. 2. Administer testosterone replacement hormone orally. 3. Encourage the client to place sperm in a sperm bank. 4. Have the client talk to another man with ejaculation dysfunction. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

53. 1. Elevating a surgical site and applying ice will reduce edema to the area. 2. The testes have been excised to remove the majority of male hormones. Replacing the hormones negates the purpose of the surgery. 3. Sperm banking is encouraged for younger men who want to have children in the future. Prostate cancer is a cancer diagnosed in older men, and sperm banking is not normally recommended. 4. Bilateral orchiectomy will render the client impotent but not with ejaculation dysfunction. TEST-TAKING HINT: The test taker should try to match the procedure to the answer option. The procedure removes hormone-producing ability, so option "2" could be eliminated because it reverses the effects of the procedure. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 420). F.A. Davis Company. Kindle Edition. 1

53. The client diagnosed with lung cancer has been told the cancer has metastasized to the brain. Which intervention should the nurse implement? 1. Discuss implementing an advance directive. 2. Explain the use of chemotherapy for brain involvement. 3. Teach the client to discontinue driving. 4. Have the significant other make decisions for the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

53. 1. This situation indicates a terminal process, and the client should make decisions for the end of life. 2. Radiation therapy is used for tumors in the brain. Chemotherapy as a whole will not cross the blood-brain barrier. 3. There is no indication the client cannot drive at this point. Clients may develop seizures from the tumors at some point. 4. The client should make decisions for himself or herself as long as possible. However, the client should discuss personal wishes with the person named in an advance directive to make decisions. TEST-TAKING HINT: The ethical principle of autonomy could help the test taker to discard option "4" as a correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 217). F.A. Davis Company. Kindle Edition. 1

54. The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regarding investigational regimens should the nurse teach? 1. Investigational regimens provide a better chance of survival for the client. 2. Investigational treatments have not been proven to be helpful to clients. 3. Clients will be paid to participate in an investigational program. 4. Only clients who are dying qualify for investigational treatments. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

54. 1. If the investigational regimen proves to be effective, then this statement is true. However, many investigational treatments have not proved to be efficacious. 2. Investigational treatments are just that— treatments being investigated to determine if they are effective in the care of clients diagnosed with cancer. There is no guarantee the treatments will help the client. 3. Clients receive medical care and associated treatments and laboratory tests at no cost, but the client is not paid. Paying the client is unethical. 4. Frequently clients who have failed standard treatments and who have no other hope of a treatment are the clients involved in investigational protocols, but the protocols can be used for any client who volunteers for investigational treatment. TEST-TAKING HINT: The test taker should think about the word "investigational" and understand its meaning. Investigational means looking into something. This should lead the test taker to choose option "2." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 218). F.A. Davis Company. Kindle Edition. 2

54. The nurse has written a care plan for a client diagnosed with a brain tumor. Which is an important goal regarding self-care deficit? 1. The client will maintain body weight within two (2) pounds. 2. The client will execute an advance directive. 3. The client will be able to perform three (3) ADLs with assistance. 4. The client will verbalize feeling of loss by the end of the shift. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 15). F.A. Davis Company. Kindle Edition.

54. 1. Maintaining weight is a nutritional goal. 2. Completing an advance directive is an end-of-life or psychosocial goal. 3. Performing activities of daily living is a goal for self-care deficit. 4. Verbalizing feelings is a psychosocial goal. TEST TAKING HINT: The test taker should read the stem of the question carefully. All of the goals could be appropriate for a client diagnosed with a brain tumor, but only one applies to self-care deficit. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 3

54. The client diagnosed with cancer of the prostate has been placed on luteinizing hormone-releasing hormone (LHRH) agonist therapy. Which statement indicates the client understands the treatment? 1. "I will be able to function sexually as always." 2. "I may have hot flashes while taking this drug." 3. "This medication will cure the prostate cancer." 4. "There are no side effects with this medication." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

54. 1. This hormone will suppress the production of male hormones, and the client will not function sexually as always. 2. The client may have hot flashes because these drugs increase hypothalamic activity, which stimulates the thermoregulatory centers of the body. 3. The medication decreases the growth rate of the cancer, but it does not cure the cancer. 4. There are side effects with all medications. These medications can cause gynecomastia, hot flashes, cardiovascular effects, and decreased sexual functioning. The LHRH agonists have fewer side effects than the estrogens. TEST-TAKING HINT: The test taker could eliminate options "3" and "4" because of the promise of no side effects or a cure. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 420). F.A. Davis Company. Kindle Edition. 2

55. The nursing staff on an oncology unit is interviewing applicants for the unit manager position. Which type of organizational structure does this represent? 1. Centralized decision making. 2. Decentralized decision making. 3. Shared governance. 4. Pyramid with filtered-down decisions. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

55. 1. A centralized system of organization means decisions are made at the top and given to the staff underneath to accept and implement. 2. A decentralized decision-making pattern means there is a fairly flat accountability chart. The unit manager has more autonomy in managing the unit, but this does not mean the staff has input into decisions. 3. Shared governance is a system where the staff is empowered to make decisions such as scheduling and hiring of certain staff. Staff members are encouraged to participate in developing policies and procedures to reach set goals. 4. A pyramid decision-making tree is an example of a centralized system. TEST-TAKING HINT: Answer options "1" and "4" basically say the same thing and could be eliminated for this reason. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 218). F.A. Davis Company. Kindle Edition. 3

55. The client diagnosed with a brain tumor was admitted to the intensive care unit with decorticate posturing. Which indicates that the client's condition is becoming worse? 1. The client has purposeful movement with painful stimuli. 2. The client has assumed adduction of the upper extremities. 3. The client is aimlessly thrashing in the bed. 4. The client has become flaccid and does not respond to stimuli. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

55. 1. Purposeful movement following painful stimuli would indicate an improvement in the client's condition. 2. Adducting the upper extremities while internally rotating the lower extremities is decorticate positioning and would indicate that the client's condition had not changed. 3. Aimless thrashing would indicate an improvement in the client's condition. 4. The most severe neurological impairment result is flaccidity and no response to stimuli. This indicates that the client's condition has worsened. TEST TAKING HINT: Neurological assessment includes assessing the client for levels of consciousness; the nurse must memorize the stages of neurological progression toward a coma and death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 38). F.A. Davis Company. Kindle Edition. 4

55. The client is diagnosed with metastatic prostate cancer to the bones. Which nursing intervention should the nurse implement? 1. Prepare for a transurethral resection of the prostate. 2. Keep the foot of the bed elevated at all times. 3. Place the client on a scheduled bowel regimen. 4. Discuss the client's altered sexual functioning. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

55. 1. This intervention addresses the prostate cancer but not the metastatic process of bone involvement. 2. There is no reason to keep the foot of the bed elevated. 3. Bone metastasis is very painful, and the client should be placed on a scheduled regimen of pain medication. Pain medication slows peristalsis and causes constipation. The client should be placed on a routine bowel management program to prevent impactions. 4. This does not address the metastasis to the bone. TEST-TAKING HINT: The test taker must decide which intervention addresses both the cancer and the metastasis to the bone. Only one (1) option does this. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 420). F.A. Davis Company. Kindle Edition. 3

56. The client is diagnosed with a pituitary tumor and is scheduled for a transsphenoidal hypophysectomy. Which preoperative instruction is important for the nurse to teach? 1. There will be a large turban dressing around the skull after surgery. 2. The client will not be able to eat for four (4) or five (5) days postop. 3. The client should not blow the nose for two (2) weeks after surgery. 4. The client will have to lie flat for 24 hours following the surgery. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

56. 1. A transsphenoidal hypophysectomy is done by an incision above the gumline and through the sinuses to reach the sella turcica, where the pituitary is located. 2. The client will be given regular food when awake and able to tolerate food. 3. Blowing the nose creates increased intracranial pressure and could result in a cerebrospinal fluid leak. 4. The client will return from surgery with the head of the bed elevated to about 30 degrees; this allows for gravity to assist in draining the cerebrospinal fluid. TEST TAKING HINT: The test taker must know the procedures for specific disease processes to answer this question, but anatomical positioning of the pituitary gland (just above the sinuses) could help to eliminate option "1," which calls for a large turban dressing. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 39). F.A. Davis Company. Kindle Edition. 3

56. Which could be a complication of cryotherapy surgery for cancer of the prostate? 1. The urethra could become scarred and cause retention. 2. The client could have ejaculation difficulties and be impotent. 3. Bone marrow suppression could occur from the chemotherapy. 4. Chronic vomiting and diarrhea causing electrolyte imbalance could occur. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

56. 1. Cryotherapy involves placing freezing probes into the prostate to freeze the cancer cells. An indwelling catheter is placed into the urethra, and warm water is circulated through the catheter to try to prevent the urethra from freezing. If the urethra scars, then the lumen will constrict, causing retention of urine. 2. Ejaculation difficulties are caused by obstruction from tumor growth. 3. Bone marrow suppression is caused by radiation or chemotherapy. 4. Cryotherapy does not cause chronic vomiting or diarrhea. TEST-TAKING HINT: The test taker should dissect the word "cryotherapy." Cryo- means "to freeze," so cryotherapy indicates some form of cold therapy. Then the test taker should decide what cold therapy could cause to happen in the area being treated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 421). F.A. Davis Company. Kindle Edition. 1

56. The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates more teaching is required? 1. "It doesn't matter if I smoke now. I already have cancer." 2. "I should see the oncologist at my scheduled appointment." 3. "If I begin to run a fever, I should notify the HCP." 4. "I should plan for periods of rest throughout the day." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

56. 1. Research indicates smoking will still interfere with the client's response to treatment, so more teaching is needed. 2. It is expected for the client to follow up with a specialist regarding subsequent treatment; therefore, the client does not need more teaching. 3. Clients diagnosed with cancer and undergoing treatment are at risk for developing infections, so more teaching is not needed. 4. Lung cancers produce fatigue as a result of physiological drains on the body in the areas of lack of adequate oxygen to the tissues, the tumor burden on the body, and the toll taken by the effects of the treatments. Cancer-related fatigue syndrome is a very real occurrence, so the client understands the teaching. TEST-TAKING HINT: Two (2) options—"2" and "3"—are instructions given to all clients regardless of disease process. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 218). F.A. Davis Company. Kindle Edition. 1

57. The client has undergone a craniotomy for a brain tumor. Which data indicate a complication of this surgery? 1. The client complains of a headache at "3" to "4" on a 1-to-10 scale. 2. The client has an intake of 1,000 mL and an output of 3,500 mL. 3. The client complains of a raspy, sore throat. 4. The client experiences dizziness when trying to get up too quickly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

57. 1. A headache after this surgery would be an expected occurrence, not a complication. 2. An output much larger than the intake could indicate the development of diabetes insipidus. Pressure on the pituitary gland can result in decreased production of vasopressin, the antidiuretic hormone (ADH). 3. A raspy sore throat is common after surgery due to the placement of the endotracheal tube during anesthesia. 4. Dizziness on arising quickly is expected; the client should be taught to rise slowly and call for assistance for safety. TEST TAKING HINT: The test taker could eliminate options "1" and "3" as expected occurrences following the surgery and not complications. Option "4" can also be expected. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 39). F.A. Davis Company. Kindle Edition. 2

57. The client is eight (8) hours post-transurethral prostatectomy for cancer of the prostate. Which nursing intervention is priority at this time? 1. Control postoperative pain. 2. Assess abdominal dressing. 3. Encourage early ambulation to prevent DVT. 4. Monitor fluid and electrolyte balance. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 403). F.A. Davis Company. Kindle Edition.

57. 1. Pain does not have priority over a fluid and electrolyte imbalance. 2. There is no dressing for a transurethral resection. The body cavity is entered through the penis. 3. Early ambulation prevents several complications, but the immediate complication is electrolyte imbalance and fluid overload. 4. With irrigation of the surgical site through the indwelling three (3)-way catheter to prevent blood clots, fluids may be absorbed through the open surgical site and retained. This can lead to fluid volume overload and electrolyte imbalance (hyponatremia). TEST-TAKING HINT: This client is eight (8) hours postoperative, so the test taker could eliminate preventing DVT (option "3"). Option "2" could be eliminated if the test taker looks at the surgical approach described in the procedure. Pain is a priority, but the test taker should read to see if another option has a higher priority. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 421). F.A. Davis Company. Kindle Edition. 4

57. The clinic nurse is interviewing clients. Which information provided by a client warrants further investigation? 1. The client uses Vicks VapoRub every night before bed. 2. The client has had an appendectomy. 3. The client takes a multiple vitamin pill every day. 4. The client has been coughing up blood in the mornings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

57. 1. This is an individual cultural/familial situation and should be encouraged unless it interferes with the medical treatment plan. The nurse should be nonjudgmental when clients discuss their cultural practices if the nurse expects the clients to be honest about health practices. 2. An appendectomy in the past should be documented, but no further information is required. 3. Many clients take a multivitamin, so this would not warrant intervention. 4. Coughing up blood is not normal and is cause for investigation. It could indicate lung cancer. TEST-TAKING HINT: The test taker should read all distracters carefully. "Further investigation" means something abnormal is occurring. Coughing up blood is always abnormal. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 218). F.A. Davis Company. Kindle Edition. 4

58. The client diagnosed with a brain tumor has a diminished gag response and weakness on the left side of the body. Which intervention should the nurse implement? 1. Make the client NPO until seen by the health-care provider. 2. Position the client in low Fowler's position for all meals. 3. Place the client on a mechanically ground diet. 4. Teach the client to direct food and fluid toward the right side. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

58. 1. Making the client NPO will not help the client to swallow. 2. A low Fowler's position would make it easier for the client to aspirate. 3. The consistency of the food is not an issue; the client will have difficulty swallowing this food as well as regular-consistency food. 4. To decrease the risk of aspiration, the client should direct food to the unaffected side of the throat; this helps the client to be able to use the side of the throat that is functioning. TEST TAKING HINT: The test taker should try to visualize the position of the client in the bed. A mostly recumbent position (low Fowler's) would increase the chance of aspiration; thus option "2" should be eliminated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 39). F.A. Davis Company. Kindle Edition. 4

58. The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse? 1. The client has an intake of 1,500 mL IV and an output of 1,000 mL. 2. The client has 450 mL of bright-red drainage in the chest tube. 3. The client is complaining of pain at a "10" on a 1-to-10 scale. 4. The client has absent lung sounds on the side of the surgery. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

58. 1. This is an adequate output. After a major surgery, clients will frequently have an intake greater than the output because of the fluid shift occurring as a result of trauma to the body. 2. This is about a pint of blood loss and could indicate the client is hemorrhaging. 3. The nurse should intervene and medicate the client, but pain, although a client comfort issue, is not life threatening. 4. The client will have a chest tube to assist in reinflation of the lung, and absent lung sounds are expected at this point in the client's recovery. TEST-TAKING HINT: Blood is always a priority. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 218). F.A. Davis Company. Kindle Edition. 2

59. The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach? 1. The test will confirm the results of the MRI. 2. The client can eat and drink immediately after the test. 3. The HCP can do a biopsy of the tumor through the scope. 4. There is no discomfort associated with this procedure. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 197). F.A. Davis Company. Kindle Edition.

59. 1. A bronchoscopy is not performed to confirm another test; it is performed to confirm diagnoses, such as cancer, Pneumocystis pneumonia, tuberculosis, fungal infections, and other lung diseases. 2. The client's throat will be numbed with a local anesthetic to prevent gagging during the procedure. The client will not be able to eat or drink until this medication has worn off. 3. The HCP can take biopsies and perform a washing of the lung tissue for pathological diagnosis during the procedure. 4. Most HCPs use an anesthetic procedure called twilight sleep to perform endoscopies, but there is no guarantee the client will not experience some discomfort. TEST-TAKING HINT: The test taker must read each stem and answer option carefully. When in medicine does one (1) test confirm another? Tests are done to confirm diagnoses. Option "4" has a false promise. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 219). F.A. Davis Company. Kindle Edition. 3

59. The client is diagnosed with a metastatic brain tumor, and radiation therapy is scheduled. The client asks the nurse, "Why not try chemotherapy first? It has helped my other tumors." The nurse's response is based on which scientific rationale? 1. Chemotherapy is only used as a last resort in caring for clients with brain tumors. 2. The blood-brain barrier prevents medications from reaching the brain. 3. Radiation therapy will have fewer side effects than chemotherapy. 4. Metastatic tumors become resistant to chemotherapy and it becomes useless. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

59. 1. Chemotherapy is systemic therapy that is used extensively in the care of clients diagnosed with cancer. However, most drugs have difficulty in crossing the blood-brain barrier and are not useful in treating brain tumors unless delivered by direct placement into the spinal column or directly to the ventricles of the brain by a device called an Omaya reservoir. 2. The blood-brain barrier is the body's defense mechanism for protecting the brain from chemical effects; in this case, it prevents the chemotherapy from being able to work on the tumor in the brain. 3. Radiation has about the same amount of side effects as chemotherapy, but the effects of radiation tend to last for a much longer time. 4. Some tumors do become resistant to the chemotherapy agents used. When this happens, the oncologist switches to different drugs. TEST TAKING HINT: The test taker can eliminate option "1" as a possible answer because it states that chemotherapy is used to treat brain tumors, but it does not tell the client why it is not being used. Option "2" is the only one that actually informs the client of a medical reason for not administering chemotherapy for a brain tumor. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 39). F.A. Davis Company. Kindle Edition. 2

59. The client diagnosed with cancer of the prostate tells the nurse, "I caused this by being promiscuous when I was young and now I have to pay for my sins." Which statement is the nurse's most therapeutic response? 1. "Why would you think prostate cancer is caused by sex?" 2. "You feel guilty about some of your actions when you were young?" 3. "Well, there is nothing you can do about that behavior now." 4. "Have you told the HCP and been checked for an AIDS infection?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 404). F.A. Davis Company. Kindle Edition.

59. 1. The nurse should never ask "why." The client does not owe the nurse an explanation. 2. The question asks for a therapeutic response from the nurse. This response is restating and clarifying. 3. This is dismissive to the client's feelings and appears to agree with the client. There is no evidence cancer of the prostate is caused by promiscuous behavior. 4. This is a problem-solving statement and does not address the client's feelings. TEST-TAKING HINT: Because the question is asking for a therapeutic response, the test taker should address the client's feelings. However, the test taker should not use this test-taking hint as an absolute because each question should be answered on its own merit. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 421). F.A. Davis Company. Kindle Edition. 2

6. The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell (WBC) count differential. 2. A large number of WBCs that decreases after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells (RBCs) that are larger than normal. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 150). F.A. Davis Company. Kindle Edition.

6. 1. A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia. 2. Leukocytosis (elevated WBCs) is normal in the presence of an infection, but it should decrease as the infection clears. 3. A low hemoglobin and hematocrit level indicates anemia and can be caused by a number of factors. Anemia does occur in leukemia, but it is not diagnostic for leukemia. 4. Red blood cells larger than normal occur in macrocytic anemias (vitamin B12 and folic acid deficiency). They are not characteristic of leukemia. TEST-TAKING HINT: The test taker should recognize elevated WBCs resolve with antibiotics as an infection. Option "3" is not specific enough to be the correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 160). F.A. Davis Company. Kindle Edition. 1

6. The nurse is teaching a class on breast health to a group of ladies at a senior citizen's center. Which risk factor is the most important to emphasize to this group? 1. The clients should find out about their family history of breast cancer. 2. Men at this age can get breast cancer also and should be screened. 3. Monthly breast self-examination is the key to early detection. 4. The older a woman gets, the greater the chance of developing breast cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

6. 1. Most women who develop breast cancer do not have a family history of the disease. Specific genes—BRCA-1 and BRCA-2— implicated in the development of breast cancer have been identified, but most women with breast cancer do not have these genes. 2. Approximately 1,000 men are diagnosed every year with breast cancer, but, as with women, it can occur at any age. Breast cancer in men frequently goes undetected because men consider this a woman's disease. 3. Mammograms can detect breast cancer earlier than breast self-examination and are the current recommendation by the American Cancer Society. 4. The greatest risk factor for developing breast cancer is being female. The second greatest risk factor is being elderly. By age 80, one (1) in every eight (8) women develops breast cancer. TEST-TAKING HINT: The test taker cannot overlook the age when it is given in a question. "Senior citizen's center" should alert the test taker to the older age group. The test taker should decide what the age has to do with the answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 410). F.A. Davis Company. Kindle Edition. 4

6. The client diagnosed with cancer has been undergoing systemic treatments and has red blood cell deficiency. Which signs and symptoms should the nurse teach the client to manage? 1. Nausea associated with cancer treatment. 2. Shortness of breath and fatigue. 3. Controlling mucositis and diarrhea. 4. The emotional aspects of having cancer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 179). F.A. Davis Company. Kindle Edition.

6. 1. Red blood cell deficiency is anemia. The client should be taught to deal with the effects of anemia, not nausea. 2. Anemia causes the client to experience dyspnea and fatigue. Teaching the client to pace activities and rest often, to eat a balanced diet, and to cope with changes in lifestyle is needed. 3. Mucositis and diarrhea may occur with chemotherapy administration, but this client's problem is anemia. 4. All clients with cancer should be assisted to discuss the impact of cancer on their lives, but this client's problem is anemia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 184). F.A. Davis Company. Kindle Edition. 2

6. Which mutated tumor suppressor gene is most likely to contribute to many types of cancer, including bladder, breast, colorectal, and lung? a. p53 b. APC c. BRCA1 d. BRCA2 Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

6. a. Mutations in the p53 tumor suppressor gene have been found in many cancers, including bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancers. APC gene mutations increase a person's risk for familiar adenomatous polyposis, which is a precursor for colorectal cancer. BRCA1 and BRCA2 mutations increase the risk for breast and ovarian cancer. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

60. The client is being discharged following a transsphenoidal hypophysectomy. Which discharge instructions should the nurse teach the client? Select all that apply. 1. Sleep with the head of the bed elevated. 2. Keep a humidifier in the room. 3. Use caution when performing oral care. 4. Stay on a full liquid diet until seen by the HCP. 5. Notify the HCP if developing a cold or fever. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 16). F.A. Davis Company. Kindle Edition.

60. 1. The client should sleep with the head of the bed elevated to promote drainage of the cerebrospinal fluid. 2. Humidified air will prevent drying of the nasal passages. 3. Because the incision for this surgery is just above the gumline, the client should not brush the front teeth. Oral care should be performed using a sponge until the incision has healed. 4. The client can eat a regular diet. 5. The HCP should be notified if the client develops an infection of any kind. A cold with sinus involvement and sneezing places the client at risk for opening the incision and developing a brain infection. TEST TAKING HINT: The test taker could choose option "5" because this is a standard instruction for any surgery. The test taker should look for more than one correct answer in an alternative-type question. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 40). F.A. Davis Company. Kindle Edition. 1,2,3,5

60. The client diagnosed with oat cell carcinoma of the lung tells the nurse, "I am so tired of all this. I might as well just end it all." Which statement should be the nurse's first response? 1. Say, "This must be hard for you. Would you like to talk?" 2. Tell the HCP of the client's statement. 3. Refer the client to a social worker or spiritual advisor. 4. Find out if the client has a plan to carry out suicide. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

60. 1. The nurse might enter into a therapeutic conversation, but client safety is the priority. 2. The nurse must first assess the seriousness of the client's statement and whether he or she has a plan to carry out suicide. Depending on the client's responses, the nurse will notify the HCP. 3. The client can be referred for assistance in dealing with the disease and its ramifications, but this is not the priority. 4. The priority action anytime a client makes a statement regarding taking his or her own life is to determine if the client has thought it through enough to have a plan. A plan indicates an emergency situation. TEST-TAKING HINT: In a question that asks for a first response, all answer options may be actions the nurse would take. Ranking the options in order of action—"4," "1," "2," "3"—may help the test taker to make a decision. Applying Maslow's hierarchy of needs, safety comes first. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 219). F.A. Davis Company. Kindle Edition. 4

61. The nurse is admitting a client with a diagnosis of rule-out cancer of the larynx. Which information should the nurse teach? 1. Demonstrate the proper method of gargling with normal saline. 2. Perform voice exercises for 30 minutes three (3) times a day. 3. Explain that a lighted instrument will be placed in the throat to biopsy the area. 4. Teach the client to self-examine the larynx monthly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

61. 1. Gargling with salt water is good for sore throats, but it does not diagnose cancer of the larynx. 2. Clients thought to have a vocal cord problem are encouraged to practice voice rest. Vocal cord exercises would not assist in the diagnosis of cancer. 3. A laryngoscopy will be performed to allow for visualization of the vocal cords and to obtain a biopsy for pathological diagnosis. 4. There is no monthly self-examination of the larynx. To visualize the vocal cords, the HCP must numb the throat and pass a fiberoptic instrument through the throat and into the trachea. TEST-TAKING HINT: The test taker must understand that, if the question states the client is admitted to "rule out" a disease, then diagnostic tests and procedures will be done to determine if, in fact, the client has the diagnosis that the HCP suspects. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 219). F.A. Davis Company. Kindle Edition. 3

61. The school nurse is preparing a class on testicular cancer for male high school seniors. Which information regarding testicular selfexamination should the nurse include? 1. Perform the examination in a cool room under a fan. 2. Any lump should be examined by an HCP as soon as possible. 3. Discuss having a second person confirm a negative result. 4. The procedure will cause mild discomfort if done correctly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 404). F.A. Davis Company. Kindle Edition.

61. 1. The body temperature should be warm for the scrotum to relax. The best place to perform testicular self-examination is in a warm to hot shower. 2. The client may note a cordlike structure; this is the spermatic cord and is normal. Any lump or mass felt is abnormal and should be checked by an HCP as soon as possible. 3. The client can confirm his own negative result; a negative result is no masses felt. 4. The procedure is painless. If pain is elicited, then an HCP should examine the client. Cancer is usually painless; the presence of pain may indicate an infection. TEST-TAKING HINT: The test taker might choose option "2" as an answer because any abnormality should be examined by an HCP. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 422). F.A. Davis Company. Kindle Edition. 2

62. The client is diagnosed with cancer of the larynx and is to have radiation therapy to the area. Which prophylactic procedure will the nurse prepare the client for? 1. Removal of the client's teeth and fitting for dentures. 2. Take antiemetic medications every four (4) hours. 3. Wear sunscreen on the area at all times. 4. Placement of a nasogastric feeding tube. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

62. 1. The teeth will be in the area of radiation and the roots of teeth are highly sensitive to radiation, which results in root abscesses. The teeth are removed and the client is fitted for dentures prior to radiation. 2. An antiemetic on a routine scheduled basis is prophylactic for nausea, and the schedule is 30 minutes before a meal. Radiation to the throat does not encompass nauseaproducing areas. 3. Sunscreen is used to prevent the penetration of ultraviolet (UV) rays into the dermis. Radiation is gamma rays. 4. The client may receive a PEG tube for severe esophagitis from irradiation of the esophagus. The client does not have a nasogastric tube. TEST-TAKING HINT: The test taker could eliminate option "4" as a form of nutritional treatment, not prophylaxis. The test taker must recognize which anatomical structures would lie within the radiation beam. The teeth of the lower jaw definitely are within the port, and the upper teeth possibly would be in range. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 219). F.A. Davis Company. Kindle Edition. 1

62. The nurse enters the room of a 24-year-old client diagnosed with testicular cancer. The fiancée of the client asks the nurse, "Will we be able to have children?" Which is the nurse's best response? 1. "Your fiancée will be able to father children like always." 2. "You will have to adopt children because he will be sterile." 3. "You and he should consider sperm banking prior to treatment." 4. "Have you discussed this with your fiancée? I can't discuss this with you." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 404). F.A. Davis Company. Kindle Edition.

62. 1. The usual treatment for testicular cancer is removal of the involved testicle followed by radiation to the area and chemotherapy. Every attempt is made to shield the remaining testicle from the radiation, but sterility sometimes occurs. 2. With artificial insemination the client may be able to father children, if the client has banked his sperm. 3. Sperm banking will allow the client to father children through artificial insemination with the client's sperm. 4. The nurse is in the client's room. The client's presence implies consent for the nurse to discuss his case with the fiancée. TEST-TAKING HINT: The nurse must abide by HIPAA rules. It is important for the nurse to know and understand the confidentiality laws. Options "1" and "2" are opposites, so only one could be correct or neither may be correct. Option "3" actually gives an option that lies between the extremes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 422). F.A. Davis Company. Kindle Edition. 3

63. The client is three (3) days post-partial laryngectomy. Which type of nutrition should the nurse offer the client? 1. Total parenteral nutrition. 2. Soft, regular diet. 3. Partial parenteral nutrition. 4. Clear liquid diet. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

63. 1. The client is three (3) days postoperative partial removal of the larynx and should be eating by this time. 2. The client should be eating normal foods by this time. The consistency should be soft to allow for less chewing of the food and easier swallowing because a portion of the throat musculature has been removed. The client should be taught to turn the head toward the affected side when swallowing to help prevent aspiration. 3. The client should be capable of enteral nutrition at this time. 4. The client should have progressed to a diet with a more normal consistency and amount. TEST-TAKING HINT: The keys to this question are "three (3) days" and "partial." Clients are progressed rapidly after surgery to as normal a life as possible. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 220). F.A. Davis Company. Kindle Edition. 2

63. The client diagnosed with testicular cancer is scheduled for a unilateral orchiectomy. Which information is important to teach regarding sexual functioning? 1. The client will have ejaculation difficulties after the surgery. 2. The client will be prescribed male hormones following the surgery. 3. The client may need to have a penile implant to be able to have intercourse. 4. Libido and orgasm usually are unimpaired after this surgery. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 404). F.A. Davis Company. Kindle Edition.

63. 1. The client usually will be able to maintain normal sexual functioning with the remaining testicle. If not, testosterone may be prescribed to improve functioning. Ejaculation is not the problem; it is impotence (erectile dysfunction). 2. This will not be done until the HCP determines the remaining testicle is not able to maintain adequate hormone production. 3. The client will be able to function sexually with the remaining testicle alone or with prescribed male hormones. 4. Sex drive (libido) and orgasms usually are unimpaired because the client still has one testicle. TEST-TAKING HINT: The key to this question is "unilateral." The client will still have one functioning testicle. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 422). F.A. Davis Company. Kindle Edition. 4

64. The nurse is preparing the client diagnosed with laryngeal cancer for a laryngectomy in the morning. Which intervention is the nurse's priority? 1. Take the client to the intensive care unit for a visit. 2. Explain that the client will need to ask for pain medication. 3. Demonstrate the use of an antiembolism hose. 4. Find out if the client can read and write. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

64. 1. This is an appropriate preoperative intervention, but it is not priority. 2. The client should be taught about pain medication administration, but this is not the highest priority. 3. The client should be told about an antiembolism hose, but it is not necessary to demonstrate the hose because the nurse will apply and remove the hose initially. 4. The client is having the vocal cords removed and will be unable to speak. Communication is a high priority for this client. If the client is able to read and write, a Magic Slate or pad of paper should be provided. If the client is illiterate, the nurse and the client should develop a method of communication using pictures. TEST-TAKING HINT: Questions addressing highest priority include all of the options being possible interventions, but only one is priority. Use Maslow's hierarchy of needs to answer the question—safety is priority. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 220). F.A. Davis Company. Kindle Edition. 4

65. The client has had a total laryngectomy. Which referral is specific for this surgery? 1. CanSurmount. 2. Dialogue. 3. Lost Chord Club. 4. SmokEnders. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

65. 1. CanSurmount is a program of cancer survivors who volunteer to talk to clients about having cancer or what the treatments involve. This group is based on the success of Reach to Recovery for breast cancer, but it is not specific to a particular cancer. 2. Dialogue is a cancer support group that brings together clients diagnosed with cancer to discuss the feelings associated with having cancer. 3. The Lost Chord Club is an American Cancer Society-sponsored group of survivors of larynx cancer. These clients are able to discuss the feelings and needs of clients who have had laryngectomies because they have all had this particular surgery. 4. SmokEnders is a group of clients working together to stop smoking. It is a group where anyone who smokes could be referred. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 220). F.A. Davis Company. Kindle Edition. 3

65. The nurse is caring for a client who is eight (8) hours postoperative unilateral orchiectomy for cancer of the testes. Which intervention should the nurse implement? 1. Provide an athletic supporter before ambulating. 2. Encourage the client to delay use of pain medications. 3. Place the client on a clear liquid diet for the first 48 hours. 4. Monitor the PT/INR levels and have vitamin K ready. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 404). F.A. Davis Company. Kindle Edition.

65. 1. The scrotum will require support during ambulation. An athletic supporter is designed to provide support in this area. 2. The client should be encouraged to take pain medications before the pain is at a high level to help the pain medication be more effective. 3. The client can be on a regular diet as soon as the client is not nauseated from the anesthesia. 4. This surgery does not increase bleeding times. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 422). F.A. Davis Company. Kindle Edition. 1

66. The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a surgical floor. Which information provided by the UAP requires immediate intervention by the nurse? 1. There is a small, continuous amount of bright-red drainage coming out from under the dressing of the client who had a radical neck dissection. 2. The client who has had a right upper lobectomy is complaining that the patientcontrolled analgesia (PCA) pump is not providing any relief. 3. The client diagnosed with cancer of the lung is complaining of being tired and short of breath. 4. The client admitted with chronic obstructive pulmonary disease is making a whistling sound with every breath. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

66. 1. The most serious complication resulting from a radical neck dissection is rupture of the carotid artery. Continuous brightred drainage indicates bleeding, and this client should be assessed immediately. 2. Pain is a priority but not over hemorrhaging. 3. Clients with cancer of the lung have fatigue and are short of breath; these are expected findings. 4. Clients with chronic lung problems are taught pursed-lip breathing to assist in expelling air. This type of breathing often produces a whistling sound. TEST-TAKING HINT: If the test taker is not sure of the answer and airway compromise is not one of the answer options, then an option dealing with bleeding is the best choice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 220). F.A. Davis Company. Kindle Edition. 1

67. The charge nurse is assigning clients for the shift. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with cancer of the lung who has chest tubes. 2. The client diagnosed with laryngeal spasms who has stridor. 3. The client diagnosed with laryngeal cancer who has multiple fistulas. 4. The client who is two (2) hours post-partial laryngectomy. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

67. 1. Chest tubes are part of the nursing education curriculum. The new graduate should be capable of caring for this client or at least knowing when to get assistance. 2. This client is in respiratory compromise, and an experienced nurse should care for the client. 3. A client with multiple fistulas in the neck area is at high risk for airway compromise and should be assigned to a more experienced nurse. 4. This client is at risk for developing edema of the neck area and should be cared for by a more experienced nurse. TEST-TAKING HINT: The question is asking for the least compromised or most stable client. The client in option "1" already has chest tubes in place and is presumably stable. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 221). F.A. Davis Company. Kindle Edition. 1

68. The nurse is writing a care plan for a client newly diagnosed with cancer of the larynx. Which problem is the highest priority? 1. Wound infection. 2. Hemorrhage. 3. Respiratory distress. 4. Knowledge deficit. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

68. 1. Wound infection is a concern, but in the list of the answer options it is not the highest priority. A wound infection can be treated, but a client who is not breathing is in a lifethreatening situation and the problem must be addressed immediately. 2. Hemorrhage is normally a priority, but bleeding is not priority over not breathing. 3. Respiratory distress is the highest priority. Hemorrhaging and infection are serious problems, but airway is priority. 4. Knowledge deficit is the lowest on this priority list. It is a psychosocial problem, and these problems rank lower in priority than physiological ones. TEST-TAKING HINT: In cardiopulmonary resuscitation the steps are airway, breathing, and then circulation. This concurs with Maslow's hierarchy of needs, which places oxygenation at the top of the hierarchy. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 221). F.A. Davis Company. Kindle Edition. 3

69. The 30-year-old male client diagnosed with germinal cell carcinoma of the testes asks the nurse, "What chance do I have? Should I end it all now?" Which response by the nurse indicates an understanding of the disease process? 1. "God does not want you to give up hope and end it all now." 2. "There is a good chance for survival with standard treatment options." 3. "There may be little hope, but ending it all is not the answer." 4. "You have a 50/50 chance of living for at least 5 years." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 405). F.A. Davis Company. Kindle Edition.

69. 1. The nurse should not impose any personal religious beliefs on the client. 2. Testicular cancers have very good prognoses, and even if the tumor returns, there is a good prognosis for extended survival. 3. There is a great deal of hope to offer these clients. 4. This is giving the client incorrect information. TEST-TAKING HINT: This is a question in which the test taker must know the information. Rarely can a nurse provide a specific percentage of survival. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 423). F.A. Davis Company. Kindle Edition. 2

69. The male client has had a radial neck dissection for cancer of the larynx. Which action by the client indicates a disturbance in body image? 1. The client requests a consultation by the speech therapist. 2. The client has a towel placed over the mirror. 3. The client is attempting to shave himself. 4. The client practices neck and shoulder exercises. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 198). F.A. Davis Company. Kindle Edition.

69. 1. This request indicates the client is accepting the situation and trying to deal with it. 2. Placing a towel over the mirror indicates the client is having difficulty looking at his reflection, a body-image problem. 3. In attempting to shave himself, the client is participating in self-care activities and also must look at his neck in the mirror, both good steps toward adjustment. 4. Neck and shoulder exercises are done to strengthen the remaining musculature, but they have nothing to do with body image. TEST-TAKING HINT: The test taker must try to match the problem with the answer choices. This would eliminate options "1" and "4." Shaving himself is a positive action, and the question asks for an action indicating a disturbance in body image. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 221). F.A. Davis Company. Kindle Edition. 2

7. The client who is scheduled to have a breast biopsy with sentinel node dissection states, "I don't understand. What does a sentinel node biopsy do?" Which scientific rationale should the nurse use to base the response? 1. A dye is injected into the tumor and traced to determine spread of cells. 2. The surgeon removes the nodes that drain the diseased portion of the breast. 3. The nodes felt manually will be removed and sent to pathology. 4. A visual inspection of the lymph nodes will be made while the client is sleeping. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

7. 1. A sentinel node biopsy is a procedure in which a radioactive dye is injected into the tumor and then traced by instrumentation and color to try to identify the exact lymph nodes the tumor could have shed into. 2. This is the older procedure in which the surgeon removed the nodes thought to drain the tumor. There was no way of knowing if the surgeon was actually removing the affected nodes. 3. The purpose of the procedure is not to rely on guesswork in determining the extent of tumor involvement. 4. Microscopic disease cannot be seen by the naked eye. TEST-TAKING HINT: The test taker could eliminate options "3" and "4" if he or she were aware of the definition of sentinel, which means "to watch over as a sentry." This might lead the test taker to determine that specific areas would have to be identified. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 410). F.A. Davis Company. Kindle Edition. 1

7. Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic. 2. Morphine, a narcotic analgesic. 3. Epogen, a biologic response modifier. 4. Gleevec, a genetic blocking agent. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

7. 1. Because of the ineffective or nonexistent WBCs (segmented neutrophils) characteristic of leukemia, the body cannot fight infections, and antibiotics are given to treat infections. 2. Leukemic infiltrations into the organs or the central nervous system cause pain. Morphine is the drug of choice for most clients with cancer. 3. Epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the BCR-ABL protein, preventing the cells from growing and dividing. TEST-TAKING HINT: If the test taker were not familiar with the drug mentioned in option "4," then this option would not be a good choice. Options "1" and "2" are common drugs and should not be chosen as the answer unless the test taker knows for sure they are contraindicated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 160). F.A. Davis Company. Kindle Edition. 3

7. Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)? a. Obesity is an example of a promoting factor. b. The stage is characterized by increased growth rate and metastasis. c. Withdrawal of promoting factors will reduce the risk of cancer development. d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion. e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 55). Elsevier Health Sciences. Kindle Edition.

7. a, c, d. Promoting factors such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversible in this stage. Increased growth, invasion, and metastasis are seen in the progressive stage. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

70. Which tumor marker information is used to follow the progress of a client diagnosed with testicular cancer? 1. CA-125. 2. Carcinogenic embryonic antigen (CEA). 3. DNA ploidy test. 4. Human chorionic gonadotropin (hCG). Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 405). F.A. Davis Company. Kindle Edition.

70. 1. CA-125 is a tumor marker used for a number of cancers but not for testicular cancer. 2. CEA is a nonspecific tumor marker used for a number of cancers, but it does not apply to testicular cancer. 3. The DNA ploidy test is used to determine the number of chromosomes and arrangement of chromosomes in a tumor cell. It is used for prognosis in some cancers, such as breast cancer, but not as a tumor marker to determine response to treatment. 4. Tumor markers are substances synthesized by the tumor and released into the bloodstream. They can be used to follow the progress of the disease. Testicular cancers secrete hCG and alpha-fetoprotein. TEST-TAKING HINT: This is a knowledge-based question. If the test taker were aware of what the test tells the HCP, then the DNA ploidy test could be eliminated. The other options are all tumor markers. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 423). F.A. Davis Company. Kindle Edition. 4

70. The HCP has recommended a total laryngectomy for a male client diagnosed with cancer of the larynx but the client refuses. Which intervention by the nurse illustrates the ethical principle of nonmalfeasance? 1. The nurse listens to the client explain why he is refusing surgery. 2. The nurse and significant other insist that the client have the surgery. 3. The nurse refers the client to a counselor for help with the decision. 4. The nurse asks a cancer survivor to come and discuss the surgery with the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 199). F.A. Davis Company. Kindle Edition.

70. 1. This is an example of nonmalfeasance, where the nurse "does no harm." In attempting to discuss the client's refusal, the nurse is not trying to influence the client; the nurse is merely attempting to listen therapeutically. 2. This is an example of paternalism, telling the client what he should do, and it is also coercion, an unethical action. 3. This is an example of beneficence, "to do good"; it is a positive action and a step up from nonmalfeasance. 4. This is an example of beneficence. TEST-TAKING HINT: If the test taker were not aware of the terms of ethical principles, then dissecting the word "nonmalfeasance" into its portions might help. Non- means "nothing" or "none," and mal- means "bad," so "no bad action" could be inferred. This would eliminate option "2." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 221). F.A. Davis Company. Kindle Edition. 1

71. The client diagnosed with cancer of the larynx has had four (4) weeks of radiation therapy to the neck. The client is complaining of severe pain when swallowing. Which scientific rationale explains the pain? 1. The cancer has grown to obstruct the esophagus. 2. The treatments are working on the cancer and the throat is edematous. 3. Cancers are painful and this is expected. 4. The treatments are also affecting the esophagus, causing ulcerations. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 199). F.A. Davis Company. Kindle Edition.

71. 1. The cancer may have grown, but this would not be indicated by the type of pain described. 2. Painful swallowing is caused by esophageal irritation. 3. Most cancers are not painful unless obstructing an organ or pressing on a nerve. This is not what is being described. 4. The esophagus is extremely radiosensitive, and esophageal ulcerations are common. The pain can become so severe the client cannot swallow saliva. This is a situation in which the client will be admitted to the hospital for IV narcotic pain medication and possibly total parenteral nutrition. TEST-TAKING HINT: The test taker must remember not to jump to conclusions and to realize what a word is actually saying. Swallowing is an action involving the esophagus, so the best choice would be either option "1" or option "4," both of which contain the word "esophagus." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 221). F.A. Davis Company. Kindle Edition. 4

71. The client diagnosed with cancer of the testes calls and tells the nurse he is having low back pain that does not go away with acetaminophen, a nonnarcotic analgesic. Which action should the nurse implement? 1. Ask the client to come in to see the HCP for an examination. 2. Tell the client to use a nonsteroidal antiinflammatory drug instead. 3. Inform the client this means the cancer has metastasized. 4. Encourage the client to perform lower back- strengthening exercises. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 405). F.A. Davis Company. Kindle Edition.

71. 1. This information could signal the onset of symptoms of metastasis to the retroperitoneum. The HCP should see the client and discuss follow-up diagnostic tests. 2. This information should be investigated and not put off. 3. This may or may not have occurred. Only diagnostic tests can confirm metastasis. 4. Low back exercises will not help the client if this is metastatic cancer, and they could increase the pain. TEST-TAKING HINT: The nurse cannot diagnose the client as having metastasis, so option "3" can be eliminated. As a rule, any pain unrelieved with pain medication requires the client to see the HCP. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 424). F.A. Davis Company. Kindle Edition. 1

72. The client who has undergone a radical neck dissection and tracheostomy for cancer of the larynx is being discharged. Which discharge instructions should the nurse teach? Select all that apply. 1. The client will be able to speak again after the surgery area has healed. 2. The client should wear a protective covering over the stoma when showering. 3. The client should clean the stoma and then apply a petroleum-based ointment. 4. The client should use a humidifier in the room. 5. The client can get a special telephone for communication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 199). F.A. Davis Company. Kindle Edition.

72. 1. This surgery removed the client's vocal cords, so he or she will not be able to speak again unless the client learns esophageal speech, uses an electric larynx, or has a surgically created transesophageal puncture. 2. The client breathes through a stoma in the neck. Care should be taken not to allow water to enter the stoma. 3. The stoma should be cleaned, but petroleumbased products should not be allowed near the stoma. A petroleum-based product is contraindicated because it is not water-soluble, could contribute to an occlusion, and is flammable. 4. The client has lost the use of the nasal passages to humidify the inhaled air, and artificial humidification is useful until the client's body adapts to the change. 5. Special equipment is available for clients who cannot hear or speak. TEST-TAKING HINT: Option "1" can be eliminated as a false promise that would undermine the nurse-client relationship. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 222). F.A. Davis Company. Kindle Edition. 2,4,5

73. The nurse has identified the concept of cellular deviation for a client diagnosed with chronic myelogenous leukemia. Which intervention should the nurse implement? Select all that apply. 1. Screen visitors for infection before allowing them to enter the room. 2. Assess the client's vital signs every four (4) hours. 3. Do not allow fresh fruits and vegetables on diet trays. 4. Monitor the client's white blood cell count. 5. Place the client on droplet isolation. 6. Check the client's bone marrow results daily. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 157). F.A. Davis Company. Kindle Edition.

73. 1. The client is at risk of infection because of the lack of mature WBCs in the circulating blood. Leukemia is a disease process involving the hematological system. White blood cells are produced in the bone marrow. The nurse screens visitors for infection because there are insufficient functioning white blood cells to protect the client from developing an infection if exposed to a virus or bacteria. 2. The client should be monitored for infection; one way to do this is to monitor the temperature. 3. Fresh fruits and vegetables may have bacteria on the skins, which could expose the client to infection. 4. The WBC count indicates the presence or absence of granulocytes, also called neutrophils or segmented neutrophils. 5. The client might be placed on Reverse Isolation or Neutropenic precautions because the client is at risk from anyone entering the room; however, there is no reason to suspect the client is a risk to others, which droplet precautions is initiated to prevent. 6. Bone marrow biopsies are not performed daily. TEST-TAKING HINT: The test taker must answer "Select all that apply" questions by viewing each option as true/false. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 176). F.A. Davis Company. Kindle Edition. 1,2,3,4

73. The nurse is caring for clients on a renal surgery unit. After the afternoon report, which client should the nurse assess first? 1. The male client who just returned from a CT scan who states he left his glasses in the x-ray department. 2. The client who is one (1) day postoperative and has a moderate amount of serous drainage on the dressing. 3. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit. 4. The client who had ileal conduit surgery this morning and has not had any drainage in the drainage bag. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 363). F.A. Davis Company. Kindle Edition.

73. 1. This client does not need to be assessed first. A ward secretary can call the department and check on the glasses. 2. A moderate amount of serous drainage is expected after a surgery. Serous drainage is pale yellow body fluid. Sanguineous is the term used to describe bloody drainage. 3. The nurse is not responsible for informing the client about operative procedures. The surgeon should be notified to see this client and provide the explanation. 4. An ileal conduit is a procedure diverting urine from the bladder and provides an alternate cutaneous pathway for urine to exit the body. Urinary output should always be at least 30 mL/hr. This client should be assessed to make sure the stents placed in the ureters have not become dislodged or blocked. TEST-TAKING HINT: Basic care of any postoperative client is to ensure urinary output. Two of the options involve tasks that can be delegated or are not in the realm of the nurse. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 383). F.A. Davis Company. Kindle Edition. 4

74. The client is diagnosed with non-Hodgkin's lymphoma. Which nursing concept should the nurse identify as priority? 1. Immunity. 2. Grieving. 3. Perfusion. 4. Clotting. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 157). F.A. Davis Company. Kindle Edition.

74. 1. Immunity is compromised when the hematopoietic system is impaired. The bone marrow is part of the initial response by the immune system to prevent disease. 2. Grieving is a possible interrelated concept because the client must adjust to the diagnosis but is not priority over a physiological problem. 3. Perfusion is not a concept normally associated with lymphoma. 4. Clotting is not a concept normally associated with lymphoma. TEST-TAKING HINT: The test taker must match the problem with the answer option. Options "3" and "4" would probably be implemented for the client with a bleeding disorder. Option "2" is a psychological problem; physiological issues are priority over psychological problems. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 176). F.A. Davis Company. Kindle Edition. 1

74. Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client? 1. Previous exposure to chemicals. 2. Pelvic radiation therapy. 3. Cigarette smoking. 4. Parasitic infections of the bladder. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 363). F.A. Davis Company. Kindle Edition.

74. 1. The client has already been exposed; this cannot be undone. 2. Pelvic radiation is prescribed for cancer in the abdomen. It is a life-saving procedure, but one of the risks of radiation therapy is the development of a secondary cancer. 3. Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking. 4. Clients may be unaware of a parasitic infection of the bladder for some time prior to diagnosis, but it is not a risk factor for cancer of the bladder. TEST-TAKING HINT: The question asks for a modifiable risk factor. Modifiable factors involve lifestyle changes, weight loss, tobacco use, and eating habits. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 383). F.A. Davis Company. Kindle Edition. 3

75. The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included? 1. Demonstrate turn, cough, and deep breathing. 2. Explain a bag will drain the urine from now on. 3. Instruct the client on the use of a PCA pump. 4. Take the client to the ICD so the client can become familiar with it. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 363). F.A. Davis Company. Kindle Edition.

75. 1. Any client undergoing general anesthesia should be taught to turn, cough, and deep breathe to prevent pulmonary complications. This is not specific to a urinary diversion procedure. 2. A urinary diversion procedure involves the removal of the bladder. In a cutaneous procedure, the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine drains into a pouch. There are numerous methods used for creating the stoma. 3. Many clients with multiple types of procedures use PCA pumps to control pain after surgery. 4. This should be done for any client who is expected to need intensive care postoperatively. TEST-TAKING HINT: The test taker must notice the phrase "specific to the procedure" to be able to correctly answer this question. All of the options are standard interventions for major surgeries, but only one is specific to the procedure. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 383). F.A. Davis Company. Kindle Edition. 2

76. The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pretherapy routine? 1. Instruct the client to remain NPO after midnight before the procedure. 2. Explain the use of chemotherapy in bladder cancer. 3. Teach the client to administer Neupogen, a biologic response modifier. 4. Have the client take Tylenol, an analgesic, before coming to the clinic. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 363). F.A. Davis Company. Kindle Edition.

76. 1. The client will have medication instilled in the bladder, which must remain in the bladder for a prescribed length of time. For this reason, the client must remain NPO before the procedure. 2. Informed consent is important to do when informing the client about chemotherapy, but this is done when the client gives consent to receiving intravesical chemotherapy, not as part of the pretherapy routine. 3. The advantage of administering chemotherapy intravesically is systemic side effects of bone marrow suppression are avoided. Neupogen is used to stimulate the production of white blood cells so a client is not at risk for developing an infection. 4. The procedure is not painful, so an analgesic is not needed. TEST-TAKING HINT: If the test taker is not aware of the term "intravesical," then dividing the word into its components may be useful. Intra- means "into" and vesical means "bladder." The test taker should choose an option that has a direct effect on urine production. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 384). F.A. Davis Company. Kindle Edition. 1

77. The client is diagnosed with Hodgkin's disease. Which data are diagnostic for Hodgkin's disease? 1. Night sweats and low-grade fever. 2. Cavitation noted on the chest x-ray. 3. Reed-Sternberg cells found on biopsy. 4. Weight loss and palpable inguinal lymph nodes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 158). F.A. Davis Company. Kindle Edition.

77. 1. Night sweats and low-grade fever do occur in Hodgkin's disease but also occur in diseases associated with an HIV infection. 2. Cavitation occurs with tuberculosis. 3. Reed-Sternberg cells found on biopsy are diagnostic for Hodgkin's disease. 4. Weight loss and palpable lymph nodes shuld be investigated but are not definitive in the diagnosis of Hodgkin's disease. TEST-TAKING HINT: The test taker must be aware of the cause of physiological changes in the body. The test taker should read every word; "diagnostic" means not just signs and symptoms, which could be attributed to several different diseases, but something that is only attributed to the disease in question. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 177). F.A. Davis Company. Kindle Edition. 3,4

77. The nurse is presenting an in-service to participants in a local health fair. Which information regarding the development of skin cancers should the nurse teach? 1. The fairer the skin, the less the risk of developing skin cancer. 2. Eating a diet high in fiber helps to minimize the risk of skin cancer development. 3. Sun exposure at a beach is less dangerous than at a stadium. 4. The participants should avoid sun exposure in the afternoon hours. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 485). F.A. Davis Company. Kindle Edition.

77. 1. The fairer the skin, the greater the risk of developing skin cancer. 2. Dietary fiber does not impact the development of skin cancer. 3. Sun exposure is not less dangerous at a beach—the exposure is basically the same. It depends on the length of time and amount of exposure to the UV rays. 4. The afternoon hours between 3:00 pm and 5:00 pm are the most dangerous times because of the heat and intensity of the rays. For people living in the Sun Belt, the time may be from 2:00 to 6:00 pm. TEST-TAKING HINT: The test taker must be aware of basic principles such as when the sun is hottest, resulting in greatest skin exposure, and that people at a beach usually are exposing more skin to the damaging rays of the sun. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 502). F.A. Davis Company. Kindle Edition. 4

77. The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care? 1. Provide meticulous skin care and pouching. 2. Apply sterile drainage bags daily. 3. Monitor the pH of the urine weekly. 4. Assess the stoma site every day. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

77. 1. Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so urine will not touch the skin. 2. Urinary diversion drainage bags are changed every four (4) to five (5) days so the skin can remain intact; the bags should be clean but not sterile. 3. The urine will have the normal pH of all urine; it is not necessary to monitor the pH. 4. The stoma should be assessed a minimum of every two (2) hours initially, then every four (4) hours. TEST-TAKING HINT: The test taker should look at time frames—daily and weekly. If the time frame is not sufficient, then the option can be eliminated as a possible correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 384). F.A. Davis Company. Kindle Edition. 1

78. The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN? 1. Assessment of the client who has had a Kock pouch procedure. 2. Monitoring of the postop client with a WBC of 22,000/mm3. 3. Administration of the prescribed antineoplastic medications. 4. Care for the client going for an MRI of the kidneys. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

78. 1. Assessment cannot be assigned to an LPN, no matter how knowledgeable the LPN. 2. This client has the laboratory symptoms of an infection; therefore, the nurse should assess and care for this client. 3. Antineoplastic medication is administered only by a qualified registered nurse. 4. It is in the scope of practice for the LPN to care for this client. TEST-TAKING HINT: The client who is the least ill or the client having the least invasive procedure is the client who should be assigned to the LPN. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 384). F.A. Davis Company. Kindle Edition. 4

78. Which interrelated psychological concept is priority for the nurse caring for a client diagnosed with leukemia? 1. Comfort. 2. Stress. 3. Grieving. 4. Coping. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 158). F.A. Davis Company. Kindle Edition.

78. 1. Comfort is appropriate for the disease but is not the priority concept. Pain alerts the client that a problem is occurring but is not life threatening. 2. Stress could be a concept but coping problems are priority. 3. Grieving is an interrelated concept but is limited in the scope of the client's needs. 4. Coping includes dealing with stress, anxiety, and grief. The nurse can help the client most by assisting in identifying the client's coping mechanisms. TEST-TAKING HINT: The test taker must be aware of concepts that are interrelated. Coping encompasses stress and grieving. The word "psychological" can rule out option "1" because comfort is pain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 177). F.A. Davis Company. Kindle Edition. 4

79. The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism? 1. The nurse allows the client to talk about not wanting to eat. 2. The nurse tells the client if he does not eat, a feeding tube will be placed. 3. The nurse consults the dietitian about the client's nutritional needs. 4. The nurse asks the family to bring favorite foods for the client to eat. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

79. 1. This is therapeutic communication and is allowing the client autonomy, but it is not an example of paternalism. 2. Paternalism is deciding for the client what is best, similar to a parent making decisions for a child. Feeding a client, as with a feeding tube, without the client wishing to eat is paternalism. 3. Consulting with a dietitian about the nutritional needs of a client is an appropriate nursing intervention, but it does not represent any ethical principle. 4. This is an excellent intervention, but it does not represent any ethical principle. TEST-TAKING HINT: The question asks for an ethical principle, and only two of the options could be considered to represent ethical principles. Option "1" is allowing the client a voice in the situation; the term "paternalism" eliminates this option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 384). F.A. Davis Company. Kindle Edition. 2

8. The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 × 106 /mm3, WBC count 150 × 103 /mm3, platelets 22 × 103 /mm3, K+ 3.8 mEq/L, and Na+ 139 mEq/L. Based on these results, which intervention should the nurse teach the client? 1. Encourage the client to eat foods high in iron. 2. Instruct the client to use an electric razor when shaving. 3. Discuss the importance of limiting sodium in the diet. 4. Instruct the family to limit visits to once a week. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

8. 1. The anemia that occurs in leukemia is not related to iron deficiency and eating foods high in iron will not help. 2. The platelet count of 22 3 103 /mm3 indicates a platelet count of 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and holding all venipuncture sites for a minimum of five (5) minutes. 3. The sodium level is within normal limits. The client is encouraged to eat whatever he or she wants to eat unless some other disease process limits food choices. 4. The client is at risk for infection, but unless the family or significant others are ill, they should be encouraged to visit whenever possible. TEST-TAKING HINT: The test taker could eliminate option "3" based on a normal laboratory value. The RBC, WBC, and platelet values are all not in normal range. The correct answer option must address one of these values. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 2

8. The client diagnosed with end-stage renal disease (ESRD) has developed anemia. Which would the nurse anticipate the HCP prescribing for this client? 1. Place the client in reverse isolation. 2. Discontinue treatments until blood count improves. 3. Monitor CBC daily to assess for bleeding. 4. Give client erythropoietin, a biologic response modifier. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 179). F.A. Davis Company. Kindle Edition.

8. 1. The client is anemic, not neutropenic, so reverse isolation is not needed. 2. This client will be receiving a form of dialysis to maintain life. Discontinuing treatments until the counts improve would be resigning the client to death. 3. The red blood cell count would not appreciably improve from one day to the next unless a transfusion had been given. 4. Erythropoietin is a biologic response modifier produced by the kidneys in response to a low red blood cell count in the body. It stimulates the body to produce more RBCs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 184). F.A. Davis Company. Kindle Edition. 4

8. The client who is four (4) months pregnant finds a lump in her breast and the biopsy is positive for Stage II cancer of the breast. Which treatment should the nurse anticipate the HCP recommending to the client? 1. A lumpectomy to be performed after the baby is born. 2. A modified radical mastectomy. 3. Radiation therapy to the chest wall only. 4. Chemotherapy only until the baby is born. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 398). F.A. Davis Company. Kindle Edition.

8. 1. Waiting until the baby is born allows the cancer to continue to develop and spread. This might be an option if the client were in the third trimester, but not at this early stage. 2. A modified radical mastectomy is recommended for this client because the client is not able to begin radiation or chemotherapy, which are part of the regimen for a lumpectomy or wedge resection. Many breast cancers developed during pregnancy are hormone sensitive and have the ideal grounds for growth. The tumor should be removed as soon as possible. 3. Radiation therapy cannot be delivered to a pregnant client because of possible harm to the fetus. 4. Chemotherapy is not given to the client while she is pregnant because of potential harm to the fetus. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 410). F.A. Davis Company. Kindle Edition. 2

8. The patient was told she has carcinoma in situ, and the student nurse wonders what that is. How should the nurse explain this to the student nurse? a. Evasion of the immune system by cancer cells b. Lesion with histologic features of cancer except invasion c. Capable of causing cellular alterations associated with cancer d. Tumor cell surface antigens that stimulate an immune response Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

8. b. Carcinoma in situ has the histologic features except invasion. Evasion of the immune system by cancer cells by various methods is immunologic escape. Oncogenic factors are capable of causing cellular alterations associated with cancer. Tumor cell surface antigens that stimulate an immune response are tumor-associated antigens. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

80. The client diagnosed with cancer of the bladder states, "I have young children. I am too young to die." Which statement is the nurse's best response? 1. "This cancer is treatable and you should not give up." 2. "Cancer occurs at any age. It is just one of those things." 3. "You are afraid of dying and what will happen to your children." 4. "Have you talked to your children about your dying?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

80. 1. This is advising the client, a nontherapeutic technique. 2. This statement does not address the client's feelings. 3. This is an example of restating, a therapeutic technique used to clarify the client's feelings and encourage a discussion of those feelings. 4. The stem did not say the client was dying. The stem said the client thinks he or she is too young to die. A conversation to discuss the client's death with the children may be premature. TEST-TAKING HINT: When the question requires a therapeutic response, the test taker should select an option addressing the client's feelings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 384). F.A. Davis Company. Kindle Edition. 3

81. The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching? 1. Have the client demonstrate catheterizing the stoma. 2. Instruct the client on how to pouch the stoma. 3. Explain the use of a bedside drainage bag at night. 4. Tell the client to call the HCP if the temperature is 99°F or less. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

81. 1. A continent urinary diversion is a surgical procedure in which a reservoir is created to hold urine until the client can selfcatheterize the stoma. The nurse should observe the client's technique before discharge. 2. The purpose of creating a continent diversion is so the client will not need a pouch. 3. Clients with cutaneous diversions that drain constantly use a bedside drainage bag at night, not those with continent diversions. 4. The client should be taught to notify the HCP if the temperature is 100°F or greater. TEST-TAKING HINT: Options "2" and "3" are related to continuous drainage and could be eliminated on this basis. The word "continent" in the stem should key the test taker to the fact this diversion is a procedure in which there is no continuous drainage of urine. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 385). F.A. Davis Company. Kindle Edition. 1

81. The nurse identifies a concept of hematologic regulation for a client diagnosed with leukemia. Which clinical manifestations support the concept? 1. The client has petechiae on the trunk and extremities. 2. The client complains of pain and swelling in the joints. 3. The client has an Hbg of 9.7 and Hct of 32%. 4. The client complains of a headache and slurred speech. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 158). F.A. Davis Company. Kindle Edition.

81. 1. Petechiae indicate a lack of clotting ability caused by decreased production of platelets. 2. Pain and joint swelling could indicate several different disease processes. 3. The H&H are low but not indicative of leukemia. 4. A headache and slurred speech could indicate a cerebrovascular accident (CVA) or other disease processes. TEST-TAKING HINT: The test taker must be aware of the cause of physiological changes in the body in order to answer this option. Platelets are produced by the bone marrow and a deficient number results in bleeding (small pinpoint areas of bleeding appear on the body). Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 177). F.A. Davis Company. Kindle Edition. 1

82. Which concepts could the nurse identify for a client diagnosed with lymphoma? Select all that apply. 1. Coping. 2. Hematologic regulation. 3. Tissue perfusion. 4. Clotting. 5. Clinical judgment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 158). F.A. Davis Company. Kindle Edition.

82. 1. Coping could be applied to any diagnosis of a cancer. 2. Hematologic regulation is the top priority identified for a client with lymphoma because the client has a problem with the cells produced by the bone marrow. 3. Tissue perfusion is not associated with lymphoma. 4. Clotting is not associated with lymphoma. 5. Clinical judgment is a concept for the nurse, not the client. TEST-TAKING HINT: The test taker must consider each option in a "Select all that apply" question as a true/false option. The lymphocytes are produced on the bone marrow; the test taker has to remember pathophysiology of the disease process. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 178). F.A. Davis Company. Kindle Edition. 1,2

82. Which information regarding the care of a cutaneous ileal conduit should the nurse discuss with the client? 1. Teach the client to instill a few drops of vinegar into the pouch. 2. Tell the client the stoma should be slightly dusky colored. 3. Inform the client large clumps of mucus are expected. 4. Tell the client it is normal for the urine to be pink or red in color. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

82. 1. Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell. 2. The stoma should be pink and moist at all times. A dusky color indicates a compromised blood supply to the stoma, and the HCP should be notified immediately. 3. There will be mucus in the urine because of the tissue used to create the diversion, but large clumps of mucus could occlude the stoma or ureters. 4. Urinary drainage should be a pale yellow to amber color. The procedure does not change the color of the urine. TEST-TAKING HINT: A dusky color is never normal when discussing body functioning. There are very few procedures for which bloody urine is a normal expectation. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 385). F.A. Davis Company. Kindle Edition. 1

83. The client is two (2) days postureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse? 1. The client complains of pain at a "3," 30 minutes after being medicated. 2. The client complains it hurts to cough and deep breathe. 3. The client ambulates to the end of the hall and back before lunch. 4. The client is lying in a fetal position and has a rigid abdomen. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

83. 1. A complaint of a "3" on a 1-to-10 pain scale is expected after medication and does not warrant notifying the HCP. 2. Pain on coughing and deep breathing after surgery is expected. 3. This indicates the client is able to ambulate and is doing activities needed to recover. 4. The client is drawn up in a position that relieves pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency. TEST-TAKING HINT: When the test taker is deciding on a priority question, the test taker should decide if the situation is expected or if it is life threatening. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 385). F.A. Davis Company. Kindle Edition. 4

84. The female client diagnosed with bladder cancer who has a cutaneous urinary diversion states, "Will I be able to have children now?" Which statement is the nurse's best response? 1. "Cancer does not make you sterile, but sometimes the therapy can." 2. "Are you concerned you can't have children?" 3. "You will be able to have as many children as you want." 4. "Let me have the chaplain come to talk with you about this." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 364). F.A. Davis Company. Kindle Edition.

84. 1. This client is asking for information and should be provided factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile. 2. This is a therapeutic response, but the client asked for information. 3. This is a false statement and lying to the client. 4. This is outside the realm of a chaplain. TEST-TAKING HINT: When the stem has the client asking for specific information, then the nurse should provide the correct information. It is easy to confuse these questions with ones requiring therapeutic responses. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 385). F.A. Davis Company. Kindle Edition. 1

9. The client who had a right modified radical mastectomy four (4) years before is being admitted for a cardiac work-up for chest pain. Which intervention is most important for the nurse to implement? 1. Determine when the client had chemotherapy last. 2. Ask the client if she received Adriamycin, an antineoplastic agent. 3. Post a message at the HOB for staff not to use the right arm for venipunctures or BPs. 4. Examine the chest wall for cancer sites. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 399). F.A. Davis Company. Kindle Edition.

9. 1. A client four (4) years postmastectomy should be finished with adjuvant therapy, which lasts from six (6) months to one (1) year. 2. The client may have received Adriamycin, which is a cardiotoxic medication, but knowing this will not change the tests performed or preparation for the tests. 3. The nurse should post a message at the head of the client's bed to not use the right arm for blood pressures or laboratory draws. This client is at risk for lymphedema, and this is a lymphedema precaution. 4. The chest wall is sometimes involved in breast cancer, but the most important intervention is to prevent harm to the client. TEST-TAKING HINT: The question is asking for an intervention common in the health-care industry. There are many breast cancer survivors who go on to develop unrelated problems, but the nurse must still be aware of the lingering needs of the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 411). F.A. Davis Company. Kindle Edition. 3

9. The client is diagnosed with vulvar cancer. Which are the most common symptoms of cancer of the vulva? 1. Red, painful lesions. 2. Vulvar itching. 3. Thin, white vulvar skin. 4. Vaginal dryness. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 431). F.A. Davis Company. Kindle Edition.

9. 1. Red, painful lesions are symptoms of lichen planus, which is a benign, although uncomfortable, lesion. 2. Cancer of the vulva may be asymptomatic, but the client usually presents with persistent long-term itching. 3. Thin, white vulvar skin indicates lichen sclerosis. 4. Vaginal dryness is not associated with cancer of the vulva. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 435). F.A. Davis Company. Kindle Edition. 2

9. The nurse writes a nursing problem of "altered nutrition" for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication prior to meals. 2. Monitor the client's serum albumin levels. 3. Assess for signs and symptoms of infection. 4. Provide skin care to irradiated areas. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 151). F.A. Davis Company. Kindle Edition.

9. 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal medication. 2. Serum albumin is a measure of the protein content in the blood that is derived from the foods eaten; albumin monitors nutritional status. 3. Assessment of the nutritional status is indicated for this problem, not assessment of the signs and symptoms of infections. 4. This addresses an altered skin integrity problem. TEST-TAKING HINT: The stem of the question asks for interventions for "altered nutrition." Assessment is the first step of the nursing process, but option "3" is not assessing nutrition. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 161). F.A. Davis Company. Kindle Edition. 2

9. Which word identifies a mutation of protooncogenes? a. Oncogenes b. Retrogenes c. Oncofetal antigens d. Tumor angiogenesis factor Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 56). Elsevier Health Sciences. Kindle Edition.

9. a. Oncogenes are the mutation of protooncogenes, which then induce tumors. Oncogenic viruses cause genetic alterations and mutations that allow the cell to express the abilities and properties it had in fetal development and may lead to cancer. Oncofetal antigens are antigens that are found on the surface and inside the cancer cells. They are an expression of the cells usually associated with embryonic or fetal periods of life and may be used as tumor markers to monitor treatment. Tumor angiogenesis factor is the substance within tumors that promotes blood vessel development. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 339). Elsevier Health Sciences. Kindle Edition.

95. Which steps should the nurse provide clients who choose to perform breast self-examination (BSE) according to the American Cancer Society (ACS) guidelines? Rank in order of performance. 1. Lie flat on the bed with a rolled towel placed under the scapula; perform palpation of each breast. 2. Pinch each nipple to see if fluid can be expressed. 3. With the breasts exposed, stand in front of a mirror and examine the breasts from front and each side. 4. In the shower, soap the breasts, and perform palpation in a systematic manner on each breast. 5. Find a private place where the selfexamination can be performed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 408). F.A. Davis Company. Kindle Edition.

95. In order of performance: 5, 3, 4, 1, 2. 5. Breast self-examination should be performed in a private area with good lighting and a comfortable temperature so the woman is warm and can be consistent in the steps. 3. The first part of BSE is performed in front of a mirror. The breasts are examined from the front and each side, then with arms down by the side, then raised, next with the arms on the hips and bending over. The woman is looking for dimpling and irregularity in size or shape. 4. The woman then gets into a warm shower and palpates each breast when the breasts are soapy and slippery. 1. The last position the woman assumes is lying flat on the bed with a towel behind each scapula and palpation is performed. 2. After each breast is palpated the last thing done is to pinch the nipples to see if there is a discharge. TEST-TAKING HINT: The test taker must remember basic guidelines for procedures and which steps are involved. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 429). F.A. Davis Company. Kindle Edition.

96. Which should the nurse teach the client regarding Breast Health Awareness (BHA) according to the American Cancer Society (ACS). Select all that apply. 1. Women at high risk should talk to the HCP about when to have a mammogram. 2. Beginning at age 45, to have a yearly mammogram. 3. To perform a breast self-examination (BSE) bimonthly. 4. To get a sonogram of the breasts semiannually. 5. To have Magnetic Rresonance Imaging of the breasts every five (5) years. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 408). F.A. Davis Company. Kindle Edition.

96. 1. Women at high risk for breast cancer should have the opportunity to have mammograms beginning earlier than recommended for routine screening. 2. According to 2015 guidelines, routine screening mammograms should begin at age 45 and be performed yearly until age 55. At age 55 mammograms should be performed biennially. 3. Beginning in their 20s, women should be told about the benefits and limitations of breast selfexamination (BSE). Even those who choose not to do BSE should be aware of how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer. BSE is performed monthly, not bimonthly. 4. MRIs are performed on women with special needs (breast implants, etc.) but are not performed on a routine basis. TEST-TAKING HINT: The test taker could eliminate option "3" based on the timing "bimonthly." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 429). F.A. Davis Company. Kindle Edition. 1,2

After learning that he has a benign tumor in his abdomen, the patient is overheard telling his wife that he has cancer. What should the nurse say to the patient and spouse? 1. "There is a growth in the abdomen but it is encapsulated and after being removed, will not recur." 2. "This type of cancer is easily treated." 3. "This type of cancer will not spread to other tissues." 4. "Even though this growth has invaded other tissues, it can be contained."

Correct Answer: 1 Rationale 1: A benign tumor is encapsulated, slow-growing, and once removed, will not recur. Rationale 2: The patient does not have cancer but rather a benign tumor. Rationale 3: Even though benign tumors will not spread to other tissues, the nurse should not refer to the growth as being cancer. Rationale 4: The growth has not invaded other tissues. Global Rationale: A benign tumor is encapsulated, slow-growing, and once removed, will not recur. The patient does not have cancer but rather a benign tumor. Even though benign tumors will not spread to other tissues, the nurse should not refer to the growth as being cancer. The growth has not invaded other tissues

The nurse is preparing to provide care to a group of assigned patients. Which patient should the nurse realize is at the highest risk for developing cancer? 1. an African American man 2. a Native American woman 3. an Hispanic man 4. an Hispanic woman

Correct Answer: 1 Rationale 1: African Americans have the highest mortality rate for all cancers and major cancers among all ethnic groups. Rationale 2: Cancer incidence and mortality are lower in Native American men and women than in any other ethnic or racial group. Rationale 3: Hispanics have higher rates of cancers associated with infectious agents, such as uterine, cervix, liver, and stomach cancer. Rationale 4: Hispanics have higher rates of cancers associated with infectious agents, such as uterine, cervix, liver, and stomach cancer. Global Rationale: African Americans have the highest mortality rate for all cancers and major cancers among all ethnic groups. Cancer incidence and mortality are lower in Native American men and women than in any other ethnic or racial group. Hispanics have higher rates of cancers associated with infectious agents, such as uterine, cervix, liver, and stomach cancer.

A patient is having a procedure that involves cutting through the skin to diagnose a mass located in the left breast. For which type of biopsy should the nurse plan care for this patient? 1. incisional 2. fine-needle 3. needle core 4. excisional

Correct Answer: 1 Rationale 1: An incisional biopsy is the removal of part of a larger tumor by cutting through the skin. Rationale 2: A fine-needle biopsy uses a very thin needle to aspirate a small amount of tissue from the tumors. Rationale 3: A needle core biopsy uses a slightly larger needle than that used for a fine-needle biopsy to extract a small amount of tissue from tumors that cannot be aspirated by fine-needle aspiration. Rationale 4: An excisional biopsy is the removal of an entire tumor through surgery. Global Rationale: An incisional biopsy is the removal of part of a larger tumor by cutting through the skin. A fine-needle biopsy uses a very thin needle to aspirate a small amount of tissue from the tumors. A needle core biopsy uses a slightly larger needle than that used for a fine-needle biopsy to extract a small amount of tissue from tumors that cannot be aspirated by fine-needle aspiration. An excisional biopsy is the removal of an entire tumor through surgery.

After a liver biopsy, a patient is diagnosed with anaplasia of liver cells. What would be indicated for this patient's care? 1. monitoring for the development of cancer 2. chemotherapy for liver cancer 3. monitoring for the onset of diabetes mellitus 4. medication to reverse the anaplastic cells

Correct Answer: 1 Rationale 1: Anaplasia is the regression of a cell to an immature or undifferentiated cell type. Anaplastic cell division is no longer under DNA control. Anaplasia usually occurs when a damaging or transforming event takes place inside the dividing, still undifferentiated cell, leading to loss of useful function. Anaplasia may occur in response to overwhelmingly destructive conditions inside the cell or in surrounding tissue. Anaplasia is not reversible, but the degree of anaplasia determines the potential risk for cancer. The patient will most likely need careful monitoring to ensure the cells do not develop into cancer. Rationale 2: The patient does not have cancer and would not need chemotherapy at this time. Rationale 3: Anaplastic cells of the pancreas would increase this patient's chances of developing diabetes mellitus. Rationale 4: Anaplastic cells cannot be reversed. Global Rationale: Anaplasia is the regression of a cell to an immature or undifferentiated cell type. Anaplastic cell division is no longer under DNA control. Anaplasia usually occurs when a damaging or transforming event takes place inside the dividing, still undifferentiated cell, leading to loss of useful function. Anaplasia may occur in response to overwhelmingly destructive conditions inside the cell or in surrounding tissue. Anaplasia is not reversible, but the degree of anaplasia determines the potential risk for cancer. The patient will most likely need careful monitoring to ensure the cells do not develop into cancer. The patient does not have cancer and would not need chemotherapy at this time. Anaplastic cells of the pancreas would increase this patient's chances of developing diabetes mellitus. Anaplastic cells cannot be reversed.

A patient diagnosed with cancer contacted an attorney about a will and a church to arrange funeral and cemetery arrangements. What do this patient's activities suggest to the nurse? 1. The patient is participating in anticipatory grieving. 2. The patient feels he is going to die within the month. 3. The patient's family will not be willing to make funeral arrangements. 4. The patient wants something to do while waiting for chemotherapy treatments.

Correct Answer: 1 Rationale 1: Anticipatory grieving is a response to loss that has not yet occurred. The patient with cancer is often confronted with facing death and making preparations for it. This can be a healthy response that allows the patient and family to work through the dying process and achieve growth in the final stage of life. Rationale 2: Participating in the activities of a will and funeral arrangements does not necessarily mean that the patient feels he is going to die within the month. Rationale 3: Participating in the activities of a will and funeral arrangements does not mean that the patient's family will not be willing to make funeral arrangements. Rationale 4: The patient is not doing these activities while waiting for chemotherapy treatments. Global Rationale: Anticipatory grieving is a response to loss that has not yet occurred. The patient with cancer is often confronted with facing death and making preparations for it. This can be a healthy response that allows the patient and family to work through the dying process and achieve growth in the final stage of life. Participating in the activities of a will and funeral arrangements does not mean that the patient feels he is going to die within the month or that the patient's family will not be willing to make funeral arrangements. The patient is not doing these activities while waiting for chemotherapy treatments.

The nurse is explaining the different types of chemotherapy to a patient recently diagnosed with cancer. Which statement would be incorrect for the nurse to tell the patient? 1. "Antitumor antibiotics disrupt RNA replication and DNA transcription." 2. "The main hormones used in cancer therapy are the corticosteroids, which are phase-specific." 3. "Mitotic inhibitors are drugs that act to prevent cell division during the M phase." 4. "Alkylating agents basically act on preformed nucleic acids by creating defects in tumor DNA."

Correct Answer: 1 Rationale 1: Antitumor antibiotics disrupt DNA replication and RNA transcription, not the other way around. This is the statement that would be incorrect for the nurse to tell the patient. Hormones and hormone antagonists are one class of chemotherapeutic agents. Rationale 2: The main hormones used in cancer therapy are the corticosteroids, which are phase-specific. Rationale 3: Mitotic inhibitors are drugs that act to prevent cell division during the M phase. Rationale 4: Alkylating agents basically act on preformed nucleic acids by creating defects in tumor DNA. Global Rationale: Antitumor antibiotics disrupt DNA replication and RNA transcription, not the other way around. This is the statement that would be incorrect for the nurse to tell the patient. Hormones and hormone antagonists are one class of chemotherapeutic agents. The main hormones used in cancer therapy are the corticosteroids, which are phase specific. Mitotic inhibitors are drugs that act to prevent cell division during the M phase. Alkylating agents basically act on preformed nucleic acids by creating defects in tumor DNA.

A patient diagnosed with breast cancer is receiving 5-Fluorouracil (5-FU). Based on the knowledge of this medication, and anticipated adverse effects or side effects, what action should the nurse perform? 1. Test stool for occult blood. 2. Monitor ECG. 3. Assess lung sounds. 4. Encourage daily fluid intake of 2‒3 liters.

Correct Answer: 1 Rationale 1: Assessing for bleeding by checking stool for occult blood is recommended when receiving 5-Fluorouracil (5-FU). Rationale 2: Monitoring the ECG is recommended in patients receiving antitumor antibiotics. Rationale 3: Assessing lung sounds is recommended in patients receiving alkylating agents. Rationale 4: Encouraging a daily fluid intake of 2‒3 liters is recommended also for patients receiving alkylating agents. Global Rationale: Assessing for bleeding by checking stool for occult blood is recommended when receiving 5-Fluorouracil (5-FU). Monitoring the ECG is recommended in patients receiving antitumor antibiotics. Assessing lung sounds is recommended in patients receiving alkylating agents. Encouraging a daily fluid intake of 2-3 liters is recommended also for patients receiving alkylating agents.

A patient diagnosed with cancer and scheduled to begin biotherapy asks the nurse how the therapy will treat the cancer. How should the nurse respond to this patient? 1. "It changes the body processes that caused the cancer by enhancing your own immunity." 2. "It uses radiation implanted into the organ with the cancer." 3. "It uses laser therapy to remove the cancer." 4. "It uses stem cells to treat the cancer."

Correct Answer: 1 Rationale 1: Biotherapy modifies the biologic processes that result in malignant cells, primarily through enhancing the person's own immune responses. This is what the nurse should explain to the patient. Rationale 2: Brachytherapy is the implantation of radiation into the organ with the cancer. Rationale 3: Photodynamic therapy uses medication that is activated by a laser to treat the cancer. Rationale 4: Peripheral blood stem cell transplantation is used to stimulate or replace nonfunctioning bone marrow. It does not treat cancer. Global Rationale: Biotherapy modifies the biologic processes that result in malignant cells, primarily through enhancing the person's own immune responses. This is with what the nurse should explain to the patient. Brachytherapy is the implantation of radiation into the organ with the cancer. Photodynamic therapy uses medication that is activated by a laser to treat the cancer. Peripheral blood stem cell transplantation is used to stimulate or replace nonfunctioning bone marrow. It does not treat cancer.

A patient, diagnosed with cancer, has been receiving radiation treatments to shrink the tumor. After several weeks, the patient tells the nurse that he does not need as much pain medication as before. What would explain the reduction of pain for this patient? 1. The radiation treatments reduced the size of the tumor and pressure on adjacent tissues. 2. The tumor is secreting pain-control chemicals initiated by the radiation. 3. The patient is getting used to having pain. 4. The patient's pain receptors have been affected by the cancer.

Correct Answer: 1 Rationale 1: Direct tumor involvement is the primary cause of the pain experienced by people with cancer. The pain from tumor involvement is believed to be mechanical, resulting from stretching of tissues and compression. Radiation treatments that are successfully shrinking a tumor would reduce the amount of tissue compression by the tumor and reduce the pain. Rationale 2: The tumor is not secreting pain-control chemicals initiated by the radiation. Rationale 3: The patient is not getting used to having pain. Rationale 4: The patient's pain receptors have not been affected by the cancer. Global Rationale: Direct tumor involvement is the primary cause of the pain experienced by people with cancer. The pain from tumor involvement is believed to be mechanical, resulting from stretching of tissues and compression. Radiation treatments that are successfully shrinking a tumor would reduce the amount of tissue compression by the tumor and reduce the pain. The tumor is not secreting pain-control chemicals initiated by the radiation. The patient is not getting used to having pain. The patient's pain receptors have not been affected by the cancer.

A female patient asks the nurse why she needs a procedure to remove part of her cervix that was infected with a virus. What should the nurse explain to this patient? 1. Human papillomavirus can cause cervical cancer. 2. The medication to treat this virus is toxic to the body. 3. If left untreated, it could spread to the liver. 4. If left untreated, it could spread to the breast.

Correct Answer: 1 Rationale 1: Human papillomavirus has been linked to the development of cervical cancer. The nurse should explain how this could occur and why the patient would benefit from having the procedure to remove the area of the cervix infected with the virus. Rationale 2: There is no medication available to treat the human papillomavirus. Rationale 3: Untreated human papillomavirus can cause melanoma, cervical, penile, and laryngeal cancer. Rationale 4: Untreated human papillomavirus can cause melanoma, cervical, penile, and laryngeal cancer. Global Rationale: Human papillomavirus has been linked to the development of cervical cancer. The nurse should explain how this could occur and why the patient would benefit from having the procedure to remove the area of the cervix infected with the virus. There is no medication available to treat the human papillomavirus. Untreated human papillomavirus can cause melanoma, cervical, penile, and laryngeal cancer.

A patient is diagnosed with hyperplasia of lung tissue. The nurse realizes that this patient's first course of treatment will most likely include: 1. identification and removal of the irritant causing the hyperplasia. 2. antibiotic therapy. 3. chemotherapy. 4. radiation therapy.

Correct Answer: 1 Rationale 1: Hyperplasia is an increase in the number or density of normal cells and occurs in response to stress, increased metabolic demands, or elevated levels of hormones. Although hyperplasia often reverses after the irritating factor is eliminated, it can lead to malignancy under certain conditions. The first course of treatment is to identify and remove the irritant causing the hyperplasia. Rationale 2: Antibiotic therapy is not a treatment for hyperplasia. Rationale 3: It is not clear whether the patient will need chemotherapy in the future. Rationale 4: It is not clear whether the patient will need radiation therapy in the future. Global Rationale: Hyperplasia is an increase in the number or density of normal cells and occurs in response to stress, increased metabolic demands, or elevated levels of hormones. Although hyperplasia often reverses after the irritating factor is eliminated, it can lead to malignancy under certain conditions. It is not clear if the patient is going to need chemotherapy or radiation therapy in the future. The first course of treatment is to identify and remove the irritant causing the hyperplasia. Antibiotic therapy is not a treatment for hyperplasia. It is not clear whether the patient will need chemotherapy or radiation therapy in the future.

A patient with neck cancer is scheduled for a diagnostic test to determine the success of treatment. For what test should the nurse expect to prepare this patient? 1. magnetic resonance imaging (MRI) 2. computed tomography 3. x-ray imaging 4. ultrasonography

Correct Answer: 1 Rationale 1: MRI is the diagnostic tool of choice for both screening and follow-up of cranial and head and neck tumors. Rationale 2: Computed tomography is used in the screening for renal cell and most gastrointestinal tumors. Rationale 3: X-ray imaging is still the method of choice for lung cancer. Rationale 4: Ultrasonography is used to detect early prostate cancers and is used to guide needle biopsy. Ultrasound imaging is also used for detecting masses in the denser breast tissue of young women. Global Rationale: MRI is the diagnostic tool of choice for both screening and follow-up of cranial and head and neck tumors. Computed tomography is used in the screening for renal cell and most gastrointestinal tumors. X-ray imaging is still the method of choice for lung cancer. Ultrasonography is used to detect early prostate cancers and is used to guide needle biopsy. Ultrasound imaging is also used for detecting masses in the denser breast tissue of young women.

A patient with a history of cancer is surprised to learn that new cancer has been diagnosed in another body part. What should the nurse realize this patient is experiencing? 1. metastasis 2. contact inhibition 3. destructive force from a benign neoplasm 4. a solid mass

Correct Answer: 1 Rationale 1: Malignant cells from the primary tumor may travel through the blood or lymph to invade other tissues and organs of the body and form a secondary tumor called a metastasis. Malignant neoplasms can recur after surgical removal of the primary and secondary tumors and after other treatments. Rationale 2: Contact inhibition is a characteristic of benign neoplasms. Rationale 3: A destructive force from a benign neoplasm is when the benign tumor impinges upon a body part, causing damage. Rationale 4: Benign tumors are usually solid masses. Global Rationale: Malignant cells from the primary tumor may travel through the blood or lymph to invade other tissues and organs of the body and form a secondary tumor called a metastasis. Malignant neoplasms can recur after surgical removal of the primary and secondary tumors and after other treatments. Contact inhibition is a characteristic of benign neoplasms. A destructive force from a benign neoplasm is when the benign tumor impinges upon a body part causing damage. Benign tumors are usually solid masses

A patient shows the nurse a new sore on the forearm that has been increasing in size and will not heal. The nurse knows that which sign could also point to a diagnosis of a malignant neoplasm? 1. noncohesive, invasive, and invades and destroys surrounding tissues 2. rapid growth, well-defined borders, and cohesiveness 3. invasive, local, and does not stop at tissue border 4. slow growth, well-defined borders, and encapsulated

Correct Answer: 1 Rationale 1: Malignant neoplasms are invasive, are noncohesive, do not stop at the tissue border, invade and destroy surrounding tissues, are characterized by rapid growth, metastasize to distant sites, are not always easy to remove, and can recur. Rationale 2: Benign neoplasms are local, cohesive, with well-defined borders. They push other tissues out of the way, are characterized by slow growth, are encapsulated, are easily removed, and do not recur. Rationale 3: Benign neoplasms are local, cohesive, with well-defined borders. They push other tissues out of the way, are characterized by slow growth, are encapsulated, are easily removed, and do not recur. Rationale 4: Benign neoplasms are local, cohesive, with well-defined borders. They push other tissues out of the way, are characterized by slow growth, are encapsulated, are easily removed, and do not recur. Global Rationale: Benign neoplasms are local, cohesive, with well-defined borders. They push other tissues out of the way, are characterized by slow growth, are encapsulated, are easily removed, and do not recur. Malignant neoplasms are invasive, are noncohesive, do not stop at the tissue border, invade and destroy surrounding tissues, are characterized by rapid growth, metastasize to distant sites, are not always easy to remove, and can recur.

The nurse is caring for a patient undergoing brachytherapy. What personal precautions should the nurse take when caring for this patient? 1. Wear a monitoring device to measure whole-body exposure. 2. Care for this patient regardless of pregnancy status. 3. Maintain the least possible distance from the patient. 4. Avoid indirect exposure with radioisotopes containers

Correct Answer: 1 Rationale 1: Many safety principles apply when caring for a patient receiving radiation. In brachytherapy, the radioactive material is placed directly into or adjacent to the tumor. The nurse should wear a monitoring device to measure whole-body exposure. Rationale 2: If the nurse is pregnant, it is advisable for her to avoid contact with radiation sources. Rationale 3: Maintain the greatest possible distance from the source of radiation. Rationale 4: Avoid direct, not indirect, exposure with radioisotopes containers; for example, do not touch the container. Global Rationale: Many safety principles apply when caring for a patient receiving radiation. In brachytherapy, the radioactive material is placed directly into or adjacent to the tumor. The nurse should wear a monitoring device to measure whole-body exposure. If pregnant, avoid contact with radiation sources. Maintain the greatest possible distance from the source of radiation. Avoid direct, not indirect, exposure with radioisotopes containers; for example, do not touch the container.

A patient will be receiving busulfan (Myleran) as treatment for leukemia. Which intervention should the nurse include in the plan of care for this patient? 1. Assess for infection. 2. Administer anti-emetic prior to chemotherapy. 3. Assess oral mucous membranes. 4. Check stool for occult blood.

Correct Answer: 1 Rationale 1: Nursing interventions for a patient receiving busulfan (Myleran) include monitoring white blood cell counts, monitoring blood urea nitrogen level, maintaining adequate fluid intake, assessing for infection, and assessing lungs for coarse rales. Rationale 2: Administering an anti-emetic prior to chemotherapy is not indicated for busulfan (Myleran). Rationale 3: Assessing the oral mucosa is not indicated for busulfan (Myleran). Rationale 4: Monitoring the stool for occult blood is not indicated for busulfan (Myleran). Global Rationale: Nursing interventions for a patient receiving busulfan (Myleran) include monitoring white blood cell counts, monitoring blood urea nitrogen level, maintaining adequate fluid intake, assessing for infection, and assessing lungs for coarse rales. Administering an anti-emetic prior to chemotherapy, assessing oral mucous membranes, and checking stool for occult blood are not indicated for busulfan (Myleran).

A patient diagnosed with prostate cancer is demonstrating signs of renal failure. What should this assessment finding suggest to the nurse? 1. obstructive uropathy 2. spinal cord compression 3. urethral strictures from radiation 4. bladder irritation from chemotherapy

Correct Answer: 1 Rationale 1: Patients with prostate cancer may experience obstruction of the bladder neck or the ureters. Bladder neck obstruction usually manifests as urinary retention, flank pain, hematuria, or persistent urinary tract infections, but ureteral obstruction is not often evident until the patient is in renal failure. Rationale 2: Spinal cord compression does not cause renal failure. Rationale 3: Urethral strictures from radiation would not cause renal failure. Rationale 4: Bladder irritation from chemotherapy would not cause renal failure. Global Rationale: Patients with prostate cancer may experience obstruction of the bladder neck or the ureters. Bladder neck obstruction usually manifests as urinary retention, flank pain, hematuria, or persistent urinary tract infections, but ureteral obstruction is not often evident until the patient is in renal failure. Spinal cord compression does not cause renal failure. Urethral strictures from radiation would not cause renal failure. Bladder irritation from chemotherapy would not cause renal failure.

The nurse suspects that a patient being treated for cancer is developing septic shock. What did the nurse assess to come to this conclusion? 1. high fever, peripheral edema, hypotension 2. cardiac dysrhythmia, increased urine output, and confusion 3. hypertension, increased urine output, and confusion 4. subnormal temperature, cardiac dysrhythmia, and thirst

Correct Answer: 1 Rationale 1: Sepsis occurs when bacteria gain entrance to the blood, grow rapidly, and produce septicemia. Signs and symptoms appear in two phases. The first phase includes vasodilation with hypovolemia, high fever, peripheral edema, hypotension, tachycardia, tachypnea, hot flushed skin with creeping mottling beginning in the lower extremities, and anxiety or restlessness. Without treatment, the shock progresses to the second phase, which includes hypotension; rapid, thready pulse; respiratory distress; cyanosis; subnormal temperature; cold, clammy skin; decreased urinary output; and altered mentation. Rationale 2: Confusion is associated with septic shock, but cardiac dysrhythmias and increased urine output are not. Rationale 3: Hypotension, not hypertension, and confusion are associated with septic shock. Increased urine output is not. Rationale 4: Subnormal temperatures can be associated with septic shock, but cardiac dysrhythmias and thirst are not. Global Rationale: Sepsis occurs when bacteria gain entrance to the blood, grow rapidly, and produce septicemia. Signs and symptoms appear in two phases. The first phase includes vasodilation with hypovolemia, high fever, peripheral edema, hypotension, tachycardia, tachypnea, hot flushed skin with creeping mottling beginning in the lower extremities, and anxiety or restlessness. Without treatment, the shock progresses to the second phase, which includes hypotension; rapid, thready pulse; respiratory distress; cyanosis; subnormal temperature; cold, clammy skin; decreased urinary output; and altered mentation. Cardiac dysrhythmias, increased urine output, hypertension, and thirst are not usual signs of septic shock.

The nurse is explaining the characteristics of malignant cells to a group of patients. Which patient statement indicates a good understanding of the information? 1. "The work of malignant cells is simpler than that of normal cells." 2. "Malignant cells continue to perform cellular functions." 3. "Malignant cells can reverse into benign cells if treated promptly." 4. "Malignant cells rarely break away from the primary tissue site and travel to other locations."

Correct Answer: 1 Rationale 1: Simplified metabolic activities are a characteristic of malignant cells. The work of malignant cells is simpler than that of normal cells. Rationale 2: Malignant cells do not perform typical cellular functions. Rationale 3: Rarely does a malignant neoplasm revert to a benign state. Rationale 4: Transplantability is another characteristic of malignant cells. Malignant cells often break away from the primary tissue site and travel to other locations in the body. Global Rationale: Simplified metabolic activities are a characteristic of malignant cells. The work of malignant cells is simpler than that of normal cells. Malignant cells loose specialization and differentiation. Malignant cells do not perform typical cellular functions. The transformation into a malignant cell is irreversible. Rarely does a malignant neoplasm revert to a benign state. Transplantability is another characteristic of malignant cells. Malignant cells often break away from the primary tissue site and travel to other locations in the body.

A patient with a history of using recreational cocaine tells the nurse that he would rather be addicted to cocaine than be diagnosed with cancer. What should the nurse respond with to this patient? 1. "Cocaine has been linked to the development of cancer." 2. "I guess if that's what you would prefer." 3. "People who use cocaine do have a lower risk of developing cancer." 4. "As long as the cocaine is pure and not mixed with toxic chemicals."

Correct Answer: 1 Rationale 1: Some recreational drugs also are implicated as carcinogens. These include the immunosuppressant promoters of heroin and cocaine. Because of this, cocaine has been linked to the development of cancer, which is what the nurse should explain with to the patient. Rationale 2: The nurse should not minimize the patient's comment by replying about preferences. Rationale 3: People who use cocaine do not have a lower risk of developing cancer. Rationale 4: There is no evidence that the purity of cocaine prevents the development of cancer. Global Rationale: Some recreational drugs also are implicated as carcinogens. These include the immunosuppressant promoters of heroin and cocaine. Because of this, cocaine has been linked to the development of cancer, which is what the nurse should respond with to the patient. The nurse should not minimize the patient's comment by replying about references. People who use cocaine do not have a lower risk of developing cancer. There is no evidence that the purity of cocaine prevents the development of cancer

A patient with cancer is experiencing lower extremity numbness and loss of motor function. What should be done to assist this patient? 1. Assess for spinal cord compression. 2. Provide intravenous fluids. 3. Administer oxygen. 4. Turn and reposition every two hours

Correct Answer: 1 Rationale 1: Spinal cord compression is most commonly associated with pressure from expanding tumors of the breast, lung, or prostate; lymphoma; or metastatic disease. Spinal cord compression constitutes an emergency because of the potential for irreversible paraplegia. Back pain is the initial symptom in almost all cases of spinal cord compression. This may progress to leg pain, numbness, paresthesias, and coldness. Later, bowel and bladder dysfunction occur and, finally, neurologic dysfunction progressing from weakness to paralysis. Treatment often consists of radiation or surgical decompression, but early detection is essential. Rationale 2: Providing intravenous fluids is not the priority. Rationale 3: Providing oxygen is not the priority. Rationale 4: Turning and repositioning every two hours is not the priority. Global Rationale: Spinal cord compression is most commonly associated with pressure from expanding tumors of the breast, lung, or prostate; lymphoma; or metastatic disease. Spinal cord compression constitutes an emergency because of the potential for irreversible paraplegia. Back pain is the initial symptom in almost all cases of spinal cord compression. This may progress to leg pain, numbness, paresthesias, and coldness. Later, bowel and bladder dysfunction occur and, finally, neurologic dysfunction progressing from weakness to paralysis. Treatment often consists of radiation or surgical decompression, but early detection is essential. The patient should be assessed for spinal cord compression and not provided with intravenous fluids, oxygen, or turned and repositioned every two hours.

A male patient's prostate-specific antigen level was 2 ng/mL. However, the patient was diagnosed with prostate cancer. What additional laboratory test was done to determine this diagnosis? 1. acid phosphatase 2. albumin 3. bilirubin 4. calcium

Correct Answer: 1 Rationale 1: The acid phosphatase level will be elevated in prostate cancer. Rationale 2: The albumin level will be decreased in malnutrition and metastatic liver cancer. Rationale 3: Bilirubin will be elevated in liver and gallbladder cancer. Rationale 4: Calcium will be elevated in bone cancer and ectopic parathyroid hormone production. Global Rationale: The acid phosphatase level will be elevated in prostate cancer. The albumin level will be decreased in malnutrition and metastatic liver cancer. Bilirubin will be elevated in liver and gallbladder cancer. Calcium will be elevated in bone cancer and ectopic parathyroid hormone production.

A patient with cancer is admitted with a weight loss of 25 lbs. over the last month with progressive anorexia. The nurse suspects this patient is experiencing what physiological effect of cancer? 1. anorexia-cachexia syndrome 2. paraneoplastic syndrome 3. infection 4. esophageal obstruction

Correct Answer: 1 Rationale 1: The anorexia-cachexia syndrome is specific to cancer because of the effect of cancer cells on the host's metabolism. The neoplastic cells divert nutrition to their own use while causing changes that reduce the patient's appetite. Early in the disease, glucose metabolism is altered, causing an increase in serum glucose levels. The tumor also secretes substances that decrease appetite by altering taste and smell and producing early satiety. Rationale 2: Paraneoplastic syndromes are indirect effects of cancer. They may be early warning signs of cancer or indicate complications or return of a malignancy. Rationale 3: An infection caused by cancer does not lead to anorexia. Rationale 4: Esophageal obstruction is not a specific physiological effect of cancer. Global Rationale: The anorexia-cachexia syndrome is specific to cancer because of the effect of cancer cells on the host's metabolism. The neoplastic cells divert nutrition to their own use while causing changes that reduce the patient's appetite. Early in the disease, glucose metabolism is altered, causing an increase in serum glucose levels. The tumor also secretes substances that decrease appetite by altering taste and smell and producing early satiety. Paraneoplastic syndromes are indirect effects of cancer. They may be early warning signs of cancer or indicate complications or return of a malignancy. An infection caused by cancer does not lead to anorexia. Esophageal obstruction is not a specific physiological effect of cancer.

A patient is scheduled for a nephrectomy for renal cancer. What should the nurse recognize is the goal for this surgery? 1. removal of the kidney 2. removal of the organ 3. bypass an obstruction 4. decrease in tumor size

Correct Answer: 1 Rationale 1: The decision to remove or resect an organ for cancer depends upon the organ and if there is some other means to replace the functioning of the lost organ. In the case of a nephrectomy, the patient's remaining kidney can maintain renal functioning. Rationale 2: Kidney function cannot be replaced chemically. Rationale 3: The removal of a kidney would not be done to bypass an obstruction. Rationale 4: The removal of a kidney would not be done to decrease the tumor's size. Global Rationale: The decision to remove or resect an organ for cancer depends upon the organ and if there is some other means to replace the functioning of the lost organ. In the case of a nephrectomy, the patient's remaining kidney can maintain renal functioning. Kidney function cannot be replaced chemically. The removal of a kidney would not be done to bypass an obstruction or to decrease tumor size.

A patient's carcinoembryonic antigen level was initially 16 ng/mL. The level is currently 6 ng/mL. What does the nurse realize this decreased level indicates for the patient? 1. The patient's treatment for cancer is effective. 2. The patient's treatment for cancer is not effective. 3. The patient has a new site of cancer. 4. The patient's cancer has metastasized.

Correct Answer: 1 Rationale 1: The normal carcinoembryonic antigen level for a nonsmoker is 2.5 ng/mL and 5.0 ng/mL for a smoker. Cancer is diagnosed with a level greater than 12 ng/mL. A decrease in the level is an indication that treatment for cancer is effective. Rationale 2: The value would increase if the treatment for cancer were not effective. Rationale 3: This laboratory test cannot determine new sites of cancer. Rationale 4: This laboratory test cannot help determine if the cancer has metastasized. Global Rationale: The normal carcinoembryonic antigen level for a nonsmoker is 2.5 ng/mL and 5.0 ng/mL for a smoker. Cancer is diagnosed with a level greater than 12 ng/mL. A decrease in the level is an indication that treatment for cancer is effective. The value would increase if the treatment for cancer were not effective. This laboratory test cannot determine new sites of cancer or if the cancer has metastasized.

The nurse is concerned that a patient receiving chemotherapy for cancer is at increased risk for developing an infection. What should the nurse include in this patient's plan of care? 1. Teach the patient to avoid crowds. 2. Encourage socialization with small children. 3. Contact physician with a temperature elevation. 4. Limit intake of protein and vitamin C.

Correct Answer: 1 Rationale 1: The nurse should instruct the patient to avoid crowds and children to reduce the risk of developing an infection. Rationale 2: The nurse should instruct the patient to avoid socializing with children to reduce the risk of developing an infection. Rationale 3: Temperature elevation is a normal sign of an infection; however, severely immunocompromised patients may not be able to mount a fever. The absence of a fever does not rule out the presence of an infection. Rationale 4: The patient should be instructed to have an adequate daily intake of protein and vitamin C to support the body's immunity. Global Rationale: The nurse should instruct the patient to avoid crowds and children to reduce the risk of developing an infection. Temperature elevation is a normal sign of an infection; however, severely immunocompromised patients may not be able to mount a fever. The absence of a fever does not rule out the presence of an infection. The patient should be instructed to have an adequate daily intake of protein and vitamin C to support the body's immunity.

The nurse is providing instructions to a patient diagnosed with renal cancer regarding when to call for help after discharge. Which statement by the patient indicates that teaching has been successful? 1. "I should call my physician if I experience new bleeding from any site." 2. "I should call my physician if I have an oral temperature higher than 100.5° F." 3. "I should call my physician if I have an episode of diarrhea." 4. "I should call my physician if I experience an occasional headache."

Correct Answer: 1 Rationale 1: The nurse should instruct the patient to call the nurse or physician if any of the following signs or symptoms occur: oral temperature higher than 101.5° F; severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen, or severe pain at a new site; difficulty breathing; new bleeding from any site; confusion, irritability, or restlessness; verbalizations of deep sadness or a desire to end life; changes in eating patterns; changes in body functioning, such as severe diarrhea or constipation; withdrawal; frequent crying; greatly decreased activity level; and the appearance of edema in the extremities or significant increase in edema already present. Rationale 2: The patient should call the nurse or physician if an oral temperature is greater than 101.5° F, not 100.5° F. Rationale 3: The physician or nurse does not need to be contacted if the patient experiences an episode of diarrhea. Rationale 4: The physician or nurse does not need to be contacted if the patient experiences an occasional headache. Global Rationale: The nurse should instruct the patient to call the nurse or physician if any of the following signs or symptoms occur: oral temperature higher than 101.5° F; severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen, or severe pain at a new site; difficulty breathing; new bleeding from any site; confusion, irritability, or restlessness; verbalizations of deep sadness or a desire to end life; changes in eating patterns; changes in body functioning, such as severe diarrhea or constipation; withdrawal; frequent crying; greatly decreased activity level; and the appearance of edema in the extremities or significant increase in edema already present. The physician or nurse does not need to be contacted if the patient experiences an episode of diarrhea or an occasional headache.

A patient is scheduled to receive a course of external radiation therapy for cancer treatment. What should the nurse instruct the patient about this therapy? 1. Wash the radiation site with plain water and no soap. 2. Shave the treated area with a straight razor. 3. Apply ice packs to the treatment site to help reduce pain. 4. Use a sunscreen for three months after the conclusion of the treatments.

Correct Answer: 1 Rationale 1: The nurse should instruct the patient to wash the skin that is marked as the radiation site only with plain water, no soap; do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period. Rationale 2: If necessary, use only an electric razor to shave the treated area. Rationale 3: Apply neither heat nor cold to the treatment site. Protect skin from sun exposure during treatment and for at least one year after radiation therapy is discontinued. Rationale 4: Cover skin with protective clothing during treatment; once radiation is discontinued, use sun-blocking agents with a sun protection factor (SPF) of at least 15. Global Rationale: The nurse should instruct the patient to wash the skin that is marked as the radiation site only with plain water, no soap; do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period. If necessary, use only an electric razor to shave the treated area. Apply neither heat nor cold to the treatment site. Protect skin from sun exposure during treatment and for at least one year after radiation therapy is discontinued. Cover skin with protective clothing during treatment; once radiation is discontinued, use sun-blocking agents with a sun protection factor (SPF) of at least 15.

A female patient tells the nurse that she does not want to have annual mammograms because the x-rays can cause cancer. How should the nurse respond to this patient? 1. "Breast cancer is the number one type of cancer in females. The risk of developing cancer from the x-rays is considerably lower than the risk of having undiagnosed breast cancer." 2. "I don't blame you. X-rays do cause cancer." 3. "Be sure to do monthly breast exams." 4. "Contact your doctor if you notice any breast changes, feel any lumps, or develop breast pain since these are all symptoms of active breast cancer."

Correct Answer: 1 Rationale 1: The nurse should respond by saying that breast cancer is the number one type of cancer in females and that the risk of developing cancer from x-rays is considerably lower than the risk of having undiagnosed breast cancer. Rationale 2: The nurse should not support the patient's belief that x-rays cause cancer. Rationale 3: The nurse should instruct the patient to perform monthly breast self-examinations; however, that is not the best response in this situation. Monthly breast examinations should not be used in place of routine mammograms. Rationale 4: Breast changes, lumps, and breast pain are not definitive symptoms of breast cancer. Global Rationale: The nurse should respond by saying that breast cancer is the number one type of cancer in females and that the risk of developing cancer from x-rays is considerably lower than the risk of having undiagnosed breast cancer. The nurse should not support the patient's belief that x-rays cause cancer. The nurse should instruct the patient to perform monthly breast self-examinations; however, that is not the best response in this situation. Monthly breast examinations should not be used in place of routine mammograms. Breast changes, lumps, and breast pain are not definitive symptoms of breast cancer.

A patient diagnosed with an 8 cm tumor in the ascending colon asks the nurse how the tumor grew so large without any major symptoms. How should the nurse respond to this patient? 1. "The pressure of the growing tumor caused the other tissue to reduce in size so the tumor could take over the space." 2. "The tumor cells bound to the tissue within the colon." 3. "The tumor cells are loosely held together so they can move about freely." 4. "The tumor cells secreted chemicals that stopped the body's normal mechanism to remove foreign tissue."

Correct Answer: 1 Rationale 1: The nurse should respond with the explanation about pressure atrophy. The pressure of a growing tumor can cause atrophy and necrosis of adjacent tissues. The malignancy then moves into the vacated space. Rationale 2: The response that the tumor cells bound to the tissue within the colon explains how the tumor became established in the colon. Rationale 3: The response about tumor cells moving about freely explains metastasis. Rationale 4: The response that tumor cells secrete chemicals that stopped the body's normal phagocytic mechanism explains how the tumor was able to continue to grow. Global Rationale: The nurse should respond with the explanation about pressure atrophy. The pressure of a growing tumor can cause atrophy and necrosis of adjacent tissues. The malignancy then moves into the vacated space. The response that the tumor cells bound to the tissue within the colon explains how the tumor became established in the colon. The response about tumor cells moving about freely explains metastasis. The response that tumor cells secrete chemicals that stopped the body's normal phagocytic mechanism explains how the tumor was able to continue to grow.

A patient diagnosed with cancer tells the nurse that he does not want to experience anymore pain. What should the nurse do to help this patient? 1. Discuss pain control options. 2. Explain that every patient with cancer has pain. 3. Review ways to reduce pain without the use of medication. 4. Instruct on why pain will continue throughout treatment.

Correct Answer: 1 Rationale 1: The pain associated with cancer is usually undertreated because of an inappropriate use of opioids and barriers related to the healthcare provider, patient, family, institution, and society. Communication and knowledge deficit are the major barriers to effective pain management. Because of this, the nurse should discuss pain control options with the patient. Rationale 2: Not every patient with cancer has pain. Rationale 3: Reviewing ways to reduce pain without the use of medication may or may not be appropriate for the patient. Rationale 4: The nurse has no way of knowing whether the patient's pain will continue throughout treatment. Global Rationale: The pain associated with cancer is usually undertreated because of an inappropriate use of opioids and barriers related to healthcare provider, patient, family, institution, and society. Communication and knowledge deficit are the major barriers to effective pain management. Because of this, the nurse should discuss pain control options with the patient. Not every patient with cancer has pain. Reviewing ways to reduce pain without the use of medication may or may not be appropriate for the patient. The nurse has no way of knowing whether the patient's pain will continue throughout treatment.

The nurse is concerned that a patient is at increased risk for developing cancer. What did the nurse assess to come to this conclusion? 1. age 51, spouse deceased, downsized from employment, history of back and leg pain 2. age 52, plays tennis twice a week, no alcohol intake, occasionally smokes a cigarette 3. age 45, premenopausal, not planning to use hormone replacement therapy 4. age 50, employed as a computer technician, uses the fitness center five times a week

Correct Answer: 1 Rationale 1: The patient who is 51 with a deceased spouse, downsized from employment, and has a history of back and leg pain is experiencing a great deal of stress. Stress resulting from severe and/or cumulative losses also implicated in promoting cancer. These losses, which are common to older adults, include the death of a spouse or friends, loss of position and status in society, and a decline in physical abilities. These repeated stressors can damage the immune system that may lead to the development of cancer. Rationale 2: This patient has fewer risk factors than the first patient. Rationale 3: This patient has fewer risk factors than the first patient. Rationale 4: This patient has fewer risk factors than the first patient. Global Rationale: The patient who is 51 with a deceased spouse, downsized from employment, and has a history of back and leg pain is experiencing a great deal of stress. Stress resulting from severe and/or cumulative losses is also implicated in promoting cancer. These losses, which are common to older adults, include the death of a spouse or friends, loss of position and status in society, and a decline in physical abilities. These repeated stressors can damage the immune system that may lead to the development of cancer. The other patients have fewer risk factors for the development of cancer.

A patient with a history of squamous cell lung cancer is admitted to the hospital with arm and periorbital edema. After a few hours, the patient exhibits dyspnea, cyanosis, tachypnea, and an altered level of consciousness. Which action should the nurse take first? 1. Administer oxygen. 2. Call the physician. 3. Monitor vital signs. 4. Initiate seizure precautions.

Correct Answer: 1 Rationale 1: The superior vena cava can be compressed by mediastinal tumors or adjacent thoracic tumors. The most common cause is small-cell or squamous-cell lung cancers. Signs and symptoms can develop slowly, and include facial, periorbital, and arm edema as early signs. As the problem progresses, respiratory distress, dyspnea, cyanosis, tachypnea, and altered consciousness and neurologic deficits can occur. Emergency measures include the following: provide respiratory support with oxygen, and prepare for a tracheostomy; monitor vital signs; administer corticosteroids to reduce edema; if the disorder is due to a clot, administer antifibrinolytic or anticoagulant drugs; provide a safe environment, including seizure precautions. Rationale 2: Contacting the physician is not the first priority. Rationale 3: Monitoring the patient's vital signs is important, but it is not the first action to take. Rationale 4: Seizure precautions would not be initiated first. Global Rationale: The superior vena cava can be compressed by mediastinal tumors or adjacent thoracic tumors. The most common cause is small-cell or squamous-cell lung cancers. Signs and symptoms can develop slowly, and include facial, periorbital, and arm edema as early signs. As the problem progresses, respiratory distress, dyspnea, cyanosis, tachypnea, and altered consciousness and neurologic deficits can occur. Emergency measures include the following: provide respiratory support with oxygen, and prepare for a tracheostomy; monitor vital signs; administer corticosteroids to reduce edema; if the disorder is due to a clot, administer antifibrinolytic or anticoagulant drugs; provide a safe environment, including seizure precautions. The nurse should provide oxygen before contacting the physician or monitoring vital signs. Seizure precautions would not be initiated first.

A patient asks the nurse how his cancer developed. Which statement should the nurse avoid in responding to this patient? 1. "The theory of cellular mutation suggests that carcinogens cause mutations in cellular RNA." 2. "Oncogenes are genes that promote cell proliferation and are capable of triggering cancerous characteristics." 3. "The majority of people do not have an inherited form of cancer." 4. "Known carcinogens include viruses, drugs, hormones, and chemical and physical agents."

Correct Answer: 1 Rationale 1: The theory of cellular mutation suggests that carcinogens cause mutations in cellular DNA, not RNA. Rationale 2: Oncogenes are genes that promote cell proliferation and are capable of triggering cancerous characteristics. Inherited cancers can become inactive by deletion or mutation. Rationale 3: The majority of people do not have an inherited form of cancer is a true statement. Rationale 4: Known carcinogens include viruses, drugs, hormones, and chemical and physical agents. Global Rationale: The theory of cellular mutation suggests that carcinogens cause mutations in cellular DNA, not RNA. Oncogenes are genes that promote cell proliferation and are capable of triggering cancerous characteristics. The majority of people do not have an inherited form of cancer is a true statement. Known carcinogens include viruses, drugs, hormones, and chemical and physical agents.

A patient with a history of smoking is diagnosed with cancer. If applying the cellular mutation theory of cancer to this patient's diagnosis, the nurse realizes that smoking impacted which stage? 1. promotion 2. initiation 3. progression 4. replication

Correct Answer: 1 Rationale 1: The theory of cellular mutation suggests that there are agents that cause mutations in cellular DNA that transforms cells into cancer cells. These agents are called carcinogens and it is believed that the carcinogenic process has three stages: initiation, promotion, and progression. Promotion may last for years and includes conditions, such as smoking or alcohol use, that act repeatedly on the already affected cells. Rationale 2: The initiation stage involves permanent damage in the cellular DNA as a result of exposure to a carcinogen that was not repaired or had a defective repair. Rationale 3: In the progression stage further inherited changes acquired during the cell replication develop into a cancer. Rationale 4: Replication is not a stage in the mutation theory of cancer. Global Rationale: The theory of cellular mutation suggests that there are agents that cause mutations in cellular DNA that transforms cells into cancer cells. These agents are called carcinogens and it is believed that the carcinogenic process has three stages: initiation, promotion, and progression. The initiation stage involves permanent damage in the cellular DNA as a result of exposure to a carcinogen that was not repaired or had a defective repair. Promotion may last for years and includes conditions, such as smoking or alcohol use, that act repeatedly on the already affected cells. In the progression stage further inherited changes acquired during the cell replication develop into a cancer. Replication is not a stage in the mutation theory of cancer.

A patient is receiving vincristine (Oncovin) for cancer treatment. Which assessment finding should indicate to the nurse that the patient is experiencing a toxic reaction? 1. pain and motor weakness 2. hypotension 3. cardiac dysrhythmias 4. stomatitis and alopecia

Correct Answer: 1 Rationale 1: The toxicity of vincristine is characterized by depression of deep tendon reflexes, paresthesias, motor weakness, cranial nerve disruptions, and paralytic ileus. Rationale 2: Hypotension is not associated with a toxic reaction to vincristine. The worst common toxic side effect of etoposide is hypotension resulting from too rapid intravenous administration. Rationale 3: Cardiac dysrhythmias are not associated with a toxic reaction to vincristine. The main toxic effect of antitumor antibiotics is damage to the cardiac muscle. Rationale 4: Stomatitis and alopecia are not associated with a toxic reaction to vincristine. Toxic effects of antimetabolites include stomatitis and alopecia. Global Rationale: The toxicity of vincristine is characterized by depression of deep tendon reflexes, paresthesias, motor weakness, cranial nerve disruptions, and paralytic ileus. The worst common toxic side effect of etoposide is hypotension resulting from too rapid intravenous administration. The main toxic effect of antitumor antibiotics is damage to the cardiac muscle. Toxic effects of antimetabolites include stomatitis and alopecia.

The nurse is preparing to assess a patient who is newly diagnosed with cancer. What should the nurse include in this assessment? 1. body image concerns 2. increased leukocytes 3. bone pain 4. increased hunger

Correct Answer: 1 Rationale 1: There are several physical and psychologic effects that occur in a patient diagnosed with cancer. One of these effects is body image concerns. Rationale 2: The patient's leukocytes are usually decreased, not increased. Rationale 3: Bone pain will depend upon the type of cancer. Rationale 4: A change in appetite can occur, although is it usually a loss of appetite. Global Rationale: There are several physical and psychologic effects that occur in a patient diagnosed with cancer. One of these effects is body image concerns. The patient's leukocytes are usually decreased, not increased. Bone pain will depend upon the type of cancer. A change in appetite can occur, although is it usually a loss of appetite.

The nurse is reviewing the results of diagnostic testing on a patient suspected of having cancer. Which diagnostic findings should the nurse identify as being consistent with the presence of a malignancy? Standard Text: Select all that apply. 1. high levels of tumor markers 2. positive biopsy results 3. low levels of tumor markers 4. decreased white blood cell count 5. increased hemoglobin and hematocrit

Correct Answer: 1, 2 Rationale 1: High levels of tumor markers are indicative of a malignancy. Rationale 2: Positive biopsy results are indicative of a malignancy. Rationale 3: High levels of tumor markers are indicative of a malignancy. Rationale 4: Leukopenia is not associated with a malignancy. Rationale 5: Increased hemoglobin and hematocrit values are not associated with a malignancy. Global Rationale: High levels of tumor markers are indicative of a malignancy. Positive biopsy results are indicative of a malignancy. Leukopenia is not associated with a malignancy. Increased hemoglobin and hematocrit values are not associated with a malignancy

A college student is diagnosed with Epstein-Barr virus. The student has a history of smoking and recreational cocaine use and works for a floor refinishing company part-time. Which factors increase this student's risk for developing cancer? Standard Text: Select all that apply. 1. drug use 2. occupation 3. smoking 4. viral infection 5. age

Correct Answer: 1, 2, 3, 4 Rationale 1: Some recreational drugs are also implicated as carcinogens. Immunosuppressant promoters include heroin and cocaine. Rationale 2: Examples of industrial and environmental carcinogens include polycyclic hydrocarbons, found in soot; benzopyrene, found in cigarette smoke; and arsenic, found in pesticides. Other industrial and environmental chemicals are considered promotional agents. These include wood and leather dust, polymer esters used in plastics and paints, carbon tetrachloride, asbestos, and phenol. Rationale 3: Benzopyrene found in cigarette smoke contributes to the development of cancer. Rationale 4: Several viruses have been associated with the development of cancer. These viruses include Epstein-Barr. Rationale Rationale 5: The patient's young age is not a risk factor for the development of cancer. Global Rationale: Some recreational drugs are also implicated as carcinogens. Immunosuppressant promoters include heroin and cocaine. Examples of industrial and environmental carcinogens include polycyclic hydrocarbons, found in soot; benzopyrene, found in cigarette smoke; and arsenic, found in pesticides. Other industrial and environmental chemicals are considered promotional agents. These include wood and leather dust, polymer esters used in plastics and paints, carbon tetrachloride, asbestos, and phenol. Benzopyrene found in cigarette smoke contributes to the development of cancer. Several viruses have been associated with the development of cancer. These viruses include Epstein-Barr. The patient's young age is not a risk factor for the development of cancer.

At the completion of a dietary history the nurse is concerned that a patient is at risk for developing cancer. Which food habit does the patient have that causes the nurse to have this concern? Standard Text: Select all that apply. 1. eats red meat 5 times a week 2. drinks 6 cups of coffee every day 3. has a salad every evening with dinner 4. prefers fried fish and chicken over baked 5. orders a deli sandwich for lunch every day

Correct Answer: 1, 2, 4, 5 Rationale 1: A diet that is high in red meat and saturated fat appears to increase the risk for cancer. Rationale 2: Both regular and decaffeinated coffee are believed to increase cancer risk. Rationale 3: Vegetables, fruits, fiber, folate, and calcium may be protective against cancer. Rationale 4: Repeatedly using fat to fry foods at high temperatures produces high levels of polycyclic hydrocarbons, which increase cancer risk considerably. Rationale 5: Some foods are considered genotoxic, such as the nitrosamines and nitrous indoles found in preserved meats and pickled, salted foods. Global Rationale: A diet that is high in red meat and saturated fat appears to increase the risk for cancer. Both regular and decaffeinated coffee are believed to increase cancer risk. Repeatedly using fat to fry foods at high temperatures produces high levels of polycyclic hydrocarbons, which increase cancer risk considerably. Some foods are considered genotoxic, such as the nitrosamines and nitrous indoles found in preserved meats and pickled, salted foods. Vegetables, fruits, fiber, folate, and calcium may be protective against cancer.

Question 51 Type: MCMA A patient is prescribed cyclophosphamide (Cytoxan) for treatment of lymphoma. What should the nurse instruct to maximize the health status of the patient while receiving this medication? Standard Text: Select all that apply. 1. Avoid eating spicy foods. 2. Discuss approaches to manage hair loss. 3. Identify approaches to reduce bone pain. 4. Brainstorm ways to manage constipation. 5. Ingest 2 to 3 liters of fluid during treatment.

Correct Answer: 1, 2, 5 Rationale 1: Adverse effects of cyclophosphamide (Cytoxan) include stomatitis. The patient should be instructed to avoid eating spicy foods. Rationale 2: Adverse effects of cyclophosphamide (Cytoxan) include alopecia. Approaches to managing hair loss should be discussed. Rationale 3: Bone pain is not an adverse effect of cyclophosphamide (Cytoxan). Rationale 4: Constipation is not an adverse effect of cyclophosphamide (Cytoxan). Rationale 5: Adverse effects of cyclophosphamide (Cytoxan) include hemorrhagic cystitis and renal failure. The nurse should instruct the patient to ingest 2 to 3 liters of fluid during treatment. Global Rationale: Adverse effects of cyclophosphamide (Cytoxan) include hemorrhagic cystitis, renal failure, alopecia, stomatitis, and liver dysfunction. The nurse should encourage a daily fluid intake of 2 to 3 liters during treatment and offer suggestions to manage hair loss. However, spicy foods are not recommended for patients with stomatitis.

A patient is to have chemotherapy provided to target the G1 phase of the cell cycle. Which medications should the nurse expect to be prescribed for this patient? Standard Text: Select all that apply. 1. Cisplatin 2. Prednisone 3. Methotrexate 4. Mercaptopurine 5. Nitrogen mustard

Correct Answer: 1, 2, 5 Rationale 1: Cisplatin is a miscellaneous medication provided during the G1 phase of the cell cycle. Rationale 2: Prednisone is a hormone provided during the G1 phase of the cell cycle. Rationale 3: Methotrexate is an antimetabolite used during the S phase of the cell cycle. Rationale 4: Mercaptopurine is an antimetabolite used during the S phase of the cell cycle. Rationale 5: Nitrogen mustard is an alkylating agents prescribed during the G1 phase of the cell cycle Global Rationale: Cisplatin is a miscellaneous medication provided during the G1 phase of the cell cycle. Prednisone is a hormone provided during the G1 phase of the cell cycle. Nitrogen mustard is an alkylating agents prescribed during the G1 phase of the cell cycle. Methotrexate and mercaptopurine are antimetabolites used during the S phase of the cell cycle.

Question 49 Type: MCMA After cytologic examination a patient is diagnosed with a tumor that is staged as TIS, N1a, M0. What does this staging classification indicate to the nurse about the patient's tumor? Standard Text: Select all that apply. 1. TIS means the tumor is in situ. 2. M0 means that it has metastasized. 3. M0 means that it has not metastasized. 4. N1a means one lymph node is involved. 5. N1a means that no lymph nodes are involved.

Correct Answer: 1, 3, 5 Rationale 1: TIS means that the tumor is in situ. Rationale 2: M0 means there is no evidence of distant metastasis. Rationale 3: M0 means there is no evidence of distant metastasis. Rationale 4: N1a means there is no metastasis to regional lymph nodes. Rationale 5: N1a means there is no metastasis to regional lymph nodes. Global Rationale: TIS means that the tumor is in situ. M0 means there is no evidence of distant metastasis. N1a means there is no metastasis to regional lymph nodes.

A patient is beginning radiation therapy as part of cancer treatment. What should the nurse teach the patient about the care of the radiation site? Standard Text: Select all that apply. 1. Clean radiation site with soap and water. 2. Apply lotion daily to prevent scaling. 3. Apply ice pack to radiation site if pain or itching occurs. 4. If needed use an electric razor for shaving. 5. Wear tight fighting clothing over the area to protect it.

Correct Answer: 1, 4 Rationale 1: The site may be cleaned with soap and water. Rationale 2: Lotion should not be applied to the site. Rationale 3: Ice packs should not be applied to the site. Rationale 4: An electric razor may be used to shave the site. Rationale 5: Tight fitting clothing should not be worn over the site. Global Rationale: Options 2, 3, and 5 are contraindicated for this patient as they will increase the likelihood of tissue trauma at the radiation site.

Question 47 Type: MCMA The nurse realizes that a patient receiving chemotherapy for cancer is at risk for developing an infection. What actions should the nurse take when caring for this patient? Standard Text: Select all that apply. 1. Monitoring red blood cell counts monthly. 2. Teaching the patient to avoid small children. 3. Teaching the patient to apply lotion daily to clean skin to prevent drying. 4. Encouraging the patient to consume a diet high in protein and vitamin C. 5. Teaching the patient to report an oral temperature above 98° F.

Correct Answer: 2, 3, 4 Rationale 1: Although RBCs are monitored, they do not diagnose infection as do WBCs. Rationale 2: Teach the patient to avoid crowds, small children, and people with infections when WBC count is at nadir (lowest point during chemotherapy) and to practice scrupulous personal hygiene. Rationale 3: Appropriate skin care measures, such as the use of a moisturizing lotion to prevent dryness and cracking ensures intact skin. Rationale 4: Improving nutrition decreases the risk of infection. Vitamin C has been shown to help prevent certain types of infection, such as colds. Rationale 5: A temperature of 98° F is normal and does not need to be reported to the nurse or physician. Global Rationale: Although RBCs are monitored, they do not diagnose infection as do WBCs. Teach the patient to avoid crowds, small children, and people with infections when WBC count is at nadir (lowest point during chemotherapy) and to practice scrupulous personal hygiene. Teach appropriate skin care measures, such as the use of a moisturizing lotion to prevent dryness and cracking ensures intact skin. Improving nutrition decreases the risk of infection. Vitamin C has been shown to help prevent certain types of infection, such as colds. A temperature of 98° F is normal and does not need to be reported to the nurse or physician.

A patient with cancer is diagnosed with malnutrition. What does the nurse realize are causes of malnutrition in this patient? Standard Text: Select all that apply. 1. decreases in metabolism resulting from increased cancer cell production 2. decreased available nutrients due to the cancers parasitic activity 3. loss of appetite due to side effects of chemotherapy 4. decreased absorption in the gastrointestinal tract 5. parenteral nutrition supplements administered via venous access devices

Correct Answer: 2, 3, 4 Rationale 1: The patient's metabolism will increase, not decrease. Rationale 2: The patient with cancer may have a decreased amount of available nutrients. Rationale 3: The patient may lose his or her appetite. Rationale 4: The patient may not be able to absorb the nutrients well from the gastrointestinal tract. Rationale 5: Parenteral nutrition is not a cause of malnutrition. It can be used to help the patient with cancer. Global Rationale: The patient with cancer may have a decreased amount of available nutrients. The patient may lose his or her appetite. The patient may not be able to absorb the nutrients well from the gastrointestinal tract. The patient's metabolism will not decrease, it will increase. Parenteral nutrition is not a cause of malnutrition. It can be used to help the patient with cancer.

The family of a patient with terminal metastatic cancer asks the nurse for guidelines regarding when to call for help when the patient is discharged to home. What guidelines should the nurse instruct this family that indicates the patient needs medical intervention? Standard Text: Select all that apply. 1. oral temperature greater than 100° F 2. difficulty breathing 3. onset of bleeding 4. resting comfortably, and reading 5. extreme hunger

Correct Answer: 2,3,5 Rationale 1: The patient should call the nurse or physician if the patient experiences an oral temperature greater than 101.5° F (38.6° C). Rationale 2: The patient should call the nurse or physician if the patient experiences difficulty breathing. Rationale 3: The patient should call the nurse or physician if the patient experiences a new onset of bleeding. Rationale 4: There is no reason to call the nurse or physician if the patient is resting comfortably and reading. Rationale 5: The patient should call the nurse or physician if the patient experiences extreme hunger. Global Rationale: The nurse should instruct the patient and family to call the physician or nurse for help with any of the following signs or symptoms: an oral temperature greater than 101.5° F (38.6°C); severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen; severe pain at a new site; difficulty breathing; new bleeding from any site, such as rectal or vaginal bleeding; confusion, irritability, or restlessness; withdrawal; greatly decreased activity level; frequent crying; verbalizations of deep sadness or a desire to end life; changes in body functioning, such as the inability to void or severe diarrhea or constipation; changes in eating patterns, such as refusal to eat, extreme hunger, or a significant increase in nausea and vomiting; and appearance of edema in the extremities or significant increase in edema already present.

A patient with a known drug allergy to Tetracycline is experiencing stomatitis from chemotherapy used to treat colon cancer. What combination mouthwashes for oropharyngeal pain control should the nurse suggest the healthcare provider prescribe for this patient? Standard Text: Select all that apply. 1. Kaiser 2. Stanford 3. Xyloxylin suspension 4. Stomafate suspension 5. Listerine antibacterial

Correct Answer: 3, 4 Rationale 1: Kaiser mouthwash contains tetracycline. Rationale 2: Stanford mouthwash contains tetracycline. Rationale 3: Xyloxylin suspension does not contain tetracycline. Rationale 4: Stomafate suspension does not contain tetracycline. Rationale 5: Listerine antibacterial is not a recommended mouthwash for oropharyngeal pain control. Global Rationale: Xyloxylin suspension and Stomafate suspension do not contain tetracycline. Kaiser mouthwash and Stanford mouthwash both contains tetracycline. Listerine antibacterial is not a recommended mouthwash for oropharyngeal pain control.

The nurse is caring for a patient diagnosed with a malignant neoplasm. What does the nurse recognize are characteristics of this neoplasm? Standard Text: Select all that apply. 1. localized encapsulated growths 2. growths demonstrating contact inhibition 3. irregularly shaped growths 4. neoplasms that cause bleeding and inflammation 5. growths that remain stable in size

Correct Answer: 3, 4 Rationale 1: Benign neoplasms are localized growths. They form a solid mass, have well-defined borders, and frequently are encapsulated. Rationale 2: Benign neoplasms tend to respond to the body's homeostatic controls. Thus, they often stop growing when they reach the boundaries of another tissue (a process called contact inhibition). Rationale 3: In contrast to benign neoplasms, malignant neoplasms grow aggressively and do not respond to the body's homeostatic controls. Malignant neoplasms are not cohesive, and present with an irregular shape. Rationale 4: Instead of slowly crowding other tissues aside, malignant neoplasms cut through surrounding tissues, causing bleeding, inflammation, and necrosis (tissue death) as they grow. Rationale 5: They grow slowly and often remain stable in size. Global Rationale: Benign neoplasms are localized growths. They form a solid mass, have well-defined borders, and frequently are encapsulated. Benign neoplasms tend to respond to the body's homeostatic controls. Thus, they often stop growing when they reach the boundaries of another tissue (a process called contact inhibition). They grow slowly and often remain stable in size. Because they are usually encapsulated, benign neoplasms often are easily removed and tend not to recur. In contrast to benign neoplasms, malignant neoplasms grow aggressively and do not respond to the body's homeostatic controls. Malignant neoplasms are not cohesive, and present with an irregular shape. Instead of slowly crowding other tissues aside, malignant neoplasms cut through surrounding tissues, causing bleeding, inflammation, and necrosis (tissue death) as they grow.

A patient tells the nurse that he has a benign tumor that has spread into his lymph glands. How should the nurse respond to this patient? 1. "What did your doctor tell you about the tumor?" 2. "Benign tumors do not spread." 3. "That's a good thing that the tumor is benign." 4. "Since it is benign, are you going to have surgery to remove it?"

Correct answer 1: Rationale 1: The patient believes that the tumor is benign; however, benign tumors do not spread. These types of tumors are encapsulated and can be easily removed. Since the patient seems to have conflicting information, the nurse should assess the patient by asking what the physician explained about the tumor. Rationale 2: The nurse should not tell the patient that benign tumors do not spread. Rationale 3: The nurse should not reinforce the patient's belief that the tumor is benign. Rationale 4: The patient may or may not know if surgery is indicated to remove the tumor. Global Rationale: The patient believes that the tumor is benign; however, benign tumors do not spread. These types of tumors are encapsulated and can be easily removed. Since the patient seems to have conflicting information, the nurse should assess the patient by asking what the physician explained about the tumor. The nurse should not tell the patient that benign tumors do not spread. The nurse should not reinforce the patient's belief that the tumor is benign. The patient may or may not know if surgery is indicated to remove the tumor