Cancer and Anemia

A nurse is counseling a 60-year-old African-American male client about risk factors for lung cancer. Teaching should focus most on what risk factor? a. Tobacco use b. Ethnicity c. Gender d. Increased age

ANS: a. Tobacco use Although all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can modify and change.Ethnicity, gender, and increasing age are associated with lung cancer, but they are not modifiable risk factors that the client can change.

458. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? 1. Clamp the surgical drain. 2. Change the dressing as prescribed. 3. Notify the surgeon. 4. Remove and replace the perineal packing.

Answer: 2 Rationale: Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. Therefore, the nurse should change the dressing as prescribed. A surgical drain should not be clamped, because this action will cause the accumulation of drainage within the tissue. The nurse does not need to notify the surgeon at this time. Drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing.

2. While collecting a health history on a patient admitted for colon cancer, which of the following questions would be a priority to ask this patient? a. Have you noticed any blood in your stool? b. Have you been experiencing nausea? c. Do you have back pain? d. Have you noticed any swelling in your abdomen?

ANS: A Early colon cancer is often asymptomatic, with occult or frank blood in the stool being an assessment finding in a patient diagnosed with colon cancer. If pain is present, it is usually lower abdominal cramping. Constipation and diarrhea are more frequent findings than nausea or ascites.

3. While planning care for a patient experiencing fatigue due to chemotherapy, which of the following is the most appropriate nursing intervention? a. Prioritization and administration of nursing care throughout the day b. Completing all nursing care in the morning so the patient can rest the remainder of the day c. Completing all nursing care in the evening when the patient is more rested d. Limiting visitors, thus promoting the maximal amount of hours for sleep

ANS: A Pacing activities throughout the day conserves energy, and nursing care should be paced as well. Fatigue is a common side effect of cancer and treatment; and while adequate sleep is important, an increase in the number of hours slept will not resolve the fatigue. Restriction of visitors does not promote healthy coping and can result in feelings of isolation.

1. The nurse would incorporate which of the following into the plan of care as a primary prevention strategy for reduction of the risk for cancer? a. Yearly mammography for women aged 40 years and older b. Using skin protection during sun exposure while at the beach c. Colonoscopy at age 50 and every 10 years as follow-up d. Yearly prostate specific antigen (PSA) and digital rectal exam for men aged 50 and over

ANS: B Primary prevention of cancer involves avoidance to known causes of cancer, such as sun exposure. Secondary screening involves physical and diagnostic examination.

5. While the nurse is obtaining the health history of a 75-year-old female patient, which of the following has the greatest implication for the development of cancer? a. Being a 75-year-old woman b. Family history of hypertension c. Cigarette smoking as a teenager d. Advancing age

ANS: D According to the American Cancer Society, 2007, the most important risk factor for cancer development is advancing age.

4. The nurse is caring for a patient who received a bone marrow transplant 10 days ago. The nurse would monitor for which of the following clinical manifestations that could indicate a potentially life-threatening situation? a. Mucositis b. Confusion c. Depression d. Mild temperature elevation

ANS: D During the first 100 days after a bone marrow transplant, patients are at high risk for life-threatening infections. The earliest sign of infection in an immunosuppressed patient can be a mild fever. Mucositis, confusion, and depression are possible clinical manifestations but are representative of less life-threatening complications.

6. In caring for a patient following lobectomy for lung cancer, which of the following should the nurse include in the plan of care? a. Position the patient on the operative side only. b. Avoid administering narcotic pain medications. c. Keep the patient on strict bed rest. d. Instruct the patient to cough and deep breathe.

ANS: D Postoperative deep breathing and coughing is important to promote oxygenation and clearing of secretions. Pain medications will be given to lessen pain and allow for deep breathing and coughing. Strict bed rest is not instituted, because early ambulation will help lessen postoperative complications such as deep vein thrombosis. Prolonged lying on the operative side is avoided.

The nurse is performing an assessment on a client with anemia. What are the typical clinical manifestations of anemia? Select all that apply. a. Pallor b. Fatigue c. Tachycardia d. Dyspnea on exertion e. Elevated temperature f. Decreased breath sounds

ANS: a, b, c, d The typical clinical manifestations of anemia are: pallor, fatigue, tachycardia, and dyspnea on exertion. Lowered O2 levels deliver less oxygen to all cells, making clients with anemia pale—especially their ears, nail beds, palms, and conjunctivae and around the mouth. Fatigue is a classic symptom of anemia because lowered O2 levels contribute to a faster pulse (i.e., cardiac rate) and tend to "wear out" a client's energy. Difficulty breathing—especially with activity—is common with anemia. Lower levels of hemoglobin carry less O2 to the cells of the body.Respiratory problems with anemia do not include changes in breath sounds. Skin is cool to the touch, and an intolerance to cold is noted. Elevated temperature would signify something additional, such as infection.

A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. a. Brain b. Bone c. Lymph nodes d. Kidneys e. Liver

ANS: a, b, c, e Typical sites of metastasis of lung cancer include the brain, bone, lymph nodes, liver, and pancreas.Kidneys are not a typical site of lung cancer metastasis.

The nurse includes which factors in teaching regarding the typical warning signs of cancer? Select all that apply. a. Persistent constipation b. Scab present for 6 months c. Curdlike vaginal discharge d. Axillary swelling e. Headache

ANS: a, b, d Change in bowel habits, a sore that does not heal, and a lump or thickening in the breast or elsewhere are all potential warning signs of cancer.Curd like vaginal discharge represents a yeast infection. Headache is not a warning sign, but may be present with multiple medical problems.

The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client? Select all that apply. a. "Provide yourself with four to six small, easy-to-eat meals daily." b. "Perform your care activities in groups to conserve your energy." c. "Stop activity when shortness of breath or palpitations is present." d. "Allow others to perform your care during periods of extreme fatigue." e. "Drink small quantities of protein shakes and nutritional supplements daily." f. "Perform a complete bath daily to reduce your chance of getting an infection."

ANS: a, c, d, e Having four to six small meals daily is preferred over three large meals. This practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. It is critical to have others help the anemic client who is extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the client. Drinking small protein or nutritional supplements will help rebuild the client's nutritional status.A complete bath needs to be performed only every other day. On days in between, the client can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities would be spaced every hour or so rather than in groups to conserve energy. Care activities need to be avoided just before and after meals.

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? a. "My mother and grandmother had breast cancer, so I am at risk." b. "I get a mammogram every 2 years since I turned 30." c. "A clinical breast examination is performed every month since I turned 40." d. "A computed tomography (CT) scan will be done every year after I turn 50."

ANS: a. "My mother and grandmother had breast cancer, so I am at risk." A strong family history of breast cancer indicates a risk for breast cancer.Annual rather than biannual screening may be indicated for a strong family history. An annual mammogram is performed after age 40 or in younger clients with a strong family history. The client may perform a self-breast examination monthly, but a clinical examination by a health care provider is indicated annually. Annual CT breast scans after age 50 are not a current recommendation.

Which information must the organ transplant nurse emphasize before a client is discharged? a. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." b. "You are at increased risk for cancer when you reach 60 years of age." c. "Immunosuppressant medications will decrease your risk for developing cancers." d. "After 6 months, you may stop immunosuppressant medications, and your risk for cancer will be the same as that of the general population."

ANS: a. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." Use of immunosuppressant medications to prevent organ rejection increases the risk for cancer and the need for cancer screening.Advanced age is a risk factor for all people, not just for organ transplant recipients. Immunosuppressant medications must be taken for the life of the organ. The increased risk for developing cancer remains as long as the client continues to take immunosuppressant drugs.

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? a. Infection with hepatitis B virus b. Consuming a diet high in animal fat c. Exposure to radon d. Familial polyposis

ANS: a. Infection with hepatitis B virus Hepatitis B and C are risk factors for primary liver cancer. Alcohol abuse is also a risk factor for the development of liver cancer.Consuming a diet high in animal fat may predispose a person to colon or breast cancer. Exposure to radon is a risk factor for lung cancer. Familial polyposis is a risk factor for colorectal cancer.

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first? a. Obtain prescribed blood cultures. b. Place the client on Bleeding Precautions. c. Initiate the administration of prescribed antibiotics. d. Give 1000 mL of IV normal saline to hydrate the client.

ANS: a. Obtain prescribed blood cultures. The intervention the nurse would first implement is to draw prescribed blood cultures. Obtaining blood cultures to identify the infectious agent correctly is the priority for this client.Placing the client on Bleeding Precautions is unnecessary. Administering antibiotics is important, but antibiotics must always be started after cultures are obtained. Hydrating the client is not the priority.

Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) working on a medical-surgical unit? a. Obtain vital signs on a client receiving a blood transfusion b. Assist a client with folic acid deficiency in making diet choices c. Administer erythropoietin to a client with myelodysplastic syndrome d. Assess skin integrity on an anemic client who fell during ambulation

ANS: a. Obtain vital signs on a client receiving a blood transfusion The appropriate task for the nurse to delegate to a UAP is obtaining vital signs on a client receiving a blood transfusion. This activity is within the scope of practice for UAPs.Assisting with prescribed diet choices, administering medication, and assessing clients are complex actions that must be done by licensed nurses.

The nurse is caring for a client who is in sickle cell crisis. What action would the nurse perform first? a. Provide pain medications as needed. b. Apply cool compresses to the client's forehead. c. Increase food sources of iron in the client's diet. d. Encourage the client's use of two methods of birth control.

ANS: a. Provide pain medications as needed. The action the nurse would perform first for a client in sickle cell crisis is to provide pain medications as needed. Analgesics are needed to treat sickle cell pain.Cool compresses do not help the client in sickle cell crisis. Birth control is not the priority for this client. Increasing iron in the diet is not pertinent for the client in sickle cell crisis.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? a. Testing of stool specimens for occult blood b. Teaching about the importance of dietary fiber c. Referring clients for colonoscopy procedures d. Giving vitamin and mineral supplements

ANS: a. Testing of stool specimens for occult blood Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.Client education and teaching is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care needs to be performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing professionals.

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all that apply. a. Limit sodium intake. b. Avoid beef and processed meats. c. Increase consumption of whole grains. d. Eat "colorful fruits and vegetables," including greens. e. Avoid gas-producing vegetables such as cabbage.

ANS: b, c, d Avoiding red meat and processed foods such as lunchmeats, and consuming bran and whole grains can reduce cancer risk and should be included in health education classes on diet and cancer risk reduction. Consuming foods high in vitamin A, including apricots, carrots, and leafy green and yellow vegetables, can also reduce cancer risk.Reducing sodium is helpful in the treatment of hypertension and heart and kidney failure, but no evidence suggests that lowering of sodium intake decreases the incidence of cancer. Eating cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage may actually reduce cancer risk.

What are the common cancers related to tobacco use? Select all that apply. a. Cardiac cancer b. Lung cancer c. Cancer of the tongue d. Skin cancer e. Cancer of the larynx

ANS: b, c, e Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Oral cancer is also a risk with "smokeless" tobacco.The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary? a. "The pneumonia vaccine is protection that I need." b. "Getting an annual 'flu shot' would be dangerous for me." c. "I must take my penicillin pills as prescribed, all the time." d. "Frequent handwashing is an important habit for me to develop."

ANS: b. "Getting an annual 'flu shot' would be dangerous for me." Further teaching is needed when a young women with sickle cell disease says, "Getting an annual 'flu shot' would be dangerous for me." The client with SCD can receive annual influenza and pneumonia vaccinations. This helps prevent the development of these infections, which could cause a sickle cell crisis.The pneumonia vaccine is also appropriate for the client with sickle cell disease to receive. Prophylactic penicillin is given to clients with SCD orally twice a day to prevent the development of infection. Handwashing is a very important habit for the client with SCD to develop because it reduces the risk for infection.

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? a. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." b. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." c. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." d. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

ANS: b. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed.No lymph nodes are involved and there is not another tumor present. A glioma is a benign tumor of the brain, so chemotherapy and radiation are not given. The client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information would the nurse explain to the parents about the risk of a child having sickle cell disease? a. "Sickle cell disease will be inherited by your children." b. "The sickle cell trait will be inherited by your children." c. "Your children will have the disease, but your grandchildren will not." d. "Your children will not have the disease, but your grandchildren could."

ANS: b. "The sickle cell trait will be inherited by your children." The statement that explains to parents about the risk of a child having sickle cell disease is that the children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.The children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? a. Vomiting b. Back pain c. Frequent urination d. Cyanosis of the toes

ANS: b. Back pain Typical sites of breast cancer metastasis include bone (manifested by back pain), lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control.Vomiting is not a sign of metastatic cancer of the breast. Although frequent urination may be a sign of bladder cancer, incontinence is more indicative of spinal metastasis. Cyanosis of the toes indicates decreased tissue perfusion, often related to atherosclerotic disease.

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? a. Grains b. Dairy products c. Leafy vegetables d. Starchy vegetables

ANS: b. Dairy products The nurse encourages the client to eat dairy products such as milk, cheese, and eggs. These foods will provide the vitamin B12 that the client needs.Grains, leafy vegetables, and starchy vegetables are not a source of vitamin B12.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? a. Easy bruising b. Dyspnea c. Night sweats d. Chest wound

ANS: b. Dyspnea Dyspnea and complaints of difficulty breathing are signs of lung cancer, as are cough, hoarseness, shortness of breath, bloody sputum, arm or chest pain, and dysphagia.Easy bruising is a nonspecific finding, and not related to lung cancer. Night sweats is a symptom of the lymphomas. A chest wound is not specific to lung cancer.

Which activity performed by the community health nurse best reflects primary prevention of cancer? a. Assisting women to obtain free mammograms b. Teaching a class on cancer prevention c. Encouraging long-term smokers to get a chest x-ray d. Encouraging sexually active women to get annual Papanicolaou (Pap) smears

ANS: b. Teaching a class on cancer prevention Primary prevention involves avoiding exposure to known causes of cancer. Education and teaching by the community health nurse assists clients with this strategy.Mammography is part of a secondary level of prevention, defined as screening for early detection. Chest x-ray is a method of detecting a cancer that is present—secondary prevention and early detection. A Pap smear is a means of detecting cervical cancer early—secondary prevention.

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that the client has an infection or an infection needs to be ruled out? a. Evidence of pus b. Wheezes or crackles c. Fever of 102°F (38.9°C) or higher d. Coughing and deep breathing

ANS: b. Wheezes or crackles The clinical manifestation that indicates the client with neutropenia has an infection or an infection that needs to be ruled out is wheezes or crackles. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.Coughing and deep breathing are not indications of infection but can help prevent it. The client with leukopenia, not neutropenia, may have a severe infection without pus or with only a low-grade fever.

A 52-year-old client tells the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? a. "Don't worry, most lumps are discovered by women during breast self-examination." b. "Does anyone in your family have breast cancer?" c. "Finding a cancer in the early stages increases the chance for cure." d. "Have you noticed a lump or thickening in your breast?"

ANS: c. "Finding a cancer in the early stages increases the chance for cure." Providing truthful information about early cancer detection addresses the client's concerns.Mammography can detect lumps smaller than those discovered by palpation. Asking about family history or symptoms is not therapeutic because it does not address the client's fear of cancer.

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is most important to communicate to the health care provider? a. "I am allergic to iodine." b. "My urinary stream is very weak." c. "My legs are numb and weak." d. "I am incontinent when I cough."

ANS: c. "My legs are numb and weak." Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur. Prostate cancer may frequently metastasize to the bone, specifically the spine.Allergy to iodine should be reported when contrast media will be used, but dye is not used in radiation therapy. A weak urinary stream and incontinence are common clinical manifestations of prostate cancer. Incontinence associated with coughing is typical of stress incontinence and is not a complication of cancer.

The nurse assess the client with which hematologic condition first? a. A 32-year-old with pernicious anemia who needs a vitamin B12 injection b. A 67-year-old with acute myelocytic leukemia with petechiae on both legs c. An 81-year-old with thrombocytopenia and an increase in abdominal girth d. A 40-year-old with iron deficiency anemia who needs a Z-track iron injection

ANS: c. An 81-year-old with thrombocytopenia and an increase in abdominal girth The nurse needs to first assess the 81-year-old client with thrombocytopenia and an increase in abdominal girth. An increase in abdominal girth in a client with thrombocytopenia indicates possible hemorrhage, and warrants further assessment immediately.The 32-year-old with pernicious anemia, the 67-year-old with acute myelocytic leukemia, and the 40-year-old with iron deficiency anemia do not indicate any acute complications, so the nurse can assess them after assessing the client with thrombocytopenia.

A 32-year-oldclient is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge? a. Heparin (Heparin) b. Warfarin (Coumadin) c. Hydroxyurea (Droxia) d. Tissue plasminogen activator (t-PA)

ANS: c. Hydroxyurea (Droxia) The nurse anticipates Hydroxyurea to be prescribed for pain for a sickle cell disease client who is being discharge. Hydroxyurea (Droxia) has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD).Clients with SCD are not prescribed anticoagulants such as heparin or warfarin (Coumadin). t-PA is used as a "clot buster" in clients who have had ischemic strokes.

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult male client indicates understanding of the nurse's instructions? a. "Cigarette smoking always causes lung cancer." b. "Taking multivitamins will prevent me from developing cancer." c. "If I have only one shot of whiskey a day, I probably will not develop cancer." d. "I need to report the pain going down my legs to my health care provider."

ANS: d. "I need to report the pain going down my legs to my health care provider." Pain in the back of the legs could indicate prostate cancer in an older adult male.Cigarette smoking is implicated in causing lung cancer and other types of cancer, but it does not always cause cancer. Investigation is ongoing about the efficacy of vitamins A and C in cancer prevention, but at this time taking vitamins does not prevent cancer. Limiting alcohol to one drink per day is only one preventive measure.

Which client does the nurse assign as a roommate for a client with aplastic anemia? a. A 34-year-old with idiopathic thrombocytopenia who is taking steroids b. A 23-year-old with sickle cell disease who has two draining leg ulcers c. A 30-year-old with leukemia who is receiving induction chemotherapy d. A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol)

ANS: d. A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) The nurse assigns as a roommate to the client with aplastic anemia a 28-year-old with glucose-6-pgisphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol. Because clients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates such as the client with G6PD deficiency anemia would be free from infection or infection risk.The client with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the client with aplastic anemia. The client with leukemia who is receiving induction chemotherapy and the client with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the client with aplastic anemia at risk, too.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? a. A diagnosis of diabetes treated with insulin and diet b. An exercise regimen of jogging 3 miles four times a week c. A history of cardiac disease d. Advancing age

ANS: d. Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.Diabetes is not known to cause lung cancer. Regular exercise is not a risk factor for lung cancer, nor does having cardiac disease predispose a person to lung cancer.

A client has a glioblastoma. The nurse begins to plan care for this client with which type of cancer? a. Liver b. Smooth muscle c. Fatty tissue d. Brain

ANS: d. Brain The prefix "glio-" is used when cancers of the brain are named.The prefix "hepato-" is included when cancers of the liver are named. The prefix "leiomyo-" is included when cancers of smooth muscle are named. The prefix "lipo-" is included when cancers of fat or adipose tissue are named.

The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention? a. Avoid asbestos. b. Wear sunscreen. c. Get the human papilloma virus (HPV) vaccine. d. Do not smoke cigarettes.

ANS: d. Do not smoke cigarettes. All of these actions are part of cancer prevention; however, tobacco is the single most important source of preventable carcinogenesis.Although asbestos may present a risk for lung cancer, it is not a likely exposure for teens. Asbestos may be found in older homes and buildings, although most schools have been through an asbestos abatement program so should not pose a risk. If some teens may be involved in the construction industry during the summer, they need to be made aware of asbestos risks. Lifetime exposure to the sun and the use of tanning beds will increase the risk for cancer, but not as much as tobacco use. The HPV vaccine will decrease the risk for cervical cancer, but will not have as much of an impact on cancer prevention as avoiding tobacco.

A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer? Oral ibuprofen (Motrin) Oral morphine sulfate (MS-Contin) Intramuscular (IM) morphine sulfate Intravenous (IV) hydromorphone (Dilaudid)

ANS: d. Intravenous (IV) hydromorphone (Dilaudid) The client with sickle cell disease needs IV pain relief, and it needs to be administered on a routine schedule (i.e., before the client has to request it).Nonsteroidal anti-inflammatory drugs may be used for clients with SCD for pain relief once their pain is under control. However, in a crisis, this choice of analgesic is not strong enough. Moderate pain may be treated with oral opioids, but this client is in a sickle cell crisis. IV analgesics would be used until his or her condition stabilizes. Morphine is not administered intramuscularly (IM) to clients with sickle cell disease (SCD). In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin.

Which statement about the process of malignant transformation is correct? a. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. b. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. c. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. d. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.

ANS: d. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage. The promotion phase of malignant transformation consists of progression when the blood supply changes from diffusion to TAF.If cell division is halted, mutation of genes does not lead to cancer development in the initiation phase. Insulin and estrogen increase cell division. Also in the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latency phase occurs between initiation and tumor formation.

The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team? a. Temperature of 96.6°F (35.9°C) b. Reports of joint pain c. Pink and dry oral mucosa d. Palpable lump in the client's axilla

ANS: d. Palpable lump in the client's axilla Clients taking immunosuppressive drugs to prevent rejection are at increased risk for the development of cancer; any lump should be reported to the physician.Fever should be reported to the physician, but this client's temperature is normal. It is not necessary to report joint pain to the transplant team; it is not a sign of rejection and is not a complication of transplant. A pink and dry oral mucosa may be a sign of dehydration, but it is not necessary to report this to the transplant team.

A client recovering from a sickle cell crisis is to be discharged. The nurse says to the client, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the primary health care provider (PHCP) will prescribe? a. Cefaclor (Ceclor) b. Vancomycin (Vancocin) c. Gentamicin (Garamycin) d. Penicillin V (Pen-V K)

ANS: d. Penicillin V (Pen-V K) The nurse expects the PHCP to prescribe Penicillin V for a client recovering from sickle cell crisis who is at risk for infection. Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in clients with sickle cell disease.Cefaclor (Ceclor) and vancomycin (Vancocin) are antibiotics more specific for short-term use and would be inappropriate for this client. Gentamicin (Garamycin) is a drug that can cause liver and kidney damage with long-term use.

The nurse is caring for a client with sickle cell disease. Which nursing action is most effective in reducing the potential for sepsis in this client? a. Check vital signs every 4 hours b. Administer prophylactic drug therapy c. Monitor for abnormal laboratory values d. Perform frequent and thorough handwashing

ANS: d. Perform frequent and thorough handwashing The most effective nursing action to reduce the risk for sepsis in a client with sickle cell anemia is to perform frequent and thorough handwashing. Prevention and early detection strategies are used to protect the client in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance.Taking vital signs every 4 hours will help with early detection of infection but is not prevention. Drug therapy is a major defense against infections that develop in the client with sickle cell disease but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the client for infection and monitoring the daily complete blood count with differential white blood cell count is early detection, not prevention.

444. The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

Answer: 1 Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.

449. The nurse is caring for a client who is postoperative following a pelvic exenteration, and the surgeon changes the client's diet from NPO (nothing by mouth) status to clear liquids. The nurse should check which priority item before administering the diet? 1. Bowel sounds 2. Ability to ambulate 3. Incision appearance 4. Urine specific gravity

Answer: 1 Rationale: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options 2, 3, and 4 are unrelated to the data in the question.

448. The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. The client's pain rating 2. Nonverbal cues from the client 3. The nurse's impression of the client's pain 4. Pain relief after appropriate nursing intervention

Answer: 1 Rationale: The client's self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Assessing pain relief is an important measure, but this option is not related to the subject of the question.

469. The nurse is providing dietary teaching for a client who underwent a partial gastrectomy to treat gastric cancer about foods high in vitamin B12. The nurse would instruct the client to include which food items in the diet that are high in this vitamin? Select all that apply. 1. Milk 2. Fish 3. Beef 4. Apples 5. Turkey 6. Bananas

Answer: 1, 2, 3, 5 Rationale: Vitamin B12 aids in hemoglobin synthesis and energy metabolism, especially folic acid metabolism. It is also essential for normal functioning of all cells, especially the nervous system, bone marrow, and gastrointestinal tract. The client who had a partial gastrectomy is at risk for vitamin B12 deficiency because of loss of the intrinsic factor, which is produced in the lining of the stomach. Foods high in this vitamin include meat such as beef, organ meats such as liver, poultry such as chicken and turkey, fish, shellfish such as clams, eggs, and dairy products such as milk and eggs. Apples and bananas both contain vitamin C. Banana is also rich in potassium.

455. The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply. 1. Pathological fracture 2. Urinalysis positive for Bence Jones protein 3. Hemoglobin level of 15.5 g/dL (155 mmol/L) 4. Calcium level of 8.6 mg/dL (2.15 mmol/L) 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

Answer: 1, 2, 5 Rationale: Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with multiple myeloma may experience pathological fractures, hypercalcemia, anemia, recurrent infections, and renal failure. In addition, Bence Jones proteinuria is a finding. A serum calcium level of 8.6 mg/dL (2.15 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. A serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) is elevated indicating a renal problem.

462. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the primary health care provider will request which prescriptions? Select all that apply. 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Decreased oral sodium intake 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone

Answer: 1, 2, 5, 6 Rationale: Cancer is a common cause of SIADH. In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1. Restrict fluid intake. 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L/minute. 5. Provide a high-calorie, high-protein diet. 6. Give meperidine, 25 mg intravenously, every 4 hours for pain.

Answer: 1, 6 Rationale: Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

453. A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress caused by the diagnosis of cancer 4. Altered perineal sensation as a side effect of radiation therapy

Answer: 2 Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts, and if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options 1, 3, or 4.

468. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Avoiding arm exercises in the immediate postoperative period 4. Maintaining an intravenous site below the antecubital area on the affected side

Answer: 2 Rationale: Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

470. The nurse is instructing a client with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the client? 1. Administer the iron at mealtimes. 2. Administer the iron through a straw. 3. Mix the iron with cereal to administer. 4. Add the iron to apple juice for easy administration.

Answer: 2 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth, because the iron stains the teeth. The client should be instructed to brush or wipe their teeth after administration. Iron is administered between meals, because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not mixed with cereal or other food items.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? 1. Administer the iron at mealtimes. 2. Administer the iron through a straw. 3. Mix the iron with cereal to administer. 4. Add the iron to formula for easy administration.

Answer: 2 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth, because the iron stains the teeth. The parents should be instructed to brush or wipe the child's teeth or have the child brush the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

454. The nurse is instructing a client to perform a testicular self-examination (TSE). The nurse should provide the client with which information about the procedure? 1. To examine the testicles while lying down 2. That the best time for the examination is after a shower 3. To gently feel the testicle with one finger to feel for a growth 4. That TSEs should be done at least every 6 months

Answer: 2 Rationale: The TSE is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.

445. When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply. 1. Limiting the time with the client to 1 hour per shift. 2. Keeping pregnant women out of the client's room. 3. Placing the client in a private room with a private bath. 4. Wearing a lead shield when providing direct client care. 5. Removing the dosimeter film badge when entering the client's room. 6. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client.

Answer: 2, 3, 4 Rationale: The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per shift. The client must be placed in a private room with a private bath. Lead shielding can be used to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room.

456. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action? 1. Measure abdominal girth. 2. Irrigate the nasogastric tube. 3. Continue to monitor the drainage. 4. Notify the primary health care provider (PHCP).

Answer: 3 Rationale: Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the PHCP (surgeon) at this time. Abdominal girth is measured to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific surgeon prescriptions to do so.

447. The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors. 2. Restrict fluid intake. 3. Teach the client and family about the need for hand hygiene. 4. Insert an indwelling urinary catheter to prevent skin breakdown.

Answer: 3 Rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.

Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1. Elevated hemoglobin level 2. Decreased reticulocyte count 3. Elevated red blood cell count 4. Red blood cells that are microcytic and hypochromic

Answer: 4 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

471. Laboratory studies are performed for a client suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1. Elevated hemoglobin level 2. Decreased reticulocyte count 3. Elevated red blood cell count 4. Red blood cells that are microcytic and hypochromic

Answer: 4 Rationale: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in clients with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

Answer: 4 Rationale: Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1.5 to 2 times the daily requirement to prevent dehydration.

7. A female patient complains of a scab that just wont heal under her left breast. During your conversation, she also mentions chronic fatigue, loss of appetite, and slight cough, attributed to allergies. What are the nurses next steps? a. Continue to conduct a symptom analysis to better understand the patients symptoms and concerns. b. End the appointment and tell the patient to use skin protection during sun exposure. c. Suggest further testing with a cancer specialist and provide the appropriate literature. d. Tell her to put a bandage on the scab and set a follow-up appointment in one week.

ANS: A A comprehensive health history is vital to treating and caring for the patient. Often times, symptoms are vague. The nurse should conduct a symptom analysis to gather as much information as possible. Questions should address the duration of the symptoms and include the location, characteristics, aggravating and relief factors, and any treatments taken thus far.

Which type of cancer has been associated with Down syndrome? a. Breast cancer b. Colorectal cancer c. Malignant melanoma d. Leukemia

ANS: d. Leukemia Leukemia is associated with Down syndrome and Turner syndrome.Breast cancer is often found clustered in families, not in association with Down syndrome. Colorectal cancer is associated with familial polyposis. Malignant melanoma is associated with familial clustering and sun exposure.

443. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

Answer: 1 Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.