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What signs and symptoms of ovarian cancer should a nurse include when educating women? 1. Menorrhagia 2. Loss of appetite 3. Urinary frequency 4. Decreasing abdominal girth 5. Pelvic pain 6. Change in bowel habits

1., 2., & 4. Correct: Signs and symptoms of ovarian cancer include irregular menses, increasing premenstrual tension, menorrhagia with breast tenderness, early menopause, abdominal discomfort, dyspepsia, Loss of appetite, pelvic pressure and urinary frequency. Indigestion, flatulence, and fullness after a light meal, and increasing abdominal girth are significant symptoms. Change in bowel habits such as constipation. 3. Incorrect: Abdominal girth will increase, not decrease.

A client with acute pancreatitis is prescribed total parenteral nutrition (TPN), methylprednisolone, and sliding scale insulin. What is the rationale for the insulin prescribed? You answered this questionCorrectly 1. Impaired endocrine function of the pancreas 2. Inability of the liver to convert glucose 3. Steroid therapy side effects 4. Dextrose concentration of TPN 5. Re-establish serum potassium level

1., 3., & 4. Correct: Really what we are saying here is why would the client be on insulin? Well, the pancreas is damaged and so the endocrine function of the pancreas is impaired. We know that hyperglycemia or pseudo diabetes is a side effect of steroid therapy and TPN is high in glucose and may require additional insulin. These are the three rationales for why they might need insulin. 2. Incorrect: If the liver can't convert glucose that will decrease the insulin need so that one is false. 5. Incorrect: Is not related at all. The NCLEX people want you to say,"I remember something about potassium and glucose, but I am not sure what. Don't fall for that, this is false. The rationale for the Insulin order is not to re-establish potassium in this question.

What signs/symptoms would the nurse expect to find in a client admitted to the unit with a diagnosis of Cushing's disease? You answered this questionIncorrectly 1. Hyperpigmentation 2. Buffalo hump 3. Hirsutism 4. Acne 5. Moon face 6. Hypotension

2., 3., 4., & 5. Correct: Cushing's disease results in an increase in glucocorticoids, mineralocorticoids, and sex hormones resulting in a buffalo hump, hirsutism, acne, moon face, and hypertension. 1. Incorrect: Hyperpigmentation occurs when the body has too little cortisol, such as with Addison's disease. 6. Increase: Hypertension would occur with Cushing's

What is priority for the client experiencing hyperparathyroid crisis? You answered this questionCorrectly 1. Support for airway and breathing. 2. Continuous cardiac monitoring for arrhythmias. 3. Provide safety precautions. 4. Prepare for emergency tracheostomy.

1. Correct: Always remember ABC, if it is relevant, and it is with hyperparathyroid crisis. 2. Incorrect: Circulation is important. This priority comes after attention has been directed toward airway and breathing. What good would come of circulating deoxygenated blood, and how long can the heart muscle last without oxygen? Always remember ABC when prioritizing in emergency situations. 3. Incorrect: Muscle weakness, thus risk for falls is a concern, but airway takes priority! 4. Incorrect: Trach would be more likely with hypoparathyroidism. Remember, in hypoparathyroidism, the client would have rigid and tight muscles which would cause laryngospasms.

What medication would the nurse anticipate for the treatment of hypothyroidism? You answered this questionCorrectly 1. Levothyroxine 2. Methimazole 3. Potassium iodide 4. Propylthiouracil

1. Correct: The client will receive levothyroxine, because what is levothyroxine? That's right it's the synthetic form of T4. 2. Incorrect: Methimazole is correct because it decreases the production of thyroid hormones. It is an antithyroid drug and it is used to "stun" the thyroid pre-operatively. It makes the thyroid "freak out" and stop producing hormones temporarily. 3. Incorrect: Iodine compounds like Lugol's solution® are incorrect because doses of iodine will do what? That's right, large doses will decrease thyroid hormone production for a few weeks. So we do not use an Iodine compound for Hypothyroidism. 4. Incorrect: Propylthiouracil stops the thyroid gland from making too much thyroid hormone. That is not a problem with hypothyroidism.

What is the nursing priority for the client experiencing hyperparathyroidism? You answered this questionIncorrectly 1. Continuous cardiac monitoring. 2. Initiate fall precautions. 3. Administer IV normal saline. 4. Begin preparations for emergency parathyroidectomy.

1. Correct: To much calcium equals sedation. Life threatening complications such as airway obstruction and cardiact arrest may occur from severely high levels of calcium. 2. Incorrect: Preventing injury is important because of bone density loss and risk of fractures. But it is not the priority. Done after maintaining airway and circulation. 3. Incorrect: IV normal saline in large volumes is done to promote calcium excretion, but it is not the priority over airway and circulation. 4. Incorrect: Surgery is indicated "when medically feasible". Cardiac monitoring is the priority at this time.

What should the nurse include in a discharge plan for a client diagnosed with lymphoma who will be receiving outpatient treatment? You answered this questionIncorrectly 1. Store raw food and ready-to-eat food separately. 2. Do not eat food from a buffet or salad bar. 3. Provide MMR vaccine if update needed. 4. Take hand sanitizer with you when you go out. 5. Emphasize importance of frequent oral hygiene with an alcohol based mouthwash.

1., 2., & 4. Correct: The client with lymphoma is susceptible to infection and should eat foods low in bacteria. Raw and uncooked meats, seafood or eggs and unwashed fruits and vegetables have a bacteria count that will be higher than desired. These foods should be kept away from food that is ready to eat. Food from a buffet or salad bar may have been left out too long. This will increase the bacterial count. It is important to perform hand hygiene frequently, even when away from home or away from a water source. The client should carry wet wipes or hand sanitizer when leaving home. 3. Incorrect: Only live vaccines (MMR, varicella, oral polio) are contraindicated in clients receiving chemotherapy. Encourage clients to maintain current immunizations for influenza and pneumonia. They are more susceptible to infection. Cancer and cancer treatment can weaken the immune system, which puts them at higher risk of serious problems if they get the flu or pneumonia. 5. Incorrect: This client is at risk for bleeding and infection due to low platelet and white cell counts. The client needs frequent oral care with a soft toothbrush and alcohol free mouthwash. Alcohol-based mouthwashes can dry out the gum and increase bleeding.

The nurse recognizes which manifestation as a sign/symptom of Hodgkin's lymphoma? You answered this questionIncorrectly 1. Drenching night sweats 2. Small, red, itchy bumps 3. Painful lymph nodes in the neck 4. Weight loss of 2 kg in 1 week 5. Flushed skin 6. Enlarged spleen

1., 2., & 6. Correct. With this disease, the body switches back and forth from fever and chills to excessive sweating. The sweating is the worst at nighttime; and many clients report waking up in the middle of the night to clothing and bedding that is completely drenched. As the lymphoma cells grow, they secrete a chemical that causes a generalized itchiness and irritation of the skin throughout the body. The spleen is part of the lymph system and works as a drainage network that defends the body against infection. Since Hodgkin's lymphoma affects the lymphatic system, the spleen is also affected. 3. Incorrect. The most common symptom of Hodgkin lymphoma is one or more enlarged lymph nodes. The enlarged lymph node may be in the neck, upper chest, armpit, abdomen or groin. The swollen lymph node is usually painless. 4. Incorrect. This is not a significant weight loss. A large decrease in weight is common in many types of cancers and is particularly noticeable in lymphoma cases. 5. Incorrect. Lymphoma lowers the body's red blood cell count, leading to anemia and even greater fatigue. Skin will be pale.

A client has been receiving 5-fluorouracil treatments for colon cancer and is admitted with weakness, fatigue, thrombocytopenia and low grade fever. Which actions would be appropriate for this client? 1. Have dedicated supplies in room 2. Place in private room 3. Provide high-calorie, high-protein diet 4. Limit visitors 5. Provide soft bristled toothbrush 6. Initiate airborne precautions

1., 2., 3., 4., & 5. Correct. This client is at risk for infection and bleeding. Keeping dedicated supplies in room will decrease the risk of infection. Limiting visitors will decrease risk of infection. This client needs a private room because the client is immunocompromised. Unless contraindicated, the client would be prescribed a high-calorie, high-protein diet. Since the client is at risk for bleeding, a soft, rather than hard bristle toothbrush is needed. 6. Incorrect: Airborne precautions are not indicated for this client. Use airborne precautions for pathogens transmitted by the airborne route, such as tuberculosis.

A client diagnosed with cancer has been losing weight. What should the nurse teach the client regarding methods for improving nutritional needs to maintain weight? You answered this questionIncorrectly 1. Add butter to foods 2. Spread peanut butter on toast 3. Add powdered creamer to milkshake 4. Use biscuits to make sandwiches 5. Eat Caesar salads once per day 6. Put honey on top of hot cereal

1., 2., 3., 4., & 6. Correct: Butter and oil added to food will add calories. This client needs more calories and more protein. Spread peanut butter or other nut butters, which contain protein and healthy fats, on toast, bread, or crackers. Use croissants or biscuits to make sandwiches which provides more calories. Add powered creamer or dry milk powder to hot cocoa, milkshakes, hot cereal, gravy, sauces, meatloaf, cream soups, or puddings to add more calories. Top hot cereal with brown sugar, honey, dried fruit, cream or nut butter. 5. Incorrect: Choose meat salads, such as chicken, ham, turkey, or tuna.

What discharge instructions should the nurse include for a client following a transsphenoidal hypophysectomy? You answered this questionIncorrectly 1. Sleep with head of bed at 35 degrees. 2. Notify the primary healthcare provider for an increased urinary output. 3. Oral care should be performed with a sponge until the incision heals. 4. Nasal packing will need to be removed in 48 hours. 5. Use a humidifier in the room. 6. Avoid bending below the level of the heart for two weeks.

1., 2., 3., 5., & 6. Correct. Sleeping with the head of the bed elevated will promote drainage of cerebrospinal fluid. An increased UOP could indicate diabetes insipidus, an adverse reaction to this surgical procedure. Because the incision for this surgery is just above the gumline, the client should not brush the front teeth. Oral care should be performed with a sponge until the incision heals. Humidified air prevents drying of nasal passages. Avoid bending and, especially, placing the head below the level of the heart for two weeks. Doing so can produce headaches and dizziness. 4. Incorrect. There is no nasal packing. The incision is located just above the gumline of the upper teeth.

The nurse recognizes which manifestation as a sign/symptom of Hodgkin's lymphoma? You answered this questionIncorrectly 1. Drenching night sweats 2. Dry, itchy skin 3. Painless lymph nodes in the neck 4. Weight loss of 2 kg in 1 week 5. Pale skin 6. Enlarged spleen

1., 2., 3., 5., & 6. Correct. With this disease, the body switches back and forth from fever and chills to excessive sweating. The sweating is the worst at nighttime; and many clients report waking up in the middle of the night to clothing and bedding that is completely drenched. As the lymphoma cells grow, they secrete a chemical that causes a generalized itchiness and irritation of the skin throughout the body. The skin becomes dry. The most common symptom of Hodgkin lymphoma is one or more enlarged lymph nodes. The enlarged lymph node may be in the neck, upper chest, armpit, abdomen or groin. The swollen lymph node is usually painless. Lymphoma lowers the body's red blood cell count, leading to anemia and even greater fatigue. Skin will be pale.The spleen is part of the lymph system and works as a drainage network that defends the body against infection. Since Hodgkin's lymphoma affects the lymphatic system, the spleen is also affected. 4. Incorrect. This is not a significant weight loss. A large decrease in weight is common in many types of cancers and is particularly noticeable in lymphoma cases.

A client who has diabetes calls the nurse hot-line reporting shakiness, nervousness, and palpitations. Which questions would yield information that would help the nurse decide that this is a hypoglycemic episode? You answered this questionIncorrectly 1. What, and when, have you eaten today? 2. Do you feel sleepy? 3. Have you been extremely thirsty? 4. Can you check your current glucose level? 5. Does your skin feel sweaty? 6. Is your vision blurry?

1., 2., 4., 5., & 6. Correct. This question will give the nurse information about how much time has elapsed since the last meal and will indicate the amount of protein and carbohydrates consumed at the last meal. Even a minor delay in meal times may result in hypoglycemia. As hypoglycemia worsens, level of consciousness declines. So asking if the client is sleepy is a good question. If the client has a glucose monitor, an accurate reading would give the nurse valuable information about how much food the client should consume now. The skin gets cool and clammy (sweaty) with hypoglycemia. As the brain gets less glucose, the eyes are affected.3. Incorrect. Polydipsia is a sign of hyperglycemia.

Which risk factor(s) should the nurse include when planning to educate a group of women about breast cancer? You answered this questionIncorrectly 1. Combination hormone therapy 2. Drinking one glass of wine daily 3. Nulliparity 4. Menarche at age 10 5. Increasing age

1., 3., 4. & 5. Correct: Postmenopausal combination hormone therapy increases the risk for breast cancer. Estrogen-only hormone replacement therapy seems to lower breast cancer risk. Nulliparity (no pregnancies) is a known risk factor for breast cancer. Factors that increase the number of menstrual cycles also increase the risk of breast cancer, probably due to increased endogenous estrogen exposure. Early menarche before age 12 is a known risk factor for breast cancer. The increased risk of breast cancer linked to a younger age at first period is likely due, at least in part, to the amount of estrogen a woman is exposed to in her life. A higher lifetime exposure to estrogen is linked to an increase in breast cancer risk. The earlier a woman starts having periods, the longer her breast tissue is exposed to estrogens released during the menstrual cycle and the greater her lifetime exposure to estrogen. The majority of breast cancer are found in women age 50 or older. 2. Incorrect: Small increase in risk with moderate alcohol consumption, not one glass of wine daily. Drinking low to moderate amounts of alcohol, however, may lower the risks of heart disease, high blood pressure and death. But, drinking more than one drink per day (for women) and more than two drinks per day (for men) has no health benefits and many serious health risks, including breast cancer. Alcohol can change the way a woman's body metabolizes estrogen (how estrogen works in the body). This can cause blood estrogen levels to rise. Estrogen levels are higher in women who drink alcohol than in non-drinkers. These higher estrogen levels may in turn, increase the risk of breast cancer.

The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? You answered this questionCorrectly 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure

2., 3., 4., & 5. Correct: Now, remember that with Addison's disease the client does not have enough steroids, so we have to ADD steroids. All of these options indicate the client is holding onto fluid, and we would expect the client to hold onto fluid when their steroid dose is too high. 1. Incorrect: We would expect weight gain with this client, and what is the amount of weight gain we worry about? That's right, anything over 2-3 lbs (0.907 - 1.360 kg) in 24 hours.

What should the nurse include in the teaching plan for a client receiving external beam radiation? You answered this questionIncorrectly 1. Small marks will be placed on the skin to mark the treatment area. 2. Lotion may be used around the treatment area to decrease dryness. 3. The radiation therapist can see, hear, and talk with you at all times during treatment. 4. The machine will make clicking and whirring noises. 5. You can breath normally during radiation treatment. 6. You will not become radioactive.

1., 3., 4., 5., & 6. Correct: Small ink marks or small tattoos will be placed on the skin to mark the treatment area. Do not remove the marks. The radiation therapist can see, hear, and talk to the client at all times during treatment. Relieve anxiety by letting client know he/she is not alone. The machine will indeed make clicking and whirring noises. Letting the client know this will also relieve anxiety. Client is not radioactive and will not radiate others. The client can safely be around other people, babies, and children. The client will need to stay very still so radiation goes to the exact same place each time, but can breathe as always and does not have to hold breath. 2. Incorrect: Do not put lotion, powder or deodorant near or on treatment area.

What signs/symptoms would the nurse expect to find in a client admitted to the unit with a diagnosis of Addison's disease? You answered this questionIncorrectly 1. Salt cravings 2. Buffalo hump 3. Body hair loss 4. Acne 5. Hyperpigmentation 6. Hypotension

1., 3., 5., & 6. Correct: Addison's disease results in a decrease in glucocorticoids, mineralocorticoids, and sex hormones resulting in a body hair loss, darkening in skin color and hypotension. Salt cravings occur because the client's sodium level decreases. 2. Incorrect: Buffalo hump occurs with Cushing's. 4. Incorrect: Acne occurs with Cushing's.

Which interventions should a nurse discuss with a client for prevention and early detection of skin cancer from exposure to ultraviolet light? You answered this questionIncorrectly 1. Use sunscreen with SPF of 10 when outdoors. 2. Stay in the shade when outdoors. 3. Wear wide brimmed hats when outdoors. 4. Examine skin monthly for changes. 5. Wear long sleeves and pants when working outdoors.

2. 3., 4., & 5. Correct: Using sunscreen with appropriate SPF level, staying in shaded areas, wearing wide brimmed hats, and protective clothing when working in the sun are effective interventions to prevent skin cancer. Examine your whole body monthly for possible changes that may be precancerous or cancerous lesions. Early detection is considered secondary prevention. 1. Incorrect: Sunscreen should have an SPF of 30 or higher. While SPF 15 is the FDA's minimum recommendation for protection against skin cancer and sunburn, the American Academy of Dermatologists recommend choosing a sunscreen with an SPF of at least 30.

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? You answered this questionCorrectly 1. Hypernatremia 2. Hypokalemia 3. Hypocalcemia 4. Hypophosphatemia

2. Correct: Insulin causes movement of potassium into the cells, which can lead to a severe reduction in serum potassium if not regulated appropriately. A severe decrease in serum potassium could be fatal. 1. Incorrect: Although insulin has been shown to increase sodium reabsorption in the kidneys, the change is not as rapid and not as life threatening as the change in potassium. 3. Incorrect: A significant change in the calcium level is not anticipated with the insulin infusion. 4. Incorrect: A significant change in the phosphorus level is not anticipated with the insulin infusion.

A client with a long-standing history of diabetes presents to the emergency department (ED) with a serum blood sugar of 400 mg/dL (22.19 mmol/L). What lab data for this client are consistent with diabetic ketoacidosis (DKA)? You answered this questionIncorrectly 1. Serum sodium 140 mEq/L (140 mmol/L) 2. Ketonuria 3. Serum potassium 5.5 mEq/L (5.5 mmol/L) 4. PaCO2 52 5. pH 7.35

2., & 3. Correct: Normally, no ketones are found in the urine. Ketonuria is associated with poorly controlled diabetes that results in hyperglycemia and breakdown of body fat and protein. Remember dilute makes numbers go down. The potassium will be elevated because insulin is needed to move potassium out of the blood and into the cell. 1. Incorrect: Sodium is essential for maintaining a stable blood pressure and fluid balance in the body. High blood sugar causes excessive urination with loss of body water and sodium. This can cause dehydration and low blood pressure. When the body needs to restore water to the bloodstream, it does so by pulling it from other tissues. This influx of water into the bloodstream may cause blood sodium to be further diluted. A low sodium level can cause symptoms of dizziness, fatigue, general weakness and, if severe, mental confusion or seizures. Insulin and intravenous fluids containing sodium chloride are used to treat the sodium deficit caused by DKA. This sodium level is normal (135-145). 4. Incorrect: The client will have an increased respiratory rate. So the PaCO2 will go down. This PaCO2 is high, so that correlates with hypoventilation. 5. Incorrect: This is a normal pH. With DKA, the client is in metabolic acidosis, so the pH will be low.

Which statements made by a client diagnosed with Addison's disease indicates to the nurse that the client understands fludrocortisone therapy? You answered this questionIncorrectly 1. "Taking my medicine at night will help me sleep." 2. "It is important to wear a medical alert bracelet all of the time." 3. "I can eat processed meats and canned foods." 4. "My medication dose will change based on my daily weight." 5. "I may need more medication if I feel fatigued."

2., 3., 4., & 5. Correct: Medical alert bracelet is an excellent way of informing healthcare providers of a life threatening condition if the client is unable to verbalize that information. This client needs a high sodium diet as they are losing sodium and retaining potassium. So the client can eat processed meats and canned foods, which are high in sodium. Steroid therapy is adjusted according to the client's weight and signs of fluid volume status. Signs of being under medicated include weakness, fatigue, and dizziness. The client will need to report these symptoms, so more medication can be given to the client. 1. Incorrect: Steroids can cause insomnia so the client does not need to take the medication prior to going to bed.

What should a community health nurse include when planning a presentation on risk factors, prevention and early detection of colon cancer? You answered this questionIncorrectly 1. Maintain a diet high in protein. 2. Instruct on weight reduction strategies as needed. 3. Regular screening should begin at age 40. 4. Yearly fecal occult blood test beginning at age 50. 5. Colonoscopy every 10 years beginning at age 45.

2., 4., & 5. Correct: There is a greater risk of developing colorectal cancer in individuals who live a sedentary lifestyle and are overweight. The fecal occult blood test detects blood in the stool through a chemical reaction. This test is done yearly starting at age 50. It is recommended that a colonoscopy be done every 10 years beginning at age 45. 1. Incorrect: A diet high in vegetables, fruits, and whole grains have been linked with a decreased risk of colorectal cancer, whereas, a diet high in red meats, processed meats, and frying can increase risk of colorectal cancer. 3. Incorrect: If there is no identified risk factors (other than age), regular screening should begin at age 50.

A nurse is caring for a client who is diagnosed with diabetic ketoacidosis (DKA). Which primary healthcare provider prescription is appropriate during the first 24 hours of treatment for this client? You answered this questionCorrectly 1. 0.45% saline solution (NaCl) at 50 mL/hr 2. 3% saline solution (NaCl) at 125 mL/hr 3. 0.9% saline solution (NaCl) at 1,000 mL/hr times 2 4. Dextrose 5% in lactated Ringer's solution at 150 mL/hr

3. Correct: 0.9% saline solution should be infused at a rate of at 1,000 mL/hr times 2, up to a total of 10 L in the first 24 hours of treatment. This client will be in a fluid volume deficit or shock and fluid replacement is essential. 1. Incorrect. 0.45% saline would not be administered at 50 mL/hr because the first goal of fluid therapy in DKA is to restore volume in a severely volume depleted client, thus we need normal saline at a faster rate to replace fluid volume. 2. Incorrect. 3% saline solution would be contraindicated in this client because it is a hypertonic solution that would worsen the client's dehydration. 4. Incorrect. Dextrose 5% in lactated Ringer's solution at 150 mL/hr is inappropriate because the blood sugar is too high for infusion of a dextrose containing solution.

What is the priority electrolyte imbalance for the nurse to monitor when caring for a client post op thyroidectomy? You answered this questionCorrectly 1. Hypercalcemia 2. Hyperkalemia 3. Hypocalcemia 4. Hypomagnesemia

3. Correct: Why is hypocalcemia the correct answer? The complication from removal of the thyroid is possible injury or removal of parathyroid glands. This produces a disturbance in calcium levels. The calcium levels fall resulting in hypocalcemia. 1. Incorrect: No, the calcium is not elevated. With possible removal of the parathyroid glands during thyroidectomy the calcium will decrease. 2. Incorrect: Potassium is not the priority electrolyte to monitor post thyroidectomy. 4. Incorrect: No, magnesium is not the priority electrolyte to monitor post thyroidectomy.

Which client diagnosis would a prescription for an intravenous infusion of 1000 mL normal saline with 20 mEq (20 mmol) potassium chloride be appropriate? You answered this questionCorrectly 1. Major burn injury 2. Kidney disease 3. Abdominal cramping with diarrhea 4. Diabetic Ketoacidosis (DKA) 5. Hypokalemia

3., 4. & 5. Correct: Clients with abdominal cramping with diarrhea, diabetic ketoacidosis, and hypokalemia are safe to receive normal saline with potassium chloride. A primary electrolyte found in the lower GI tract is potassium. Therefore, diarrhea can result in excessive losses of potassium and associated hypokalemia can occur. When insulin is given to the client in DKA, it causes a transport of both glucose and potassium out of the blood and into the cell, resulting in hypokalemia. Finally, a client who has hypokalemia from other causes would need potassium replacement as well. 1. Incorrect: Tissue destruction from a major burn will cause release of potassium from the cell and into the blood. Thus, hyperkalemia occurs. An IV infusion with potassium will make the problem worse. 2. Incorrect: With kidney disease and the resulting diminished renal function, the client is at risk for sodium and potassium retention.