Exam 4
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Eat wholesome meals. Avoid spicy and fatty foods. Avoid intake of fluids. Eat warm or hot foods.
Avoid spicy and fatty foods. The patient receiving chemotherapy that is eating spicy foods is putting themselves at higher risk of stomatitis. The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.
The nurse's discharge teaching plan for the woman hospitalized with PID should reinforce which of the following potentially life-threatening complications? -Involuntary infertility -Chronic pelvic pain -Depression -Ectopic pregnancy
Ectopic Pregnancy Rationale:Over a million women experience an episode of PID annually, resulting in over100,000 becoming infertile. One in eight women with a history of PID experiences difficulty getting pregnant (CDC, 2019m). Complications include ectopic pregnancy, pelvic abscess, subfertility, recurrent or chronic episodes of the disease, chronic abdominal pain, pelvic adhesions, and depression
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action? Eggs and milk Fish and poultry Ham and bacon Green, leafy vegetables
Ham and bacon Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon. Also, foods highest in nitrate include leafy greens, but since the question is talking about carcinogens, it is important to note that green leafy vegetables are not liked to the likelihood of forming cancer.
The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which is an example of a vasomotor symptom experienced by menopausal women? Weight gain Bone density Hot flashes Heart disease
Hot Flashes
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings. Inspect the skin frequently.
Inspect the skin frequently. Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
Which is a growth-based classification of tumors? -Sarcoma -Carcinoma -Malignancy -Leukemia
Malignancy Tumors can be classified bases on growth (benign or malignant) or by the basis of the cell or tissue of origin (carcinomas, sarcomas, lymphomas, and leukemias).
The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as: duration. intensity. frequency. peak.
frequency. Explanation: Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. The peak or acme of a contraction is the highest intensity of a contraction.
A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client? the medroxyprogesterone injection oral contraceptive pills (OCPs) a copper intrauterine device implantable contraceptives
oral contraceptive pills (OCPs) Considering the client's smoking habit, oral contraceptive pills may be contraindicated. Oral contraceptives are highly effective when taken properly, but can aggravate many medical conditions, especially in women who smoke. The medroxyprogesterone injection or copper intrauterine devices are not contraindicated in this client and can be used with certain precautions. Implantable contraceptives are subdermal time-release implants that deliver synthetic progestin; these are highly effective and are not contraindicated in this client.
When using the contraceptive patch, a client should understand that it: should be applied to the breasts, hips, or back. should be covered when swimming in a pool because of chlorine's effect on the adhesive. is immediately effective after application. should be applied to the abdomen, buttocks, or back.
should be applied to the abdomen, buttocks, or back. The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? A psychiatric diagnosis everyone has at one time or another. A side effect of the neoplastic drugs. A normal reaction to the diagnosis of cancer. An aberrant psychologic reaction to the chemotherapy.
A normal reaction to the diagnosis of cancer. Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? -Wear disposable gloves and protective clothing. -Break needles after the infusion is discontinued. -Disconnect I.V. tubing with gloved hands. -Throw I.V. tubing in the trash after the infusion is stopped.
Wear disposable gloves and protective clothing.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? uses the treadmill for 30 minutes on 5 days each week eats red meat such as steaks or hamburgers every day works as a secretary at a medical radiation treatment center drinks one glass of wine at dinner each night
eats red meat such as steaks or hamburgers every day Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.
A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? Closely monitor the client for at least 3 months. Closely monitor the client for at least 3 days. Closely monitor the client for at least 4 weeks. Closely monitor the client for at least 5 months.
Closely monitor the client for at least 3 months. After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
A woman with HPV is likely to present with which nursing assessment finding? -Profuse, pus-filled vaginal discharge -Clusters of genital warts -Single painless ulcer -Multiple vesicles on genitalia
Clusters of genital warts
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Control Cure Prevention Palliation
Control The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.
A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse? "The surgeon is going to use a laser to remove the area." "The surgeon is going to use liquid nitrogen to freeze the area." "The surgeon is going to use radiofrequency to ablate the area." "The surgeon is going to use medication to inject the area."
The surgeon is going to use liquid nitrogen to freeze the area. Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.
The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "The child will be held by the mother on her lap with his back toward the health care provider." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible." "The child will be placed in the prone position with the nurse holding the child still." "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back."
"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.
The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? "The hair loss is usually temporary." "New hair growth will return without any change to color or texture." "Clients with alopecia will have delay in grey hair." "Wigs can be used after the chemotherapy is completed."
"The hair loss is usually temporary." Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder."
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.
Which of the following is considered to be the most potent neuromodulators? Enkephalins Efferent Afferent Endorphins
Endorphins Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent.
*distinguish frequency of contractions from duration*
Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction.
When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. General health Medication history Sexual history Surgical history School history
General health, Medication history, Sexual history (5P's), Surgical history The nurse will need to gather a thorough health history that will include information related to general health, medications, past sexual history, and surgical history.
Which of the following contraceptive methods offers protection against sexually transmitted infections (STIs)? -Oral contraceptives -Withdrawal -Latex condom -Intrauterine system
Latex Condom
The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care? Preventing constipation Observing for diarrhea Assessing for impaired urinary elimination Observing for bowel incontinence
Preventing constipation The most common side effects associated with opioid use are sedation, nausea, and constipation. Respiratory depression is also a commonly feared side effect of opioid use. Urinary elimination and bowel incontinence are not affected by opioid use.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment." "I'm worried I'll expose my family members to radiation." "I'll wear protective clothing when outside."
"I'm worried I'll expose my family members to radiation." The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Excisional biopsy Incisional biopsy Needle biopsy Punch biopsy
Excisional biopsy Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which are common vasomotor symptoms? Chronic fatigue and confusion Forgetfulness and irritability Night sweats and hot flashes Decrease in sexual response and appetite
Night sweats and hot flashes the only listed vasomotor symptoms. forgetfulness and irritability and chronic fatigue and confusion are cognitive changes, decrease in sexual response and appetite are physiologic changes.
Which comment by a woman would indicate that a diaphragm is not the best contraceptive device for her? "My husband says it is my job to keep from getting pregnant." "I have a hard time remembering to take my vitamins daily." "Hormones cause cancer and I don't want to take them." "I am not comfortable touching myself down there."
"I am not comfortable touching myself down there." Diaphragms require the woman to insert them up to 2 hours prior to intercourse and can be left in for up tp 6 hours after intercourse. They are inserted with spermicidal jelly or cream around the dome (which is not a hormone). DIaphragms have to be fitted by the health care provider and should be resized if the woman experiences a gain or loss of 10 lbs or more. Diaphragms are user-controlled, non hormonal methods that are needed only at the time of intercourse, but they are not effective unless used correctly. Women need to receive thorough instruction about diaphragm use and should practice putting one in and taking it out before they leave the health care officeProtection against ovarian cancer,
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? "I floss my teeth every morning." "I use an electric razor to shave." "I take a stool softener every morning." "I removed all the throw rugs from the house."
"I floss my teeth every morning." A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.
A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "The use of surrogates is more acceptable today." "Being childless is not as bad as you think it is."
"I will call the health care provider to come visit with you." The nurse needs to notify the health care provider because the client does not have a clear understanding of the outcomes of the procedure in which she is about to undergo.
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? "She always cries when the person holding her has on glasses...I guess glasses scare her." "She typically breastfeeds, but lately we have had to supplement with some oat cereal." "She has been irritable for the last hour....seems like she is just upset for some reason." "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper."
"She has been irritable for the last hour....seems like she is just upset for some reason." Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.
A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize? "Take the medication on an empty stomach." "Start taking the medication when you first get your period." "Add an aspirin to the regimen if you do not get relief right away." "It is normal for your bowel movements to be black."
"Start taking the medication when you first get your period." When taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for dysmenorrhea, it is important for the woman to start therapy prophylactically and use sufficient doses to maximally suppress prostaglandin production. NSAIDs should be taken with food to prevent gastrointestinal upset. They should not be taken with aspirin because doing so can increase the risk of bleeding, which would be noted with black stools.
A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse? "A bath will make you feel better." "Do you want to skip the bath today?" "Would you like to talk about what you are feeling?" "I can give you some medicine to make you feel better."
"Would you like to talk about what you are feeling?" By asking the client talk may open the door for further discussion and sharing of feelings, fears, etc. A bath will make the client feel better and asking if the client wishes to skip the bath today are matter-of-fact comments and disconnect, resulting in a shutdown to further communication. The nurse stating that medication could be given is a quick fix and demonstrates a nontherapeutic response.
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is "You will need to practice birth control measures." "You will continue having your menses every month." "You will experience menopause now." "You will be unable to have children."
"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.
After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? 1 2 3 4
3 The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows:1 = awake and alert; no action necessary2 = occasionally drowsy but easy to arouse; requires no action3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.
The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? -A lack of fully developed hearing. -A less discriminating sense of touch. -Visual acuity that has not fully developed. -A less discriminating sense of taste.
A less discriminating sense of taste.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Adjuvant therapy is likely. Palliative care is likely. Repeat biopsy is needed before treatment begins.
Adjuvant therapy is likely. T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Serving small portions of bland food Encouraging rhythmic breathing exercises Administering metoclopramide and dexamethasone as ordered Withholding fluids for the first 4 to 6 hours after chemotherapy administration
Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? Onset of cancer after age 50 in family member A first cousin diagnosed with cancer A second cousin diagnosed with cancer An aunt and uncle diagnosed with cancer
An aunt and uncle diagnosed with cancer The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.
A 9-year-old client suffered a head injury. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? Assess the level of consciousness (LOC). Notify the primary health care provider. Place the child on fall precaution. Place a patch over the client's affected eye.
Assess the level of consciousness (LOC). Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? -Autologous -Prophylactic -Therapeutic --Allogeneic
Autologous Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.
A client returns to the surgeon's office for a report on a diagnostic procedure to determine the cell composition of the client's abdominal neoplasm. Which terms are significant to indicate the likelihood of the tumor spreading? Select all that apply. benign neoplasm primary site lesion angiogenesis
Benign, Neoplasm, Angiogenesis Tumors are classified according to their cell of origin and whether their growth is benign, meaning not invasive or spreading, or malignant, meaning invasive and capable of spreading. New growths of abnormal tissue are called neoplasms, which demonstrate uncontrolled cell growth that follows no physiologic demand. The term angiogenesis refers to growth of new blood vessels that allow cancer cells to grow, so tumor spreading is involved. The term primary site may be used in reference to the origins of an initial tumor if metastasis, or the development of a secondary tumor from the primary tumor at a distant location, has occurred. A lesion generally appears on the skin and looks like a mole.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? -No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis -Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis -Can't assess tumor or regional lymph nodes and no evidence of metastasis -Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? -Promotion -Initiation -Prolongation -Progression
Progression The stages in order are 1. initiation, 2. Promotion, and 3. progression. Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? Erythema Flare Extravasation Thrombosis
Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Extravasation Stomatitis Nausea and vomiting Bone pain
Extravasation Definition:The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it. The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
The nurse works in a pain clinic and sees clients who have various conditions resulting in pain. A number of modalities are prescribed for the clients' treatments. For which client will the nurse question a prescription for a transcutaneous electrical nerve stimulator (TENS)? older adult client who has degenerative joint disease client who plans to use it on an as needed basis client who is postoperative for surgery to the leg client who is 4 months' pregnant
client who is 4 months' pregnant The TENS unit is contraindicated for the pregnant client because it is not known how the TENS unit will affect the fetus. The TENS unit is used for clients who have chronic pain, such as the one who has degenerative joint disease, and for clients who are recovering from surgery. The TENS unit may be used whenever the client feels a need for it.
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. eye opening verbal response motor response fontanels (fontanelles) posture
eye opening, verbal response, motor response
A client diagnosed with cancer has the tumor staged and graded based on what factors? How they tend to grow and the cell type How they spread and tend to grow How they differentiate the cell type How they spread and differentiate
How they tend to grow and the cell type Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer. Stage refers to size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis. TNM is often used to describe the stage of the tumor. Grading systems seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin (differentiation).The grade corresponds with a numeric value ranging from I to IV. Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. Tumors that do not clearly resemble the tissue of origin in structure or function are described as poorly differentiated or undifferentiated and are assigned grade IV. These tumors tend to be more aggressive, less responsive to treatment, and associated with a poorer prognosis as compared to well-differentiated, grade I tumors.
The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? It is used to remove cancerous cells using a needle. It removes an entire lesion and the surrounding tissue. It removes a wedge of tissue for diagnosis. It treats cancer with lymph node involvement.
It removes a wedge of tissue for diagnosis. The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority? Administer lorazepam rectally to the client. Refer the client to a neurologist. Discuss dietary therapy with the client's caregivers. Protect the child from hitting the arms against the bed.
Keeping the child safe during a seizure is the highest priority. The nurse will protect the child from hitting the arms on the bed or other nearby objects. If the seizure continues, lorazepam may be indicated to stop the seizure. The client would be referred to a neurologist for follow-up care; however, this is not a priority. Dietary therapy is considered for clients with chronic seizure disorders who do not respond to medication therapy.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a bone marrow transplant? Monitor the client's toilet patterns. Monitor the client closely to prevent infection. Monitor the client's physical condition. Monitor the client's heart rate.
Monitor the client closely to prevent infection. Until transplanted bone marrow begins to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.
A couple reports that the condom broke while they were having sexual intercourse last night. What would you advise to prevent pregnancy? Inject a spermicidal agent into the woman's vagina immediately. Obtain emergency contraceptives and take them immediately. Douche with a solution of vinegar and hot water tonight. Take a strong laxative now and again at bedtime.
Obtain emergency contraceptives and take them immediately. Condoms are not perfect barriers because breakage and slippage can occur. Emergency postcoital contraception may need to be sought to prevent a pregnancy. EC's should be used within 72 to 120 hours of unprotected intercourse to prevent pregnancy. The sooner ECs are taken, the more effective they are. They reduce the risk of pregnancy for a single act of unprotected sex by almost 90% (WHO, 2018b). The methods currently available in the United States are (1) ulipristal acetate (UPA), an oral progesterone receptor agonist-antagonist (Ella); (2) levonorgestrel (LNG), an oral progestin (Plan B One-Step); (3) the copper intrauterine device (Cu-IUD); and (4) off-label use of combined oral contraceptives
A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? NSAIDs Corticosteroids Opioid analgesics Nonopioid analgesics
Opioid analgesics The nurse would expect to administer opioid analgesics to a client with severe pain following a mastectomy. Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are usually the drugs of choice for both acute and persistent moderate chronic pain. Corticosteroids would be used to address inflammation and swelling.
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Prophylactic Reconstructive Salvage
Palliative Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? Place the client in a private room. Place a chair next to the bed to allow the spouse to sit. Have visitors wear dosimeters for safety. Allow visitors to telephone only.
Place the client in a private room. Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.
The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort? endometrial ablation dilatation and curettage (D&C) uterine artery embolization hysterectomy
hysterectomy If the client does not respond to medical therapy, surgical intervention might include dilatation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.
Which are noncontraceptive benefits of combined oral contraceptives? Select all that apply. Protection against ovarian cancer Protection against endometrial cancer Protection against breast cancer Reduction in incidence of ectopic pregnancy Prevention of functional ovarian cysts Reduction in the risk of deep venous thrombosis Reduction in the risk of colorectal cancer
Protection against ovarian cancer, Protection against endometrial cancer, reduction in incidence of ectopic pregnancy, Reduction in the risk of colorectal cancer. OCP's slightly increase the risk of developing breast cancer. full list of benefits: Reduced incidence of ovarian, colorectal, and endometrial cancer Treatment of symptoms of endometriosis Decreased incidence of acne and hirsutism Decreased incidence of ectopic pregnancy Decreased incidence of acute PID and possible protection against PID Reduced incidence of fibrocystic breast disease Decreased perimenopausal symptoms Reduced risk of developing uterine fibroids Maintenance of bone mineral density Improvement in asthmatic symptoms Delayed onset of multiple sclerosis and arthritis Increased menstrual cycle regularity Lower incidence of colorectal cancer Decreased number of pregnancy-related deaths by preventing pregnancy Reduced iron-deficiency anemia due to heavy menstrual bleeding Reduced incidence of dysmenorrhea (Oyelowo & Johnson, 2018)
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of 2.6 mEq/L Blood pressure of 120/64 to 130/72 mm Hg Sodium level of 142 mEq/L
Serum potassium level of 2.6 mEq/L Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? Onset and character of fever Degree and extent of nuchal rigidity Signs of increased intracranial pressure (ICP) Occurrence of urine and fecal contamination
Signs of increased intracranial pressure (ICP) Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? White blood cell (WBC) count of 9,000 cells/mm3 Stage 3 pressure ulcer on the left heel Temperature of 98.3° F (36.8° C) Ate 75% of all meals during the day
Stage 3 pressure ulcer on the left heel A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.
A 30-year-old client would like to try using basal body temperature (BBT) as a fertility awareness method. Which instruction should the nurse provide the client? Avoid unprotected intercourse until BBT has been elevated for 6 days. Avoid using other fertility awareness methods along with BBT. Use the axillary method of taking the temperature. Take temperature before rising, and record it on a chart.
Take temperature before rising, and record it on a chart. The client should be instructed to take her temperature before rising and record it on a chart. If using this method by itself, the client should avoid unprotected intercourse until the BBT has been elevated for 3 days. The client should be informed that other fertility awareness methods should be used along with BBT for better results. The oral method is better suited than the axillary method for taking the temperature in this case.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? -The client should consider getting a wig or cap prior to beginning treatment. -Alopecia related to chemotherapy is relatively uncommon. -The hair will grow back within 2 months post therapy. -The hair will grow back the same as it was before treatment.
The client should consider getting a wig or cap prior to beginning treatment. If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.
The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? To remove the tumor from the brain To prevent the formation of new cancer cells To analyze the lymph nodes involved To destroy marginal tissues
To prevent the formation of new cancer cells Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: expected chemotherapy-related adverse effects. chemotherapy exposure and risk factors. signs and symptoms of infection. reinforcement of the client's medication regimen.
chemotherapy exposure and risk factors. The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will: show movement of the GI tract. remove a tissue sample from the GI tract. show tumor "hot spots" in the GI tract. provide a three-dimensional cross-sectional view.
show movement of the GI tract. A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor.
A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has had a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend? transdermal contraception sterilization cervical cap diaphragm
transdermal contraception The fact that this woman has a latex allergy rules out the cervical cap and diaphragm. Moreover, the diaphragm is contraindicated in her case due to her papillomavirus infection. The best choice for her is transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily.
A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? visceral pain referred pain cutaneous pain somatic pain
visceral pain Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial. Somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix.
