Inter Medsurg 1

After change-of-shift report on the oncology unit, which patient should the nurse assess first?

Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)

A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which is most important to report to the health care provider?

There is an area on the breast that is hot, pink, and tender to touch.

The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

Heparin

A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. Which information will the nurse include when discussing HRT with the patient?

She and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer.

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?

The UAP assists the patient to use dental floss after eating.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?

The patient's visitors bring in fresh peaches.

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?

White blood cells (WBC) 2700/µL

After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about

tamoxifen (Nolvadex).

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem?

Encourage the patient to purchase a wig or hat to wear when hair loss begins.

A patient with a small immobile breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that

FNA is done in the outpatient clinic, and results are available in 1 to 2 days.

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?

Hemoglobin (Hgb) level

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?

Hospitalization is required for several weeks after the stem cell transplant.

A patient with stage II breast cancer tells the nurse, I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I should do? Which response by the nurse is best?

Tell me what you understand about the surgical options that are available.

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching?

The patient swims several days each week.

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?

White blood cell (WBC) count of 2800/µL

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

A 24-yr-old patient who received neck radiation and has blood oozing from the neck

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective?

"I will need follow-up examinations for many years after treatment before I can be considered cured."

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?

"Malignant tumors may spread to other tissues or organs."

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?

Apply prescribed anesthetic gel to oral lesions before meals

A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which topic indicates that the student needs more education about breast cancer diagnostic testing?

CA 15-3 level testing

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)?

Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory result would the nurse expect to find?

Elevated reticulocyte count

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect?

Elevated temperature

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?

I rarely have the energy to get out of bed."

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which nursing action should be included in the plan of care?

Post a sign at the bedside warning against blood pressures or venipunctures in the right arm.

When the nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), which assessment finding is most important to communicate to the health care provider?

The patients apical pulse is irregular.

The health care provider orders a liver/spleen scan for a patient who has been in a motor vehicle accident. Which action should the nurse take before this procedure?

Assist the patient to a flat position.

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information?

"Can you tell me what has been helpful to you in the past when coping with stressful events?"

When a patient is scheduled for stereotactic core biopsy of the breast, which information will the nurse include in patient education?

A local anesthetic will be given before the biopsy specimen is obtained.

A patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching?

Check wound drains for excessive blood or any foul odor.

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?

Clean the perianal area carefully after every bowel movement.

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider?

Crackles heard at the lung bases

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider?

Increased carcinoembryonic antigen (CEA)

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

Numbness of the extremities

During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?

Obtain more information about the family history.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?

Patient has crackles up to the midline posterior chest.

Which information shown in the accompanying figure about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care provider?

Platelet count

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

Stop the infusion if swelling is observed at the site.

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?

Suggest use of a daily planner and encourage adequate rest and sleep.

The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)?

The patient's age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy.

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

"Do you take salicylates?"

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?

"I can buy aloe vera gel to use on my skin."

When the nurse is caring for a patient with left arm lymphedema, which action will be included in the plan of care?

Assist with application of compression dressings

To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in her breast, which question is most pertinent for the nurse to ask?

At what age did you start having menstrual periods?

During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. Which action should the nurse take first?

Question the patient about any medications being currently used.

Which information will the nurse include when teaching a patient about the transverse rectus abdominis musculocutaneous (TRAM) procedure?

Recovery from the TRAM surgery takes at least 6 to 8 weeks.

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?

C. Hematuria

Following a lumpectomy, a patient is scheduled for external beam radiation to the right breast. Which information should the nurse include in patient teaching?

Careful skin care in the radiated area will be necessary.

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care?

Establish time to take a short walk almost every day.

After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that teaching has been successful?

I will avoid reaching over the stove with my left hand.

After the nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been effective?

I will call immediately if I have any eye problems.

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?

Serum sodium of 126 mEq/L

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?

Shortness of breath

A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?

The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to

instruct the patient to call if she notices ankle swelling.

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

"Do you have any history of lung disease?"

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective?

"The biopsy will help decide the treatment for my enlarged prostate."

A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate?

"The cancer involves only the cervix."

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?

"Would you like to talk about options for the care of your children?"

When the nurse is assessing the breasts of a 31-year-old, which finding is most indicative of a need for further evaluation?

A nodule that is 1 cm in size, painless, and fixed

Which of the following nursing interventions for the patient who has had right-sided breast-conservation surgery and an axillary lymph node dissection is appropriate to delegate to an LPN/LVN?

Administering an analgesic 30 minutes before the scheduled arm exercises

The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?

Blueberry yogurt

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care?

Dysfunctional family processes related to effect of illness on family members

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?

IL-2 enhances the body's immunologic response to tumor cells.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?

The UAP stands by the patient's bed for 30 minutes talking with the patient.

The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer?

Discuss risks associated with cigarette smoking during each patient encounter.

When teaching a 28-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that

performing BSE right after the menstrual period will improve comfort

The pathology report for a 42-year-old who has had a modified radical mastectomy identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the patient about

tamoxifen (Nolvvadex)

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

Assess for sensation and strength in the legs

A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure

Decreasing the tumor size will improve the effects of other therapy

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?

A 2-cm nontender supraclavicular node

Which action should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection?

Ask the patient to describe what she knows about the surgery

A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test?

Bone marrow biopsy

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient?

Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action would address the cause of the patient problem?

Avoid giving the patient foods that are strongly disliked.

A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate?

Administer prescribed antiemetics 1 hour before the treatments.

The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer?

Baked chicken

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

Have the patient lie on the left side for 1 hour.

Which statement by a 52-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that patient teaching may be needed?

Mastectomy will be the best choice to decrease the chance of cancer recurrence.

A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?

Rinse the mouth before and after each meal and at bedtime with a saline solution.

When the nurse is working in the womens health care clinic, which of these actions is appropriate to take?

Talk about magnetic resonance imaging (MRI) with a 26-year-old with a BRCA-1mutation.

The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?

Wash hands and avoid persons who are ill.

The nurse reviews the complete blood count (CBC) and white blood cell (WBC) differential of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?

White blood cells (WBCs) 15,500/µL