Med Surg 273 Exam 2
Name three collaborate problems/ potential complications of Acute Leukemia
infection bleeding DIC renal dysfunction tumor lysis syndrome musositosis
the nurse is conducting a class on drugs for malignant tumors for a group of new oncology staff members. which best describes the action of interferons in the management of malignant tumors?
interferons have antiviral and anti tumor properties and strengthen the immune system
Which of the following dietary recommendations should the nurse make to increase the intake of nutrients needed for erythropoiesis?
Milk, eggs, liver and green leafy vegetables.
The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?
"My cancer has now spread to my liver."
A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following?
"My partner will not need any treatment."
The client diagnosed with ovarian cancer is prescribed radiation therapy for regional control of the disease. Which statement indicates the client requires further teaching?
"Nausea caused by radiation therapy cannot be controlled."
The client with benign prostatic hyperplasia has undergone a transurethral resection of the prostate. (TURP) and is asking why he needs continuous bladder irrigation. (CBI). The nurse's best response would be:
"The irrigation prevents blood from clotting and blocking the catheter."
A client is having prostate-specific antigen (PSA) testing done. Which result would the nurse identify as abnormal?
4.6 nanograms/milliliter
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?
50
The nurse working on the postoperative unit receives a report on various clients. Based on the information provided, whom should the nurse see first?
A 67-year-old male patient recovering from a prostatectomy, with a potassium level of 4.0 mEq/L and a serum sodium level of 130 mEq/L. Vital signs are temperature 99.2°F, pulse 88, respirations 22, and blood pressure 156/92.
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?
A leukocyte count >100,000/mm3
The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a negative biopsy report?
A wide excision of lump will be performed.
The risk of breast cancer and/or ovarian cancer is often greatly increased if:
A woman inherits a harmful mutation in the BRCA 1 and/ or BRCA 2 gene.
Which hormone causes the kidneys to reabsorb sodium?
Aldosterone
Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true.
Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity.
Which of the following medication classifications are associated with erectile dysfunction? Select all that apply.
Antifungals Antipsychotics Beta blockers Antiseizure agents Antispasmodics
A client is beginning external beam radiation to the right axilla after a lumpectomy. The nurse should teach the client to:
Apply deodorant only under the left arm.
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?
Apply prolonged pressure to needle sites or other sources of external bleeding
Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?
Brachytherapy
Which type of yeast infection is manifested by white, cheeselike discharge?
Candidiasis
The nurse notes that the client's urine is blood-tinged following cystoscopy. Which nursing action should the nurse take next?
Document the finding in the health record.
When a female client reports profuse purulent discharge, dysuria, and bleeding, the advance practice nurse is most likely to prescribe which medication to treat this condition?
Doxycycline for 1 week
A client has chronic myeloid leukemia and leukocytosis. Which clinical manifestations would the nurse expect to find when assessing this client?
Dyspnea and slight confusion.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia?
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
A client with end-stage renal disease has a decreased red blood cell production. What medication can the nurse administer with physician's order that will increase the production of erythrocytes?
Epoetin alfa
The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends
Exercising at least 60 minutes per day doing moderate to vigorous activties at least 5 days per week
True/False. In most laboratories, prostate-specific antigen (PSA) values greater than 4ng/mL are considered elevated and a positive indicator of prostate cancer.
False PSA levels are not a positive indicator of prostate cancer
True/False. Herpes Simplex Virus-2 (HSV-2) is able to be cured with treatment with acyclovir.
False.
The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone?
Finasteride (Proscar)
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important?
Flush the toilet twice after every use.
When triaging in the clinic, which client should be seen first? The client with:
Genital herpes infection diagnosed yesterday, complaining of a headache.
A patient who complains of a dull, continuous pain in the suprapubic area that occurs with, and at the end of, voiding would most likely be diagnosed with which of the following?
Interstitial cystitis
A nurse is teaching a 53-year-old man about prostate cancer, given the fact that he has a family history of the disease. What information should the nurse provide to best facilitate the early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done as recommended.
Which component of client teaching helps the nurse assist a client following treatment for cancer of the prostate gland to manage and minimize the possibility of a recurrence of the primary cancer or metastasis?
Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies.
When assessing a client with anemia, which assessment is essential?
Health history, including menstrual history in women
The nurse understands that the client should be with human papilloma virus (HPV) vaccine per the health care provider's orders. What is this vaccine for?
Help prevent cervical cancer
A nurse is obtaining health history from a woman with suspected cervical cancer. Which of the following would the nurse identify as a possible risk factor?
History of chronic pelvic infections
An oncology nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse should anticipate what imbalance?
Hypercalcemia
A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order?
I.M.
The nurse is providing an educational presentation on toxic shock syndrome to a group of adolescents. Which preventive measure is a primary focus for this group?
If using tampons, change frequently.
All prostatectomies include the risk of damage to the pudendal nerve. Therefore, postoperatively, the nurse assesses for:
Impotence
The nurse is providing education regarding sexually transmitted infections. Which statement regarding herpes virus 2 (herpes genitalis) is accurate?
In pregnant women with active herpes, babies delivered vaginally may become infected with the virus.
A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for?
Infection
A nurse is preparing a presentation about cervical cancer for a local woman's group. Which of the following would the nurse include as a possible risk factor for the development of cervical cancer?
Infection with humanpapilloma virus (HPV)
Which statement is accurate regarding sildenafil?
Its side effects include headache, flushing, and dizziness.
The nurse reports to work an evening shift on the postsurgical unit. Based on the information received before beginning the shift, which client does the nurse need to see first?
June, 2 days after abdominal surgery, reports chest discomfort. June's vital signs are temperature, 99.4°F, pulse 98, respirations 12, and blood pressure 140/86.
A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic tests to confirm. What test would physician order?
KUB
When caring for a client with an uncomplicated mild urinary tract infection (UTI), the nurse knows that recent studies have shown which drug to be a good choice for short-course (e.g., 3-day) therapy?
Levofloxacin
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?
Maintain nutrition.
A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms?
Multiple myeloma
a patient is asking about the use of saw palmetto for prostate health. The nurse tells him that drugs that interact with saw palmetto include:
NSAIDs
Which medication should be readily available for patients receiving epidural opioids who are experiencing respiratory depression?
Naloxone
What assessment finding best indicates that the client has recovered from induction therapy?
Neutrophil and platelet counts within normal limits
The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?
Observe stools for blood.
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?
Obtain the pain medication and delay the bath and position change until the medication reaches its peak.
What term refers to the time the pain began?
Onset
A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?
Packed red blood cells (RBCs)
A patient is admitted to a hospital with a diagnosis of spastic, neurogenic bladder. The nurse is aware that the pathophysiology of this condition is primarily due to which of the following occurrences?
Patient's inability to exert motor control
Yellow-green vaginal discharge, pelvic pain and dyspareunia are signs and symptoms of________
Pelvic Inflammatory Disease
A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure?
Peripheral edema
A client's blood work reveals a platelet level of 17,000/mm3. When inspecting the client's integumentary system, what finding would be most consistent with this platelet level?
Petechiae
A client with a history of chronic renal infections is to undergo CT with contrast. Before the procedure, the nurse should complete which action?
Place emergency medical equipment in the procedure room.
The nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?
Places the client in a private room
A client has been diagnosed with a lymphoid stem cell defect. This client has the potential for a problem involving which of the following?
Plasma cells
The nurse would interpret that a client is most severely at risk for bleeding when which of the following is noted on laboratory test results?
Platelets are 20,000.
The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?
Pneumococcal vaccine
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.
Popliteal Inguinal Submental Neck
A young mother with a 2 year old and a 6 month old is experiencing fatigue related to anemia. The client states that she is having difficulty performing the activities needed for her job, family, and home. With what task is it most appropriate for the nurse to assist the client?
Prioritizing and balancing activities and rest.
A client is being taught to self-administer a narcotic analgesic by means of an intravenous pump system. Which of the following functions is designed to help prevent the client from unintentionally overdosing?
Programming the dosage and time interval into the device
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client?
Promote safety.
You are providing care for the 25 year old college student with an upper urinary tract infection. Which intervention should you delegate to the UAP Unlicensed Assistant Personnel /PCA Patient Care Assistant?
Providing the client with a clean-catch urine sample container.
A 27-year-old female client is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this client is "disturbed body image related to perception of femininity." What intervention would be most appropriate for this client?
Reassure the client that she will still be able to have intercourse with sexual satisfaction and orgasm.
The nurse is monitoring a client who is in the hospital and has a fentanyl patch in place for the control of breakthrough pain for breast cancer. What would be a concern for the nurse when she obtains vital signs for this client?
Respiratory rate of 10 breaths/minute
A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this client, the nurse should assign the highest priority to which nursing diagnosis?
Risk for Infection
An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder?
Severe asthma
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?
Shorten the period of neutropenia
Which type of hemolytic anemia is categorized as inherited disorder?
Sickle cell anemia
f extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first?
Stop the infusion immediately while leaving the catheter in place.
Which STD seems to accelerate in HIV-positive clients?
Syphilis
Which of the following is the only reliable source for quantifying pain?
The client
Which situation might cause the nurse to think that the client has von Willebrand's disease?
The client has prolonged bleeding following surgery.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
The client reports bladder spasms and the urge to void.
The client had a total abdominal hysterectomy (TAH) for cancer of the uterus. Which discharge instructions should the nurse teach?
The client should practice pelvic rest until seen by the HCP.
The nurse is caring for the following clients. Which client should the nurse assess first?
The client whose platelet count is 75,000 per cubic millimeter of blood.
Which of the following findings in the focused assessment of a mole on a client's skin should is a priority for the nurse report to the health care provider?
The mole is now a deeper, darker brown with irregular margins, different from the last exam.
When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI?
The number of sexual partners
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.
Which of the following is true regarding the use of narcotic analgesics in older adults?
There is an increased potential for falls related to sedation.
The nurse assesses a patient for late-stage chronic lymphocytic leukemia (CLL) by looking for what?
Thrombocytopenia.
True/False. Chlamydial infection and gonorrhea infections often coexist.
True. Chlamydial infection and gonorrhea infections often coexist.
True/False. Prostatitis is the most common urologic diagnosis in men younger than 50 years of age.
True. Prostatitis is the most common urologic diagnosis in men younger than 50 years of age.
True/False. Syphilis is a treatable disease that can cause deafness, meningitis, and low birth weights in newborns.
True. Syphilis is a treatable disease that can cause deafness, meningitis, and low birth weights in newborns.
True/False. Testicular cancer is the most common cancer diagnosed in men between ages 15 and 35 years of age.
True. Testicular cancer is the most common cancer diagnosed in men between ages 15 and 35 years of age.
True/False: When Iron Sucrose is administered to a client, it is a priority to assess for hypotension.
True. When Iron Sucrose is administered to a client, it is a priority to assess for hypotension.
True/False: When assessing for a blood transfusion reaction, the nurse assess for back pain.
True. When assessing for a blood transfusion reaction, the nurse assess for back pain.
When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction?
Type II (cytolytic, cytotoxic) hypersensitivity reaction
Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy?
Using a reliable method of contraception for several weeks.
A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?
Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
The client is to receive a unit of packed red blood cells. What is the nurse's first action?
Verify that the client has signed a written consent form.
A client is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications?
Vitamin B12
For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of
Vitamin B12
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
Vitamin B12 deficiency
A client with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin. The nurse should recognize the possible need for what antidote?
Vitamin K
In a normal blood clotting cycle, the final formation of a clot will occur at which of the following times?
When fibrin reinforces the platelet plug.
Lifestyle influences that are considered risk factors for colorectal cancer include:
a high fat low fiber diet
several patients have standard orders for acetaminophen as needed for pain. When the nurse reviews their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication?
a patient admitted with severe hepatitis
when giving calcium intravenously the nurse needs to administer it slowly, keeping in mind that rapid intravenous administration may cause which problem?
cardiac dysrhymias
during treatment with doxorubicin (adriamycin) the nurse must monitor closely for which potentially life threatening adverse effect?
cardiomyopathy
____________ cancer is the leading cause of gynecologic cancer deaths in the United States.5. A vesicovaginal fistula is an opening between the bladder and the vagina.
cervical
A client had a cystoscopy. Which of the following indicate that the client has developed a complication after the cystoscopy?
chills
a patient is experiencing stomatitis after a round of chemotherapy. which intervention by the nurse is correct?
clean the mouth with a soft bristle toothbrush and warm saline solution.
_________ is the appropriate substance other than water to give a patient who is taking oral iron supplements.
orange juice
Which are the following are clinical manifestations found in the assessment of a client with Multiple Myeloma? SELECT ALL THAT APPLY
-hypercalcemia -bone pain -renal failure
A nurse is reviewing the health history of a client who has been diagnosed with endometrial cancer. Which of the following would the nurse identify as a factor increasing this client's risk? Select all that apply.
-Obesity -Nulliparity
Which statement by the client demonstrates an understanding related to a Pap test?
"I need to have my first Pap test when I turn 21 or earlier if I become sexually active."
A client presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?
Assess for signs of injury.
Which condition is a downward displacement of the bladder toward the vaginal orifice?
Cystocele
when teaching a patient who is taking oral contraceptive therapy for the first time, the nurse relates that adverse effects may include which of the following?
nausea
a patient calls the clinic because she realized she missed on dose of an oral contraceptive. which statement from the nurse is appropriate?
- go ahead and take the missed dose now, along with todays dose - you will need to use a backup form of contraception concurrently for 7 days
The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? SELECT ALL THAT APPLY.
-"I can usually keep my ostomy pouch on for 3 to 7 days before changing it." -"I must use a skin barrier to protect my skin from urine."
The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.
-"I will never have another urinary stone again." -"I need to take allopurinol." -"Tylenol is best to control my pain." -"I'm so glad I don't have to make any changes in my diet."
During a client's examination and consultation, the physician keeps telling the client,"You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply.
-"You have a new growth of abnormal tissue in your abdomen." -"You have an abdominal tumor."
the nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection?
-fever -sore throat -chills
Which of the following are clinical manifestations found in the nursing assessment of a client with Acute Myeloid Leukemia? SELECT ALL THAT APPLY.
-fever due to neutropenia -ecchymosis due to thrombocytopenia -dyspnea due to anemia
A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress?
"I do not understand why this happened to me."
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?
"I have difficulty breathing when walking 30 feet."
The nurse is obtaining the history from a client who is suspected of having pelvic inflammatory disease (PID). Which client statement would help support the suspicion of PID?
"I was 15 years old when I first had sex."
our client, a 50year old female is finishing her chemotherapy treatment of (CAF: cyclophosphamide [Cytoxan] doxorubicin [Adriamycin] and fluorouracil [5-FU]. You have finished teaching her the effects of CAF. You know that she understands the instructions regarding cyclophosphamide when she states:
"I will drink 2000 to 3000 mL of fluid each day."
Which statement by the client who is performing self-catheterization indicates a need for further teaching?
"I will need a sterile catheter kit each time I self-catheterize."
Which statement form the patient regarding the use of Selective Estrogen Receptor Modulators (SERM) raloxifene reflects a good understanding of the medication.
"I will need to stop this medication three days prior to any long airplane flights. Flights greater than 7 hours."
During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations?
"I will track follow-up appointments in my smartphone so she receives all three injections."
A 50-year-old is diagnosed with stage II prostate cancer. The client is upset and verbalizes that he would rather die than have any surgery. Which is the best response by the nurse?
"What concerns you most about having surgery?"
A 55-year-old Asian man has a PSA level of 4.8 ng/mL. Based on the client's PSA level, which assessment question does the nurse need to ask?
"When was the last time you experienced ejaculation?"
The client is taking continuous-release oxycodone for chronic pain and now reports constipation. What should be the first question the nurse asks the client?
"When was your last bowel movement?"
When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?
- a patient who needs enermas and antibiotics to control GI bacteria
when iron sucrose is administered which nursing interventions are correct?
- administer large doses over 2.5 to 3.5 hours intravenously -monitor the patient for hypotension
A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)
- assesses the client for any sun exposure - avoids shaving the irradiated skin
The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which clients would receive the greatest benefit from this program? Select all that apply.
-A young female client with bulimia nervosa -An older adult client on a fixed income -A client with Crohn's disease
Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply.
-Acute pyelonephritis -Renal abscess
A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? (Select all that apply.)
-Age -Cigarette smoking -Occupation
A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take? Select all that apply.
-Asks the client to open his or her mouth to facilitate inspection of the oral mucosa -Instructs the client to brush the teeth with a soft toothbrush -Consults with the healthcare provider about use of nystatin
Following bone marrow aspiration of a client, analysis reveals more than 20% immature blast cells. Platelet counts are 9000/mm³. What nursing interventions should the nurse employ for the care of this client? Select all that apply.
-Assess for mental state changes. -Administer prescribed docusate daily.
A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.)
-Assess level of consciousness. -Apply pressure to the bleeding sites. -Check intake and output records.
What interventions are most appropriate for the nurse to include in the plan of care for a client at risk for infection? Select all that apply.
-Assess skin and mucus membranes every shift. -Auscultate lung sounds every shift and as needed. -Encourage the client to take deep breaths every 4 hours while awake.
The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the client, she admits that she drinks around 600 mL (20 oz) of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.
-Breast cancer -Esophageal cancer -Liver cancer
The nurse has been asked to provide health information to a female patient diagnosed with cystitis. Select all the teaching points that apply.
-Cleanse around the perineum and urethral meatus after each bowel movement. -Drink liberal amounts of fluid. -Void no more frequently than every 6 hours to allow urine to dilute the bacteria in the bladder.
Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.)
-Constipation -Pruritus -Nausea
The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.
-Egg white omelet with spinach and mushrooms -Steamed broccoli and carrots -Turkey breast on whole wheat bread
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.
-Hyperkalemia -Hyperuricemia -Hyperphosphatemia
When evaluating a patient's response to acute pain, the nurse assesses for the presence of physiologic responses associated with the pain experience. Select all that apply:
-Increased cardiac output -Increased metabolic rate -Hyperglycemia -Decreased urinary output
The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply.
-Infection -Bleeding
The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply.
-Leukocytosis -Abdominal distention
A client is hospitalized with sickle cell anemia and the nurse is preparing a teaching plan to review with the client and the client's family. Which interventions should be included? Select all that apply.
-Never exceed the recommended dosages of analgesics. -Dress warmly in cold temperatures. -While participating in physical exercise, wear constrictive clothing to support circulation.
A client has just undergone a urinary diversion procedure. What management issues related specifically to urinary diversion would be included in this client's care plan? Select all that apply.
-Observe for leakage of urine or stool from the anastomosis. -Maintain renal function. -Assess for signs and symptoms of peritonitis.
A client develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? Select all that apply.
-Obtain appropriate blood specimens -Collect a urine sample to detect hemoglobin -Document the reaction according to policy
A client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply.
-Pain -Gastrointestinal symptoms -Changes in voiding
Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply.
-Petechiae -Enlarged lymph nodes -Weakness and fatigue -Bone pain
When the Testoderm form of testosterone is ordered to treat hypogonadism in a teenaged boy, which instructions by the nurse are correct?
-Place the patch on clean, dry scrotal skin that has been shaved. -remove the old patch before applying a new patch
The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.)
-Place the patient in an upright position with the feet dependent. -Administer diuretics as prescribed. -Discontinue the transfusion. -Administer oxygen.
The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply.
-Rate of growth -Ability to cause death -Ability to spread
One of the potential problems for a client with a urinary diversion is disturbed body image related to change in appearance and function. The expected outcome is that the client will accept the altered appearance and perform self-care. Which activities would help in achieving that expected outcome? Select all that apply.
-Reassure the client that nursing staff will provide care until he or she is ready. -Discuss the change in function and let the client know what to expect when recovery from surgery is complete. - Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice.
The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.)
-Reduce exposure to excessive sunlight -Smoking cessation -Decrease alcohol intake
Which nursing diagnoses may be appropriate for a client with prostate cancer? Select all that apply.
-Sexual dysfunction - Anxiety -Readiness for enhanced knowledge
What does the nurse understand is the advantage of using intraspinal infusion to deliver analgesics? (Select all that apply.)
-Side effects of systemic analgesia are reduced. -Effects on pulse, respirations, and blood pressure are reduced. -The need for injections decreases in frequency.
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply.
-Sloughing tissue -Tissue necrosis -Effectiveness of the antidote
Which of the following are true statements about effective radiation therapy? Select all that apply.
-Slower-growing tissues at rest (muscle) are more radioresistant. -Tumors that are well oxygenated are more sensitive to radiation. - Tumors that are small in size and dividing rapidly are more sensitive.
Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? Select all that apply.
-Stop the medication infusion at the first sign of extravasation. -Aspirate any residual drug from the IV line. -Administer an antidote, if indicated.
A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? Select all that apply.
-The patient can void sooner than with a urethral catheter. -The suprapubic catheter allows for more mobility. -The suprapubic catheter permits measurement of residual urine without urethral instrumentation.
For which reasons are nonpharmacologic pain management techniques used? Select all that apply.
-They help decrease the sensation of pain. -They help decrease the distress a client experiences as a result of pain. -They allow clients to match the technique to their own individual and cultural preferences.
The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply.
-Use a lip lubricant. -Use dental floss every 24 hours. -Rinse the mouth with normal saline.
The nurse is teaching a client with acute prostatitis about measures to promote comfort and self-care. Which of the following would the nurse include in the teaching plan? Select all that apply.
-Use warm sitz baths several times a day. - Avoid drinking coffee, tea, and colas. - Avoid sitting for prolonged periods.
a patient has been given a prescription for transdermal scopolamine patches (transform-scop) for motion sickness for use during a vacation cruise. the nurse will include which instructions?
-apply the patch for 3 to 4 hours before boarding the ship -the patch needs to be placed on a nondairy area just behind your ear -change the patch every 3 days -rotate the application sites
while administering bevacizumab (avastin) what will the nurse assess to look for drug related toxicities?
-blood pressure - urine protein level
Cancer chemotherapy drugs can be divided into two main groups:
-cell cycle specific -cell cycle non specific
A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.
-client history -risk factors -tumor markers
Name three precautions the RN must take when administering chemotherapy
-double- layeredPowder-free gloves, -long sleeve polyethylene disposable gown, -wash hands with soap and water.
The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following:
-evaluates the pain level using the established pain scale -assesses respirations, pulse, and blood pressure -consults with the healthcare provider about the client's report
Name three focused assessment findings of the patient with severe anemia_
-fatigue -pallor -hypotension
The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which signs of infection? SELECT ALL THAT APPLY.
-fever - sore throat - chills
A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.
-instructs the client to discontinue calcium -asks about nausea and vomiting -teaches the client to report abdominal or bone pain
the nurse Is preparing to administer dronebinol (Marino) to a patient. which statement about dronabintol therapy are true?
-it is approved for nausea and vomitting related to cancer chemotherapy - it is approved to help stimulate the appetite in patients with nutritional wasting due to cancer or aids - it may cause drowsiness or euphoria
When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.
-muscle weakness -cramps and spasms in the legs -loss of balance and coordination
Name three characteristics of malignant cells.
-no apoptosis -tumors grow by invading and destroying surrounding tissue -multiply rapidly -cells are not fully functional
when administering vitamin and mineral supplements, the nurse implements which appropriate interventions?
-not administering oral calcium tablets along with oral tetracyclines -monitoring the heart rhythm ECG of a patient receiving a magnesium infusion - giving oral niacin with milk or food to decrease gastrointestinal upset - monitoring for the formation of renal stones in patients taking large doses of vitamin C
The nurse is caring for a patient who becomes severly nauseated during chemotherapy. Which intervention is the most appropriate to manage the client's nausea?
-provide antiemetic medications 30 to 60 mins before chemo begins
A client is being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply.
-resection and fulguration -topical application of an antineoplastic drug
The American Cancer Society Screening Guidelines for the Early detection of Cancer in average-risk asymptomatic people direct which of the following?
-secondary prevention
A client with challenging menopausal symptoms has discussed treatment options with the physician and now has some questions for the nurse. The client asks, "What are the potential risks of hormone replacement therapy?" What is the best answer?
-sroke, heart disease, breast cancer All options are correct.
Your client has a Continuous Bladder Irrigation (CBI) after aa Transurethral Resection of the Prostate (TURP). His Intake for 8 hours is: IV fluids: 1000mL Oral intake 850mL IV antibiotics: 100 mL CBI Irrigation fluid 6000mL His Total Output for 8 hours is 7800mL. What is his TRUE urine output?
1800 mL
Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis?
Acute pain related to sickle cell crisis
The nurse is preparing to administer a unit of platelets to an adult client. When administering this blood product, which of the following actions should the nurse perform?
Administer the platelets as rapidly as the client can tolerate.
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia?
Applying prolonged pressure to needle sites or other sources of external bleeding
A client with advanced leukemia is responding poorly to treatment. The nurse finds the client tearful and trying to express feelings, but he is clearly having difficulty. What is the nurse's mostappropriate action?
Ask if the client would like the nurse to sit with him while he collects thoughts.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?
Assess renal function.
A clientwith anemia has a hemoglobin of 6.5 g/dL. The client is experiencing cerebral tissue hypoxia. Which of the nursing interventions would be the most important in providing safe care for this client/patient?
Assisting in ambulation to the bathroom.
the nurse is giving a cholinergic- blocking drug and will assess the patient for which contraindications to these drugs?
BPH
When the nurse is performing an assessment and finds no physical cause for a patient's pain, what should the nurse do when the patient continues to complain of pain?
Believe a patient when he or she states that pain is present.
The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?
Catheterize the client immediately after the client voids.
A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do?
Catheterize the client.
A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem?
Chronic bacterial prostatitis
A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia?
Chronic lymphocytic leukemia
The nurse at the diabetes clinic is instructing a client who is struggling with compliance to the diabetic diet. When discussing disease progression, which manifestation of the disease process on the urinary system is most notable?
Clients have chronic renal failure.
During a routine office visit, a client mentions difficulty maintaining an erection. While reviewing the client's medical history, the nurse notes the client's medication history. Which medication would the nurse interpret as a potential cause of erectile dysfunction? Select all that apply.
Clonidine Lorazepam Nadolol Fluoxetine
The nurse is caring for an older client whose chart reveals that the client has a reversible cause of urinary incontinence. The nurse creates a plan of care for which condition?
Constipation
A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the disease. What potential etiology should the nurse explain to this client?
Decreased production of platelets.
Which of the following would the nurse expect to find when assessing a client with phimosis?
Difficulty cleaning under the foreskin
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?
Do not administer if respirations are less than 12 breaths per minute
the nurse is teaching a patient about the possible adverse effect of priapism, which may occur when taking erectile dysfunction drugs. The nurse emphasizes that, if this occurs the most important action is to
seek medical attention immediately
A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, what action should the nurse take?
Infuse each unit over 30-60 minutes per client tolerance.
a patient has been taking Finasteride (proscer) for almost a year. The nurse knows that which is most to evaluate at this time?
PSA levels
the nurse will assess which laboratory test result before administration of vitamin k?
PTT and INR
A patient diagnosed with endometriosis asks for an explanation of the disease. What should the nurse explain to the patient?
Tissue from the lining of the uterus has implanted in areas outside the uterus.
a patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. during rounds, the nurse finds him unresponsive, with respiration of 8 breaths/min and bp of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next?
administer an opiate antagonist per standing orders
a patient who is receiving chemotherapy with cisplastin (platinol) has developed pneumonia. the nurse would be concerned about nephrotoxicity if which type of antibiotic was ordered as treatment for the pneumonia at this time?
aminoglycoside
the nurse is administering an intravenous dose of iron dextran. for which potential adverse effect is most important for the nurse to monitor at this time?
anaphylaxis
For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication
around the clock, with additional doses as needed for breakthrough pain
the nurse is providing education about cholinergic-blocking drug therapy to an elderly patient.
avoid exposure to high temperatures
A 25 year old college student is diagnosed with an upper urinary tract infection. Which of the following would be documented on the medical record?
cystitis
Name three signs and symptoms of bleeding in a patient/client_
dark urine tarry stools bleeding gums tachycardia bruising
when assessing for adverse effects of cholinergic-blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect?
dry mouth
the nurse is assessing a patient who is to receive dinoprostone (pristine e2). which condition would be a contraindication to this drug?
ectopic pregnancy
the nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for
excessive bleeding and bruising
While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping the client in a semi-sitting position. The nurse advises this in order to:
facilitate pelvic drainage and minimize the upward extension of the infection.
when planning care for a patient who is receiving interferon therapy the nurse must keep in mind that the major dose limiting factor is
fatigue
the nurse is monitoring a patient who has been receiving aldesleukin (IL 2) (Proleukin) for treatment of malignant melanoma. Which adverse effect if noted on assessment is of primary concern?
fluid retention
A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:
hematuria
while teaching a patient who is about to receive cyclophosphamide (cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse edicts such as
hemorrhagic cystitis
when chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity?
hydrating the patient with iv fluids before chemotherapy
Bacterial infections are common in patients with Chronic Lymphocytic Leukemia and intravenous treatment with_____________________ may be given to patients with recurrent infections..
immunoglobulins
if extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first?
stop the infusion immediately while leaving the catheter in place
the nurse is administering methotrexate as part of the treatment for RA and will monitor for which sign of bone marrow suppression?
increased bleeding tendencies
A client is prescribed amitriptyline (an antidepressant) for incontinence. The nurse understands that this drug is an effective treatment because it:
increases bladder neck resistance.
the nurse is reviewing the use of obstetric drugs. which situation is an indication for an oxytocin (pitocin) infusion?
induction of labor at full term
the nurse is teaching a patient about oral iron supplements. which statement is correct?
it is better absorbed on an empty stomach but if that causes your stomach to be upset you can take it with food
in caring for a patient recieving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgrastim after the chemotherapy is completed. which statement correctly describes when the nurse will begin the filgrastim therapy?
it will be initiated 24 hours after the chemo is completed
A client receives a sealed radiation implant to treat cervical cancer. When caring for this client, the nurse should:
maintain the client on complete bed rest with bathroom privileges only.
the nurse is performing an assessment of a patient who is asking for a prescription for sildenafil (Viagra). Which finding would be contraindicated to its use?
medication list that includes nitrates
a patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches have. The nurses best response includes which of these features?
more constant drug levels for analgesia
the nurse is discussing therapy with clomiphene (clomid) with a husband and wife who are considering trying this drug as part of treatment for infertility. it is important that they may be informed of which possible effect of this drug?
multiple pregnancy twins or more
A client reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem?
neurogenic bladder
Sildenafil: a pharmacologic agent used to treat erectile dysfunction: are contraindicated in men who take _________________________, because taken together, these medications can cause severe hypotension.
nitrates
when administering oral iron tablets the nurse should keep in mind that the most appropriate substance other than water to give with these tablets is
orange juice
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?
pathologic bone fractures.
During a counseling session for a group of teenage athletes, the use of androgenic steroids is discussed. The nurse will explain that which problem is a rare but devastating effect of androgenic steroid use?
peliosis of the liver
A client enters the clinic with complaints of a sore mouth. Physical assessment reveals a beefy red tongue. These symptoms are most suggestive of which of the following disorders?
pernicious anemia
the nurse is assessing a patient who is to receive folic acid supplements. it is important to rule out which condition before giving the folic acid?
pernicious anemia
A client asks the nurse what PSA is. The nurse should reply that it stands for:
prostate-specific antigen, which is used to screen for prostate cancer.
the nurse is caring for a patient who becomes severely nauseated during chemotherapy. which intervention is most appropriate?
provide antiemetic medications 30 to 60 minutes before chemotherapy begins
During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring
respiratory function.
a patient receiving chemotherapy is experiencing severe bone marrow suppression. which nursing diagnosis is most appropriate at this time?
risk for infection
A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to:
see her gynecologist to remove and clean the pessary at regular intervals.
a 33 yr old patient is in the outpatient cancer center for his first round of chemotherapy. the nurse knows that which schedule is the most appropiate timing for the intravenous antiemetic drug?
thirty minutes before chemotherapy begins
a patient who has been receiving chemotherapy tells the nurse that he has been searching the internet for anti nausea remedies and that he found a reference to a product called emetrol (phosphorated carbohydrate solution). he wants to know if this drug would help him. what is the nurses best answer?
this drug may not help the more severe nausea symptoms associated with chemotherapy
a patient with renal failure has severe anemia, and there is an order for darbepoetin (aranesp). As the nurse assesses the patient, which condition listed will the nurse consider a contraindication to use of this medication?
uncontrolled hypertension
the nurse is reviewing the medical history of a patient who is about to receive therapy with entaracept (enbrel). which of the conditions if present would be a contraindication or caution for therapy with this drug?
urinary tract infection
A client has been diagnosed with pernicious anemia. During client education, the nurse emphasizes the importance of lifelong intramuscular administration of:
vitamin B12.
while caring for a newly admitted patient who has a long history of alcoholism, the nurse anticipates that part of the patients medication regimen will include which vitamin?
vitamin b1 (thiamine)
a patient has go malabsorption due to severe intestinal damage from a gastrointestinal infection. the nurse will need to assess for signs of a deficiency of which vitamin?
vitamin b12 (cyanocobalamin)
the nurse has provided patient education regarding therapy with the SERM raloxifine (evista). which statement from the patient reflects a good understanding of the instruction?
when I take that long flight to asia, I will need to stop taking this drug at least 3 days before I travel
the nurse is providing wound care for a patient with a stage IV pressure ulcer and expects the patient will receive which supplement to assist in wound healing?
zinc
