NUR 211 Exam 1 Practice Questions
A nurse is providing teaching to a client who has cancer and is receiving external radiation therapy. Which of the following statements by the client indicates an understanding of the teaching? A. " I need to protect the area from sunlight." B. "I'm going to apply a heating pad to the area after each treatment" C. " I'll massage the area once per day" D. "I'll wash the markings off after each therapy treatment"
A. " I need to protect the area from sunlight."
A nurse on an oncology unit is providing discharge teaching to an adolescent female client who received a bone marrow transplant for leukemia. Which of the following information should the nurse include in the teaching? ( select all that apply) A. "Take your temperature twice each day." B. " You may return to school if you feel strong enough." C. "It is important to always wear shoes" D. "Clean your toothbrush weekly with isopropyl alcohol." E. "Avoid using tampons"
A. "Take your temperature twice each day." C. "It is important to always wear shoes" E. "Avoid using tampons" rationale: Clients who are postoperative bone marrow transplants are immunosuppressed and should be monitored for signs of infection, prevent injury and decrease the risk of infection.
A nurse is providing preoperative teaching to a client who has lung cancer and will undergo a pneumonectomy. Which of the following statements should the nurse include? (select all that apply) A. "You will have a chest tube in place after surgery" B. "We'll frequently help you turn, cough, and breathe deeply after surgery." C. "You will have to remain in bed for about 2 days after the surgery" D. "We'll give you oxygen to support your breathing if you need it." E. "You should expect pain for the first few days after surgery"
A. "You will have a chest tube in place after surgery" B. "We'll frequently help you turn, cough, and breathe deeply after surgery." D. "We'll give you oxygen to support your breathing if you need it."
The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which intervention should be implemented to prepare the client for this procedure? ( Select all that apply) A. Administer high dose chemotherapy B. Teach the client about autologous transfusion C. Have the family members HLA typed D. Monitor the complete blood cell count daily E. Provide central line care per protocol
A. Administer high dose chemotherapy C. Have the family members HLA typed D. Monitor the complete blood cell count daily E. Provide central line care per protocol Rationale: all the bone barrow cells must be destroyed prior to bone marrow transplantation. The best bone marrow donor comes from an identical twin but next best match would come from a sibling. CBC must be monitored daily to assess for infection, anemia, and thrombocytopenia. Clients will have at least one multiple line CVA.
A nurse is caring for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following actions should the nurse take? A. Administer ibuprofen B. Limit daily fluid intake C. Apply cold compresses to painful joints D. Withhold live virus immunizations
A. Administer ibuprofen
A client is diagnosed with cancer of the lung. Which interventions should be included in the plan of care? (Select all that apply) A. Apply O2 B. Have the dietitian plan for six small meals per day C. Place client in respiratory isolation D. Assess vital signs for fever E.Listen to lung sounds every shift
A. Apply O2 B. Have the dietitian plan for six small meals per day` D. Assess vital signs for fever E.Listen to lung sounds every shift
The nurse is assisting the HCP with a bone marrow biopsy. Which intervention postprocedural has priority? A. Apply pressure to site for 5-10 minutes B. Medicate for pain with morphine slow IVP C. Maintain HOB in high fowlers position D. Apply O2 via nasal cannula at 5 L/Min
A. Apply pressure to site for 5-10 minutes
A nurse is planning care for a client who has acute myelogenous leukemia and a platelet of 48,000/mm. Which of the following interventions should the nurse include? A. Avoid IM injections B. Assess the client for ecchymosis once per shift C. Do not allow the client to have visitors D. Encourage daily flossing between teeth
A. Avoid IM injections
The nurse is planning the care of a client diagnosed with aplastic anemia. Which interventions should be taught to the client? (Select all the apply) A. Avoid alcohol B. Pace Activities C. stop smoking D. Eat a balanced diet E. Use a safety razor
A. Avoid alcohol B. Pace Activities D. Eat a balanced diet
A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of therapy? A. Bone marrow suppression B. Liver toxicity C. Nausea D. Stomatitis
A. Bone marrow suppression
A nurse is providing teaching to a client who has a new prescription for tamoxifen to treat breast cancer. The nurse should include that which of the following is an adverse effect of this medication? A. Hot flashes B. Insomnia C. Increased appetite D. Constipation
A. Hot flashes
A nursing is teaching a client who has a new prescription for imatinib to treat chronic myeloid leukemia. Which of the following instructions should the nurse include? (Select all that apply) A. Clean fruits and vegetables throughly B. Increase calcium intake C. weight yourself daily D. Perform hand hygiene frequently E. Avoid grapefruit and grapefruit juice
A. Clean fruits and vegetables throughly C. weight yourself daily D. Perform hand hygiene frequently E. Avoid grapefruit and grapefruit juice
A nurse is teaching a client who has a new diagnosis of breast cancer about the drug tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen? A. DVT B. COPD C.Diabetes mellitus D. Alcohol use disorder
A. DVT
A client is hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. The client is symptomatic but refused blood transfusions. What medication does the nurse prepare to administer? A. Epoetin Alfa B. filgrastim C. Mesna D. Detrazoxane
A. Epoetin Alfa
The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? (select all that apply) A. Facial edema in the morning B. Weight loss of 20lbs (9kg) in 1 month C. Serum calcium level of 12 mg/dL D. Serum sodium level of 136 mg/dL E. Serum potassium level of 3.4 mg/dL F. Numbness and tingling of the lower extremities
A. Facial edema in the morning C. Serum calcium level of 12 mg/dL F. Numbness and tingling of the lower extremities
A nurse is caring for a postmenopausal client who is concerned that she might have an elevated risk of breast cancer. After conducting a risk assessment, the nurse should identify which of the following factors as increasing the clients breast cancer risk? (select all that apply) A. Increased breast density B. BMI of 32 C. Having given birth to 5 children D. Undergoing hormonal replacement therapy for 10 years E. Having 1-2 alcoholic drinks per week
A. Increased breast density B. BMI of 32 D. Undergoing hormonal replacement therapy for 10 years
A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following food? A. Lentils B. Avocados C. Cabbage D. Broccoli
A. Lentils
A nurse is planning care for a client who is receiving chemotherapy and has a protein deficiency. Which of the following interventions should the nurse include in the plan of care? (select all that apply) A. Mix powered skim milk into liquid milk B. Add raw egg to fruit smoothies C. Add a slice of cheese to hot veggies D. Add honey to hot tea E. Mix yogurt into fresh fruit
A. Mix powered skim milk into liquid milk C. Add a slice of cheese to hot veggies E. Mix yogurt into fresh fruit rationale: Dairy products are a good source of protein.
A nurse is caring for a client who is receiving radiation therapy to treat lung cancer. Which of the following actions should the nurse take? A. Observe for signs of infection B. Examine the skin for generalized urticaria C. Review Laboratory test results for low hemoglobin D. Monitor the mouth for signs of xerostomia
A. Observe for signs of infection
A nurse is assessing a child who has acute lymphocytic leukemia and is receiving vincristine sulfate. Which of the following findings is the nurses priority? A. Paresthesia B. Alopecia C. Stomatitis D. Constipation
A. Paresthesia
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? A. Glucose B. Calcium C. Potassium D. Prothrombin time
B. Calcium
A nurse is caring a school aged child who has sickle cell anemia and was admitted for a vaso-occlusive crisis. Which of the following findings should the nurse report to the provider immediately? A. Slurred speech B. Hemoglobin level of 9 g/dL C. Hematuria D. Pain level of 7 on FACES scale
A. Slurred speech rationale: is an indication of a stroke
A nurse is considering drug therapy options for a client who has metastatic breast cancer that is postive for HER2. Which of the following drugs should the nurse expect the provider to prescribe? A. Trastuzumab B. Imatinib C.Leuprolide D. Flutamide
A. Trastuzumab
A nurse is teaching a client who has a new prescription for mercaptopurine to treat leukemia. Which of the following instructions should the nurse include? (select all that apply) A. Use contraception if pregnancy is a risk B. Perform oral hygiene frequently C. Avoid activities that require mental alertness D. Perform Hand Hygiene frequently E. Avoid activities that can cause injury
A. Use contraception if pregnancy is a risk B. Perform oral hygiene frequently D. Perform Hand Hygiene frequently E. Avoid activities that can cause injury
A nurse is assessing a client following a trastuzumab infusion to treat mestastatic breast cancer. Which of the following findings should the nurse recognize as an indication that the client is experiencing an adverse reaction of the drug? (Select all that apply) A. Wheezing B. Dyrhythmias C. Hypotension D. Fever E. Ascites
A. Wheezing B. Dyrhythmias C. Hypotension D. Fever
A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase consumption of which of the following foods? A. beef liver B. oranges C. Turnips D. Whole milk
A. beef liver
A nurse is teaching a client who had pernicious anemia. The nurse should encourage the client to increase consumption of which of the following foods? A. eggs B. Squash C. Kale D. Tofu
A. eggs
A nurse is caring for a client who is recieving Vincristine to treat lung cancer. The nurse should monitor the client and recognize which of the following manifestations as an indication that the client is experiencing an adverse effect of the drug. A. weak hand grasp B.Constricted pupils C. Bradycardia D.Crackles
A. weak hand grasp rationale: Vincristine is a vinca alkaloid that can cause peripheral neuropathy.
A nurse is preparing to administer packed RBCs to a client who is anemic. Which of the following actions should the nurse take? (Select all that apply) A. Insert a 23-gauge angiocatheter with an IV adaptor B. Check to determine the packed RBCs are less than 1 week old C. Administer the packed RBCs over a 6-hr period D. Ask another nurse to check the packed RBCs label against the medical record E. Prime the transfusion tubing with 0.9% sodium chloride
B. Check to determine the packed RBCs are less than 1 week old D. Ask another nurse to check the packed RBCs label against the medical record E. Prime the transfusion tubing with 0.9% sodium chloride
Which finding would the nurse expect to see in a patient with a hemoglobin level of 8 g/dL? (Select all that Apply) A. Palpitations B. Conjunctival pallor C. Sternal tenderness D. HR at 104 beats/min
B. Conjunctival pallor D. HR at 104 beats/min
A nurse is caring for a client who has breast cancer and is recieving a combination of chemotherapy medications. The client express confusion about the therapy. Which of the following explanations should the nurse provide? A. " The risk for renal toxicity is lessened when a combination of chemotherapy medications are used." B. " The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed" C. " The use of chemotherapy medications will shorten the time you have to be in treatment" D. " The combination of chemotherapy medication will eliminate the potential of bone marrow suppression"
B. " The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed"
A nurse is teaching the parents of a 10 year old child who has iron-deficiency anemia. Which of the following statements by a parent indicates an understand of the teaching? A. "I will give my child an iron tablet once each day at bedtime" B. "I will administer the iron tablet with orange juice" C. " I will encourage my child to take an antacid with the iron tablet" D. "I will crush the iron tablet prior to giving it my child."
B. "I will administer the iron tablet with orange juice"
A patient whose lung cancer has metastasized to the bone reports lethargy, nausea, and vomiting. The healthcare provider monitor suspects the patient is experiencing hypercalcemia. Which of the following assessments associated with hypercalcemia would confirm the healthcare provider's suspicion? A. Serum calcium level 10mg/dL B. Decreased deep tendon reflexes C. Presence of Chvosteck's sign D. Abdominal cramps and diarrhea
B. Decreased deep tendon reflexes
A nurse is caring for a client who has a new diagnosis of breast cancer. The client becomes quiet and withdrawn and says to the nurse, "What do you think people will say about me when im gone?" Which of the following responses should the nurse make? A. "What are you worried they will say about you?" B. "The thought of having breast can may seem hopeless" C. "Maintaining a positive attitude can influence your recovery." D. "You will be remembered as a kind person."
B. "The thought of having breast can may seem hopeless"
A nurse in a provider's office is reviewing the medical records of a group of clients. Which of the following clients is at risk for iron deficiency? (select all that apply) A. a client who is postmenopausal B. A client who is a vegetarian C. A middle adult male client D. A client who is pregnant E. A toddler who is overweight
B. A client who is a vegetarian D. A client who is pregnant E. A toddler who is overweight
A patient with Leukemia is undergoing hematopoietic stim cell transplantation using stem cell harvested from the patient prior to high dose chemotherapy. Which type of transplantation procedure is being used for this patient? A. allogeneic B. Autologous C. Engraftment D. Syngeneic
B. Autologous
During a routine physical examination, a nurse observes a 1-cm lesion on a clients chest. The lesion is raised and flesh-colored with pearly white boarders. The nurse should recognize that this finding is suggestive of which of the following types of skin cancer? A. Squamous cell carcinoma B. Basal Cell carcinoma C. Malignant melanoma D. Actinic keratosis
B. Basal Cell carcinoma
A nurse is admitting a child who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate? A. Neutropenic B. Bleeding C. Contact D. Droplet
B. Bleeding
A 4-year old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? A. Lumbar puncture showing no blast cells B. Bone Marrow biopsy showing blast cells C. Platelet count of 350,00 mm3 D. White blood cell count 4500 mm3
B. Bone Marrow biopsy showing blast cells
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema in the affected arm? A. Placing cool compresses on the affected arm B. Elevating the affected arm on a pillow above the heart C. Avoiding arm exercises in the immediate postop period D. Maintaining an IV site below the antecubital area on the affected area
B. Elevating the affected arm on a pillow above the heart
A nurse is teaching a group of clients about skin cancer. The nurse should explain that basal cell carcinoma originates from which of the following tissues? A. Subcutaneous B. Epidermis C. Dermis D. Stratum corneum
B. Epidermis
The client diagnosed with anemia begins to complain of dyspnea when ambulating in the hall. Which intervention should the nurse implement first? A. Apply O2 via nasal cannula B. Get a wheelchair for the client C. Assess the clients lung fields D. Assist the client when ambulating in the hall
B. Get a wheelchair for the client
A nurse is caring for a client who has acute lymphocytic leukemia and reports a fever, chills, fatigue, and pallor over the past week. When checking the client's laboratory results, which of the following values should the nurse identify as contributing to the clients fatigue and pallor? A. Magnesium 22.0 mEq/L B. Hgb 6.5 h/dL C. WBC count 9.6/mm3 D. Creatinine 0.8 mg/dL
B. Hgb 6.5 h/dL
The nurse is providing care for a client with acute myeloid leukemia. Which of the following nursing diagnosis are appropriate for this client? ( select all that apply) A. Fluid volume excess B. Imbalanced nutrition C. Risk for autonomic dysreflexia D. Ineffective protection E. Acute confusion
B. Imbalanced nutrition D. Ineffective protection Rationale: Imbalanced nutrition due to fatigue and anorexia, ineffective protection due to
A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care? A. Check the IV site for bleeding every 8hr B. Limit IM injections C. Obtain a reaction temperature every 8 hr D. Check the client for proteinuria
B. Limit IM injections
A nurse is admitting a child who has acute lymphocytic leukemia. Which of the following laboratory values should the nurse expect? A. Platelets 500,000mm B. RBCs 2.5 million/uL C. WBCs 4,000/mm D. Hct 60%
B. RBCs 2.5 million/uL
A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? A. Monitor visitors for manifestations of infection B. Remind the client to use an electric razor C. Encourage frequent rest periods D. Instruct the client to rinse mouth daily with normal saline
B. Remind the client to use an electric razor
A nurse is transfusing a unit of B-positive fresh frozen plasma to a client whose blood type is O-negative. Which of the following actions should the nurse take? A. Continue to monitor for manifestations of a transfusion reaction B. Remove the unit of plasma immediately and start an IV infusion of normal saline solution C. Continue the transfusion and repeat the type and crossmatch D. Prepare to administer a dose of diphenhydramine IV
B. Remove the unit of plasma immediately and start an IV infusion of normal saline solution Rationale: B- positive is not compatible with O-negative blood causing a hemolytic transfusion reaction (fever, chills, flank pain). The nurse should stop the transfusion and start a new infusion with new tubing.
The client is four hours post -lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse? A. The client has an intake of 1500 mL IV and an output of 1000mL B. The client has 450 mL of bright-red drainage in the chest tube C. The client is complaining of pain at a 10 on a 1-to-10 scale D. The client has absent lung sounds on the side of the surgery
B. The client has 450 mL of bright-red drainage in the chest tube
A client returns to the clinic for follow-up treatment following a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that melanoma has which characteristics? (Select all that apply) A. lesion is painful to touch B. lesion is highly metastatic C. Lesion is a nevus that has changes in color D. Skin under the lesion is reddened and warm to touch E. Lesion occurs in body area exposed to outdoor sunlight
B. lesion is highly metastatic C. Lesion is a nevus that has changes in color
A nurse is discharging a child who has sickle cell anemia after an acute crisis episode. What instructions should the nurse include? A. " Monitor your child's temperature daily" B. "Restrict outdoor play activity to 1 hour per day" C. "Offer fluids to your child multiple times every day" D. "Apply cold compresses when your child expresses pain"
C. "Offer fluids to your child multiple times every day"
A nurse is providing discharge instructions to a client who had sickle cell crisis. Which of the following statements indicates that the client understands the instructions? A. "I should try to drink at least 2 L of fluids per day" B. " I can still fly out to visit my sister in Colorado for a while" C. "Physical activity is good for me, but I need to avoid overexertion" D. "I can still go skiing during the cold winter months"
C. "Physical activity is good for me, but I need to avoid overexertion"
A nurse is providing discharge teaching to a client who is postoperative following a right mastectomy for breast cancer. The client will be discharged with two Jackson-Pratt drains. Which of the following information should the nurse include in the teaching? A. " Empty the drainage tube once per day" B. "Shower is permitted before the drainage tubes are removed" C. "The drainage tubes often are removed at the same time as the stitches" D. "Do not begin exercising the arm until the provider removes the drainage tubes"
C. "The drainage tubes often are removed at the same time as the stitches"
A nurse on a pediatric unit is caring for a group of clients. Which of the following findings should be the nurses priority? A. A child who has asthma and a pulse oximetry of 94% B. A child who has nephrotic syndrome and 1+ protein on urine dipstick C. A child who has sickle cell anemia and a urine specific gravity of 1.030 D. A child who has insulin-dependent diabetes mellitus and a finger stick glucose reading of 110 mg/dL
C. A child who has sickle cell anemia and a urine specific gravity of 1.030 Rationale: urine specific gravity of 1.030 indicated dehydration. Dehydration could cause sickle cell crisis to occlude the child's circulation. ABC - circulating is priority because the delivery of O2 to critical organs
A nurse is talking with a group of women at a community center about the current recommendations for early detection of breast cancer. The nurse should explain which of the following options? A. Begin monthly breast self-examinations at age 40 B. Have a clinical breast examination each year after age 30 C. Begin annual mammograms at age 40 D. Have breast magnetic resonance imaging every 5 years after age 50
C. Begin annual mammograms at age 40
A nurse is planning care for a client who is post operative following a radical mastectomy. Which of the following interventions should the nurse include in the plan? A. Rest the arm on the affected side on the bed when the client is sleeping B. Instruct the client to keep the affected arm flexed when ambulating C. Begin exercises with the client 1 day after the procedure D. Maintain the client on bed rest for 2 days after the procedure
C. Begin exercises with the client 1 day after the procedure
A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following actions should the plan to nurse take? A. Leave the client 5 min after beginning the transfusion. B. Infuse the transfusion at a rate of 200 mL/hr. C. Check the client's vital signs every hour during the transfusion. D. Flush the blood tubing with dextrose 5% in water.
C. Check the client's vital signs every hour during the transfusion
A nurse in a dermatology clinic is using the ABCDE method while screening several skin lesions from skin cancer on a client. Which of the following findings should the nurse report to the provider? A. Symmetric shape B. Border regularity C. Color Variation within a lesion D. Diameter >4mm
C. Color Variation within a lesion
The client diagnosed with anemia has a Hgb of 6.1 g/dL. Which complication should the nurse assess for? A. decreased pulmonary functioning B. Impaired muscle functioning C. Congestive heart failure D. Altered gastric secretions
C. Congestive heart failure rationale: The heart tried to compensate for the lack of oxygen by becoming tachycardic. The heart can only do this for so long before showing s/s of failure
A patient is 5 hours post op from a left-sided mastectomy. she says that the incision and the inner side of her arm from the armpit to the elbow are numb. Select the nurse's best action. A. Teach the patient to avoid lifting heavy objects B. Measure the circumference of the patients left arm C. Document and reassure the patient that this is expected D. Notify the surgeon of the assessment finding
C. Document and reassure the patient that this is expected
A nurse is caring for an 8-year old who has sickle cell anemia. Which of the following actions should the nurse take? A. Apply cool compresses to the painful area B. Initiate contact isolation precautions C. Give the child flavored popsicles D. Administer phytonadione
C. Give the child flavored popsicles
What sign and symptom will the nurse expect to assess in the client diagnosed with vaso-occlusive sickle cell crisis? A. Lordosis B. Epistaxis C. Hematuria D. Petechiae
C. Hematuria
A nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. Which of the following information should the nurse include in the teaching? A. Hospitalization is required when administering each treatment B. The maximum effect of the medication will occur in 6 months. C. Hypertension is a common adverse effect of this medication D. Blood transfusions are needed with each treatment
C. Hypertension is a common adverse effect of this medication Rationale: Hypertension is a common adverse effect due to the rise in production of erythrocytes.
A nurse is caring for a client who has a new prescription for topotecan therapy to treat resistant, small-cell lung cancer. The nurse should advise the client against taking which of the following types of over-the-counter drugs while receiving the therapy? A. Folic acid B. St. Johns Wort C. Ibuprofen D. Aluminum Hydroxide
C. Ibuprofen
A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse include in the plan? A. Administer ferrous sulfate supplementation B. Increase dietary intake of folic acid C. Initiate weekly injections of Vitamin B12 D. Initiate a blood transfusion
C. Initiate weekly injections of Vitamin B12
A nurse is caring for a client who is receiving brachytherapy. Which of the following measures should the nurse include in the clients plan of care? A. plan to spend extra time with the client to provide emotional support B. Ensure that chemotherapy medications do not extravagate into the clients tissue C. Keep the door to the clients room closed D. Encourage family members and friends to visit for at least 1 hour per day
C. Keep the door to the clients room closed
A nurse is caring for a client who had a left lower lobectomy to treat lung cancer. Which of the following factors will have a significant impact on the plan of care for this client? A. The client will need intensive smoking cessation education B. After surgery, the prognosis for clients with lung cancer is usually good. C. Lung cancer usually has metastasized before the client presents with symptoms D. Oxygen therapy is ineffective following a lobectomy
C. Lung cancer usually has metastasized before the client presents with symptoms
A nurse is planning care for an adolescent who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions should the nurse include in the plan of care A. Apply cold compresses to the child's extremities B. Administer meperidine every 4 hours until the crisis has resolved C. Maintain the child on bed rest D. Decrease the child's fluid intake for 8 hr
C. Maintain the child on bed rest
A nurse in a dermatologist's office is planning an educational session about skin cancer. Which of the following should the nurse include as risk factors for skin cancer? (Select all that apply.) A. Dark Skin B. Under 40 years of age C. Overexposure to ultraviolet light D. Previous skin injury E. Genetic predisposition
C. Overexposure to ultraviolet light D. Previous skin injury E. Genetic predisposition
A nurse is assessing a client who has pernicious anemia. Which of the following findings should the nurse expect? A. Thick, white coating on the clients tongue B. Decreased pulse rate C. Parenthesias in the hands and feet D. Joint pain in the extremities
C. Parenthesias in the hands and feet
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early signs of this oncological emergency? A. Cyanosis B. Arm edema C. Periorbital edema D. Mental status changes
C. Periorbital edema
A nurse is caring for a client who is 1 day postoperative following a left radical mastectomy. Which of the following client behaviors should alert the nurse that the client is having difficulty adjusting to the loss of her breast? A. Asking for pain medication every 3 hr B. Asking questions about the information on her postoperative care pamphlet C. Refusing to look at the dressing or surgical incision D. Performing arm exercises one or twice a day
C. Refusing to look at the dressing or surgical incision
A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) to a client who has anemia. Which of the following actions should the nurse take first? A. Hang an IV infusion of 0.9% sodium chloride with the blood B. Check the clients identification number with number on the blood C. Witness the informed consent D. Obtain pretransfusion vital signs
C. Witness the informed consent
The community health nurse is instructing a group of young female clients about breast self-exam. The nurse should instruct the clients to perform the examination at which time? A. At the onset of menstruation B. Every month during ovulation C. Weekly at the same time of day D. 1 week after menstruation begins
D. 1 week after menstruation begins
A nurse is teaching a client how to perform a breast self-examination (BSE). The nurse should identify which of the following findings as an indication of breast cancer? A. Lumps that are mobile and tender on palpation prior to menstrual period B. Multiple round masses that are tender and found in both breast C. Bilaterally darkened areolas D. A nontender, hard lump that is palpated in a breast
D. A nontender, hard lump that is palpated in a breast
A client who has stage II breast cancer ask the nurse about sites of metastasis for the cancer. Which of the following response should the nurse provide? A. "Its too soon to worry about something that might not happen." B. "Breast cancer tends to metastasize to the stomach" C. "Metastasis is unlikely since we detected your cancer early." D. "Breast cancer tend to metastasize to the bones."
D. "Breast cancer tend to metastasize to the bones."
A nurse is providing teaching to a client who has cancer and is undergoing external radiation treatment. Which of the following statements by the client indicated an understanding of teaching? A. " I should use petroleum-based lotions on the areas being radiated" B. " I will dry the area being radiated by rubbing in a circular pattern" C. " I will apply sunscreen to the area being radiated when I spend time in the sun" D. "I should use a hand, instead of a washcloth, to wash the areas being radiated"
D. "I should use a hand, instead of a washcloth, to wash the areas being radiated"
When assessing a lesion diagnosed as basal cell carcinoma, the nurse most likely expects to note which findings? (Select all that apply) A. An irregularly shaped lesion B. A small papule with a dry, rough scale C. A firm, nodular lesion topped with crust D. A pearly papule with a central crater and a waxy boarder E. Location in the bald spot atop the head that is exposed to outdoor sunlight
D. A pearly papule with a central crater and a waxy boarder E. Location in the bald spot atop the head that is exposed to outdoor sunlight
The male client with sickle cell anemia come to the ED with a temperature of 101.4 and tells the nurse that he is having a sickle cell crisis. What diagnostic test should the nurse anticipate the ED doctor order? A. Spinal tap B. hemoglobin electrophoresis C. Sickle-turbidity test D. Blood cultures
D. Blood cultures
Which treatment is likely to be planned for a patient who develops pernicious anemia after a gastrectomy? A. Triple- drug therapy B. IV therapy C. Quadruple- drug therapy D. Cobalamin replacement therapy
D. Cobalamin replacement therapy
A home health nurse is visiting an older adult client who has anemia. Which of the following foods should the nurse recommend to increase the clients iron intake? A. Greek Yogurt B. Bran muffin C. Peanut butter sandwich D. Dried fruit
D. Dried fruit
A nurse is planning care for a client during a sickle cell crisis. Which of the following interventions should the nurse include in the clients plan of care? A. Maintain the clients keens and hips in a flexed position B. Apply cold compresses to painful joints C. Withhold opioids until the crisis is resolved D. Encourage increased fluid intake
D. Encourage increased fluid intake
A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome? A. Irregular cardiac rhythm B. Numbness in the hands C. Muscle cramps D. Facial edema
D. Facial edema
The client is diagnosed with CLL after routine lab tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? A. CCL s not serious, and the clients die from other causes first B. There are no symptoms with this form of leukemia C. This is a childhood illness and is self-limiting D. In early stages of CLL, the client may be asymptomatic
D. In early stages of CLL, the client may be asymptomatic
A nurse is reviewing laboratory values for an adult client who has sickle cell anemia and a history of reviewing blood transfusion. For which of the following complications should the nurse monitor? A. Hypokalemia B. Lead poisoning C. Hypercalcemia D. Iron Toxicity
D. Iron Toxicity Rationale: A client who is receiving several blood transfusions is at risk for an excess storage of iron.
A community health nurse is teaching a group of clients about melanoma. Which of the following characteristics of lesions associated with melanoma should the nurse include in the teaching? A. One soild color B. Symmetrical shape C. <6mm in diameter D. Irregular boarder
D. Irregular boarder
The healthcare provider is assessing a patient with a diagnosis of lung cancer after a left lobectomy. Which of the following assessment is an early indication the patient has developed atelectasis? (select all that apply) A. Central cyanosis B. Inspiratory wheezing bilaterally C. Intercoastal retractions D. Low grade fever E. Decreased breath sounds in the right lung
D. Low grade fever E. Decreased breath sounds in the right lung
A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which of the following dietary recommendations should the nurse share with client? A. Eat with metal utensils B. Limit coffee C. Avoid citrus foods D. Offer mints
D. Offer mints
A nurse is collecting a health history from a female client who is undergoing screening from breast cancer. Which of the following factors should the nurse identify for placing the client at the greatest risk for developing breast cancer? A. Obesity B. Oral contraceptive use C. Alcohol use D. Over 50 years of age
D. Over 50 years of age
A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing skin cancer? A. Age over 60 B. Genetic predisposition C. Light-skinned race D. Overexposure to sun light
D. Overexposure to sun light
A nurse is assessing a client for manifestations of aplastic anemia. Which of the following findings should the nurse expect? A. Plethoric appearance of facial skin B. Glossitis and weight loss C. Jaundice with an enlarged liver D. Petechiae and ecchymosis
D. Petechiae and ecchymosis rationale: The hallmark sign of aplastic anemia is pancytopenia. Petechiae and ecchymosis is related to the severe thrombocytopenia
Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? A. Elevated hemoglobin level B. Decreased reticulocyte C. Elevated Red blood cell count D. Red blood cells that are microcytic and hypochromic
D. Red blood cells that are microcytic and hypochromic
A nurse is assessing a female client who is taking hormonal therapy for breast cancer. What assessment finding requires the nurse to notify the primary health care provider immediately? A. Irregular menses B. Edema in the lower extremities C. Ongoing breast tenderness D. Red, warm, swollen calf
D. Red, warm, swollen calf
A nurse is caring for a client who the provider suspects might have pernicious anemia. The nurse should expect the following diagnostic tests? A. sweat test B. Haptoglobin C. Antinuclear antibodies D. Schilling test
D. Schilling test
Which client is at the greatest risk for development of skin cancer? A. The African American male who lives in the northeast B. The elderly Hispanic female who moved from Mexico as a child C. The client who has a family history of basal cell carcinoma D. The client with fair complexion who cannot get a tan
D. The client with fair complexion who cannot get a tan
A nurse is preparing to administer cisplatiin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? A. Hallunications B. Pruitus C. Hand and foot syndrome D. Tinnitus
D. Tinnitus
A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? A. Hallucinations B. Pruritus C. Hand and foot syndrome D. Tinnitus
D. Tinnitus
A nurse is planning a presentation for a group of older adults at a community center about risk factors for cancer. Which of the following factors increases the risk of developing cancer after age 60? A. High-protein diet B. Insufficient calcium intake C. Declining muscle mass D. Weakened immune responses
D. Weakened immune responses
When caring for a client with an internal radiation implant, the nurse should observe which principles? (select all that apply) A. Limiting the time with the client to 1 hour per shift B. Keeping pregnant women out the clients room C. Placing the client in a private room with a private bath D. Wearing a lead shield when providing direct client care E. Removing the dosimeter film badge when entering the clients room F. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client
Keeping pregnant women out the clients room C. Placing the client in a private room with a private bath D. Wearing a lead shield when providing direct client care
A nurse is preparing a teaching plan for a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching? a. Bottled water is an appropriate choice to increase fluid intake. b. The salad bar is a healthy choice when dining out. c. Soft-boiled eggs are an appropriate source of protein. d. Eating at a buffet is a good choice to increase caloric intake.
a. Bottled water is an appropriate choice to increase fluid intake.