NURS 405 Unit 1 Quiz (Weeks 1-3)

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? Salmeterol Albuterol Cromolyn Ipratropium

Albuterol Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse should identify what main goal of care? Cure of the disease Enhancing quality of life Controlling symptoms Palliation

Cure of the disease Rationale: The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure of the disease.

A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally? Pancreatic enzymes Anti-inflammatory agents Recombinant human DNase Bronchodilators

Pancreatic enzymes Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation.

An oncology nurse recognizes a client's risk for fluid imbalance while the client is undergoing treatment for leukemia. What related assessments should the nurse include in the client's plan of care? Select all that apply. Measuring and recording the client's intake and output Monitoring the client's hepatic function Monitoring the client's electrolyte levels Auscultating the client's lungs frequently Measuring the client's weight on a daily basis

Measuring and recording the client's intake and output Monitoring the client's electrolyte levels Auscultating the client's lungs frequently Measuring the client's weight on a daily basis

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? "Give your child high-calorie foods and snacks." "Administer water soluble vitamins." "Feed your child foods that are high in protein." "Give pancreatic enzymes with meals." "Give your child foods high in fat."

"Give your child high-calorie foods and snacks." "Feed your child foods that are high in protein." "Give pancreatic enzymes with meals." ***Most people with cystic fibrosis (CF) need supplements of the fat-soluble vitamins (A, D, E, and K)

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? "We will place the liquid in the front of her gums, just below her teeth." "We'll try to get her to drink lots of fluids throughout the day." "She needs to eat foods that are high

"We will place the liquid in the front of her gums, just below her teeth." Rationale: When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? "Do you have any bruises on your feet or shins?" "Open your mouth so I can look inside your cheeks and lips." "Let me see the palms of your hands and soles of your feet." "Will you show me how you walk across the room?"

"Will you show me how you walk across the room?" Rationale: Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit, stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the hands and feet provide information about signs of petechiae, purpura, or pallor.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete? Electroencephalogram (EEG) Complete blood count (CBC) Pulmonary function test Arterial blood gas (ABG)

Arterial blood gas (ABG) The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment. A CBC is a blood test used to test for disorders including anemia, infection, and leukemia. An EEG is a test used to find problems related to electrical activity of the brain. A pulmonary function test is performed to evaluate the respiratory system. Based on the findings, the child is experiencing respiratory distress and has an elevated temperature. Airway and breathing are priority over an elevated temperature. The child's blood pressure is within normal range for this age. A pulmonary function test is most commonly used for children with asthma in an outpatient setting, and is done on medically stable children, not used to determine respiratory distress of someone who is desaturating.

A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death. Communicate to the health care provider the need to provide more information to the client and family. Assess how much information is desired from the client in terms of illness, treatment, and complications.

Assess how much information is desired from the client in terms of illness, treatment, and complications. Rationale: As with any client exhibiting anxiety and fear about a prognosis, listening should come first in order to assess how much information the client wants to have regarding the illness, treatment and potential complications. This is an ongoing assessment, since needs and interest in information changes throughout the course of treatment. Managing a client's care is a team effort, so involving the primary care provider and family is important, but not the nurse's priority action. Offering pastoral services and role restructuring has its place in treatment but should be discussed after an assessment of the client's needs. A discussion about palliative care and hospice is not appropriate at this time. Offering realistic hope is important and only after all treatment options are exhausted, or the client is diagnosed as terminal, should palliative and/or hospice care be co

A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action? Initiate measures to prevent venous thromboembolism (VTE). Check the client's most recent platelet level. Place the client on protective isolation. Ambulate the client to promote circulatory function.

Check the client's most recent platelet level. Rationale: The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.

A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor? Left ventricular hypertrophy Labyrinthitis Decreased bone density Hypercoagulation

Decreased bone density Rationale: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis (decreased bone density) and osteolytic lesions. Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation or cardiac hypertrophy as a result of multiple myeloma.

A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply. Discouraging fresh flowers in the child's room Placing the child in a semiprivate room Encouraging an intake of raw fruits and vegetables Avoiding rectal exams, suppositories, and enemas Placing a mask on the child when outside the room

Discouraging fresh flowers in the child's room Avoiding rectal exams, suppositories, and enemas Placing a mask on the child when outside the room Rationale: Generally, neutropenic precautions include placing the child in a private room; avoiding rectal suppositories, enemas, and examinations; placing a mask on the child when outside the room; avoiding the intake of raw fruits and vegetables; and not permitting fresh flowers or live plants in the room.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority? Applying EMLA to the lumbar puncture site Administering promethazine as ordered for nausea Educating the family about chemotherapy and its side effects Educating the child and family about the testing procedures

Educating the child and family about the testing procedures The priority would be educating the child and family about the testing procedures so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun.

The nurse is preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? Auscultation Inspection Percussion Palpation

Palpation When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

The clinical nurse educator is presenting health promotion education to a client who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? Using an electric shaver rather than a razor Avoiding highly crowded public places Avoiding direct sun exposure in excess of 15 minutes daily Avoiding grapefruit juice and fresh grapefruit

Avoiding highly crowded public places Rationale: The risk of infection is significant for these clients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the client's medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease? Follow the client's erythrocyte sedimentation rate over time. Document the client's response to erythropoietin injections. Follow the trends of the client's hematocrit. Document the color of the client's palms and face during each visit.

Follow the trends of the client's hematocrit. Rationale: The course of polycythemia vera can be best ascertained by monitoring the client's hematocrit, which should remain below 45%. Erythropoietin injections would exacerbate the condition. Skin tone should be observed, but is a subjective assessment finding. The client's erythrocyte sedimentation rate is not relevant to the course of the disease.

A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain? Helping the client manage the opioid analgesic regimen Teaching the client to use NSAIDs effectively Educating the client about the effective use of hot and cold packs Implementing distraction techniques

Helping the client manage the opioid analgesic regimen Rationale: For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain, though they may be useful as adjuncts.

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 which imbalance? Hyperproteinemia Elevated red blood count (RBC) Hypercalcemia Elevated serum viscosity

Hypercalcemia Rationale: Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin but would not result from bone destruction. The RBC count will decrease, not increase, resulting in anemia due to the abnormal protein produced from the malignant cells. Hyperproteinemia is defined as high protein in the blood and is commonly seen in clients with dehydration but would not result from bone destruction.

A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML). Assessment of which factor most directly addresses the most common cause of death among clients with leukemia? Electrolyte levels Nutritional status Infection status Liver function

Infection status Rationale: Because of the lack of mature and normal granulocytes that help fight infection, clients with leukemia are prone to infection. In clients with AML, death typically occurs from infection or bleeding. Symptoms of AML include weight loss, fever, night sweats, and fatigue, which would guide the nurse to monitor the client's nutrition and electrolytes. Gastrointestinal problems (nausea and vomiting) and electrolyte imbalances (hyperkalemia and hypocalcemia) may result from chemotherapy use. The liver is responsible for metabolism and metabolic detoxification, so monitoring liver function is important for the client who is receiving chemotherapy. These problems may contribute to and/or result in death but are not the most common cause.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. Use guided imagery and therapeutic touch. Initiate pain assessment with a standardized pain scale. Administer meperidine as ordered.

Initiate pain assessment with a standardized pain scale. The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? Inspiratory stridor Toxic appearance High fever Dysphagia

Inspiratory stridor A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis.

The nurse is caring for a 13-year-old boy with acute myeloid leukemia (AML) who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? Recognizing abilities that are unaffected by the disease Providing realistic expectations of treatments and outcomes Involving the boy in decisions whenever possible Acknowledging the boy's feelings of anger with the disease

Involving the boy in decisions whenever possible Involving the boy in the decision-making process will best help his sense of control. Whether he is included in important decisions about therapy or minor decisions like menus or dress, it will give him a sense of control over his situation. Acknowledging feelings of anger, recognizing his abilities, and providing realistic expectations will reduce body image disturbance and build self-esteem.

The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults? Unlike adult cancers, childhood cancers are less responsive to treatment. The majority of childhood cancers can be prevented. Most childhood cancers affect the tissues rather than organs. Childhood cancers are usually localized when found.

Most childhood cancers affect the tissues rather than organs. Rationale: Childhood cancers usually affect the tissues, not the organs, as in adults. Metastasis often is present when the childhood cancer is diagnosed. Childhood cancers, unlike adult cancers, are very responsive to treatment. Unfortunately, little is known about cancer prevention in children.

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? Pernicious anemia Sickle cell anemia Aplastic anemia Folic acid anemia

Pernicious anemia Monthly injections of vitamin B12 are used to treat pernicious anemia. Aplastic anemia is characterized by a decrease in all blood cells necessitating a bone marrow transplant. Folic acid deficiency anemia is treated with dietary measures and possible folic acid supplementation. Sickle cell anemia is treated supportively with a focus on preventing sickling crisis, infection, and other complications.

A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's care plan? Protective isolation and vigilant use of standard precautions Including the family in planning the client's activities of daily living Monitoring and treating the client's pain Provision of a high-calorie, low-texture diet and appropriate oral hygiene

Protective isolation and vigilant use of standard precautions Rationale: Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the client's survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage? Elimination of all residual leukemic cells Intense therapy to strengthen remission Rapid promotion of complete remission Reduction of risk for central nervous system (CNS) disease

Rapid promotion of complete remission Rationale: Induction is done to rapidly produce a complete remission. Consolidation or intensification is the stage when remission is strengthened, and leukemic cell burden is reduced. Maintenance attempts to eliminate all residual leukemic cells, and CNS prophylaxis is the stage that attempts to reduce the development of CNS disease.

The nurse is examining a 5-year-old. Which sign or symptom is a reliable first indication of respiratory illness in children? Slow, irregular breathing A bluish tinge to the lips Increasing lethargy Rapid, shallow breathing

Rapid, shallow breathing Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? Tachypnea with retractions Pale skin color Fever Oxygen saturation level of 96%

Tachypnea with retractions Rationale: Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization.

A child is in the emergency department with an asthma exacerbation. Upon auscultation, the nurse is unable to hear air movement in the lungs. What action should the nurse take first? administer corticosteroids administer a beta-2 adrenergic agonist start a peripheral IV administer oxygen

administer a beta-2 adrenergic agonist When lung sounds are unable to be heard in a child with asthma, the child is very ill. This means there is severe airway obstruction. The air movement is so severe that wheezes cannot be heard. The priority treatment is to administer an inhaled short-term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started, but until the bronchi are dilated, no oxygen can get through to the lung fields. An IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation.

Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult client who is otherwise healthy. The client and the care team have collaborated and the client will soon begin induction therapy. The nurse should prepare the client for: daily treatment with targeted therapy medications. an aggressive course of chemotherapy. radiation therapy on a daily basis. hematopoietic stem cell transplantation.

an aggressive course of chemotherapy. Rationale: Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies.