리피컷 oncology

73.When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. 1.Verify patency of the line by the presence of a blood return at regular intervals. 2.Inspect the insertion site for swelling, erythema, or drainage. 3.Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present. 4.If unable to aspirate blood, reposition the client and encourage the client to cough. 5.Contact the health care provider about verifying placement if the status is questionable.

1 2 4 5 "A major concern with IV administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of blood return when administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. The nurse should also assess the insertion site for signs of infiltration, such as swelling and redness. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is questionable and may require a declotting regimen (Abbokinase). The nurse should not administer any drug if the IV line is not open or does not have an adequate blood return."

"1.A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse incorporate into the discharge instructions? Select all that apply. 1.Drink at least 3,000 mL of fluid each day. 2.Minimize daily activities. 3.Keep urine alkaline to prevent urinary tract infections. 4.Avoid odor-producing foods, such as onions, fish, eggs, and cheese. 5.Wear snug clothing over the stoma to encourage urine flow into the drainage bag.

1 4 "An adequate fluid intake aids in the prevention of urinary calculi and infection. Odor-producing foods can produce offensive odors that may impact the client's lifestyle and relationships. Lack of activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow."

"A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply. 1."I will take Tylenol for pain." 2."I do not need to inspect the puncture site." 3."I will not be able to play basketball for the next 2 days." 4."I will take aspirin if I have pain." 5."I can apply an ice pack or a cold compress to the puncture site."

1, 3, 5. 3. Acetaminophen (Tylenol) is a safer analgesic than aspirin in order to avoid bleeding. Contact sports or trauma to the site should be avoided. Cool compresses should limit swelling and bruising. The puncture site should be inspected every 2 hours for bleeding or bruising during the first 24 hours. CN: Reduction of risk potential; CL: Evaluate

98.The nurse is developing a discharge plan about home care with a client who has lymphoma. The nurse should emphasize which of the following? 1.Use analgesics as needed. 2.Take a shower with perfumed shower gel. 3.Wear a mask when outside of the home. 4.Take an antipyretic every morning.

1. Analgesics are used as needed to relieve painful encroachment of enlarged lymph nodes. Perfumed shower gel will increase pruritus. Wearing a mask does not protect the client from infection if pathogens are not spread by airborne droplets. Antipyretics should be used to treat fever symptomatically after infection is ruled out

"96.When assessing the client with Hodgkin's disease, the nurse should observe the client for which of the following findings? 1.Herpes zoster infections. 2.Discolored teeth. 3.Hemorrhage. 4.Hypercellular immunity.

1. Herpes zoster infections are common in clients with Hodgkin's disease. Discoloring of the teeth is not related to Hodgkin's disease but rather to the ingestion of iron supplements or some antibiotics such as tetracycline. Mild anemia is common in Hodgkin's disease, but the platelet count is not affected until the tumor has invaded the bone marrow. A cellular immunity defect occurs in Hodgkin's disease in which there is little or no reaction to skin sensitivity tests. This is called anergy. CN: Physiological adaptation; CL: Analyze

94.A client with a suspected diagnosis of Hodgkin's disease is to have a lymph node biopsy. The nurse should make sure that personnel involved with the procedure do which of the following when obtaining the lymph node biopsy specimen for histologic examination for this client? 1.Maintain sterile technique. 2.Use a mask, gloves, and a gown when assisting with the procedure. 3.Send the specimen to the laboratory when someone is available to take it. 4.Ensure that all instruments used are placed in a sealed and labeled container.

1. The nurse must ensure that sterile technique is used when a biopsy is obtained because the client is at high risk for infection. In most cases, a lymph node biopsy is sent immediately to the laboratory once it is placed in a specific solution in a closed container. It is not necessary to wear a gown and mask when obtaining the specimen. It is not necessary to use special handling procedures for the instruments used. CN: Management of care; CL: Apply

"20.A nurse is planning care for a client who underwent a percutaneous needle biopsy of the kidney. What should the nurse plan to do immediately after the biopsy? Select all that apply. 1.Assess the biopsy site. 2.Take vital signs every hour. 3.Assess urine for hematuria. 4.Place the client in a prone position. 5.Assess the client for chest pain.

134 "The nurse should assess the biopsy site for bleeding and hematoma formation. The client should remain prone for 8 to 24 hours after the biopsy. A pressure dressing will aid in blood coagulation. Vital signs assessment should be taken every 5 to 15 minutes for the first hour and then less often if the client is stable. The urine does not need to be collected and kept on ice. The nurse should collect serial urine specimens to assess for hematuria. A renal biopsy does not put the client at increased risk for chest pain."

4.A 42-year-old female highway construction worker is concerned about her cancer risks. She has been married for 18 years, has two children, smokes one pack of cigarettes per day, and occasionally drinks one to two beers. She is 30 lb (13.6 kg) overweight, eats fast food often, and rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What behavioral changes should the nurse instruct this client to make to decrease her risk of cancer? Select all that apply. 1.Improve nutrition. 2.Decrease alcohol consumption. 3.Use sunscreen. 4.Stop smoking. 5.Lose weight. 6.Change her job to work inside.

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"A nurse is caring for a client who is undergoing chemotherapy. Current laboratory values are noted on the chart. Which action would be most appropriate for the nurse to implement? Hgb 12 plt 108,000 WBC 1600 ANC 1,000 1.Wearing a protective gown and particulate respiratory mask when completing treatments. 2.Washing hands before and after entering the room. 3.Restricting visitors. 4.Contacting the physician for a prescription for hematopoietic factors such as erythropoietin.

2

12.The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with which product? 1.Baking soda. 2.Soap. 3.Hydrogen peroxide. 4.Alcohol.

2

21.When planning a culturally sensitive health education program the nurse should: 1.Locate the program at an existing government facility. 2.Integrate folk beliefs and traditions of the target population into the content. 3.Prepare materials in the primary language of the program sponsor. 4.Exclude community leaders from the dominant culture from initial planning efforts."

2

41.A nurse is assessing a female who is receiving her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain? 1."Has your hair been falling out in clumps?" 2."Have you had nausea or vomiting?" 3."Have you been sleeping at night?" 4."Do you have your usual energy level?

2

53.A 36-year-old female is scheduled to receive external radiation therapy and a cesium implant for cancer of the cervix. Which of the following statements would be most accurate to include in the teaching plan about the potential effects of radiation therapy on sexuality? 1."You can have sexual intercourse while the implant is in place." 2."You may notice some vaginal dryness after treatment is completed." 3."You may notice some vaginal relaxation after treatment is completed." 4."You will continue to have normal menstrual periods during treatment."

2

64.A client undergoing chemotherapy tells the nurse, "I do not want to get out of bed in the morning because I am so tired." The nursing plan of care should include: 1.Education on the use of filgrastim. 2.Individually tailored exercise program. 3.Weight lifting when not experiencing fatigue. 4.Bed rest until chemotherapy is completed.

2

65.A nurse is reviewing the chart of an adult male with cancer. The health care provider has prescribed filgrastim 400 mcg, subcutaneously once daily. The nurse reviews the laboratory report and determines treatment has been effective when: 1.Hemoglobin is 16 g/dL (160 g/L). 2.WBC count is 3,500/mm3 (3.5 × 109/L). 3.Platelet count is 200,000/mm3 (200 × 109/L). 4.RBC count is 4.3 million/mm3 (4.3 × 1012/L).

2

19.A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for the next 8 weeks. Which of the following indicates that the client understands how to manage the urine as a biohazard. The client will: 1.Void into a bedpan and then empty the urine into the toilet. 2.Disinfect the urine and toilet with bleach for 6 hours following a treatment. 3.Clean the bathroom daily with disinfectant wipes. 4.Use a separate bathroom from the rest of the family for the next 8 weeks."

2 "After intravesical chemotherapy, the client must treat the urine as a biohazard; this involves disinfecting the urine and the toilet with household bleach for 6 hours following a treatment. It is not necessary to use a bedpan and then empty the urine in the toilet; the client can use the toilet, but must disinfect the urine with bleach. The bathroom does not need to be cleaned daily with disinfectant wipes. The client does not need to use a separate bathroom as long as the client's urine is disinfected with bleach."

8.After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which of the following complications related to pelvic surgery? 1.Peritonitis. 2.Thrombophlebitis. 3.Ascites. 4.Inguinal hernia.

2 "After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision."

17.A 42-year-old is interested in making dietary changes to reduce the risk of colon cancer. What dietary selections should the nurse suggest? 1.Croissant, granola and peanut butter squares, whole milk. 2.Bran muffin, skim milk, stir-fried broccoli. 3.Granola, bagel with cream cheese, cauliflower salad. 4.Oatmeal, raisin cookies, baked potato with sour cream, turkey sandwich.

2 "High-fiber, low-fat diets are recommended to reduce the risk of colon cancer. Stir-frying, poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of refined flour. They are also high in fat, as are peanut butter squares and whole milk, granola, cream cheese, and sour cream.

62.A client with cancer is afraid of experiencing a febrile reaction associated with blood transfusions. The nurse should explain to the client that: 1."Febrile reactions are caused when antibodies on the surface of blood cells in the transfusion are directed against antigens of the recipient." 2."Febrile reactions can usually be prevented by administering antipyretics and antihistamines before the start of the transfusion." 3."Febrile reactions are rarely immune-mediated reactions and can be a sign of hemolytic transfusion." 4."Febrile reactions primarily occur within 15 minutes after initiation of the transfusion and can occur during the blood transfusion."

2 "The administration of antipyretics and antihistamines before initiation of the transfusion in the frequently transfused client can decrease the incidence of febrile reactions. Febrile reactions are immune-mediated and are caused by antibodies in the recipient that are directed against antigens present on the granulocytes, platelets, and lymphocytes in the transfused component. They are the most common transfusion reactions and may occur with onset, during transfusion, or hours after transfusion is completed."

75.A client with pancreatic cancer, who has been bed-bound for 3 weeks, has just returned from having a left subclavian, long-term, tunneled catheter inserted for administration of analgesics. The nurse has not yet received radiographic results for confirmation of placement. The client becomes restless and dyspneic and has chest pain radiating to the middle of the back. Physical assessment reveals tachycardia and absent breath sounds in the left lung. The nurse should further assess the client for: 1.An air embolus. 2.A pneumothorax. 3.A pulmonary embolus. 4.A myocardial infarction.

2 "The client is exhibiting signs and symptoms of a pneumothorax from the insertion of the subclavian venous catheter. Although it is possible that the client suffered an air embolus during the procedure, and the client is at risk for pulmonary emboli because of his immobility, absent breath sounds immediately after insertion of a subclavian line are strongly suggestive of a pneumothorax. Unilateral absent breath sounds are not associated with a myocardial infarction."

"71.The nurse assesses the mouth and oral cavity of a client with human immunodeficiency virus (HIV) infection because the most common opportunistic infection initially presents as: 1.Herpes simplex virus (HSV) lesions on the lips. 2.Oral candidiasis. 3.Cytomegalovirus (CMV) infection. 4.Aphthae on the gingiva.

2 "The most common opportunistic infection in HIV infection initially presents as oral candidiasis, or thrush. The client with HIV should always have an oral assessment. HSV and CMV are opportunistic infections that present later in acquired immunodeficiency syndrome. Aphthous stomatitis, or recurrent canker sores, is not an opportunistic infection, although the sores are thought to occur more often when the client is under stress"

18.Which of the following is an environmental factor that increases the risk of cancer? 1.Gender. 2.Nutrition. 3.Immunologic status. 4.Age."

2 . Environmental factors include place of residence, nutrition, occupation, personal habits, iatrogenic factors, and physical environment. Gender, immunologic status, and age are individual factors.

72.When teaching about prevention of infection to a client with a long-term venous catheter, the nurse determines that the client has understood discharge instructions when the client states which of the following? 1."I will not remove the dressing until I return to the clinic next week." 2."My husband or I will do the dressing changes three times per week, exactly the way you showed us." 3."I will monitor my temperature once each weekday." 4."I know it is very important to wash my hands after irrigating the catheter."

2 The most important intervention for infection control is to continue meticulous catheter site care. Dressings are to be changed two to three times per week depending on institutional policies. Temperature should be monitored at least once a day in someone with a vascular access device. Hand washing before and after irrigation or any manipulation of the site is a must for infection prevention. CN: Safety and infection control; CL: Evaluate

"Cancer prevalence is defined as: 1.The likelihood cancer will occur in a lifetime. 2.The number of persons with cancer at a given point in time. 3.The number of new cancers in a year. 4.All cancer cases more than 5 years old.

2 The word prevalence in a statistical setting is defined as the number of cases of a disease present in a specified population at a given time. CN: Health promotion and maintenance; CL: Apply

103.The client is a survivor of non-Hodgkin's lymphoma. Which of the following statements indicates the client needs additional information? 1."Regular screening is very important for me." 2."The survivor rate is directly proportional to the incidence of second malignancy." 3."The survivor rate is indirectly proportional to the incidence of second malignancy." 4."It is important for survivors to know the stage of the disease and their current treatment plan."

2. It is incorrect that the survivor rate is directly proportional to the incidence of second malignancy. The survivor rate is indirectly proportional to the incidence of second malignancy, and regular screening is very important to detect a second malignancy, especially acute myeloid leukemia or myelodysplastic syndrome. Survivors should know the stage of the disease and their current treatment plan so that they can remain active participants in their health care. "

17.The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which of the following measures would be most effective? 1.Avoid people with respiratory tract infections. 2.Maintain a daily fluid intake of 2,000 to 3,000 mL. 3.Use sterile technique to change the appliance. 4.Irrigate the stoma daily.

2. Maintaining a fluid intake of 2,000 to 3,000 mL/day is likely to be most effective in preventing urinary tract infection. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.

42.A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. The nurse should report which of the following laboratory results to the oncologist before the next dose of chemotherapy is administered? Select all that apply. 1.Hemoglobin of 14.5 g/dL (145 g/L). 2.Platelet count of 40,000/mm3 (40 × 109/L). 3.Blood urea nitrogen (BUN) level of 12 mg/dL (4.28 mmol/L). 4.White blood cell count of 2,300/mm3 (2.3 × 109/L). 5.Temperature of 101.2°F (38.4°C). 6.Urine specific gravity of 1.020.

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"40.The client who is receiving chemotherapy is not eating well but otherwise feels healthy. Which meal suggestion would be best for this client? 1.Cereal with milk and strawberries. 2.Toast, gelatin dessert, and cookies. 3.Broiled chicken, green beans, and cottage cheese. 4.Steak and french fries.

3

"82.Which of the following clients with cancer should the nurse assess first? 1.A 38-year-old woman receiving internal radiation therapy for cervical cancer. 2.A 27-year-old man with leukemia hospitalized for induction of high-dose chemotherapy. 3.A 75-year-old man with metastatic prostate cancer with a pathologic fracture of the femur who is in pain. 4.A 23-year-old woman undergoing surgery for placement of a central venous catheter.

3

12.A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which of the following risk factors should the nurse discuss? 1.Family history. 2.Lifestyle choices. 3.Age. 4.Menopause or hormonal events.

3

4.The nurse should assess the client with bladder cancer for which of the following? 1.Suprapubic pain. 2.Dysuria. 3.Painless hematuria. 4.Urine retention.

3

60.Which of the following nursing interventions would be most helpful in improving the respiratory effort of a client with metastatic lung cancer? 1.Teaching the client diaphragmatic breathing techniques. 2.Administering cough suppressants as prescribed. 3.Teaching and encouraging pursed-lip breathing. 4.Placing the client in a low semi-Fowler's position.

3

63.An adult who recently had a right pneumonectomy for lung cancer is admitted to the oncology unit with dyspnea and fever. The nurse should: 1.Place the client on the left side. 2.Position the client for postural drainage. 3.Provide education on deep-breathing exercises. 4.Instruct the client to maintain bed rest with bathroom privileges.

3

68.An adult is dying from metastatic lung cancer, and all treatments have been discontinued. The client's breathing pattern is labored, with gurgling sounds. The client's spouse asks the nurse, "Can't you do something to help with the breathing?" Which of the following is the nurse's best response in this situation? 1.Direct the unlicensed personnel to assess the client's vital signs and provide oral care. 2.Suction the client so that the client's spouse knows all interventions were performed. 3.Reposition the client, elevate the head of the bed, and provide a cool compress. 4.Explain to the spouse that it is standard practice not to suction clients when treatments have been discontinued.

3

70.An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused client assessment for: 1.Ascites. 2.Pleural friction rub. 3.Dyspnea. 4.Peripheral edema.

3

73.The nurse is caring for a client from Southeast Asia who has HIV-AIDS. The client does not speak or comprehend the English language. The nurse should? 1.Contact the hospital's chaplain. 2.Do an Internet search for the Joint United Nations Programme on HIV/AIDS. 3.Utilize language-appropriate interpreters. 4.Ask a family member to obtain informed consent.

3

7.A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client's understanding of the surgical procedure by explaining that an ileal conduit: "1.Is a temporary procedure that can be reversed later. 2.Diverts urine into the sigmoid colon, where it is expelled through the rectum. 3.Conveys urine from the ureters to a stoma opening on the abdomen. 4.Creates an opening in the bladder that allows urine to drain into an external pouch.

3 "An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Diversion of urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy."

"19.A client at risk for lung cancer asks about the reason for having a computed tomography (CT) scan as part of the initial exam. The nurse's best response is which of the following? "A CT scan 1.Is far superior to magnetic resonance imaging for evaluating lymph node metastasis." 2.Is noninvasive and readily available." 3.Is useful for distinguishing small differences in tissue density and detecting nodal involvement." 4.Can distinguish a malignant from a nonmalignant adenopathy."

3 "CT scanning is the standard noninvasive method used in a workup for lung cancer because it can distinguish small differences in tissue density and can detect nodal involvement. CT is comparable to magnetic resonance imaging in evaluating lymph node metastasis. CT is noninvasive and usually available, but these are not the main reasons for its use. CT can distinguish malignancy in some situations only."

"55.A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend: 1.Evaluation by a dentist. 2.Alcohol-based mouth wash rinses. 3.Artificial saliva. 4.Vigorous brushing of teeth after each meal.

3 "Head and neck radiation can cause the complication of stomatitis and decreased salivary flow. A saliva substitute will assist with dryness, moistening food, and swallowing. Meticulous mouth care is needed; however, alcohol and vigorous brushing will increase irritation. Evaluation by a dentist to perform necessary dental work is done prior to initiation of therapy.

83.The nurse is making a follow-up telephone call to a 52-year-old client with lung cancer. The client now has a low-grade fever (100.6°F [38.1°C]), nonproductive cough, and increasing fatigue. The client completed the radiation therapy to the mass in the right lung and mediastinum 10 weeks ago and has a follow-up appointment to see the physician in 2 weeks. The nurse should advise the client: 1.To take two acetaminophen tablets every 4 to 6 hours for 2 days and call the physician if the temperature increases to 101°F (38.3°C) or greater. 2.That this is an expected side effect of the radiation therapy and to keep his appointment in 2 weeks. 3.To contact the physician for an appointment today. 4.To go to the nearest emergency department.

3 "The client is exhibiting early symptoms of pulmonary toxicity as a result of the radiation therapy. These are not expected adverse effects of radiation. The client should be examined to differentiate between an infection and radiation pneumonitis. Suggesting that the client take acetaminophen and call back in 2 days is inappropriate. These signs and symptoms are not indicative of a true emergency, but the client should be seen by a health care provider before the next appointment."

71.The nurse is planning with a client who has cancer to improve the client's independence in activities of daily living after radiation therapy. Which of the following is an appropriate nursing intervention? 1.Refer the client to a community support group after discharge from the rehabilitation unit. 2.Make certain that a family member is present for the rehabilitation sessions. 3.Provide positive reinforcement for skills achieved. 4.Inform the client of rehabilitation plans made by the rehabilitation team.

3 "The positive reinforcement builds confidence and facilitates achievement of rehabilitation goals. Community support may or may not be applicable after discharge. Although family support is an important component of rehabilitation, reinforcing the skills the client has acquired is of greater importance when regaining independence. Rehabilitation plans should include the client, family, or both.

"80.A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120, blood pressure 88/48, respiratory rate of 14, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 (6 kPA), PO2 95 (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which of the following prescriptions first? 1.Oxygen at 4 L per nasal cannula. 2.Repeat lab work in 4 hours. 3.5% dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h. 4.12 lead EKG.

3 "The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should first infuse the IV fluids with the addition of potassium. There is no indication that the client needs oxygen at this time since the PO2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse, the infusion of fluids may cause the heart rate to return to normal, and the 12 lead EKG can be prescribed after starting the intravenous fluids."

"57.A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZT is to: 1.Destroy the virus. 2.Enhance the body's antibody production. 3.Slow replication of the virus. 4.Neutralize toxins produced by the virus.

3 "Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus."

54.The nurse caring for a client who is receiving external beam radiation therapy for treatment of lung cancer should assess the client for which of the following? 1.Diarrhea. 2.Improved energy level. 3.Dysphagia. 4.Normal white blood cell count.

3 Radiation-induced esophagitis with dysphagia is particularly common in clients who receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum and is within the field of primary treatment. Diarrhea may occur with radiation to the abdomen. Decreased energy level and decreased white blood cell count are potential complications of radiation therapy."

"37.Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is distressed about hair loss. The nurse should do which of the following? 1.Have the client wash and massage the scalp daily to stimulate hair growth. 2.Explain that hair loss is temporary and will quickly grow back to its original appearance. 3.Provide resources for a wig selection before hair loss begins. 4.Recommend that the client limit social contacts until hair regrows.

3

"16.The nurse is assessing a 60-year-old who has hoarseness. The nurse should conduct a focused assessment to determine: 1.Patterns of medication use and history of alcohol consumption. 2.Exposure to sun and family history of head and neck cancers. 3.Exposure to wood dust and a high-fat diet. 4.History of tobacco use and alcohol consumption.

4

99.The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. Which of the following describes the involvement of the disease? 1.Involvement of a single lymph node. 2.Involvement of two or more lymph nodes on the same side of the diaphragm. 3.Involvement of lymph node regions on both sides of the diaphragm. 4.Diffuse disease of one or more extralymphatic organs."

"1. In the staging process, the designations A and B signify that symptoms were or were not present when Hodgkin's disease was found, respectively. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs. CN: Physiological adaptation; CL: Apply

"13.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. 1."If I limit my fluid intake, I will not have to empty my ostomy pouch as often." 2."I can place an aspirin tablet in my pouch to decrease odor." 3."I can usually keep my ostomy pouch on for 3 to 7 days before changing it." 4."I must use a skin barrier to protect my skin from urine." 5."I should empty my ostomy pouch of urine when it is full."

3 4 "The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 mL/day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight of the urine from pulling the appliance away from the skin."

95.The client with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. After the procedure, which does the nurse assess first? 1.Vital signs. 2.The incision. 3.The airway. 4. neurologic signs

3. Assessing for an open airway is always first. The procedure involves the neck; the anesthesia may have affected the swallowing reflex, or the inflammation may have closed in on the airway, leading to ineffective air exchange. Once a patent airway is confirmed and an effective breathing pattern established, the circulation is checked. Vital signs and the incision are assessed as soon as possible, but only after it is established that the airway is patent and the client is breathing normally. A neurologic assessment is completed as soon as possible after other important assessments."

7.Which of the following groups would benefit most from education regarding potential risk factors for melanoma? 1.Adults older than age 35. 2.Senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet B rays. 3.Parents with children. 4.Employees of a chemical factory.

3. Sun damage is a cumulative process. Parents should be taught to apply sunscreen and teach their children to use sunscreen at an early age. Although preventive education is always valuable, serious sunburns in childhood are associated with an increased risk of melanoma. Adults and senior citizens have already been exposed to the harmful effects of the sun and, although they, too, should use sunscreen, they are not the group that will most benefit from intervention. Exposure to chemicals is not a risk factor for melanoma."

"102.A client with advanced Hodgkin's disease is admitted to hospice because death is imminent. The goal of nursing care at this time is to: 1.Reduce the client's fear of pain. 2.Support the client's wish to discontinue further therapy. 3.Prevent feelings of isolation. 4.Help the client overcome feelings of social inadequacy.

3. Terminally ill clients most often describe feelings of isolation because they tend to be ignored, they are often left out of conversations (especially those dealing with the future), and they sense the attitudes of discomfort that many people feel in their presence. Helpful nursing measures include taking the time to be with the client, offering opportunities to talk about feelings, and answering questions honestly. CN: Psychosocial adaptation; CL: Synthesize

"3.A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, the nurse should be sure the client: 1.Has a bowel movement. 2.Has received the first dose of pain medication. 3.Has voided. 4.Has no blood in the urine.

3. The nurse should verify that the client has voided prior to discharge in order to evaluate bladder function. Bowel function is not expected to be affected by this procedure. There may not be a need for pain medication immediately post procedure and before discharge, but the nurse should assess the client's pain status and inform the client about the use and side effects of the medication. It is normal for the client to have hematuria because of the procedure.

72.The nurse is administering Didanosine (Videx) to a client with HIV. Before administering this medication, the nurse should check which lab test results? Select all that apply. 1.Elevated serum creatinine. 2.Elevated blood urea nitrogen (BUN). 3.Elevated aspartate aminotransferase (AST). 4.Elevated alanine aminotransferase (ALT). 5.Elevated serum amylase.

345 " The nurse should withhold the medication and notify the physician immediately if the client develops manifestations of pancreatitis or hepatic failure including nausea and vomiting, severe abdominal pain, elevated bilirubin, or elevated serum enzymes (eg, amylase, AST, ALT). If both BUN and creatinine are elevated, the client may have kidney disease."

"18.The nurse evaluates the effectiveness of the client's postoperative plan of care. Which of the following would be an expected outcome for a client with an ileal conduit? 1.The client verbalizes the understanding that physical activity must be curtailed. 2.The client will place an aspirin in the drainage pouch to help control odor. 3.The client demonstrates how to catheterize the stoma. 4.The client will empty the drainage pouch frequently throughout the day.

4

"49.A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and the skin is warm and pale. The vital signs are BP 80/30, P 132, R 28, T 103°F (39.4°C), and oxygen saturation 84%. The central line insertion site is inflamed. After calling the rapid response team, what should the nurse do next? 1.Place cold, wet compresses on the client's head. 2.Obtain a portable ECG monitor. 3.Administer a prescribed antipyretic. 4.Insert a peripheral intravenous fluid line and infuse normal saline.

4

"56.A nurse is planning care for a 25-year-old female client who has just been diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse, "How could this have happened?" The nurse responds to the question based on the most frequent mode of HIV transmission, which is: 1.Hugging an HIV-positive sexual partner without using barrier precautions. 2.Inhaling cocaine. 3.Sharing food utensils with an HIV-positive person without proper cleaning of the utensils. 4.Having sexual intercourse with an HIV-positive person without using a condom.

4

"8.A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? 1.Apply sunscreen only after going into the water. 2.Avoid peak exposure hours from 9 am to 1 pm. 3.Wear loosely woven clothing for added ventilation. 4.Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

4

15.A female client who has a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The most appropriate nursing goal for this client is to: 1.Manage her anxiety about her health. 2.Learn how to care for the urinary diversion. 3.Overcome feelings of worthlessness. 4.Express fears about the urinary diversion."

4

38.A client is receiving chemotherapy for the diagnosis of brain cancer. When teaching the client about contamination from excretion of the chemotherapy drugs within the first 48 hours, the nurse should instruct the client that: 1.A bathroom can be shared with an adult who is not pregnant. 2.Urinary and bowel excretions are not considered contaminated. 3.Disposable plates and plastic utensils must be used during the entire course of chemotherapy. 4.Any contaminated linens should be washed separately and then washed a second time, if necessary."

4

60.In educating a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is: 1.Premarital serologic screening. 2.Prophylactic treatment of exposed people. 3.Laboratory screening of pregnant women. 4.Ongoing sex education about preventive behaviors.

4

10.When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently. Which of the following indicate that the client is following instructions? 1.The skin around the stoma is red. 2.The urine is a deep yellow. 3.There is no odor present." 4. the seal around the stoma is intact

4 If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin; thus if the seal is intact, the client is emptying the appliance regularly. The skin around the seal should not be red or irritated, which could indicate a leak. There will likely be an odor from the urine. Deep yellow urine indicates that the client should be increasing fluid intake.

50.A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which of the following should the nurse include in client teaching? 1.Use a heating pad under the right arm. 2.Immobilize the right arm. 3.Place ice on the area after each treatment. 4.Apply deodorant only under the left arm.

4 " The nurse should instruct the client to avoid using chemicals such as a deodorant and hot or cold, or applications such as a heating pad or ice pack to the area being treated. The client should be encouraged to use the extremity to prevent muscle atrophy and contractures."

101.The nurse explains to the client with Hodgkin's disease that a bone marrow biopsy will be taken after the aspiration. What should the nurse explain about the biopsy? 1."Your biopsy will be performed before the aspiration because enough tissue may be obtained so that you won't have to go through the aspiration." 2."You will feel a pressure sensation when the biopsy is taken but should not feel actual pain; if you do, tell the doctor so that you can be given extra numbing medicine." 3."You may hear a crunch as the needle passes through the bone, but when the biopsy is taken, you will feel a suction-type pain that will last for just a moment." 4."You will be shaved and cleaned with an antiseptic agent, after which the doctor will inject a needle without making an incision to aspirate out the bone marrow"

. 2. A biopsy needle is inserted through a separate incision in the anesthetized area. The client will feel a pressure sensation when the biopsy is taken but should not feel actual pain. The client should be instructed to inform the physician if pain is felt so that more anesthetic agent can be administered to keep the client comfortable. The biopsy is performed after the aspiration and from a slightly different site so that the tissue is not disturbed by either test. The client will feel a suction-type pain for a moment when the aspiration is being performed, not the biopsy. A small incision is made for the biopsy to accommodate the larger-bore needle. This may require a stitch."

"39.A client is receiving vincristine. Client teaching by the nurse should include instructions on: 1.Use of loperamide. 2.Fluid restriction. 3.Low-fiber, bland diet. 4.Bowel regimen.

4 "A side effect of vincristine is constipation, and a bowel protocol should be considered. Loperamide is used to treat diarrhea. Fluids should be encouraged, along with high-fiber foods to prevent constipation."

97.The client with Hodgkin's disease develops B symptoms. These manifestations indicate which of the following? 1.The client has a low-grade fever (temperature lower than 100°F [37.8°C]). 2.The client has a weight loss of 5% or less of body weight. 3.The client has night sweats. 4.The client probably has not progressed to an advanced stage.

. 3. A temperature higher than 100.4°F (38°C), profuse night sweats, and an unintentional weight loss of 10% of body weight represent the cluster of clinical manifestations known as the B symptoms. Forty percent of clients with Hodgkin's disease have B symptoms, and B symptoms are more common in advanced stages of the disease. CN: Physiological adaptation; CL: Analyze .

48.A client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy? 1.Decrease in appetite. 2.Drowsiness. 3.Spasms of the diaphragm. 4.Cough and shortness of breath.

4 "Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity."

9.The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on these data, the nurse should: 1.Change the appliance bag. 2.Notify the physician. 3.Obtain a urine specimen for culture. 4.Encourage a high fluid intake.

4 "Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary. CN: Reduction of risk potential; CL: Synthesize

67.A terminally ill client in hospice care is experiencing nausea and vomiting because of a partial bowel obstruction. To respect the client's wishes for conservative management of the nausea and vomiting, the nurse should recommend the use of: 1.A nasogastric (NG) suction tube. 2.IV antiemetics. 3.Osmotic laxatives. 4.A clear liquid diet.

4 "The use of diet modification is a conservative approach to treat the terminally ill or hospice clients who have nausea and vomiting related to bowel obstruction. Osmotic laxatives would be harder for the client to tolerate. An NG tube is more aggressive and invasive. IV antiemetics are also invasive. The hospice philosophy involves comfort and palliative care for the terminally ill.

44.A client with malignant melanoma asks the nurse about the prognosis. The nurse should base a response that informs the client that the prognosis depends on: 1.The amount of ulceration of the lesion. 2.The age of the client. 3.The location of the lesion on the body. 4.The thickness of the lesion.

4 "Tumor or lesion thickness is the predictive factor for survival. Cutaneous melanoma that is confined to the epidermis has a high cure rate. Asymmetry, border, color, and diameter are known as the "ABCDs" of melanoma. Thus, the amount of ulceration, age, and location are not clearly associated with the prognosis."

6.If the client develops lower abdominal pain after a cystoscopy, the nurse should instruct the client to do which of the following? 1.Apply an ice pack to the pubic area. 2.Massage the abdomen gently. 3.Ambulate as much as possible. 4.Sit in a tub of warm water.

4 Lower abd pain after cystoscopy is frequently caused by bladder spasms. warm water can help relax muscles

4.A nurse is conducting a cancer risk screening program. Which of the following clients is at greatest risk for skin cancer? 1.45-year-old physician. 2.15-year-old high school student. 3.30-year-old butcher. 4.60-year-old mountain biker."

4. Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes.

"100.A client is undergoing a bone marrow aspiration and biopsy. What is the best way for the nurse to help the client and two upset family members handle anxiety during the procedure? 1.Allow the client's family to stay as long as possible. 2.Stay with the client without speaking. 3.Encourage the client to take slow, deep breaths to relax. 4.Allow the client time to express feelings.

. 3. Encouraging the client to take slow, deep breaths during uncomfortable parts of procedures is the best method of decreasing the stress response of tightening and tensing the muscles. Slow, deep breathing affects the level of carbon dioxide in the brain to increase the client's sense of well-being. Allowing the client's family to stay may be appropriate if the family has a calming effect on the client, but this family is upset and may contribute to the client's stress. Silence can be therapeutic, but when the client is faced with a potentially life-threatening diagnosis and a new, invasive procedure, taking deep breaths will be more effective "in reducing the stress response. Expressing feelings is important, but deep breathing will promote relaxation; the nurse can encourage the client to express feelings when the procedure is completed. CN: Psychosocial adaptation; CL: Synthesize

"11.The nurse should teach the client with an ileal conduit to prevent urine leakage when changing the appliance by using which of the following procedures? 1.Insert a gauze wick into the stoma. 2.Close the opening temporarily with a cellophane seal. 3.Suction the stoma before changing the appliance. 4.Avoid oral fluids for several hours before changing the appliance.

1

"41.Which of the following factors places a client at greatest risk for skin cancer? 1.Fair skin and history of chronic sun exposure. 2.Caucasian race and history of hypertension. 3.Dark skin and family history of skin cancer. 4.Dark skin and history of hypertension.

1

46.A client is using a herbal therapy while receiving chemotherapy. The nurse should: 1.Determine what substances the client is using, and make sure that the physician is aware of all therapies the client is using. 2.Guide the client in the decision-making process to select either Western or alternative medicine. 3.Encourage the client to seek alternative modalities that do not require the ingestion of substances. 4.Recommend that the client stop using the alternative medicines immediately.

1

15.The incidence and risk of cancer increase when smoking is combined with: 1.Asbestos exposure and alcohol consumption. 2.Ultraviolet radiation exposure and alcohol consumption. 3.Asbestos exposure and ultraviolet radiation exposure. 4.Alcohol consumption and human papillomavirus (HPV) infection.

1 "Asbestos and alcohol, when combined with smoking, produce a synergistic effect and result in increased cancer risk and incidence. Ultraviolet radiation exposure is associated with skin cancer. HPV exposure is associated with cervical cancer. However, the risks of contracting these types of cancer are not markedly increased when combined with smoking."

59.The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with human immunodeficiency virus (HIV) infection is that it: 1.Is an acquired immunodeficiency virus (AIDS)-defining illness. 2.Is curable only after 1 year of antiviral therapy. 3.Leads to cervical cancer. 4.Causes severe electrolyte imbalances.

1 "HSV infection is one of a group of disorders that, when diagnosed in the presence of HIV infection, are considered to be diagnostic for AIDS. Other AIDS-defining illnesses include Kaposi's sarcoma; cytomegalovirus of the liver, spleen, or lymph nodes; and Pneumocystis carinii pneumonia. HSV infection is not curable and does not cause severe electrolyte imbalances. Human papillomavirus can lead to cervical cancer."

9.A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, the nurse's best response would be to explain that: 1.Some melanomas have a familial component, and she should seek medical advice. 2.Her personal risk is low because most melanomas occur at age 60 or later. 3.Her personal risk is low because melanoma does not have a familial component. 4.She should not worry because she did not experience severe sunburn as a child."

1 "Malignant melanoma may have a familial basis, especially in families with dysplastic nevi syndrome. First-degree relatives should be monitored closely. Malignant melanoma occurs most often in the 20- to 45-year-old age-group. Severe sunburn as a child does increase the risk; however, this client is at increased risk because of her family history."

"16.The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent: 1.Urine reflux into the stoma. 2.Appliance separation. 3.Urine leakage. 4.The need to restrict fluids.

1 "The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent urine reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2,000 to 3,000 mL of fluid each day; it would be inappropriate to suggest decreasing fluid intake.

58.A nurse is caring for a client 24 hours after an abdominal-perineal resection for a bowel tumor. The client's wife asks if she can bring him some of his favorite home-cooked Italian minestrone soup. The nurse should first? 1.Auscultate for bowel sounds. 2.Ask the client if he feels hunger or gas pains. 3.Consult the dietician. 4.Encourage the wife to bring the soup."

1 "The nurse should perform a thorough assessment of the abdomen and auscultate for bowel sounds in all four quadrants. Clients who have gastrointestinal surgery may have decreased peristalsis for several days after surgery. The nurse should check the abdomen for distention and check with the client and the medical record regarding the passage of flatus or stool. Consulting a dietician would be inappropriate because the client must be kept on nothing-by-mouth status until bowel sounds are present. The nurse should explain to the wife that it is too soon after surgery for her husband to eat.

43.The nurse is developing a program about skin cancer prevention for a community group. Which of the following should be included in the program? Select all that apply. 1.Purchase sunscreen containing benzophenones to block UVA and UVB rays. 2.Use sunscreen with a minimum of 15 sun protection factor (SPF). 3.Obtain genetic screening to identify risk of melanoma. 4.Apply sunscreen only on sunny days, especially between 10 AM and 2 PM. 5.Have a pigmented lesion biopsied by shaving if it looks suspicious. 6.Rub baby oil to lubricate skin before going out in the sun."

1 2 "Sunscreen should be applied 20 to 30 minutes before going outside, even in cloudy weather. Sunscreen with a minimum of 15 SPF should be used. Sunscreen containing benzophenones block both UVA and UVB rays. The rays of the sun are most dangerous between 10 AM and 2 PM. Genetic screening is not indicated, although a mutated gene has been identified in some families with high incidence of melanoma. A prior diagnosis of melanoma and having a first-degree relative diagnosed with melanoma increases a person's risk. Lesions should not be shave biopsied; excisional biopsy technique is used. Baby oil will increase the adverse effects of sun exposure; sunscreen protection should be used."

2.A nurse is caring for a client with an ileal conduit. When assessing the stoma, which of the following outcomes are not desirable? Select all that apply. 1.Dermatitis. 2.Bleeding. 3.Fungal infection. 4.Use of adhesive solvent on the skin around the stoma. 5.Placing skin cement on the faceplate of the collection bag."

1 2 3 "Dermatitis with alkaline encrustations may occur when alkaline urine comes in contact with exposed skin. Yeast infections (or fungal infections) are another common peristomal skin problem. If the stoma is irritated from rubbing, there will be bleeding. The nurse and client should avoid irritating the stoma. Adhesive solvent should be used on a gauze pad to remove old adhesive and should, therefore not contact the stoma directly. Only a minimal amount of skin cement is applied to the faceplate of the collection bag and skin to secure the appliance over the stoma, so obstruction of the stoma by the cement would not be possible if correct technique is followed. CN: Physiological adaptation; CL: Evaluate

42.A nurse is providing teaching to a client about skin cancer. Which of the following should the nurse explain are risk factors for skin cancer? Select all that apply. 1.Increasing age. 2.Exposure to chemical pollutants. 3.Long-term exposure to the sun. 4.Increased pigmentation. 5.Genetics. 6.Immunosuppression.

1 2 3 5 6 "Risk factors associated with skin cancer include age, exposure to chemical pollutants, exposure to the sun, genetics, and immunosuppression. As individuals age, the risk of developing skin cancer increases. Long-time exposure to the sun and exposure to chemical pollutants (nitrates, coal, tar, etc.) increases the risk of skin cancer. Individuals who have less skin pigmentation (ie, fair, blue-eyed people) have a higher risk of skin cancer because they tend to incur sunburns rather than tan. Family history plays a role in cancer. Regardless, immunosuppressed individuals are at a higher risk for the development of any type of cancer, as the body's defenses are not functioning properly."

"51.A client receiving radiation therapy for lung cancer is having difficulty sleeping. The nurse should: 1.Suggest the client stop watching television before bed. 2.Assess the client's usual sleep patterns, amount of sleep, and bedtime rituals. 3.Tell the client sleeplessness is expected with radiation therapy. 4.Suggest that the client stop drinking coffee until the therapy is completed.

2 "

"93.Which of the following clinical manifestations does the nurse most likely observe in a client with Hodgkin's disease? 1.Difficulty swallowing. 2.Painless, enlarged cervical lymph nodes. 3.Difficulty breathing. 4.A feeling of fullness over the liver.

"2. Painless and enlarged cervical lymph nodes, tachycardia, weight loss, weakness and fatigue, and night sweats are signs of Hodgkin's disease. Difficulty swallowing and breathing may occur, but only with mediastinal node involvement. Hepatomegaly is a late-stage manifestation. CN: Physiological adaptation; CL: Analyze

5.A client is to have a cystoscopy. Which of the following indicate that the client has developed a complication after the cystoscopy? 1.Dizziness. 2.Chills. 3.Pink-tinged urine. 4.Bladder spasms.

2 chills could indicate the onset of acute infection that can progress to septic shock

"43.A nurse is checking the laboratory results of a client with colon cancer admitted for further chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory result should be reported to the health care provider? 1.Blood glucose level of 95 mg/dL (5.3 mmol/L). 2.Total cholesterol level of 182 mg/dL (10.1 mmol/L). 3.Hemoglobin level of 12.3 mg/dL (123 g/L). 4.Albumin level of 2.8 g/dL (28 g/L).

4 "The nurse must recognize that an albumin level of 2.8 g/dL (28 g/L) indicates catabolism and potential for malnutrition. Normal albumin is 3.5 to 5.0 g/dL (35 to 50 g/L); less than 3.5 (35 g/L) indicates malnutrition. The other laboratory results are normal."

52.A 56-year-old female client is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The nurse should further assess the client for indications of: 1.Hiatal hernia. 2.Stomatitis. 3.Radiation enteritis. 4.Esophagitis.

4

56.A client undergoing chemotherapy has a white blood cell count of 2,300/mm3 (2.3 × 109/L), hemoglobin of 9.8 g/dL (98 g/L), platelet count of 80,000/mm3 (80 × 109/L), and potassium of 3.8. Which of the following should take priority? 1.Blood pressure 136/88. 2.Emesis of 90 mL. 3.Temperature 101°F (38.3°C). 4.Urine output 40 mL/h.

3

61.Which of the following should be included in the teaching plan for a client with cancer who is experiencing thrombocytopenia? Select all that apply. 1.Use an electric razor. 2.Use a soft-bristle toothbrush. 3.Avoid frequent flossing for oral care. 4.Include an over-the-counter nonsteroidal anti-inflammatory (NSAID) daily for pain control. 5.Monitor temperature daily. 6.Report bleeding, such as nosebleed, petechiae, or melena, to a health care professional.

1 2 3 6

"61.A male client with human immunodeficiency virus (HIV) infection becomes depressed and tells the nurse: "I have nothing worth living for now." Which of the following statements would be the best response by the nurse? 1."You are a young person and have a great deal to live for." 2."You should not be too depressed; we are close to finding a cure for AIDS." 3."You are right; it is very depressing to have HIV." 4."Tell me more about how you are feeling about being HIV positive."

4

44.Which of the following is the most reliable early indicator of infection in a client who is neutropenic? 1.Fever. 2.Chills. 3.Tachycardia. 4.Dyspnea."

1

76.In setting goals for a client with advanced liver cancer who has poor nutrition, the nurse determines that which of the following is a desired outcome for the client? The client will: 1.Have normalized albumin levels. 2.Return to ideal body weight. 3.Gain 1 lb (0.45 kg) every 2 weeks. 4.Maintain current weight.

4

"69.A client is concerned about losing the hair on the head as a result of chemotherapy. Which of the following responses from the nurse will be most helpful to the client? 1."The new growth of hair will be gray." 2."The hair loss is temporary." 3."New hair growth will always be the same texture and color as it was before chemotherapy." 4."The client should avoid use of wigs when possible."

2

"14.A client has an ileal conduit. Which of the following solutions will be useful to help control odor in the urine collecting bag after it has been cleaned? 1.Salt water. 2.Vinegar. 3.Ammonia. 4.Bleach.

2

47.A client diagnosed with cancer is receiving chemotherapy. The nurses should assess which of the following diagnostic values while the client is receiving chemotherapy? 1.Bone marrow cells. 2.Liver tissues. 3.Heart tissues. 4.Pancreatic enzymes.

1

57.A client with bladder cancer has lost an estimated 500 mL blood in the urine. The client's hemoglobin is 8.0 g/dL (80 g/L), and the physician prescribes a unit of packed blood cells. To administer the packed red blood cells, the nurse should: 1.Attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. 2.Start an additional 22G IV site because the packed blood cells must be given in a separate line. 3.Attach the packed blood cells to the existing 22G IV of 5% dextrose using Y tubing. 4.Start an additional IV access device with a 22G Intracath.

1

66.The nurse is teaching the client who is receiving chemotherapy and the family how to manage possible nausea and vomiting at home. The nurse should include information about: 1.Eating frequent, small meals throughout the day. 2.Eating three normal meals a day. 3.Eating only cold foods with no odor." 4.Limiting the amount of fluid intake.

1

91.A nurse is assessing an adult who has been receiving chemotherapy. The client has a platelet count of 22,000 cells/mm3 (22 × 109/L) and has petechiae on the lower extremities. The nurse should advise the client to: 1.Increase the amount of iron in the client's diet. 2.Apply lotion to the lower extremities. 3.Elevate the legs. 4.Consult the oncologist.

4 "Petechiae are tiny, purplish, hemorrhagic spots visible under the skin. Petechiae usually appear when platelets are depleted. Bleeding gums or oozing of blood may accompany the petechiae, and the client should seek medical assistance immediately. Increasing iron in the diet will not improve the platelet count. Lotion will not treat the petechiae. Elevating the legs will not cause the petechiae to disappear. CN: Physiological adaptation; CL: Synthesize