POP 300 F Exam 3

A nurse in a clinic is talking with a client scheduled for a sentinel lymph node biopsy. Which of the following information should the nurse include? A. Dye is used during the procedure B. The lymph nodes closest to the tumor are removed during the biopsy C. A small amount of chemo is used to test the lymph node response D. A 2mm plus of tissue is removed during the biopsy

A

A nurse is caring for a client who has acute inflammatory bowel disease. Which of the following nutritional supplements should the nurse anticipate providing to this client? A. Hydrolyzed B. Polymeric C. Milk based supplement D. Modular

A

A nurse is planning care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse include in the plan of care? A. Determine the need for informed consent B. Send testing results to the clients insurance agency C. Verify prescription for a tumor marker assay D. Ensure the client is placed in a recovery position after testing

A

A nurse is reviewing the medical record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the path report: T2-N3-MX. Which of the following findings should the nurse identify as a supporting diagnosis? A. Tumor is moderate in size B. No lymph node involvement C. Tumor is receptive to current med therapy D. Cancer has metastasized to other areas of body

A

A patient is admitted with anorexia nervosa and a serum potassium of 2.4. What complication is most important for the nurse to observe for in this pt? A. Dysthymias B. Muscle weakness C. Increased urine output D. Anemia and leukopenia

A

A malnourished pt has been diagnosed with protein deficiency. Which complications should the nurse anticipate? Select all that apply A. Edema B. Asthma C. Anemia D. Malabsorption syndrome E. Impaired wound healing F. GI bleed

A, c, e

<1,000 involved in immune response especially cell mediated immunity-important in immunity against pathogens, fungal infections, rejection of transplanted tissues, contact hypersensitivity reactions, and tumor immunity

ABS lymph

excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements and verbal utterances that are usually more rapid than normal; inattention and distractability are common; assessment: difficulty in performing age appropriate tasks, highly distractible, extremely limited attention span, impulsive, accident prone, low frustration tolerance, often shift form one uncompleted task to another categorized as combined, predominately inattentive or predominately hyperactive predisposing factors: lead, dietary, psychosocial, family status treatment: cns stimulant (increases dopamine and norepinephrine-does not cure but is the first line treatment)

ADHD

the oncoming nurse hears in handoff report that the patient with cancer received an as needed oral dose of lorazepam. which question is the oncoming nurse most likely to ask the off-going nurse in relation to the med? a. "what did the pt say about location and level of pain?" b. "were you able to determine what was making the pt so anxious?" c. "when is the pt allowed to have another dose?" d. "did the pt have a normal bm after the med?"

b

which action will the nurse plan to take for a 40yo patient with MS who has urinary retention caused by a flaccid bladder? a. decrease evening fluid intake b. teach pt how to use the Cred method (used to improve bladder emptying) c. suggest the use of adult incontinence briefs for nighttime only d. assist the pt to the commode every 2 hours during the day

b

which assessment data would make the nurse suspect that the client has ALS? a. complaints of double vision and droopy eyelids b. fatigue and progressive muscle weakness c. loss of sensation below umbilicus d. paresthesias

b

which assessment finding strongly suggests that the pt with cancer is having incident pain? a. frequently reports pain 30-35 minutes before next dose b. demonstrates protectiveness of right arm whenever moving or standing up c. reports continuous burning and tingling sensation in LLE d. appears quiet, withdrawn, and depressed when family leaves after visiting

b

which behavioral approach should a nurse utilize when caring for children diagnosed with disruptive behavior disorders? a. involve parents in designing and implementing treatment b. reinforce positive actions to encourage repetition of desired behaviors c. provide opportunities to learn appropriate peer interactions d. administer psychotropic meds to improve quality of life

b

which finding would be most likely in a child diagnosed with separation anxiety disorder? a. child has history of antisocial behaviors b. Childs mother is diagnosed with anxiety disorder c. child previously had extroverted temperament d. Childs parents have an inconsistent parenting style

b

which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate intellectual disability? a. meeting all of the clients self-care needs to avoid injury b. providing simple directions and praising clients independent self-care efforts c. avoiding interference with the clients self-care efforts in order to promote autonomy d. encouraging family to meet the clients self-care needs to promote bonding

b

which nursing intervention should be prioritized when caring for a child diagnosed with intellectual disability? a. encourage the parents to always prioritize the needs of the child b. modify the Childs environment to promote independence and encourage impulse control c. delay extensive diagnostic studies until the child is developmentally mature d. provide one-on-one tutorial education in a private setting to decrease overstimulation

b

which patient should the charge nurse assign to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for one week? a. 34yo patient with newly diagnosed MS b. 68yo with ALS c. 56yo with Guillain-Barre syndrome in respiratory distress d. 25yo admitted with a c4 level spinal cord injury

b

which pt with a health problem related to GI cancer would be most appropriate to assign to a LPN under supervision of RN leader? a. needs blood transfusion secondary to GI bleeding b. needs enemas and antibiotics to control GI bacteria c. needs preoperative teaching for bowel resection surgery d. needs central line insertion for chemo

b

Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. skeletal protein. b. glycogen. c. visceral protein. d. fat stores.

b, a, d, c

the community health nurse is preparing an education class on ovarian cancer for a group of women. which s/s should the nurse include in the presentation? select all that apply a. feeling hungry all the time b. urinary urgency or frequency c. experiencing pelvic or abdominal swelling d. sense of feeling that something is 'falling out' e. devleophing macular-papular rash over abdomen

b, c

the nurse is planning to teach a client with malabsorption syndrome about the necessity of following a low-fat diet. the nurse develops a list of high fat foods to avoid and should include which food items on the list? select all that apply a. oranges b. broccoli c. margarine d. cream cheese e. luncheon meats f. broiled haddock

b, c

The nurse is caring for a client with pneumonia, who has severe malnutrition. The nurse should assess the patient for which of the following assessment findings? (Select all that apply.) 1. Heart disease 2. Sepsis 3. Hemorrhage 4. Skin breakdown 5. Diarrhea

b, c, d

A nurse is planning care for a client who is undergoing chemo and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (Select all that apply) a. encourage a high fiber diet b. eliminate standing water in the room c. have client wear a mash when leaving the room d. have client specific equipment remain in the room e. eliminate raw foods from the clients diet

b, c, d, e

a client is diagnosed with having a bowel tumor. the nurse should monitor the client for which complications of this type of tumor? select all that apply? a. flatulence b. peritonitis c. hemorrhage d. fistula formation e. bowel perforation f. lactose intolerance

b, c, d, e

the nurse is teaching a group of clients about the warning signs of cancer. which s/s should the nurse mention to the group ? select all that apply a. areas of alopecia b. sores that do not heal c. nagging cough or hoarseness d. indigestion or difficulty swallowing e. change in bowel/bladder habits f. absence or decreased frequency of menses

b, c, d, e

a breast feeding mother of an infant with lactose intolerance asks the nurse about dietary measures. what foods should the nurse tell the mother are acceptable to consume while breastfeeding? select all that apply a. 1% milk b. egg yolk c. dried beans d. hard cheeses e. green leafy veggies

b, c, e

patients receiving chemo are at risk for thrombocytopenia related to the therapy or cancer disease progress. which actions for bleeding precautions can be delegated to assistive personnel? select all that apply a. provide mouthwash with alcohol for oral rinsing b. use paper tape on fragile skin, if needed c. use a soft toothbrush or oral sponge d. gently insert the rectal thermometer e. handle gently to reduce bruising f. avoid overinflation of the bp cuff

b, c, e, f

the nurse should recognize which of the following findings contribute to a clients development of ADHD? select all that apply a. father was a smoker b. client born 7 weeks premature c. client is lactose intolerant d. client has a sibling diagnosed with ADHD e. client has been diagnosed with dyslexia

b, d

a client is having a diagnostic workup for colorectal cancer. which factors in the clients history place the client at an increased risk? select all that apply a. high fiber diet b. high fat diet c. minimal alcohol use d. high carb diet e. history of IBD f. maternal grandfather who had hx

b, d, e

the community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. which risk factors for breast cancer should the nurse list on the poster? select all that apply a. multiparity b. early menarche c. early menopause d. family history of breast cancer e. high-dose radiation exposure to chest f. previous cancer of the breast, uterus, or ovaries

b, d, e, f

reduces release of excitatory NTs and stimulates resultant relief of spasticity relieves cramping, spasms, tightness of muscles caused by spasticity

baclofen (tizanidine)

___ therapy good for ADHD, ODD, conduct disorder rewards are given for good behavior

behavior

harmless growth that does not spread or invade other tissues

benign

slow natural progression of MS, decrease frequency and severity of exacerbations, and reduce accumulation of lesions within the brain and spinal cord

beta interferon

helps cause urination and emptying stimulates muscarinic receptors, which contracts and decreases bladder capacity, therefore producing urination

bethanechol

definitive means of diagnosing cancer removal of tissue sample for pathological analysis to determine if malignant or benign can be done via needle, incisional, or excisional

biopsy

side effect of filgrastim

bone pain

placing the solid med in the mouth against the mucous membranes of the cheek until it dissolves -pts should alternate cheeks to avoid mucosal irritation -should not be chewed or swallowed or no liquids -acts locally on mucosa or systemically as it is swallowed in saliva

buccal

A client is receiving an enteral feeding at 65 mL/hr. The gastric residual volume in 4 hours was 125 mL. What is the priority nursing intervention? 1. Assess bowel sounds. 2. Raise the head of the bed to at least 45 degrees. 3. Continue the feedings; this is normal gastric residual for this feeding. 4. Hold the feeding until you talk to the primary care provider.

c

The clinic nurse prepares instructions for a client diagnosed with leukemia who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? a. avoid food and fluids for next 12-24 hours b. swab mouth with lemon and glycerin 4 times/day c. rinse mouth with diluted solution of baking soda or saline d. brush teeth with soft bristled toothbrush and use floss TID

c

The nurse is caring for a chemotherapy client with a low platelet aggregation level. Which likely caused this decreased platelet production? a. anemia b. thrombocytopenia c. bone marrow suppression d. low H and H

c

a 49yo patient with MS is to begin treatment with glatiramer acetate (Copaxone). which information will the nurse include in patient teaching? a. recommendation to drink at least 4L of fluid a day b. need to avoid driving or operating machinery c. how to draw up and administer injections of the medication d. use of contraceptive methods other than oral contraceptives

c

a child diagnosed with ADHD is having difficulty completing homework assignments. what information should the nurse include when teaching the parents about task performance improvement? a. isolate the child when completing homework to increase focus b. withhold privileges if homework is not completed within a 2 hour period c. parents should divide homework task into smaller steps and provide an activity break d. administer an extra dose of methylphenidate prior to homework

c

a client recently diagnosed with MS asks why her symptoms are so much different than her mother who also has MS. how should the nurse respond? a. "Your mother must have a different type of MS." b. "You and your mother may have been diagnosed at different periods in your lives." c. "The disease can present differently depending on which areas of the CNS are involved." d. "Are you sure you mother also has MS?"

c

a client with MS is experiencing muscle weakness, spasticity, and an ataxic gait. on the basis of this information, the nurse should include which client problem in the poc? a. inability to care for self b. interruption of skin integrity c. interruption in physical mobility d. inability to perform ADLs

c

a community health center is preparing a presentation on the prevention and detection of cancer. which task would be best to assign to the LPN? a. explain screening exams and diagnostic testing for common cancers b. discuss how to plan a balanced diet and reduce fats/preservative c. prepare a poster on the seven warning signs of cancer d. describe strategies for reducing risk factors such as smoking and obesity

c

a community health nurse is providing an educational session on cancer of the cervix for women living in the community. the nurse informs the community residents that which is an early sign of this type? a. abdominal pain b. constant and profuse bleeding c. irregular vaginal bleeding or spotting d. dark and foul smelling vaginal discharge

c

a mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her child's ADHD. which nursing reply best addresses the mothers concern? a. physician will probably switch from Ritalin to CNS stimulant b. physician may prescribe an antihistamine with the Ritalin to improve effectiveness c. child probably developed a tolerance to Ritalin and may need a higher dose d. developed sensitivity to Ritalin and may be exhibiting an allergy

c

a newly hired nurse, who has 2 years of med surg experience but limited experience caring for patients with cancer, seems to be consistently under-medicating the patients pain. what would the supervising nurse do first? a. reassess all pts pain and administer additional pain meds as needed b. write an incident report and inform the nurse manager about the nurses performance c. assess the new hires understanding and beliefs about cancer pain and treatments d. ask the nurse about past experience in administering pain meds

c

a nurse is caring for a client who is undergoing chemo and reports severe nausea. which of the following statements soul the nurse make? a. "Your nausea will lessen with each course of chemo." b. "Hot food is better tolerated due to the aroma." c. "Try eating several small meals throughout the day." d. "Increase your intake of red meat as tolerated."

c

a patient who has breast cancer is receiving immunotherapy in the form of trastuzumab, a MoAb. which medication side effect is the patient most likely to experience? a. capillary leak syndrome b. hepatotoxicity c. flu like symptoms d. memory loss

c

a preschool child diagnosed with autism has been engaging in constant head-banging behavior. which nursing intervention is appropriate? a. place client in restraints until aggression subsides b. sedate client with neuroleptic meds c. hold clients head steady and apply a helmet d. distract the client with a variety of games and puzzles

c

an athletic young man with pain, a low--grade fever, and anemia was recently diagnosed with Ewing sarcoma. the surgeon recommended amputation of the right lower leg for an operable tumor. the nurse discovers the pt preparing to leave the hospital to go "on a long hiking trip." what is the priority nursing concept to to consider? a. pain b. cellular regulation c. stress and coping d. adherence

c

based on the following lab values, what is the priority problem? WBC 4,500 Hgb 5.9 Plt 82,000 a. WBC b. RBC c. Hgb d. Plt

c

charge nurse discovers that two nurses have switched pt assignments because nurse A "does not like taking care of patients with prostate cancer." which action would the change nurse take first? a. insist they switch back and talk to each of them at end of shift b. allow them this flexibility, as long as pts are well cared for it doesn't matter if assignments are changed c. ask nurse a to explain her position and seek alternatives to prevent future issues d. explain to them that all pts deserve kindness and care regardless of their condition or the nurses personal feelings

c

chemo dosage is frequently based on total body surface area, so it is important to perform which assessment before administering chemo? a. measure clients abdominal girth b. calculate clients BMI c. measure clients current height/weight d. ask client about his/her weight and height

c

during report, the float nurse hears that the pt is receiving IV vincristine that will finish within the next 15 minutes. the IV site is intact, and the pt is not having any problems with the infusion. the float nurse is not certified in chemo administration. what is the priority action? a. ask off-going nurse to stay until infusion is finished b. ask off-going nurse about problems to expect with the infusion c. contact charge nurse and discuss lack of certification d. look up drug side effects and monitor because the infusion is almost complete

c

during the handoff report, the oncoming day shift nurse hears that cancer patient is on around the clock dosing of morphine but that end of dose pain might be occurring. which question is the most important to ask the night shift nurse? a. "how many times did you have to give a bolus dose of morphine?" b. "did the patient tell you the pain was greater than 5 out of 10?" c. " did you notify HCP and were changes prescribed?" d. "did you try any non pharm therapies or adjuvants?"

c

for a patient experiencing side effects of radiation therapy, which task would be most appropriate to delegate to AP? a. help pt cope with fatigue and lack of energy b. encourage participation in a walking program c. report amount and type of food consumed from tray d. check the skin for redness and irritation after the treatment

c

for a patient receiving the chemotherapeutic drug vincristine, which side effect would be reported to the HCP? a. fatigue b. nausea c. paresthesia d. anorexia

c

for care of a patient who has oral cancer, which task would be appropriate to assign to an LPN? a. assisting pt perform oral hygiene b. explain when brushing and flossing are contraindicated c. giving antacids and sucralfate suspension as prescribed d. recommending saliva substitutes

c

in planning care for a child diagnosed with autism, which would be a realistic client outcome? a. communicate all needs verbally by discharge b. participate with peers in a team sport by day 4 c. establish trust with at least one caregiver by day 5 d. perform most self-care tasks independently

c

potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial feedings -shifts result form hormonal and metabolic changes and may cause serious clinical complications -potassium, magnesium, and phosphate move intracellularly, resulting in low serum levels and edema -can cause: hypophophatemenia, abnormal sodium and fluid balance, changes in glucose, protein, fat metabolism, thiamine deficiency, hypokalemia, hypomagnesemia, cardiac dysrhythmias, heart failure, respiratory distress, convulsions, coma, or death

refeeding syndrome

Change in bowel/bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump Indigestion or trouble swallowing Obvious change in wart or mole Nagging cough or hoarseness

risk factors of cancer

characterized by excessive fear or anxiety concerning the separation from those with whom the individual is attached; anxiety beyond what would be expected and interferes with social, academic, occupational, or other functioning occurs prior to 18 but can happen after no meds approved for children SSRIs may be given predisposing factors: children of parents with anxiety disorders, stressful life event, possible overattachment, separation conflicts, parental overprotection, maternal depression, insecure attachment anticipation of separation results in tantrums, crying, screaming, complaint of physical problems, clinging, worrying, fear of sleeping away from home, depressed mood treatment-help maintain anxiety at manageable level when separation occurs, assist with development of more adaptive coping, develop trust and demonstrate ability to interact appropriately with others

separation anxiety disorder

in absence of marked fluid loss, this value lags behind actual protein changes by more than 2 weeks-making it a poor indicator of acute changes in nutritional status

serum albumin

A predictable and often unavoidable adverse effect produced at a usual therapeutic dose -range from being harmless to causing serious symptoms/injury -if serous enough to negate the beneficial effects of the therapeutic action of the med, med will be d/c -most common reasons for pt stopping the med include anorexia, n/v/c/d, drowsiness

side effect

undesired, unintended, unexpected response to a given med

side effect

eye blinking, neck jerking, shoulder shrugging, facial grimacing

simple motor tic

inability to effectively use verbal and nonverbal means of communication

social communication disorder

designed to meet specific nutritional needs in certain illness (ex. liver failure, pulmonary disease, HIV)

specialty

cancer in situ

stage 0

tumor limited to the tissue of origin (local tumor growth)

stage 1

limited local spread

stage 2

extensive local and regional spread

stage 3

metastasis present

stage 4

malnutrition, or primary PCM, that occurs when nutritional needs are not met -chronic starvation without inflammation -ex. anorexia nervosa

starvation related

eradicates diseased tumor cells or bone marrow components to make way for grafting of transplanted healthy cells treatment of several malignant and non malignant diseases have to give very high doses of chemo with/without radiation "rescue" damaged bone marrow through proliferation (usually takes 2-4 weeks to start making new blood cells)

stem cells transplant

injection into tissues just below the dermis of the skin

subcutaneous

readily absorbed after being placed under the tongue to dissolve -should not be swallowed or chewed -should not drink until med is completely dissolved to avoid interfering with desired effect

sublingual

used as an adjunct to meals and fluid intake in the patient whose nutritional intake is deficient -provide advanced nutrition and calories are relatively inexpensive -ex. milkshakes, puddings, etc. -role in improving nutritional status when used between meals

supplements

two meds that have a combined effect that is greater than the effect of the meds separately -ex. alcohol and antidepressants -HCP can combine some meds to create an interaction that has a beneficial effect (such as a pt taking diuretic and vasodilator to control bp overall)

synergistic effect

personality characteristics that define an individuals mood and behavioral tendencies; sum of physical, emotional, and intellectual components that affect or determine a persons actions and reactions

temperament

expected or predicted physiological response caused by a med -some meds have more than one -knowing how long for each med allows you to provide patient education and accurately evaluate the desired effect of a med

therapeutic effects

condition in which the number of circulating platelets are abnormally low <100,000 high risk for hemorrhage <20,000

thrombocytopenia

6.4-8.2 combination of albumin, globulin, and pre-albumin

TSP (total serum protein)

ten days ago, a patient received chemo for his non-Hodgkins lymphoma, stage IV. drugs were administer through his port and included doxorubicin, cycophosphamide, and vincristine. this morning, his blood work is as follows WBC .5, Hgb 7.6, RBC 3.0, and platelets 20,000. the nurse will include which of the following priority intervention in the plan of care? a. cutting nails to prevent scratching that could lead to bleeding or infection b. initiating a low residue diet to prevent constipation c. initiating neutropenic precautions and temp Q4 d. starting an IV line for anticipated blood and platelet administration

c

the hh nurse is visiting a client with a. diagnosis of MS. the client has been taking oxybutynin. the nurse evaluates the effectiveness of the med by asking the client which assessment question? a. "are you consistently fatigued?" b. "are you having muscle spasms?" c. "are you getting up at night to urinate?" d. "are you having normal bm's?"

c

the nurse caring for a client with advancing ALS knows the leading cause of death is a. infection from pressure injuries b. injuries from falls c. paralysis d. respiratory tract infections

c

the nurse is analyzing the lab results of a client with leukemia who has received a regimen of chemo. which lab value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemo? a. anemia b. decreased platelets c. increased uric acid level d. decreased leukocyte count

c

the nurse is analyzing the lab results of a client with leukemia who has received a regimen of chemo. which lab value would the nurse specifically note as a result of the massive cell destruction that resulted from the chemo? a. anemia b. decreased platelets c. increased uric acid d. decreased leukocytes

c

the nurse is caring for a client diagnosed with Alzheimers disease. the nurse should anticipate that the client has changes in which component of the nervous system? a. glia b. peripheral nerves c. neuronal dendrites d. monoamine oxidase

c

the nurse is caring for a client undergoing external radiation. the client has developed a dry desquamation of the skin in the treatment area and the nurse is teaching about management of the skin reaction. which comment made by the client suggests understanding of the instructions? a. "I don't need to stay out of the sun or put on sunscreen" b. " I can use ice packs to relieve itching in the treatment area." c. "when bathing I will use lukewarm water on the affected area." d. "I can lubricate the irritated area with an ointment like bacitracin."

c

the nurse is monitoring a client for s/s related to superior vena cava syndrome. which is an early sign of this oncological emergency? a. cyanosis b. arm edema c. periorbital edema d. mental status changes

c

the patient is learning about skin care related to external radiation that he is receiving. which instruction should the nurse include in the teaching? a. keep area shaved of hair b. keep area covered if reddened c. avoid extreme temperature to the area d. cleanse skin often and apply lotion afterward

c

the patient with cancer needs and initial course of treatment with continued maintenance treatments and ongoing observation for s/s over a prolonged period of time. which patient statement is cause for greatest concern? a. "my s/s will be eventually cured, I'm happy I don't have to worry any longer." b. "my doctor is trying to help me control the s/s; I am grateful for the extension of time with my family." c. "my pain will be relived, but I am going to die soon ;I would like to have control over my own life and death." d. "initially I may have to take some time off work for my treatments; I can probably work full time in the future."

c

which instruction would the nurse give to the AP about caring for a patient who is experiencing "chemo brain"? a. "the pt can understand you but cannot speak clearly." b. "be cautious; the pt may be unpredictably aggressive." c. "calmly give explanations if the pt seems forgetful." d. "report immediately if the pt complains of a headache."

c

which of the following would be a good exercise recommendation for the client with ALS? a. climbing stair stepper b. jumping rope c. riding stationary bike d. running

c

which question will the RN ask the LPN who is assigned to do an enteral feeding for a patient with a small-bore tube? a. have you evaluated the nutritional status of the patient? b. is the patient tolerating the supine position after feedings? c. have you had any problems checking the residual? d. is the patient developing any problems related to the feedings?

c

which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? a. modify environment to decrease stimulation and provide opportunities for quiet reflection b. convey unconditional acceptance and positive regard c. recognize escalating aggressive behaviors and intervene before violence occurs d. provide immediate positive feedback for appropriate behaviors

c

which interventions are the most appropriate for a client who is experiencing thrombocytopenia? select all that apply a. use straight edge razor for shaving b. obtain rectal temp Q8h c. check secretions for frank/occult blood d. give vitamin K IM e. encourage fluid intake to avoid constipation f. provide oral sponges or soft toothbrush for oc

c, e, f

a group of diseases characterized by uncontrolled and unregulated growth of cells 2 dysfunctions occur in process of cancer development-defective cells proliferation and defective cell differentiation

cancer

bodys main source of energy and are the chief protein sparing ingredient in nutritionally sound diet -DRI recommends 45-65% of total calories from this source -simple: monosaccharides (glucose, frutose) fundi n honey and fruits; disaccharides (sucrose, maltose, lactose) found in table sugar, malted cereal and milk -complex: polysaccharides include starches like cereal grains, potatoes, and legumes

carbs

Tumor in epithelial tissue

carcinoma

monitor for signs of inflammation and infection -phlebitis can readily occur d/t hypertonic solution -local manifestations: erythema, tenderness, exudate at insertion site -systemic manifestations: fever, chills, n/v, malaise -immunosuppressed pts higher risk for infection -change dressings as needed -culture specimen of site/catheter or drainage or blood cultures and chest xray

catheter related infection

condition in which the number of circulating platelets are abnormally low <100,000 high risk for hemorrhage <20,000 Measures to protect against bleeding and injury -no anticoagulants -avoid sneezing, coughing, straining at stools -give stool softeners -discourage alcohol intake -measure LOC Q4 -electric razor -non-skid socks -monitor for petechiae, nose bleeds, blood in urine or stools -educate patient on s/s -avoid invasive procedures as much as possible -soft bristle toothbrush and no floss -no IM/SUBq -administer neumega as ordered to simulate platelet creation

thrombocytopenia

decreased platelets

thrombocytopenia

what is your patients priority problem? WBC 4,500 Hgb 5.9 PLT 82,000

Hgb

presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods; may cause distress or interfere with important areas of functioning tics must be present for one year (worse tics during puberty) predisposing factors: maternal alcohol use, infection, low birth weight, ADHD and OCD hx in family typically begins with simple motor ticstreatment: comprehensive behavioral intervention (reduce tic severity, how to manage and notice triggers), speech therapy, deep brain stimulation meds-antipsychotics, alpha agonists

tourettes

often develop after prolonged intake of a med or when a med accumulates in the blood because of impaired metabolism or excretion -antidotes available to treat some specific types

toxic effect

elements that include chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium, zinc

trace

minimum blood serum concentration of med reached just before the next scheduled dose

trough

occurs when nutritional reserves are depleted, and nutrient and energy intake are not sufficient to meet daily needs or metabolic stress

undernutrition

pure or total vegetarians and eat only plants -primary deficiency is a lack of cobalamin (vitamin B12) obtained from animal protein, special supplements or foods fortified with the vitamin -other deficiencies include calcium, zinc, and vitamins A and D

vegan

exclusion of red meat from the diet -without well-planned diet, vitamin or protein deficiencies can occur

vegetarian

may cause severe tissue damage and cause tissue breakdown/necrosis

vesicant

manifestations: megaloblastic anemia, anorexia, glossitis, sore mouth and tongue, pallor, neurologic problems, weight loss, nausea, constipation

vitamin B12 (cobalamin)

manifestations: anorexia, fatigue, nervous irritability, constipation, paresthesias, insomnia

vitamin B12 (thiamine)

manifestations: seizures, dermatitis, anemia, neuropathy with motor weakness, anorexia

vitamin B6 (pyridoxine)

manifestations: bleeding gums, loose teeth, easy bruising, poor wound healing, scurvy, dry/itchy skin

vitamin C

manifestations: muscular weakness, excessive sweating, diarrhea and other GI problems, bone pain, active or healed rickets, osteomalacia

vitamin D

manifestations: neurologic deficits

vitamin E

manifestations: blood coagulation problems

vitamin K

manifestations: dry/scaly skin, increased susceptibility to infection, night blindness, anorexia, eye irritation, keratinization of respiratory and GI mucosa, bladder stones, anemia, retarded growth

vitamin a (retinol)

organic compounds needed in small amounts for normal metabolism -function primarily in enzyme reactions that facilitate amino acid, fat, and carb metabolism -water soluble: C, B-complex -fat-soluble: A, D, E, K

vitamins

various words or sounds, such as squeaks, grunts, barks, sniffs, snorts, coughs; include repeating certain words or phrases out of context, ones old sounds/words, or repeating what others say complex-uttering obscenities

vocal tic

blisters and weeping skin can develop during radiation

wet desquamation

use of chemicals as a systemic therapy for cancer goal is to eliminate or reduce number of cancer cells in the primary and metastatic site most common to combine agents in multi drug regimens most commonly in IV chemo induced side effects: result of destruction of normal cells (esp bone marrow, GI tract, and integumentary) acute toxicity: occurs during or right after administration-anaphylaxis, dysrhythmias, hypersensitivity delayed effects: n/v, mucositis, alopecia, bone marrow suppression, altered bowel function chronic toxicity: damage to organs (can either be long term or late effects)

chemo

malnutrition, or secondary PCM, related to conditions that have sustained mild to moderate inflammation -occurs when dietary intake does not meet tissue needs, although it would be under normal conditions -ex. organ failure, cancer, RA, obesity

chronic disease related

___ therapy used for tourrettes, separation anxiety, ADHD, ODD, conduct disorder changes negative thoughts into positive intervene with depressive, disruptive, impulse control, and conduct disorders

cognitive behavioral

squatting, hopping, skipping, tapping, retracing steps

complex motor tic

the nurse is assessing the clients loc and documents that the client has delirium. on the basic of this documentation, the nurse should determine that there is damage to which area of the nervous system? a. temporal and frontal lobe b. hippocampus and frontal lobe c. limbic system and cerebral hemispheres d. reticular activating system and cerebral hemisphere

d

the nurse is caring for a client diagnosed with breast cancer receiving combination chemo. which nursing intervention is the most appropriate? a. give 2 agents from same med class b. give 2 agents with like nadirs at the same time c. tests clients knowledge about each agents nadir d. avoid giving agents with the same nadirs and toxicities at the same time

d

the nurse is caring for a client with metastatic breast cancer. the client describes a new and sudden sharp pain in the back. based on this assessment finding, which is the priority nursing intervention? a. document the findings b. administer pain meds c. place heating pad on pts back d. notify HCP

d

the nurse is caring for a client with prostate cancer who is being treated with hormone therapy. what should the nurse monitor for in order to evaluate the effect of this treatment? a. increased testosterone b. increased prostaglandins c. increases circulating androgens d. decreased circulating androgens

d

the nurse is performing an admission assessment of a client with a possible right colon tumor. which s/s should the nurse anticipate the client may report? a. frequent diarrhea b. crampy gas pains c. flat, ribbon-like stools d. dull abdominal pain exacerbated by walking

d

the nurse is planning care for the client with a neurogenic bladder caused by MS. the nurse plans for fluid administration of at least 2000 mL/day. which plan would be most helpful to the client? a. 400-500mL/ meal and 500-600 in evening before bed b. 400-500mL with each meal and additional fluids in the morning, but not after midday c. 400-500mL each meal, with all extra fluid concentrated in afternoon/evening d. 400-500mL/meal, and 200-250mL at midmorning/afternoon/late afteroon

d

the nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. the nurse should check which diagnostic test noted in the clients record to determine the stage of this disease? a. blood studies b. bone marrow exam c. excisional lymph node biopsy d. PET scan

d

the nurse is teaching a client who has iron deficiency anemia about foods that she should include in her diet. the nurse determines that the client understands the dietary modifications if which items are selected from the menu? a. nuts and milk b. coffee and tea c. cooked rolled oats and fish d. oranges and dark green leafy veggies

d

the nurse manager is teaching the nursing staff about s/s related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late s/s of this oncological emergency? a. headache b. dysphagia c. constipation d. ECG changes

d

the nurse teaches skin care to a client receiving external radiation therapy. which client statement indicates the need for further instruction? a. "I will handle the area gently." b. "I will wear loose fitting clothing." c. "I will avoid the use of deodorants." d. "I will limit sun exposure to 1 hour daily."

d

the nurse would be most concerned about a prescription for total parental nutrition fat emulsion for a patient with which condition? a. GI obstruction b. severe anorexia c. chronic diarrhea/vomiting d. fractured femur

d

the nursing instructor is teaching about pharmacological treatments for ADHD. which information about atomoxetine (Strattera) should be included in the lesson plan? a. Strattera, unlike methylphenidate, is a CNS depressant b. when taking Strattera, a client should eliminate all red food coloring from the diet c. Strattera will be a life long intervention for clients diagnosed with this disorder d. Strattera, unlike Ritalin, is a SNRI

d

the oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. the nurse determines that further teaching is needed if a nursing staff member states which is a characteristic of the disease? a. reed-stern berg cells present b. lymph nodes, spleen, and liver are involved c. prognosis depends on stage of disease d. disease occurs most often in those 75 years or older

d

the patient who is reaching chemo describes a burning sensation in the leg, which the HCP diagnoses as neuropathic pain secondary to the therapy, the nurse is most likely to question the prescription of which drug? a. imipramine b. carbamazepine c. gabapentin d. morphine

d

when providing care for a patient with thrombocytopenia, the nurse must avoid administering aspirin and aspirin containing products because they a. disguise fever b. destroy RBCs c. increase ICP d. interfere with platelet aggregation

d

which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual disability? a. client can perform some self-care activities independently b. client has advanced speech development c. other than possible coordination problems, the clients psychomotor skills are not affected d. the client communicates wants and needs by acting out behaviors

d

which information about a 60yo patient with MS indicates that the nurse should consult with the HCP before giving the prescribed dose of dalfampridine (Ampyra)? a. patient has relapsing-remitting MS b. patient walks a mile a day for exercise c. patient complains of pain with neck flexion d. the patient has an increased serum creatinine level

d

which question is the HH nurse most likely to ask to evaluate the efficacy of a biphosphate med that was prescribed for pt with cancer? a. "has the med helped relieve the discomfort in your mouth?" b. "have you noticed any increase or change in your energy level?" c. "has the med helped to stop n/v?" d. "has the med relieved the bone pain that you reported?"

d

selective potassium channel blocker that improves nerve conduction in damaged nerve segments may improve walking speed

dalfampridine

removing as much of the tumor as possible can make chemo or radiation more effective

debulking

process of young immature (unspecialized) cells taking on individual characteristics and reaching their mature (specialized) form and function.

differentiation

after absorbed, it is distributed within the body to the tissues and organs and ultimately to its specific site of action -rate and extent depend on physical and chemical properties of the med and physiology of person taking it -once it enters the bloodstream, carried throughout tissues and organs-speed depends on vascularity of various tissues and organs -med must pass through all tissues and biological membranes of the organ (membrane permeability) -degree to which meds bind to serum proteins

distribution

interaction that occurs when a drug affects the use of nutrients in the body -adverse interactions include incompatibilities, altered drug effectiveness, and impaired nutritional status -drug side effects, herbs, or dietary supplements

drug nutrient

length of time during which a med is present in a concentration great enough to produce a therapeutic effect

duration

difficulty with math

dyscalculia

difficulty writing

dysgraphia

difficulty reading

dyslexia

repeating words or sounds of others

echolalia

free radical scavenger that may relieve effective of oxidative stress-likely factor in progression of ALS given for 2 weeks, then stopped for 2 weeks

edaravone

contains predigested nutrients that are easier for a partially dysfunctional GI tract to absorb

elemental

nutrition delivered directly into the GI tract, bypassing the oral cavity used with the patient who has a functioning GI tract but is unable to take any/enough oral nourishment or when it is unsafe to do so -indications: anorexia, orofacial fractures, head/neck cancer, neurologic/psychiatric conditions that prevent oral intake, extensive burns, critical illness, chemo/radiation therapy -easily administered, safer, more physiologically efficient and less expensive -wide variety of formulas, varying by concentration, flavor, osmolality, and amount of protein/sodium/fat -delivery options are continuous infusion or intermittent (bolus) by pump/gravity/syringe -given through tube, catheter or stoma -access depends on anticipated length of time required, degree of risk for aspiration, patients clinical status, adequacy of digestion and absorption, and patients anatomy -feedings can start within 24h after surgically placed G or J tube (w/o waiting for flatus or bm) -PEG tube feedings can start within 4h of insertion -maintaining feeds: check tube placement before feeding/meds, assess for bowel sounds before feeding, flush NG/gastrostomy tube as needed, evaluate nutritional status, keep hob 30-45 angle, assess regularly for complications -preventing aspiration: hob 30-45 degrees or reverse trendelenburg, hob elevated for 30-60 min after bolus feed, feeds continuously, minimize sedation, perform frequent oral functioning *typically started full strength at slow rates, with an increase in rate every 8-12 hours (if no signs of intolerance) -reduces sepsis, minimizes hyper metabolic response to trauma, decreases hospital mortality, and maintains intestinal structure/function -aspiration of EN leads to the irritation of the lungs and bronchial mucosa, resulting in decreased blood supply to the affected pulmonary tissue which leads to necrotizing infection, pneumonia, and potential abscess formation -measure gastric residual volume q4-6h in continuous feedings (>500mL should lead to the implementation of measures to reduce the risk of aspiration) *most accurate method for verification of tube placement is xray (followed by pH of secretions)

enteral feeding

meds administered in the epidural space via a catheter -route for regional anesthesia for surgical procedures -can be by continuous infusion or bolus

epidural

after metabolized, meds exit the body through the kidneys, liver, bowel, lungs, and exocrine glands, as the chemical makeup of the med determines the organ of excretion

excretion

impairment in communicating through language or speech

expressive language disorder

radiation treatment that can be given to the area include external tissues and internal target pt is never radioactive during treatment side effects: fatigue, anorexia, bone marrow suppression, skin erythema/dry desquamation/wet desquamation, decrease in salivary flow resulting in dry mouth, taste loss, pneumonitis (chest radiation), alters gastric secretions, mucosal ulcers, n/v/d symptoms resolve when treatment finishes

external beam

infiltration of drugs into tissue around the infusion site that can cause tissue damage

extravasation

major source of energy for the body; stored in adipose tissue and abdominal cavity, acting as carriers of essential fatty acids and fat-soluble vitamins -no more than 20-35% of total calories

fats

-OG/NG/ND/NJ appropriate for short term feeding (less than 4 weeks) -ND/NJ transpyloric tubes used when pathophysiologic conditions call for feeding the patient below the pyloric sphincter-placement in small intestine decreases chance of aspiration -gastrostomy: used with pts with intact/unobstructed GI tract; -PEG: fewer risks than surgical placement -jejunostomy: necessary to reduce the risk for aspiration -GJ tube allows for simultaneous gastric decompression and small bowel feeding

feeding tubes

abuse: denying access to personal resources, stealing, coercion, making changes to wills/trusts

financial

manifestations: impaired cell division and protein synthesis, megaloblastic anemia, anorexia, fatigue, sore tongue, diarrhea, forgetfulness

folate (folic acid)

cells differ slightly from normal cells and are well differentiated

grade 1

cells are more abnormal and moderately differentiated

grade 2

cells are very abnormal and poorly differentiated

grade 3

cells are immature and primitive (anaplasia) and undifferentiated cell of origin is difficult to determine

grade 4

12-16 critical is < 10 standard care for PRBC administration is below 7

hgb

excessive psychomotor activity that may be purposeful or aimless physical movements and verbal utterances that are more rapid than normal

hyperactivity

unpredictable effects in which a patient overreacts or under reacts to a med or has a reaction different from normal

idiosyncratic reaction

decrease number of attacks, decrease severity of attack, and prevent further formation of new brain lesions

immunosuppressant

affects nutrient metabolism and is an important part of nutritional status -changes in expression of proinflammatory (interleukin-6) and anti-inflammatory cytokines -cytokin changes result in increased protein and skeletal muscle breakdown, increased BMR, increased glucose turnover, decreased negative acute phase protein production, and increased positive acute phase protein

impact of inflammation

trait of acting without reflection and without thought to the consequences of the behavior; abrupt inclination to act on certain behavioral urges

impulsiveness

may happen with a person with a pattern of alcohol/drug use, chronically ill, or those with poor dietary practices, GI tract surgery, poorly planned vegetarian diets -manifestations of vitamin imbalances range from skin conditions to neurologic signs

incomplete diet

-cancer cells arise from normal cells due to changes in genes in lifetime -involves mutation in genetic structure of cells (any change) -cancer causing agents capable of altering cells-chemical, radiation, viral

initiation phase

after an adolescent diagnosed with ADHD begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a two month period. what is the best explanation for this weight loss? a. moa causes a decrease in appetite b. hyperactivity seen in ADHD causes increased caloric expenditure c. side effects cause nausea, therefore, caloric intake is decreased d. increased ability to concentrate allows the client to focus on activities rather than food

a

which assessment finding is the most critical and needs to be addressed first? a. pt with small cell lung cancer has tracheal deviation after a pulmonary resection b. pt with bladder cancer has decreased urination after intravesical chemo c. pt with non-Hodgkin lymphoma has cardiac dysrhythmias after chemo d. pt has more severe abdominal pain after a bowel resection for colon cancer

a

which patient is at greatest risk for pancreatic cancer? a. an older AA man who smokes b. a young obese asian woman with gallbladder disease c. young AA with type 1 diabetes d. elderly white woman who has pancreatitis

a

you are caring for a patient with breast cancer who had chemo 7 days ago. below are the most recent labs. what is your priority nursing diagnosis/problem? WBC 0.6 Hgb 8.0 Plt 36,000 a. risk for infection b. activity intolerance c. risk for bleeding d. ask for injury

a

a nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. which of the following actions should the nurse take? (select all that apply) a. permit visitors to stay with the client 30 minutes at a time b. warn pregnant individuals to visit the room only once daily c. wear a dosimeter when in the clients room d. placed soiled dressings in a biohazard bag before discarding in the regular trash e. dipose soiled linens in the hamper outside the clients room

a, b, c

which of the following risk factors noted during a family history assessment should a nurse associate with the potential development of intellectual disability? select all that apply a. family history of Tay-Sachs b. childhood meningococcal infection c. deprivation of nurturance and social contact d. history of maternal multiple motor and verbal tics e. diagnosis of maternal major depressive disorder

a, b, c

the nurse is preparing a poc for a client with a diagnosis of ALS. on assessment, the nurse notes that the client is severely dysphagic. which intervention should be included in the poc? select all that apply a. provide oral hygiene after each meal b. assess swallowing ability frequently c. allow the client sufficient time to eat d. maintain suction at bedside

a, b, c, d

the community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. which are risk factors for cervical cancer? select all that apply a. smoking b. multiple sex partners c. HIV infection d. annual gyno exams e. first intercourse before 17yo

a, b, c, e

the nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. which assessment findings noted in the clients record are associated with this diagnosis? select all that apply a. fever b. weight loss c. night sweats d. visual changes e. enlarged, painless lymph nodes

a, b, c, e

in the care of a pt with neutropenia, what tasks would the nurses delegate to AP to perform? select all that apply a. Q4h vitals b. report temp greater than 100.4 c. assess for sore throat, cough, or burning with urination d. gather supplies to prepare the room for protective precautions e. report superinfection, such as candidiasis f. practice good hand washing technique

a, b, d, f

A patient is receiving total parenteral nutrition (TPN). What are the primary interventions the nurse should follow to prevent a central line infection? (Select all that apply.) 1. Change the dressing using sterile technique. 2. Change TPN containers every 48 hours. 3. Change the TPN tubing every 24 hours. 4. Monitor glucose levels to watch and assess for glucose intolerance. 5. Elevate head of the bed 45 degrees to prevent aspiration.

a, c

the nurse is teaching the client about risk factors for skin cancer. which statements by the client indicate that teaching was successful? select all that apply a. "I have to avoid excessive exposure to sunlight." b. "my dark skin color predisposes me to skin cancer." c. "I am at higher risk for skin cancer because my mother had one." d. "I am at higher risk for skin cancer because I am 20yo." e. "I am immune to skin cancer because I work as a pest control exterminator"

a, c

which are warning signs of head and neck cancer? select all that apply a. difficulty swallowing b. well-fitting dentures c. lump in neck, mouth, throat d. persistent or unexplained oral bleeding e. cough and sore throat that resolved five days after pharyngitis

a, c, d

the nurse is caring for a client with lung cancer and bone metastasis. what s/s 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 in 1 month c. serum calcium of 12 d. serum sodium of 136 e. serum potassium of 3.4 f. numbness and tingling of the lower extremities

a, c, f

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia.

a, d, e

which of the following interventions should a nurse anticipate implementing when planning care for children diagnosed with ADHD? select all that apply a. behavior modification b. anti anxiety meds c. competitive group sports d. group therapy e. family therapy

a, d, e

The nurse is evaluating the recent lab results for a patient. Which labs are the best indicators for malnutrition? (Select all that apply.) 1. Serum total protein 2. Potassium 3. Lipids 4. Albumin 5 Serum BUN

a, e

deserting of an older person by caregiver

abandonment

occurs when medication molecules pass into the blood from the site of med administration -factors that influence include route of admin, ability of med to dissolve, blood flow to site of admin, body surface area, lipid solubility -each route of admin has different rate -transdermal: slow d/t physical makeup of skin -PO: have to pass through entire GI tract, so rate is slow -mucous membrane or respiratory airway: rate is quick d/t tissues containing many blood vessels -IM/subq: more quickly than PO; IM enter bloodstream more quickly than subq -IV: produces most rapid d/t meds immediately available when they enter the systemic circulation

absorption

malnutrition related to acute disease or injury states with marked inflammatory response -ex. major infection, burns, trauma, surgery

acute disease (injury) related

persons ability to adapt to the requirements of daily living and the exceptions of their age and cultural group determines level of severity of IDD

adaptive functioning

results in death, disability, or hospitalization; life threatening, or requires intervention to prevent harm

adverse effect

undesired, unintended, and often unpredictable responses to a med -range from mild to severe, can happen immediately or over time -those most at risk are young and old pts, pregnant woman, pts taking multiple meds, pts extremely under/overweight, renal/liver disease -if mild and tolerable, the pt can remain on the meds -not tolerated and are potentially harmful, stop the med immediately

adverse effect

3.5-5.5 normal 3.0-3.5 mild risk of malnutrition 2.5-3.0 mod risk for malnutrition less than 2.5 severe risk binds to calcium so decreased levels also causes decreased calcium as it decreases, peripheral edema occurs and can mask muscle wasting-may not see improvements in lab levels for several weeks, so pre albumin is more accurate when monitoring long term malnutrition

albumin

what is your patients priority problem? WBC .4 Hgb 6.8 PLT 8,000

all

unpredictable responses to a med where the med or chemical acts as an antigen, triggering the release of the antibodies in the body

allergic reaction

fundamental units of protein structure -22 types either essential or nonessential -body can make nonessential if an adequate supply of protein is available -body cannot make 9 essential-availability depends totally on dietary sources

amino acids

Decreased RBC

anemia

circulating blood contains abnormally low RBC Hgb<10 RBC < 1 million fatigue most common distressing -cluster cares -daily CBC to monitor H&H -assess skin and pressure points -allow for rest periods -aerobic exercise -high protein/calorie diet -PRBCs as ordered -erythropoietin SQ as ordered

anemic

ability of the cancer to make a blood supply cancer cells secrete angiogenesis factors which promote new capillary growth that supply the tumor with blood supply

angiogenesis

disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains; characterized by impairment in measured intellectual performance and adaptive skills across multiple domains four levels-mild, moderate, severe, profound; onset prior to age 18 can do PET scan (red=too much functioning, purple=low, black=no) predisposing factors: inborn errors, chromosomal, single gene abnormalities, disruption in embryonic development, general medical conditions in infancy, sociocultural or autism

intellectual disorder

a physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. which information about this med should the nurse provide to the parents? a. if one dose of Ritalin is missed, double the next dose b. administer Ritalin to the child after breakfast c. administer Ritalin to the child just before bedtime d. a side effect of Ritalin is decreased ability to learn

b

a preschool child is admitted to a psych unit with a diagnosis of autism. to help the child feel more secure on the unit, which intervention should a nurse include in this clients plan of care? a. encourage and reward peer contact b. provide consistent caregivers c. provide a variety of safe daily activities d. maintain close physical contact throughout the day

b

a primary nursing responsibility is the prevention of lung cancer by assisting pts in the cessation of smoking or other tobacco use. which task would be appropriate to delegate to the LPN? a. develop a quit plan b. explain how to apply a nicotine patch c. discuss strategies to prevent relapse d. suggest ways to deal with urges for tobacco

b

a pt with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion. which treatment does the nurse anticipate that the HCP will prescribe first? a. fluid bolus b. fluid restrictions c. urinalysis d. sodium restricted diet

b

used when the tumor dose of radiation needs to be high to eradicate the tumor commonly used in head/neck and gynecologic malignancies pt is radioactive plan care for minimal contact-1/2 hour per shift (no pregnant females) mark room with radiation label need to count number of radioactive materials (look like BBs) wear radiation badge

internal beam

injection into the dermis just under the epidermis

intradermal

injection into the muscle

intramuscular

a pt with uterine cancer is being treated with intracavitary radiation therapy. the AP reports that pt insisted on ambulating to the bathroom and reports "something feels like it is coming out." what is the priority action? a. assess AP's knowledge; explain rationale for strict bedrest b. assess for dislodgment; use forceps and lead container to retrieve and store as needed c. assess pts knowledge of treatment plan and her willingness to participate d. notify HCP about dislodgment of radiation implant

b

administration involving the infusion of med directly into bone marrow -most commonly used in infants and toddlers who have poor access to intravascular space, when emergency arises, or IV access impossible

intraosseous

after assessing the patients pain patterns, the nurse determines that frequently breakthrough cancer pain is occurring. which member of the health care team is the nurse most likely to contact first? a. physical therapist to reevaluate physical therapy routines b. HCP to review medication, dosage, and frequency c. assistive personnel to increase help with ADLs d. psychiatric clinical nurse specialist to evaluate psychogenic pain

b

after chemo, a pt is being closely monitored for tumor lysis syndrome. which lab result requires particular attention? a. platelet b. electrolytes c. RBC d. WBC

b

administered into the peritoneal cavity and absorbed into circulation -chemo, insulin, antibiotics

intraperitoneal

syringe and need or a chest tube is used to administer meds directly into the pleural space -chemo agents most common

intrapleural

administered through a catheter surgically placed in the subarachnoid space or one of the verticals of the brain -long-term treatment

intrathecal

injection into a vein

intravenous

for a patient with osteogenic sarcoma, which lab value causes the most concern? a. sodium level 135 b. calcium level 13 c. potassium level 4.9 d. BUN 10

b

for the client with stomatitis resulting from chemo, the poc should include which intervention? a. inspect mouth every week for fungus b. encourage foods with neutral or cool temps c. give the client spicy foods to stimulate the sense of taste d. perform frequent oc using commercial alcohol based mouthwash

b

the clinic nurse has conducted a health screening clinic to identity clients who are at risk for cervical cancer. the nurse is reviewing the assessment findings in the records of the clients who attended the clinic. which client is at lowest risk for developing this type of cancer? a. multiparity client b. single white client c. client with history of chronic cervicitis d. client who had early, frequent intercourse with multiple partners

b

may cause damage vein causing phlebitis

irritant

the community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. what information should the nurse include in the educational session a. older women more likely to get mammograms b. treatment decisions based on woman's overall health c. women younger than 65yo more likely to get breast cancer d. woman age is main factor used to decide which screening methods to use

b

the nurse has conducted a cancer prevention seminar for clients in an ambulatory setting. the nurse determines that teaching was effective if the clients select which food on the menu? a. broiled beef, canned corn, rice b. broccoli, baked fish, mashed potato c. bacon, scrambled egg, French fries d. bologna, canned asparagus, white bread

b

consume plants, dairy products, and eggs

lacto ovo vegetarian

the nurse has provided instructions for a client regarding testicular self-exam. which client statement indicates the need for further teaching regarding TSE? a. "I know to report any small lumps" b. "I examine myself every 2 months" c. "I examine myself after I take a warm shower." d. "I feel a hard and cordlike thing in the back and going up"

b

the nurse is caring for a client with leukemia. in assessing the client for signs of leukemia, the nurse determines that what should be monitored? a. platelets b. bone marrow biopsy c. WBC count d. CBC

b

minerals that include calcium, chloride, magnesium, phosphorus, potassium, sodium, sulfur

major

impaired absorption of nutrients from the GI tract -decreases in digestive enzymes or in bowel surface area can quickly lead to a deficiency state -many drugs have undesirable GI side effects and alter normal digestive and absorptive processes -ex. antibiotics can change normal flora of intestines, which decreases the body's ability to make biotin

malabsorption syndrome

harmful tumor, capable of spreading and invading other tissues far removed from the site of origin

malignant

the nurse is counseling a woman about decreased her risk for cervical cancer. which statement by the client indicates a need for further counseling? a. "I need to seek prompt treatment for vaginitis." b. "condoms are only needed only if I do not trust a new partner" c. "a partner who is uncircumcised will present an increased risk" d. "I need to keep appointments for Pap tests at the frequency advised by my PCP"

b

the nurse is preparing to care for a client with a diagnosis of metastatic cancer. the nurse notes documentation in the clients chart that the client is experiencing cachexia. which should the nurse expect to note on assessment? a. elevated bp and ascites b. sunken eyes and a hollow cheek appearance c. periorbital edema and swelling around the ears d. generalized edema and presence of weight gain

b

the nurse is providing dietary instructions to a client with a diagnosis of hyperphospahtemia. the nurse determines that the client understands the instructions fi the client states the importance of eliminating which item from the diet? a. tea b. fish c. coffee d. grape juice

b

the nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with radiation (cesium) implant. which instruction should the nurse provide to the client? a. avoid douching for at least 1 year b. use vaginal dilator 3 times/week c. sexual activity can be resumed in about 2 months d. bedrest is recommended for at least one week after

b

the nurse is providing teaching to a client who will undergo chemo for cancer, and alopecia is expected from the chemotherapeutic agent. which statement made by the client indicates a need for further teaching? a. "excessive hair brushing should be avoided" b. "I can't believe my hair loss will be permanent" c. "I guess ill have to stop using my electric hair curling rod." d. "I will have my hair stylist cut my hair short just for my treatments."

b

the nurse is reviewing the record for a client seen in the health care clinic and notes that the PCP has documented a diagnosis of ALS. which initial clinical manifestation of this disorder should the nurse expect to see documented in the record? a. muscle wasting b. mild clumsiness c. altered mentation d. diminished gag reflex

b

A nurse is planning care for a client who had malnutrition due to cancer. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Advise client to keep a food diary B. Encourage the client to brush teeth before and after meals C. Assess the lab report of ferritin D. Eat nutrient dense foods last at meal time E. Encourage the client to limit drinking fluids during meals

A, b, c, e

A nurse is caring for a client who had lung cancer and is exhibiting manifestations of syndrome of inappropriate anti diuretic hormone (SIADH). Which of the following findings should the nurse report to the provider (select all that apply) A. Behavioral changes B. Client report of headache C. Urine output 40mL/hr D. Client report of nausea E. Increased urine specific gravity

A, b, d

progressive neuromuscular disorder with a loss of motor neurons death typically 3-5 years later no cure-goal is to slow progression, slow symptoms, allow a longer and more productive life with treatment also known as Lou Gehrig's disease exact cause unknown-risk factors include genetics, gene mutations, smoking, and environmental factors (thought athletes and military history d/t exposure to toxins or influence of intense exertion) history taken (family, work, social), physical history, clinical manifestations other diagnostics to rule out other things (MS, stroke, etc.): MRI, EMG, blood/urine samples, lumbar puncture, genetic testing MEDS: -Riluzole: decreases amount of glutamate in the brain; main drug used the longest; slows progression of symptoms -Edarvone: free radical scavenger used to reverse effects of toxicative stress; given IV for 2 weeks then stopped for 2 weeks; newer and approved by FDA in the last few years -Stem cells: send protective factors to motor neurons in the spinal cord and brain to protect them from dying SYMPTOM MANAGEMENT: -spasticity: stiff/tight/contracted muscles-baclofen and diazepam -pain: muscle/nerve/spasticity pain-Gabapentin -swallowing: amitriptyline helps to dry up secretions to decrease chance of aspirating NURSING MANAGEMENT: -assess resp system: work/rate of breathing, lung sounds, resp tract infection s/s; airway clearance therapy, chest physiotherapy -monitor chewing and swallowing -education: AD, lifestyle changes, diet (easy to chew/swallow), physiotherapy, low impact aerobic exercise, assistive devices

ALS (amyotrophic lateral sclerosis)

Tumor of grandular organs

Adenocarcinoma

a patient is currently undergoing a course of chemo, feels lonely and isolated. she tells the nurse that she wants to get involved in a few of her normal activities. which essential precaution should the nurse advise the patient to take when she begins to resume her activities? a. avoid large crowds b. use only your own bathroom c. do not eat cooked foods d. maintain your own pre-illness schedule

a

A client has recently been placed on a low sodium diet. He asks the nurse about appropriate drinks for his diet. What is the best choice for this client? A. 2% milk B. Fresh lemonade C. Sports drinks D. Diet soda

B

A frail older adult with recent severe weight loss is taught to eat a high protein, high calorie diet at home. Which foods would the nurse suggest for breakfast? A. OJ and dry toast B. Oatmeal with butter and cream C. Banana and unsweetened yogurt D. Waffles with fresh strawberries

B

A nurse is teaching a client who is scheduled for nuclear imaging for suspected cancer. Which of the following statements should the nurse give? A. "The presence of a liver enzyme will be identified." B. "You will be given an injection of a radioactive substance." C. "An endoscope will be inserted through your mouth." D. "The tumor will be aspirated."

B

A pt is being admitted with anorexia nervosa. Which clinical manifestations should the nurse anticipate? A. Sensitivity to heat, fatigue, and polycythemia B. Hair loss, dry yellowish skin and constipation C. Tented skin turgor, hyperactive reflexes and diarrhea D. Dysmenorrhea, hypoactive bowel sounds, and hunger

B

A pt who cannot afford enough food for her family states that she only eats after her children have eaten. At a clinic visit she reports bleeding gums, loose teeth, and dry, itchy skin. Which vitamin deficiency would the nurse expect? A. Folic acid B. Vitamin C C. Vitamin D D. Vitamin K

B

A pt with ESRD receiving dialysis and diabetes, has a blood glucose level of 50. Which of the following is the best oral treatment for the pts hypoglycemia? A. 8 ounces OJ B. 8 ounces apple juice C. 8 ounces tomato juice D. 1 whole banana

B

The nurse is teaching a pt with type 1 diabetes who has surgery to revise a lower leg stump with a skin graft about nutrition. What food should the nurse teach the pt to best to best facilitate healing? A. Nonfat milk B. Chicken breast C. Fortified oatmeal D. Olive oil and nuts

B

A nurse is collecting information from a client in a providers office. Which of the following findings should the identify as an indication of possible cancer? (Select all that apply) A. Temp of 102 for more than 48 hours B. Sore that does not heal C. Difficulty swallowing D. Unusual discharge E. Weight gain 4lb in two weeks

B, c, d, e

determines meds/med classes that should not be used or should be used carefully in older adults drug-drug, drug-disease, drug-syndrome interactions

BEERS

measure of weight for height -<18.5 underweight -18.5-24.9 normal -25-29.9 overweight ->30 obese -outside normal range is associated with increased morbidity and mortality

BMI

A 30yo pt has gluten-induced enteropathy. The nurse instructs the pt on foods that need to be eliminated from her diet. The nurse determines that teaching was successful when the client chooses to eliminate: A. Milk and dairy products B. Protein-containing foods C. Wheat products D. Fresh fruits and veggies

C

A nurse is caring for a client who is receiving chemo and bad mucositis. Which of the following actions should the nurse take? A. Use glycerin soaked swan to clean clients teeth B. Encourage increased intake of citrus fruit juices C. Obtain a culture of the lesions D. Provide an alcohol based mouthwash for oral hygiene

C

A nurse is planning care for a client who has a platelet count of 10,000. Which of the following interventions should the nurse include in the plan of care? A. Apply prolonged pressure to puncture site after blood sampling B. Administer epoetin Alfa as prescribed C. Place client in private room D. Have client use oral topic anesthetic before meals

C

A nurse is teaching a client about screening prevention for cancer. Which of the following statements by the client indicates an understanding of the teaching? A. "I will need to have a mammogram every 2 years beginning at age 45." B. "I should have a colonoscopy every 15 years beginning at age 60." C. "I will need to have an annual breast exam every year after 40." D. "I should have a fecal occult test done every 3 years."

C

The nurse is providing care for a pt who is a strict vegetarian. Which would be beet dietary choices the nurse recommends to prevent iron deficiency? A. Brown rice and kidney beans B. Cauliflower and egg substitute C. Soybeans and hot breakfast cereal D. Whole grain bread and citrus fruits

C

the nurse teaches the oncology patient that the usual symptoms of infection are absent in the cancer patient with neutropenia because a. most infections are d/t organisms that are part of the body normal flora b. WBCs drop rapidly and recovery time is slow c. neutrophils are necessary to produce an inflammatory response d. immunoglobulins are reduced

C

a patient who has cancer will need ongoing treatment for pain. which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain? a. "an illustrated guide to the analgesic ladder." b. "common questions about radiation therapy" c. "how to make preparations for your cancer surgery" d. "how nerve blocks can help to manage cancer pain"

a

a person who is receiving chemo is approaching the nadir period. which instruction will the team leader give to the LPN? a. monitor neutrophil count; be vigilant for s/s of infection b. expect n/v; give antiemetics as prescribed c. observe for breakthrough pain; report frequency of bolus doses of opioids d. monitor for anorexia; initiate daily weights as needed

a

a pt with terminal liver cancer is receiving end of life care. the pt is weka and restless and her skin is mottled and cool. dyspnea develops and she appear anxious and frightened. what would the nurse do first? a. administer PRN dose of morphine elixir b. alert RRT and call HCP c. deliver breaths at 20/min with a bag valve mask and prepare for intubation d. sit quietly with the patient and offer emotional support and comfort

a

A nurse is teaching a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates understanding of the procedure? A. "A test of my bone marrow will be performed." B. "A lymph node will be removed." C. "A needle will be inserted into a mass." D. "A small skin sample will be obtained."

D

dry peeling skin

Dry desquamation

test nerve conduction through small electric shocks through the nerves to see how fast the nerves are working can do sensory and vision see how long it takes to get through the muscles

EMG (electromyography)

Tissue of plasma cells

Myeloma

decreased WBC

Neutropenia

the nurse is teaching a client about the risk factors associated with colorectal cancer. the nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? a. age younger than 50 b. history of colorectal polyps c. family history of rectal cancer d. chronic IBD

a

Tumor of blood forming cells

Leukemia

Tumor of lymph tissue

Lymphoma

autoimmune chronic progressive degenerative disease of brain and spinal cord first diagnosis between 20-50, more common in women usually for diagnosis you need to have plaque in at least two different areas unknown cause-infectious, immunologic, and genetic factor triad precipitating factors: physical injury, smoking, emotional stress, excessive fatigue, pregnancy, poor state of health chronic inflammation-> demyelination-> scarring in CNS auto reactive T-cells (lymphocytes)-migrate to CNS-disrupt blood-brain barrier-plaque formation in CNS CLINICAL MANIFESTATIONS: -insidious and gradual -vague s/s occur over months to years-diagnosis can also take years d/t vague s/s -symptoms dependent on area of CNS involvement: sudden muscle weakness in 1+ limbs, spasticity (muscles, nystagmus, tremors, gait instability), blindness in one eye, patchy blindness, muscle tingling, cognitive impairment over time, concentration/memory issues, poor judgement, depression, fatigue (aggravated by heat, humidity, stress), bowel bladder dysfunction, constipation, emotional changes, pseudo bulbar affect those pregnant with MS can experience remission or improvement in s/s, but once the baby is born they are more likely to have s/s reoccurrence DIAGNOSTICS: -hx and clinical/physical manifestations -MRI of brain and spinal cord: presence and location of plaques, inflammation, possible other diagnoses -Lumbar puncture: increase in ImG in CSF -EMG -Evoked potentials MEDS: -corticosteroids: most helpful during exacerbation to help with inflammation; ACTH, prednisone; plasmaphoreiss or IVIG if corticosteroids not helping -immunomodulators: beta interferon modifies disease progression and prevent relapse; given subq; normally taken for a long time -immunosuppressants: methotrexate -fingolimod: prevent lymphocytes from reaching CNS and causing damage symptom management: -bladder problems: bethanechol-retention and oxybutynin-overactive -spasticity: baclofen, dantrolene, tizanidine -cognitive impairment: donepezil -walking: dalfampridine helps improve walking speed Important: allow for rest periods, assist with ADLs as needed, adequate fluids (at least 2000mL/day), well balanced diet, high fiber diet (issues with constipation) education: identifying triggers (fatigue, illness, extremes), self-cath, infection prevention indicated: ask if client has AD, apply oxygen via NC, start client on IV antibiotics, obtain portable xray contraindicated: start on clear liquid diet, prepare for intubation non-essential: perform catheterization

MS (multiple sclerosis)

characterized by persistent pattern of angry mood and defiant behavior that occurs more frequently than usually observed, that interferes with areas of functioning behavior must be distinct, pervasive, and more disruptive stubborn, procrastination, careless, resistant to directions, social avoidance, temper tantrums, running away, testing limits no meds prescribed for this-encourage therapy participation, help client accept responsibility for their behavior, promote feelings of self-worth typically begins at 8 predisposing factors: childhood trauma, power/control issues/stuggle between parents or between parents and child

ODD

what is your patients priority problem? WBC 4.4 Hgb 7.5 PLT 5,000

PLT

the oncology nurse is providing a teaching session for a group of nursing students regarding the risks and causes of bladder cancer. which statement by a student would indicate a need for further teaching? a. "bladder cancer most often occurs in women" b. "using cigarettes and drinking coffee can increase the risk" c. "bladder cancer generally is seen in adults older than 40" d. "environmental health hazards have been implicated as a cause."

a

4-6 critical is <1

RBC

when caring for the client with ALS, it is important to remember that the client a. does not lose cognitive function b. has adequate strength at the beginning of the day c. will experience remission and exacerbations d. increased risk of falls due to shuffling gait

a

slows progression of ALS by decreasing amount of glutamate in in the brain, therefore decreasing the damage to motor neurons most common drug used the longest

Riluzole

any yes prompts further discussion S-sleep disorders P-problems eating/feeding I - incontinence C-confusion E-Evidence of falls S-skin breakdown

SPICES

Tumor of mesenchymal tissue

Sarcoma

when planning care for a client, which med classification should a nurse recognize as effective in the treatment of Tourettes disorder? a. antipsychotic meds b. antimanic meds c. tricyclic antidepressants d. MAOI

a

when staff assignments are made for the care of pts receiving chemo, which consideration related to chemo drugs is the most important? a. administration of chemo requires precautions to protect self and others b. many chemo drugs are vesicants c. chemo drugs are frequently given through CVADs d. oral and IV routes of administration are the most common

a

5,000-10,000

WBC

pt with breast cancer had chemo 7 days ago. WBC 0.6 Hgb: 8.0 PLT 36,000 what is the priority problem

WBC

A client is receiving intravesical chemotherapy for cancer of the bladder. The nurse should plan to take which action after the completion of each treatment? a. encourage increased intake of oral fluids b. provide increased doses of opioid analgesics c. palce client on strict contact isolation for 24 hours d. keep client NPO

a

A client who is receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What should be the nurse's priority action? 1. Have the patient turn on the left side and perform a Valsalva maneuver. 2. Clamp the intravenous (IV) tubing to prevent more air from entering the line. 3. Have the patient take a deep breath and hold it. 4. Notify the health care provider immediately.

a

A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: A) Dementia. B) Depression. C) Delirium. D) Disengagement.

a

The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy for treatment of breast cancer. The nurse should plan which measure to treat this complication? a. rinse mouth with diluted baking soda or saline b. use lemon and glycerin swabs liberally on painful oral lesions c. brush teeth and use non-waxed dental floss BID d. place client NPO for 12 hours then resume liquids

a

Which action can a nurse delegate to assistive personnel (AP)? 1. Performing glucose monitoring every 6 hours on a patient 2. Teaching the client about the need for enteral feeding 3. Administering enteral feeding bolus after tube placement has been verified 4. Evaluating the client's tolerance of the enteral feeding

a

Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. X-ray b. Air insertion c. Observing patient for coughing d. pH measurement of gastric aspirate

a

a 64yo patient who has ALS is hospitalized with pneumonia. which nursing action will be included in the plan of care? a. assist with activity rom b. observe for agitation and paranoia c. give muscle relaxants as needed to reduce spasms d. use simple words and phrases to explain procedures

a

a child diagnosed with autism has the nursing diagnosis of disturbed professional identity. which outcome would best address this clients diagnosis? a. client will name body parts as separate from others by day 5 b. client will establish means of communicating personal needs by discharge c. client will initiate social interactions with caregivers by day 4 d. client will not harm self or others by discharge

a

a client with MS has issues with completely emptying the bladder. the physician orders the client to take ___, which will help with bladder emptying. a. bethanechol b. dalfampridine c. methylprednisolone d. oxybutynin

a

a client with MS tells a hh nurse that she is having increasing difficulty in transferring from the bed to chair. what is the initial nursing action? a. observe client demonstration b. start restorative nursing program before an injury occurs c. seize the opportunity to discuss potential nursing home placement d. determine number of falls that the client has had in recent weeks

a

a client with liver cancer who is receiving chemo tells the nurse that some foods taste bitter.the nurse should try to limit which food that is most likely to taste bitter for the client? a. pork b. custard c. potatoes d. cantaloupe

a

a nursing instructor presents a case study in which a 3yo child is in constant motion and is unable to sit still during story time. the instructor asks a student to evaluate this Childs behavior. which student response indicates an appropriate evaluation of the situation? a. behavior must be evaluated according to developmental norms b. symptoms of ADHD c. symptoms of early stages of autism d. behavior indicates possible symptoms of ODD

a

a patient has been admitted to the oncology unit with chemo induced myelosuppression. his blood tests show a decreased WBC, RBC, Hct, and normal platelet counts. based on this data, which of the following nursing diagnosis would the nurse prioritize as most important? a. risk for infection b. risk for injury c. fatigue d. alteration in nutrition

a

the nurse has instructed a client in the foods that are best to consume on a low fat diet. the nurse determines that the client understand this diet if the client indicates which food is lowest in fat? a. bran muffin b. cheese omelet c. bagel with cream cheese d. dry toast and strawberry jelly

d

an adolescent client who was diagnosed with conduct disorder at the age of 8 is sentenced to juvenile detention after bringing a gun to school. how should the nurse apply knowledge of conduct disorder to this clients situation? a. childhood onset conduct disorder is more severe than the adolescent onset type, and these individuals likely develop antisocial personality disorder in adulthood b. childhood onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood c. childhood onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and therefore improvement is likely d. childhood onset conduct disorder is has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive OOD

a

during your discharge teaching to a client with MS, you educate the client on how to avoid increasing symptoms and relapses. you tell the client to avoid a. people who are sick b. salt in their diet c. dairy products d. extreme cold

a

for a patient who is receiving chemo, which lab result is of particular importance? a. WBC 3000 b. serum potassium 3.4 c. pre albumin 14 d. BUN 9

a

priority problems for a cancer patient with anemia would include a. activity intolerance and skin integrity b. skin care and oral hygiene c. infection and bleeding tendencies d. bleeding tendencies and weakness

a

the community health nurse conducts a health promotion program for community members regarding testicular cancer. the nurse determines that further information is needed if a community member states that which is a sign of testicular cancer? a. alopecia b. back pain c. painless testicular swelling d. heavy sensation in scortum

a

the nurse has conducted dietary teaching for a client diagnosed with iron deficiency anemia. the nurse instructs the client that which food is a good dietary source of iron? a. apricots b. oranges c. egg whites d. refined white bread

a

the nurse instructs the client with CKD who is receiving hemodialysis about dietary modifications. the nurse determines that the client understands these dietary modifications if the client selects which items? a. cream of wheat, blueberries, coffee b. sausage and eggs, banana, OJ c. bacon, cantaloupe, tomato juice d. cured pork, grits, strawberries, OJ

a

the nurse is assessing a 48yo client diagnosed with MS. which clinical manifestation warrants immediate intervention? a. client has congested cough and dysphagia b. client has dysarthria and scotomacs c. client has muscle weakness and spasticity d. client has scanning speech and diplopia

a

the nurse is caring for a patient with esophageal cancer. which task could be delegated to assistive personnel? a. assisting with oral hygiene b. observing response to feedings c. evaluating risk for aspiration d. initiating weight measurements as needed

a

the nurse is caring for the client who is suspected of having lung cancer. the nurse should assess the client for which most frequent early symptom of lung cancer? a. cough b. hoarseness c. hemoptysis d. pleuritic pain

a

the nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? a. encouraging fluids b. providing frequent oral care c. coughing and deep breathing d. monitoring RBC count

a

the nurse is doing preop teaching to a client newly diagnosed with stage 1 cervical cancer. which statement by the client indicates that education was effective? a. "I have carcinoma that is just in the cervix" b. "my carcinoma has extended to the pelvis and vagina" c. "I have carcinoma that has extended beyond the cervix but has not extended to the pelvic wall" d. "my carcinoma has extended beyond the true pelvis and has involved the bladder or rectal mucosa"

a

the nurse is interviewing a patient who was treated several months ago for breast cancer. the pt reports taking NSAIDs for back pain. which pt comment is cause for greatest concern? a. "NSAIDs are really not relieving the back pain." b. "NSAID tablets are too large, and they are hard to swallow." c. "I gained weight because I eat a lot before taking the NSAID." d. "the NSAIDs are upsetting my stomach in the morning."

a

the nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. which pt statement is most likely to suggest an early manifestation? a. "last night my back really hurt and I had trouble sleeping." b. "my leg has been giving out when I try to stand." c. "my bowels are just not moving like they usually do." d. "when I try to pass urine, I have difficulty starting my stream."

a

the nurse is presenting at a community education program related to cancer prevention. based on current cancer death rates, the nurse emphasizes what as most important preventable action for both men and women? a. smoking cessation b. routine colonoscopy c. yearly mammograms d. healthy eating habits

a

the nurse is providing dietary instructions to a client regarding a high protein diet. the nurse should instruct the client to consume which food item that is highest in protein content? a. 1c cottage cheese b. 1 oz swiss cheese c. 2 tbsp peanut butter d. 1c evaporated whole milk

a

the nurse is providing discharge dietary teaching to a client with IBS. what comment made by the client tells the nurse that further instruction is needed? a. "Ill eat more beans and peas" b. "I should eliminate caffeine and alcohol" c. "im afraid my son will get this disease" d. "I know I need to take vitamins and mineral supplements"

a

the nurse is reviewing the history of a client with bladder cancer. the nurse expects to note documentation of which most common s/s of this cancer? a. dysuria b. hematuria c. urgency d. frequency

a

the nurse is reviewing the lab results of a client diagnosed with multiple myeloma. which would the nurse expect to note specifically in this disorder? a. increased calcium b. increased WBC c. decreased BUN d. decreased plasma cells

a

the nurse is taking a history from a client suspected of having testicular cancer. which data will be most helpful in determining the risk factors for this type of cancer? a. age and race b. martial status c. number of children d. number of sexual partners

a

heterogenous group of neurodevelopment syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors; includes impairment in social interaction, communication, imaginative activity, and restricted activities/interests does not play with others-difficulty forming peer relationships, strict routines, consumes excessive amounts of fluid, only eat foods they like predisposing factors-maternal asthma or allergies, advanced maternal age, brain volume enlarged meds-riperidone (risk for NMS, tardive dyskinesia, hyperglycemia), and apripiprazole (risk for sedation, drooling, tremors, vomiting, EPS) targets aggression, deliberate self-injury, temper tantrums, quickly changing moods (does not target core symptoms)

autism

A nurse has taken report for the evening shift on an adolescent inpatient unit. Which client should the nurse address first? A. A client diagnosed with oppositional defiant disorder being sexually inappropriate with staff B. A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu C. A client diagnosed with conduct disorder who is demanding special attention from staff D. A client diagnosed with attention deficit disorder who has a history of self-mutilation

b

A nurse sees an assistive personnel (AP) perform the following intervention for a patient receiving continuous enteral feedings. Which action would require immediate attention by the nurse? 1. Fastening tube to the gown with new tape 2. Placing client supine while giving a bath 3. Monitoring the client's weight as ordered 4. Ambulating patient with enteral feedings still infusing

b

A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

b

The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? a. clotting time 12 seconds b. platelets 50,000 c. ammonia 28 d. WBC 4,500

b

a 27yo client is undergoing evaluation of lumps in her breasts. in determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time? a. after menses b. before menses c. during menses d. any time, regardless of menstrual cycle

b

a 36yo is admitted to the children's unit with probable acute lymphocytic leukemia (ALL). admission assessment reveals that. she is pale, listless, and febrile. what is most likely the result of the fever? a. anemia b. neutropenia c. thrombocytopenia d. polycythemia

b

a 6yo is prescribed methylphenidate (Ritalin) for a diagnosis of ADHD. when teaching the parents about his med, which nursing statement explains how Ritalin works? a. sedation side effects assist child by decreasing energy level b. how it works is unknown. although it is a stimulant, it does combat the symptoms of ADHD c. helps child focus by decreasing the amount of dopamine in the basal ganglia and neuron synapse d. decreases hyperactivity by increasing serotonin levels

b

a child has been diagnosed with autism. the distraught mother cries out, "I'm such a terrible mother. what did I do to cause this?" which nursing reply is most appropriate? a. researchers don't really know what causes it, but the relationship between autism and fetal alcohol syndrome is being explored b. poor parenting doesn't cause this. research has shown that abnormalities in Brian structure and/or function are to blame. this is beyond your control. c. research has shown that the mother appears to play a greater role in the development of this disorder than the father d. lack of early infant bonding with the mother has shown to be a cause of autism. did you bottle or breastfeed?

b

a child has been recently diagnosed with mild intellectual disability. what information about this diagnosis should the nurse include when teaching the Childs mother? a. need constant supervision b. develop academic skills up to a sixth grade level c. appear different than their peers d. significant sensory motor impairment

b

a client has an IQ of 47. which nursing diagnosis best addresses a client problem associated with this degree of intellectual disability? a. risk for injury r/t self-mutilation b. altered social interaction r/t non adherence to social convention c. altered verbal communication r/t delusional thinking d. social isolation r/t severely decreased gross motor skills

b

a client is admitted to the hospital with suspected bladder cancer. the nurse assesses the client for which early s/s of this disease? a. proteinuria and dysuria b. hematuria and absence of pain c. painful urination and hematuria d. pyuria and palpable abdominal mass

b

a client is admitted with exacerbation of MS. the nurse is assessing the client for possible precipitating factors. which factor, if reported by the client, should the nurse identify as being unrelated to the exacerbation? a. annual flu vaccine b. ingestion of increased fruits and veggies c. established routine of walking 2 miles each day d. recent period of extreme outside ambient temps

b

a client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. the nurse interprets the client may be experiencing which condition? a. rupture of the bladder b. development of a vesicovaginal fistula c. extreme stress caused by diagnosis of cancer d. altered perineal sensation d/t radiation

b

a patient had radiation therapy 3 months ago and recently the HCP prescribed epoetin. which instruction will the home health nurse give to the home health aid related to this new therapy? a. encourage the patient to eat smaller amounts until nausea subsides b. allow the patient to rest between care activities until energy improves c. help patient to stand up slowly until orthostatic hypotension resolves d. frequently cleanse the mouth with clear water until mucusitis abates

b

repetitive and persistent pattern of bevhairo in which the basic rights of others or major age appropriate societal norms or rules are violated; physical aggression common and peer relationships are disturbed, destruction of property, theft, use of projection as defense mechanism, risk for antisocial behavior as adult, low self-esteem manifested by tough guy image, lack of feelings of remorse or guilt childhood onset before age 10 adolescent onset after age 10 predisposing factors: power relationships of defiant groups, ineffective parenting, lack of supervision, frequent changes in residence, economic stressors meds target specific problems and behaviors-2/3rd generation antipsychotics, TCAs, mood stabilizers, anxiolytics

conduct disorder

treat acute exacerbations of MS reduce edema and acute inflammation at site of demyelination, but do not affect ultimate outcome or degree of residual neurologic impairment from disease exacerbation

corticosteroids

A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. reports episodes of nightly nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

d

A patient is receiving both parenteral (PN) and enteral nutrition (EN). When would the nurse collaborate with the health care provider and request a discontinuation of parenteral nutrition? 1. When 25% of the patient's nutritional needs are met by the tube feedings 2. When bowel sounds return 3. When the central line has been in for 10 days 4. When 75% of the patient's nutritional needs are met by the tube feedings

d

The nurse is caring for a client with dysphagia and is feeding her a pureed chicken diet when she begins to choke. What is the priority nursing intervention? 1. Suction her mouth and throat. 2. Turn her on her side. 3. Put on oxygen at 2 L nasal cannula. 4. Stop feeding her.

d

Which statement made by the parents of a 2-month-old infant requires further education by the nurse? 1. "I'll continue to use formula for the baby until he is at least a year old." 2. "I'll make sure that I purchase iron-fortified formula." 3. "I'll start feeding the baby cereal at 4 months." 4. "I'm going to alternate formula with whole milk, starting next month."

d

a client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. which assessment finding would the nurse expect to note specifically in the client? a. fatigue b. weakness c. weight gain d. enlarged lymph nodes

d

a client is diagnosed with moderate case of acute UC. the nurse doing dietary teaching should give the client examples of foods to eat that represent which therapeutic diet? a. high fat with milk b. low fiber with milk c. high protein with milk d. low fiber without milk

d

a client receiving chemo is experiencing mucositis. the nurse should advise the client to use which item as the best substance to rinse the mouth? a. alcohol based mouthwash b. hydrogen peroxide mixture c. lemon flavored mouthwash d. weak salt and bicarbonate mouth rinse

d

a client with ALS arrives in the ED with complaints of shortness of breath and increased coughing and congestion after eating. the squad reports that the oxygen saturations were 83% on room air and that lung sounds had coarse rhonchi bilaterally. what is the priority nursing intervention? a. administer a dose of oral steroids b. call speech therapy for a swallowing evaluation c. consult social work for home setup d. place client on 2L O2 NC

d

a client with hypertension has been told to maintain a diet low in sodium. the nurse who is teaching this client should include which food item in a list provided? a. tomato soup b. boiled shrimp c. instant oatmeal d. summer squash

d

a client with leukemia is receiving busulfan and allopurinol. the nurse should tell the client that the purpose of the allopurinol is to prevent which symptom? a. nausea b. alopecia c. vomiting d. hyperuricemia

d

a nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate intellectual disability. which student statement indicates that further instruction is needed? a. clients can work in a sheltered workshop setting b. clients can perform some personal care activities c. clients may have difficulty relating to peers d. clients can successfully completely elementary school

d

an 8yo diagnosed with ADHD was admitted 5 days ago for management of temper tantrums. what would be a priority nursing intervention during the termination phase of the nurse-client relationship? a. set a contact with the client to limit acting out behaviors while hospitalized b. teach importance of taking fluoxetine (Prozac) consistently, even when feeling better c. discuss behaviors that are and are not acceptable on the unit d. ask the client to demonstrate learned coping skills without direction form the nurse

d

an older patient needs treatment for severe localized pain related to postherapetic neuralgia secondary to chemo. the nurse is most likely to question the prescription of which medication? a. lidocaine patch b. gabapentinoid c. capsaicin patch d. tricyclic antidepressant

d

based on the following labs, what is the priority problem? WBC 4.4 Hgb 7.5 Plt 5,000 a. WBC b. Hgb c. RBC d. Plt

d

during the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of this disease? a. diarrhea b. hypermenorrhea c. abnormal bleeding c. abdominal distention

d

the hh nurse has been discussing interventions to prevent constipation in a client with MS. the nurse determines that the client is using the information most effectively if the client reports which action? a. drinking total of 1000 mL/day b. giving herself an enema every morning before breakfast c. taking stool softeners daily and a glycerin suppository once a week d. initiating a bm every other day, 45 minutes after the largest meal of the day

d

deficit, excess, or imbalance of essential nutrients that can occur with or without inflammation -affects body composition and functional status -contributing factors: food insecurity, illness, surgery, injury, hospitalization, prolonged illness, sepsis, draining wounds, burns, hemorrhage, fractures, immobilization, anorexia, n/v/d, GI disease -manifestations: range from mild to emaciation to death; dry/scaly skin, brittle nails, rashes, hair loss, mouth crusting/ulceration, changes in tongue, decreased muscle mass, muscle weakness, mental changes (confusion or irritability); speed at which it develops depends on quantity and quality of protein intake, caloric value, illness, and age -more susceptible to infections, increased risk of anemia due to the lack of iron and folic acid -diagnosis is based on body composition, history of weight loss, nutrient intake, measure of functional status -serum potassium often increase, RBC/hgb indicate presence or degree of anemia, lymphocyte count decreases, liver enzymes increase, serum vitamins usually decrease

malnutrition

when one med modifies the action of another -common with several meds -some meds increase/decrease action of others or alter the way the med is absorbed, metabolized, or eliminated

med interaction

after a med reaches its site of action, it becomes metabolized into a less active or inactive form that is easier to excrete -biotransformation: occurs under influence of enzymes that detoxify, breakdown, and remove biologically active chemicals (mostly happening in liver)

metabolism

ability of neoplastic cells to spread from the original site of the tumor to distant organs, spreading at the same cell type as the original neoplastic tissue rapid growth of primary tumor and development of own blood supply hematogenous-tumor cells penetrate blood vessels and travel around and adhere to small vessels and get stuck and grow in distant organs skip-lymphatic system tumors may be trapped by sentinel lymph nodes-tumors that bypass the local lymph nodes can travel to distant nodes

metastasis

consists of single macronutrient preparations and is not nutritionally complete -can be added to other foods to meet individual nutritional needs

modular

most common effect of chemo low counts of all three blood cells (WBC, RBC, PLT) onset is related to life span of type of blood cells WBC affected first, especially neutrophils-> within 1-2 weeks platelets affected in 2-3 weeks RBC within 120 days severity depends on chemo used, dosages, and radiation treatment field

myelosuppression

visual guide for sensible meal planning that helps individuals to eat healthfully and make good food choices -focuses on the proportions of 5 food groups that you should eat at each meal

myplate

time where patient has the lowest blood count 7-10 days after starting therapy highest time for infection and bleeding-need to monitor CBC daily need to treat side effects of depleted cell counts

nadir

failure or refusal to provide basic needs

neglect

abnormal new growth of tissue that serves no useful purpose and may harm to host organism synonymous with tumor

neoplasm

-invades adjacent tissues -does not exhibit contact inhibition -able to break off cells that migrate through blood stream or lymphatics to grow in distant site -uncontrolled cell growth-cells are immortal and continue to reproduce -serves no useful purpose -invade, erode, spread -ability to divide without anchorage-can divide while moving -accelerated use of nutrients -use body nutrients more rapidly

neoplastic cells

abnormally low WBC count -have to take precautions to prevent infection/sepsis -private room -reverse isolation -no fresh fruits/veggies -no fresh flowers -avoid catheters, NG, rectal temp -education on handwashing -VS Q4 and temp -daily CBC for WBC count -avoid large crowds/sick people -Filgrastrim (Neupogen)

neutropenic

-do not invade adjacent tissues -exhibits contact inhibition -constant predictable growth-cell=cell death -cant grow outside specific environment -have specific designated purpose -cant invade, erode, or spread

normal cells

altered mucous membranes -avoid alcohol and tobacco -encourage good oral hygiene -avoid mouth washes with alcohol -discourage spicy/hot foods -offer topical agents for relief of pain per order -apply water soluble lubricant to lips to avoid becoming dry -offer popsicles -avoid foods that are difficult to chew or are highly acidic -administer nystatin oral suspension or Mycelex tabs to prevent fungal infections -use oral assessment to monitor changes altered skin integrity -skin be affected due to less oxygen moving throughout -fatigue may affect movement -alopecia occurs d/t chemo -turning every 2 hours and elevate bony prominences -lotion skin -wash and comb hair gently -reassure/support patient GI effects -High protein and calorie diet -offer small frequent meals -do not rush meals -daily weight -offer bland or pureed foods -monitor/treat n/v -avoid spicy, alcohol and tobacco -identify food preferences -provide oral care -TPN or enteral feedings may be needed to maintain nutritional balance malnutrition -may have protein and calorie deficiency characterized by fat and muscle depletion -refer to nutritionist -high protein and calorie diet -monitor albumin, total serum protein, and absolute lymphocyte counts to monitor nutrition n/v -may occur within 1 hour of chemo administration or a few hours after radiation to chest/abdomen -utilize anti-emetics if needed -encourage food/drink when not nauseous -give prophylactic anti-emetic and anti-anxiety one hour before treatment -assess for s/s of dehydration and metabolic alkalosis -non-pharm treatments diarrhea -low fiber/residue diets -increase in frequency and liquidity of stools -sitz baths -keep area clean and dry -record number, volume, consistency, and character of stools/day -anti-diarrheal, anti-spasmodics, anti-motility mucositis -assess oral mucosa every day -nutritional supplements if intake decreased -oral care before and after each meal -topical analgesics -antibiotics if infection present -magic mouthwash-usually has three of the following: antihistamine or anticholinergic, local anesthetic, antacid, antifungal, corticosteroid, antibiotic anorexia -may be related to inflamed mouth, emotions, lack of taste of food -usually peaks around 4 weeks of treatment -monitor daily weight -nutritional supplements (PPN or enteral) skin reactions d/t radiation -goal is to prevent infection and promote wound healing -erythema occurs 1-24 hours after treatment -no heating pads or ice-can cause more damage -avoid constricting garments, harsh chemicals, lotions, or deodorants -lubricate dry skin with plain lotion

nursing care

sum of processes by which one takes in and uses nutrients -continuum from under to normal to over -important for energy, growth, and maintaining and repairing body tissues -results from eating balanced diet -major components include macronutrients (carbs, fats, proteins), micronutrients (vitamins, minerals, electrolytes), and water -estimate of daily calories is kcal/kg (average adult should consume 20-25 cal/kg to lose weight and 25-30 to maintain weight)

nutrition

common aging changes -loss of high frequency sound -decreased REM/dreaming -less tear production/opacity of lens -increased light sleep -gfr decreases 1%/year after 40 -weakening of pelvic floor -late sense of bladder fullness -arterial stiffening -altered baroreflex mechanism -decreased cough reflex and response to hypercapnia and hypoxia -weaker resp muscles -degenerative changes -diminished bone mass/loss of height -slower reaction time -thinner epidermis/dermis -decreased sweat and sebaceous glands -increased risk of skin tears -decreased subq tissue -decreased ability to adjust to heat/cold extremes atypical changes: -pneumococcal pna: tachypnea, lethargy, falls, functional status decline, decreased appetite -MI: fatigue, nausea, functional status decline, sob -UTI: confusion, anorexia, nocturia, enuresis, new/worsening incontinence -GERD: dysphasia, chest pain, hoarseness, chronic cough, recurrent asp pna -dysphagia: watery eyes, runny nose while eating/drinking, recurrent asp pna increased risk for med errors, side effects, and non adherence with increased number of meds START SLOW GO LOW

older adult

period of time it takes after med administration for it to produce a therapeutic effect

onset of action

easiest and most commonly used route of med admin -slower onset of action -more prolonged effect -more pt generally prefer

oral

ingestion of more food than is required for body needs

over nutrition

treat overactive bladder works by relaxing bladder muscles to prevent contractions

oxybutynin

repeating ones own sounds or words

palilalia

Decreased WBC, RBC, and platelets

pancytopenia

medical condition with deficiency of all three blood counts critically ill- in nadir period

pancytopenia

injecting a med into body tissue -ID/subq/IM/IV -can also be adminstered epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial

parenteral

administration of nutrients directly into bloodstream and is used when the GI tract cannot be used for ingestion, digestion, and absorption of essential nutrients -indications: chronic/severe diarrhea and vomiting, complicated surgery/trauma, GI obstruction, GI tract anomalies/fistulae, intractable diarrhea, severe anorexia, severe malabsorption, short bowel syndrome, sepsis, burns -customized to meet the needs of each patient and reformulated as the pts condition changes (pts need supplemental vitamin K) -base solutions contain dextrose and protein in the form of amino acids and electrolytes/vitamins/trace elements can be added to meet patient needs -disuse of GI tract may cause bacteria to move from the unused gut into the bloodstream, resulting in septicemia -calories mainly come from carbs in the form of dextrose and by fat in the form of fat emulsion -fat emulsions supply large number of calories in a small amount of fluid, which is beneficial when the patient is at risk for fluid overload (these emulsions are administered through a separate peripheral line or through central line by using Y connector) -administered as central or peripheral, which differ in nutrient content and tonicity -central: indicated when long term support is needed or the pt has high protein/caloric requirement; hypertonic; glucose ranges 20-50%; infused in large central vein so rapid dilution can occur -peripheral: used when nutritional support is needed for only short time, protein and caloric requirements are not high, the risk for central catheter is too great, or to supplement inadequate oral intake; fewer nutrients, less hypertonic, increases risk for phlebitis, potential fluid overload complication, requires large volumes of fluid (pt may not be able to tolerate) -complications: refeeding syndrome, metabolic problems, catheter related problems, hyper/hypoglycemia, hemorrhage/occlusion, phlebitis, thrombosis, -thorax, sepsis, air embolus, hyperlipidemia, essential fatty acid def. -maintaining infusion: aseptic technique, change tubing/filter Q24h, monitor infusion pump/rate, check label with order -assessing effectiveness: monitor vitals q4-8h, daily weight, accurate I/O, determine cause of weight changes, monitor glucose/electrolytes/CBC *if bag finishes before 24h mark, a 10-20% dextrose solution or 5% solution can be given to prevent hypoglycemia *maintain bg level of 140-180 -if infusion falls behind schedule, do not increase the rate (too rapid administration of a hypertonic dextrose solution can result in osmotic diuresis and dehydration) -once pt is able to meet 1/3-1/2 their kcal needs/day, HCP usually decrease infusion by half original volume and increase EN to meet patients needs

parenteral nutrition

-body selectively uses carbs (glycogen) rather than fat and protein to meet metabolic needs -carb stores, found in liver and muscles, are minimal, and can be totally depleted within 18 hours -protein is only used in its normal participation in cellular metabolism -once carb stores are depleted, body converts skeletal protein to glucose for energy -alanine and glutamine are first amino acids used in gluconeogenesis (process by which the liver forms glucose) -resulting plasma glucose allows metabolic processes to continue -when these amino acids are used for energy, the person may be in negative nitrogen balance -within 5-9 days, the body uses fat to supply much of needed energy -depletion of fat stores depends on the amount available, generally used up in 4-6 weeks -when fat stores are gone, the body uses visceral and body proteins, including those in internal organs and plasma, that rapidly decrease because they are only remaining body source of energy available -as protein depletion continues, liver function becomes impaired and protein synthesis decreases, lowering plasma oncotic pressure -oncotic pressure decreases, body fluids shift form vascular space into interstitial compartment -albumin leaks into interstitial space along with the fluid and edema becomes observable -as total blood volume decreases, the skin appears dry and wrinkled -as fluids shift to the interstitial space, ions also move-sodium increases in amount within the cell and potassium and magnesium shift to the extracellular space -sodium potassium exchange pump has high energy needs, using 20-50% of all calories ingested -when diet is extremely deficit in calories and essential proteins, the Na+/K+ pump will fail, leaving sodium inside the cell (along with water) and the cell expands -the liver loses the most mass during protein deprivation and fat gradually infiltrates the liver due to decreased synthesis of lipoproteins -death will rapidly ensue if the person does not receive dietary protein and necessary nutrients

patho of starvation

time it takes for a med to reach its highest effective peak concentration

peak action

abuse: striking, over sedation, restraining

physical

blood serum concentration reached and maintained after repeated, fixed doses

plateau

150,000 - 450,000

platelets

includes milk-based slenderized foods -includes commercially prepared whole-nutrient formulas -to be effective, pts GI tract needs to be able to absorb whole nutrients

polymeric

15-40 more accurate when monitoring long term malnutrition as well as recent malnutrition drawn weekly if pt is on TPN

pre albumin

protein made by the liver that has a half-life of 2 days, making it a better indicator of recent or current nutritional status

pre albumin

ANC less than 500

profound neutropenia

characterized by increased growth rate of tumor, increased invasiveness, and metastasis vascularization is critical to the supply of nutrients to the metastatic tumor

progression phase

process of a cancer cell copying its DNA and dividing into two cells; if dividing more rapidly, it means the cancer is faster growing or more aggressive.

proliferation

characterized by proliferation of altered cells increase in altered cell population increases likelihood of more mutations promoting factors include dietary fat, obesity, smoking, alcohol use can change lifestyle to modify these factors and reduce risk of cancer

promotion phase

essential part of a well-balanced diet and are needed for tissue growth, repair, and maintenance; body regulatory functions; and energy production -10-35% of daily calories -complete: contain all amino acids (eggs, fish, meats, milk/milk products, poultry) -incomplete: lacks one or more of essential amino acids (grains, legumes, nuts, seeds)

proteins

goal is to destroy the malignant tumor affects only the tissues in the treatment field destroys the cells ability to reproduce

radiation