Set

A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PCA pump for pain control. The client reports nausea and vomiting. Which of the following actions should the nurse take? A) Insert a nasogastric tube. B.) Administer an anti emetic C.) Encourage use of the incentive spirometer D.) Auscultate bowel sounds.

D.) Auscultate bowel sounds.

Non pharmacological approach that the nurse may implement for patients who are experiencing pain that focuses on diverting the patient's attention away from the pain sensation by promoting pleasurable and meaningful stimuli is: A.) Massage B.) Heat/cold C.) Guided Imagery D.) Distraction

D.) Distraction

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the clients is developing superior vena cava syndrome? A.) Irregular cardiac rhythm B.) Numbness in the hands C.) Muscle cramps D.) Facial edema

D.) Facial edema

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A.)- Metastasis B.)- Tumor angiogenesis C.)- Immunologic escape D.)- Immunologic surveillance

D.) Immunologic surveillance

A nurse is collecting a health history from a client who has skin cancer. Which of the following findings in the client's history is the highest risk factor for developing skin cancer? A.) Age over 60 B.) Genetic predisposition C.) Light- skinned race D.) Overexposure to sunlight

D.) Overexposure to sunlight

A patient with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? A.) Blood urea nitrogen (BUN) B.) Serum phosphate C.) Serum potassium D.) Uric acid level

D.) Rationale: Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about storing unopened vials of insulin. Which of the following pieces of information should the nurse include in the teaching? A.) Store the vials in the freezer B.) Store the vials at room temperature C.) Store the vials by the window D.) Store the vials in the refrigerator

D.) Store the vials in the refrigerator

The nurse explains that when the patient received tetanus antitoxin with the antibodies in it, the patient received a ___________ type of immunity. A.) Active natural B.) Passive natural C.) Active artificial D.) Passive artificial

D.) When a person receives an inoculation of antibodies from another source, as with tetanus antitoxin, it is considered a passive immunity.

what are nursing priorities for tumor lysis syndrome?

fluids and give allopurinol

A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect?

hyponatremia

A patient is admitted with a secondary immunodeficiency from chemotherapy. The nursing plan of care should include provisions for:

infection control.

A nurse is reinforcing teaching about preventing long term complications of retinopathy and neuropathy with an older adult client who has diabetes mellitus. Which of the following actions is the most important for the nurse to include in the teaching?

maintain stable blood glucose levels.

What timeframe must blood be transfused within once it has been removed from refrigeration?

4 hours

A nurse is contributing to the plan of care for a client who has thrombocytopenia due to chemotherapy. Which of the following interventions should the nurse include?

Avoid IM injections

A nurse is collecting data on a client who complains of fatigue, weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and photosensitivity. Systematic lupus erythematosus (SLE) is suspected. The nurse further checks for which manifestation that is also indicative of the presence of SLE?

Butterfly rash on the cheeks and bridge of the nose

A nurse is caring for a client who request pain medication. Which of the following actions should the nurse perform first? A.) Review the effects of the pain medication. B.) Administer the medication. C.) Reposition the client D.) Determine the location of the pain.

D.) Determine the location of the pain.

a nurse is assessing a client who has Cushing's syndrome. which of the following findings should the nurse expect?

Hyperpigmentation

Which of the following are diseases which result from one's own immune system attacking the body? (select all that apply) A.)Lupus erythematosus B.)Glomerulonephritis C.)Polio D.)Rheumatoid arthritis E.)Thrombocytopenic purpura F.)Osteoarthritis

A, B, D, E

What is B-cell proliferation dependent on?

Antigen stimulation

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action?

Apply pressure on the radiated area to prevent bleeding

A nurse is caring for a client who is postoperative. The nurse should base her pain management interventions primarily on which of the following methods of determining the intensity of the client's pain?

The client's self-report of pain severity

A nurse is collecting data from a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at the insertion site, and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first? A.) Take a photograph of the peripheral IV site B.) Obtain and record the client's vital signs C.) Stop the infusion D.) Identity all medications administered through the IV site for the past 24 hours.

C.) Stop the infusion

The nurse is assisting in caring for a client with an inoperable lung tumor and helps develop a plan of care by addressing complications related to the disorder. The nurse includes monitoring for the early signs of vena cava syndrome in the plan. Which early sign of this oncological emergency should the nurse include monitoring for in the plan of care?

Edema of the face and eyes

Which condition is likely to occur from not getting enough rest/sleep? A.) Obesity B.) Hypertension C.) Diabetes D.) Cancer

Hypertension. (HTN)

A client who is human immunodeficiency virus (HIV) positive has had a tuberculin skin test. The results show a 7-mm area of induration. How should the nurse interpret the test?

It is positive

what are oncologic complications of superior vena cava syndrome?

SOB, neck vein distention, facial edema, plethora

In which patient should the nurse be most concerned about immunodeficiency disorder?

The patient on long-term radiation therapy for cancer

A nurse is caring for a client who has Addison's disease and is at risk for addisonian crisis. Which of the following actions should the nurse take?

Weigh the client daily

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend?

A bland, low-fiber diet.

The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that immunization provides which?

Acquired immunity from disease

A nurse is reinforcing teaching about the manifestations of Hyperglycemia with a client who has diabetes mellitus. Which of the following statements by the client indicates and understanding of the teaching?

"I will be more thirsty than usual"

A nurse is caring for a client who reports recurrent flank pain, nausea, and vomiting for 24hr. which of the following actions is the nurse's priority? A.) Monitor intake and output B.) Strain the urine. C.) Administer the pain medication. D.) Administer an antiemetic.

Administer the pain medication.

Nurse is monitoring pt who is post op following a thyroidectomy. Which of the following data should the nurse identify as the priority to monitor?

Airway Patency

The nurse reviews the care plan of a client with cancer and notes that the client has a problem with adequate food intake related to side effects of therapy. In order to enhance appetite and nutrition, the nurse should offer which advice to the client?

Avoid strong smelling foods

What is the purpose of plasmapheresis in the treatment of rheumatoid arthritis?

To remove pathologic substances present in the plasma

When caring for the client receiving cancer chemotherapy which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A, C, D. Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count. Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

A patient who works in a plant nursery and has suffered an allergic reaction to a bee sting is stabilized and prepared for discharge from the clinic. During discussion of prevention and management of further allergic reactions, the nurse identifies a need for additional teaching based on which comment?

"I will need to take maintenance doses of corticosteroids to prevent reactions to further stings

The nurse assesses a female client with a diagnosis of primary adrenal insufficiency (Addison's disease). The nurse recognizes which finding associated with the disease? 1. Bronze pigmentation of skin with patchy areas 2. Increased body or facial hair 3. Purplish or red striae on the abdomen 4. Supraclavicular fat pad

1

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply 1.Radiation 2.Chemotherapy 3.Increased fluid intake 4.Decreased oral sodium intake 5.Serum sodium level determination 6.Medication that is antagonistic to antidiuretic hormone

1, 2, 5, 6 Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

The nurse cares for a client who is experiencing exophthalmos as a complication of Graves' disease. Which nursing action(s) should be included in the client's plan of care? Select all that apply. 1. Administer artificial tears to moisten the conjunctiva 2. If eyelids don't close during sleep, lightly tape them shut 3. Recommend the use of dark glasses to prevent irritation 4. Teach about the importance of smoking cessation 5. Teach avoidance of eye movement to prevent further damage

1,2,3,4

In the intensive care unit, the nurse cares for a client admitted with a head injury who develops syndrome of inappropriate antidiuretic hormone. Which data should the nurse expect with the onset of this condition? Select all that apply. 1. Decreased serum osmolality 2. High serum osmolality 3. High urine specific gravity 4. Increased urine output 5. Low serum sodium

1,3,5

The nurse teaches disease management to a group of clients with type I diabetes mellitus. Which of the following should the nurse teach as signs or symptoms associated with hypoglycemia? Select all that apply. 1. Diaphoresis 2. Flushing 3. Pallor 4. Polyuria 5. Trembling

1,3,5

A client is suspected of having Graves' disease (hyperthyroidism). Which signs and/or symptoms are expected to be present in this client? Select all that apply. 1. Anxiety 2. Bradycardia 3. Dry skin 4. Heart palpitations 5. Protrusion of the eyeballs 6. Weight gain

1,4,5

A nurse is caring for a client who has Cushing syndrome due to adrenal tumor. Which assessment finding should the nurse anticipate in this client? Select all that apply. 1. Hirsutism 2. Hypotension 3. Serum potassium is 5.8 mEq/L 4. Serum sodium is 154 mEq/L 5. Truncal obesity

1,4,5

What is Humoral immunity based on? ( select all that apply) A.) Production of antibodies by B cells B.) T cells are activated by an antigen. C.)The body's response to an antigen D.) Sensitized T cells destroy the antigen E.) Helper T cells activate phagocytosis

A, C, E

For the fill in the blank question regarding Tumor markers, its going to be 1 of 3 markers, so just memorizes them all... 1.)Prostate- specific antigen or (PSA) - Prostate cancer. Specific for cellular activity. Requires a physician's interpretation. 2.) CA-125 -Ovarian cancer. Detected in the blood and peritoneal ascites. Elevated in patients with gynecologic cancers. 3.) CA-19-9 -Pancreatic or hepatobiliary cancer

1.) Prostate- specific antigen 2.) CA-125 3.) CA-19-9

The nurse is caring for a client who is prescribed 15 units of NPH insulin to be administered at 0700. At which of the following times of day is most appropriate for the nurse to plan a snack? A. 0500 B. 0900 C. 1000 D. 1500

1500; 8 hours after NPH administration is the middle of the peak time for intermediate acting insulins. The client is at greatest risk for hypoglycemia and this may require a snack at this time. Clients should be educated to check blood glucose about 8-10 hours after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 grams of carbohydrates, followed by rechecking of the blood glucose in 15 minutes. If the blood glucose has returned to normal at this time, the client should then consume a small amount of protein to maintain a steady-state glucose level. All clients should receive education on signs and symptoms of hypoglycemia and hyperglycemia.

The nurse recommends to the busy mother of three that the antihistamine fexofenadine (Allegra) would be more beneficial than diphenhydramine (Benadryl) because allegra: A.) is inexpensive B.)Contains a stimulant for an energy boost. C.)Does not dry out the mucous membranes D.) Does not induce drowsiness.

D.) Allegra does not induce drowsiness as does benadryl.

The nurse is preparing to care for a client with immunodeficiency. The nurse should plan to address which problem as the priority? 1.Anxiety 2.Fatigue 3.Risk for infection 4.Need for social isolation

3.) Risk for infection. The client with immunodeficiency has inadequate or no immune bodies and is at risk for infection. The priority concern would be risk for infection. The question presents no data indicating that the client is experiencing anxiety. Fatigue may be a problem and the client may need to be placed on protective isolation but these are not the priority problems for this client. Infection can be life-threatening and is the priority.

The nurse evaluates the effectiveness of desmopressin use for diabetes insipidus in a client with a pituitary tumor. Which client assessment finding indicates that the medication is having the desired effect? 1. Appetite has improved 2. Blood glucose is 110 mg/dL (6.1 mmol/L) 3. Urine output has decreased 4. Urine specific gravity is lower

3. Urine output has decreased

A client is receiving external radiation to the neck for cancer of the larynx. Which is the most likely expected effect? 1. Dyspnea 2.Diarrhea 3.Sore throat 4.Constipation

3.) Sore throat. In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Dyspnea may occur with lung involvement. Diarrhea and constipation may occur with radiation to the gastrointestinal tract.

The nurse cares for a group of clients on a medical surgical floor. The client with which condition is at highest risk for developing syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Carpal tunnel syndrome 2. Diabetes mellitus 3. Sciatica 4. Small cell lung cancer

4

A nurse is reviewing guidelines to prevent diabetic ketoacidosis during periods of illness with a client who has type 1 diabetes mellitus. Which of the following should the nurse include in the guidelines? A.) Test blood glucose every 6 hr. B.) Administer usual daily dose of insulin C.) Report blood glucose greater than 220 mg/dL. D.) Limit juices, soda, and gelatin.

B.) Administer usual daily dose of insulin.

A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical manifestations should the nurse expect to observe? (Select all that apply) A.) Buffalo hump B.) Purple striations C.)Moon face D.)Tremors E.)Obese extremities

A, B, C

A nurse is planning care for a client who is postoperative. Which of the following statements about pain management should the nurse consider when implementing client care? (select all that apply) A.) Use of analgesics will eventually lead to addiction B.) Each client's expression of pain may be different and individualized. C.) Patient-controlled analgesia (PCA) offers a constant level of opioids within therapeutic range. D.) Pain level and pain tolerance can be assessed using a scale from 0 to 10 E.) The client will express the feeling of pain both verbally and non verbally.

A, B, C, D

When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information.The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? Select all that apply. a. Hyponatremia b. Mental status changes c. Azotemia d. Bradycardia e. Weakness

A, B, E

Which of the following provide the body with innate immunity (Select all that apply.) A.)Skin and mucous membranes B.)Lungs C.)Heart D.)Tears and Saliva E.)Natural intestinal and vaginal flora F.)Stomach acid

A, D, E, F

A nurse is reinforcing preoperative teaching with a client who has colorectal cancer and is schedule to undergo placement of colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching?

I can have only liquids for 2 days before the surgery

Which symptom would be classified as a mild transfusion reaction? A.) Orthopnea B.)Tachycardia C.)Hypotension D.)Wheezing

A.)

The nurse is teaching a client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. Which statement should the nurse include in the teaching? A.). "Hold the device alongside the neck." B.) "Insert the device into the tracheostomy." C.) "Swallow air into the esophagus to make speech." D.) "Hold the device over the upper portion of the sternum."

A.) " Hold the device alongside the neck."

A nurse is reinforcing teaching to client who has cancer and is receiving external radiation therapy. Which of the following statements made by the client indicates an understanding of the teaching? A.) I need to protect the area from sunlight B.) I'm going to apply skin lotion to the are every day C.) I'll massage the area once per day D.)I'll wash the markings off after each therapy treatment

A.) "I need to protect the area from sunlight"

A nurse is caring for a client who has new diagnosis of acute systemic lupus erythematousus (SLE) and is scheduled to begin medication therapy. Which of the following types of medications should the nurse expect to administer? A.) Corticosteroids B.) Antihistamine C.) Antivirals D.) Opioids

A.) Corticosteroids

The LPN/LVN has arrived at the patient's beside with a unit of packed cells to be connected to an IV that is infusing. When the RN arrives, what is the first thing the nurses must do? A.) check to ensure that the donor and recipient numbers match according to policy B.) Request the patient to sign the card on the packed cells C.) Immediately administer the packed cells. D.)Check the patient's ID bracelet and then administer the packed cells.

A.) Donor and recipient numbers are specific and must be thoroughly checked and identified with an armband.

A nurse is caring for 6-month infant who is postoperative following a myringotomy. Which of the following pain scales should the nurse use to determine the instant's pain level? A.) Flacc B.) Oucher C.) Faces D.) Visual Analog Scale

A.) Flacc

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. Which finding should alert the nurse that health care provider (HCP) notification is required? A.) Calcium level of 15 mg/dL B.) Potassium level of 3.8 mEq/L C.) Platelet count of 200,000 cells/mm3 D.) White blood cell (WBC) count of 6,000 cells/mm3

A.) Hypercalcemia is a serum calcium level greater than 10.0 mg/dL. It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the HCP needs to be notified. Options 2, 3, and 4 indicate normal laboratory values.

What should the nurse include to assess for in the plan of care for a patient undergoing Plasmapheresis? A.) Hypotension B.)Hypersensitivity C.)Urticaria D.)Flank pain

A.) Hypotension

A nurse is collecting data from a client who has Addison's disease. Which of the following findings should the nurse expect? A.) Hypotenstion B.) Weight gain C.) Sugar craving D.) Pale skin tone

A.) Hypotenstion

A nurse is assessing a client who reports acute pain. The nurse should anticipate which of the following findings? A.)Increased Heart rate B.)Decreased respiratory rate C.) Hyperactive bowel sounds. D.) Decreased blood pressure.

A.) Increased heart rate

A nurse is contributing to the plan of care for a client who has cancer and is scheduled to receive internal radiation therapy. Which of the following actions should the nurse recommend? A.) Place the client in a private room B.) Secure a dosimeter badge to the client's gown C.) Don a cover gown before entering the client's room D.) Dispose of dislodged implants in a bio hazard sharps container

A.) Place the client in a private room

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods taste bitter. The nurse would try to limit which food that is most likely to cause this bitter taste for the client? A.) Pork B.) Custard C.) Potatoes D.) Cantaloupe

A.) Pork. Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or rancid. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet, such as mild-tasting fish, cold chicken, turkey, eggs, or cheese. Custard, potatoes, and cantaloupe are not likely to cause distortion of taste.

A nurse is collecting data from a client who has Cushing's syndrome. Which of the following skin manifestations should the nurse expect to find. A.) Purple striae on the chest and abdomen B.) Butterfly rash across the bridge of the nose C.) Bronze skin pigmentation D.) Jaundice of the face and sclera

A.) Purple striae on the chest and abdomen

When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? A.) Can you tell me what has been helpful to you in the past when coping with stressful events? B.) How long ago were you diagnosed with this cancer? C.) Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon? D.) How do you feel about having a possibly terminal illness?

A.) Rationale: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.

A client has been prescribed acarbose (Precose) for treatment of diabetes mellitus. Client teaching regarding this medication should include which instructions? Select all that apply. A.) The medication should be taken with each meal B.)Abdominal cramping is common C.) Fatty stools are common D.) Dizziness should be expected E.) The medication should be taken with a full glass of water only F.) Side effects include excessive flatulence.

A.) The medication should be taken with each meal B.) Abdominal cramping, F.) excessive flatulence,

What should the nurse do because of the increasing strength of the dose in the immunotherapy? A.) Observe the patient for at least 20 minutes after administration B.)Take the vital signs every 10 minutes for an hour C.) Have the patient lie down quietly for an hour D.)Place a warm compress on the area to speed its absorption.

A.) The patient should be observed for 20 minutes after the increased does of the allergen. If anaphylaxis is going to occur, it will do so within that time frame.

A nurse on an oncology unit is reinforcing discharge teaching for an adolescent client who received a bone marrow transplant for leukemia. Which of the following information should the nurse include? (Select all that apply.) A.) You should take your temperature at a least once a day B.) You may return to school if you feel strong enough C.) Examine your feet every day D.) Clean your toothbrush weekly with isopropyl alcohol"

A.) You should take your temperature at least once a day, C.) Examine your feet every day.

15. A patient is undergoing internal radiation therapy. In planning her care for the day, the nurse must remember to: a.) stand at the greatest distance away from the site where an internal radiation device is in the patient's body. b.) spend as much time as possible with the patient because of the patient's fear. c.) retrieve the applicator and replace if it becomes dislodged. d.) provide the patient's family with chairs near the patient.

A.) stand at the greatest distance away from the site where an internal radiation device is in the patient's body.

A nurse is reinforcing teaching on glucose monitoring with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates understanding

I will check my urine once a day for glucose

A nurse is assisting with the plan of care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A.) Check the client's blood glucose for hypoglycemia B.) Check for hypertension C.) Weight the client weekly D.) Insert an indwelling urinary catheter

B.) Check for hypertension

37. Which of the following foods that are recommended for prevention of colorectal cancer in men. (Select all that apply.) a. Oranges, peaches, pears b. Pasta, bread, muffins c. Bacon, pork, beef d. Chicken, pinto beans, asparagus e. Ice cream, cheese, butter f. Pretzels, gelatin dessert, applesauce

ANS: A, D, F. Eating plenty of fruits, vegetables, and whole grain foods and limiting intake of high- fat foods will help prevent colorectal cancer in men.DIF: Cognitive Level: KnowledgeREF: Page 2016, Health Promotion box, Table 57-1TOP: Colorectal cancer in men

A nurse is reinforcing teaching with a client about cancer prevention and plans to address the importance of foods high in antioxidants. Which of the following foods should the nurse include in the teaching? A.) Cottage cheese B.) Fresh berries C.) Bran cereal D.) Skim milk

B.) Fresh berries

What is the term for transplantation of tissue between members of the same species?

Allograft

what does allupurinol do?

Allopurinol is used to treat gout or kidney stones, and to decrease levels of uric acid in certain cancer patients.

The nurse is caring for a client with systemic lupus erythematosus (SLE) that is affecting the hematopoietic system. Based on this, which signs and symptoms should the nurse anticipate and collect data on? Select all that apply.

Anemia Splenomegaly Lymphadenopathy

A nurse is caring for a client who is receiving chemotherapy and has laboratory data revealing bone marrow suppression. The nurse should include which of the following instructions in the teaching?

Avoid eating fresh fruits and vegetables(can contain bacteria)

How does normal aging change the immune system?

B cells show deficiencies in activity

The nurse is teaching a group of adults about the warning signs of cancer. Which signs should the nurse provide 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 or bladder habits F.) Absence or decreased frequency of menses

B, C, D, E Cancer is a neoplastic disorder that can involve all body systems. In cancer, cells lose their normal growth-controlling mechanism. Some signs include sores that do not heal, a nagging cough or hoarseness, indigestion or difficulty swallowing, and a change in bowel or bladder habits. Areas of alopecia occur following cancer chemotherapy. Absence of menses is not a specific sign; however, abnormal occurrence of menses may be.

A nurse is collecting data from a client. Which of the following findings should the nurse identify as an indication of protein- calorie malnourishment? (Select all that apply) A.) Exophthalmos B.) Dry, brittle hair C.) Edema D.) Butterfly rash on the face E.) Poor would healing

B, C, E

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse determines that teaching has been effective when the client identifies which of the following manifestations of hypoglycemia? (select all that apply.) A.)Polyuria B.)Blurry vision C.)Tachycardia D.)Polydipsia E.)Sweating

B, C, E

To provide examples of an active acquired immunity, the nurse uses the example of a person who has acquired immunity from measles because that person has had: ( select all that apply.) A.)Chickenpox and mumps B.)Measles C.)An extremely healthy immune system D.)An inoculation against measles E.)Maternal antibodies against measles

B, D

The nurse outlines the functions of the immune system as those actions which (select all that apply.) A.) Prevention of hemorrhage B.)Protection of the body's internal enviroment C.) Maintenance of hemoglobin level D.) Maintenance of homeostasis by removing damaged cells. E.) Destruction of growth of abnormal cells.

B, D, E

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function?Select all that apply. a.) Explain to the client that the colostomy is only temporary. b.) Encourage the client to participate in changing the ostomy c.) Obtain a psychiatric consultation. d.) Offer to have a person who is coping with a colostomy visit. e.) Encourage the client and family members to express their feelings and concerns.

B, D, E

If a nurse is sensitive to latex gloves, what potential food sensitivities might the nurse develop? ( Select all that apply.) A.)Peanuts. B.)Avocados C.)Milk D.)Bananas E.)Tomatoes F.)Potatoes

B, D, E, F

A nurse is caring for a client who is postoperative and has a history of Addison's disease. For which of the following manifestations should the nurse monitor? A.)Hypernatremia B.)Hypotension C.)Bradycardia D.)Hypokalemia

B.) Hypotension

A nurse is reinforcing teaching with a client who has stomatitis due to chemotherapy. Which of the following statements by the client indicates a need for further instructions? A.) I will use a soft toothbrush or foam swab for oral care. B.) I will cleanse my mouth after meals with an alcohol based mouthwash C.) I will use a straw when I drink liquids D.) I will rinse my mouth frequently with a hydrogen peroxide solution

B.) I will cleanse my mouth after meals with an alcohol based mouthwash

Immediately after the nurse administers an intradermal injection of a suspected antigen during allergy testing, the patient complains of itching at the site, weakness and dizziness. Which action by the nurse is most appropriate initially? A.) Elevate the arm above the shoulder. B.) Administer subcutaneous epinephrine. C.) Apply a warm compress to area. D.) Apply a local anti-inflammatory cream to the site.

B.) Injection of subcutaneous epinephrine should be given at the first sign of allergy.

A nurse is monitoring a client following a thyroidectomy. Which of the following findings should the nurse identify as an indication of hypoparathyroidism? A.) Elevated blood pressure B.) Involuntary muscle spasms C.) Cold intolerance D.) Weight loss

B.) Involuntary muscle spasms

17. Which complaint should a nurse consider a warning sign for cancer? a.) Intense pain in an area such as a hip or groin after carrying several gallons of paint up a ladder and painting the garage b.) Persistent indigestion associated with difficulty swallowing c.) Diarrhea that lasts 2 days after an all-day picnic at the beach d.) A painful lump under the umbilicus that recedes when pushed but comes out again with a sneeze or hard cough

B.) Persistent indigestion associated with dysphagia

An anxious patient enters the emergency room with angioedema of the lips and tongue, dyspnea, urticaria, and wheezing after having eaten a peanut butter sandwich. What should be the nurse's first intervention? A.) Apply cool compresses to urticaria B.)Provide oxygen per non-re-breathing mask C.) Cover patient with a warm blanket D.) Prepare for venipuncture for the delivery of IV medication

B.) Provision of oxygen is the initial primary intervention. Anaphylaxis may advance very rapidly and the patient may have to be intubated. Covering the patient with a warm blanket is not wrong, but not an initial intervention.

A patient undergoing external raidiaton has developed a dry desquamation of the skin in the treatment area. The nurse knows that teaching about management of the skin reaction has been effective when the patient says. a. "I can use ice packs to relieve itching in the treatment area." b. "I can buy a steroid cream to use on the itching area." c. "I will expose the treatment area to a sun lamp daily." d. "I will scrub the area with warm water to remove the scales."

B.) Rationale: Steroid (over-the-counter [OTC] hydrocortisone) cream may be used to reduce itching in the area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

What is the major negative effect of cell-mediated immunity? A.) Depression of bone marrow B.)Rejection of transplanted tissue C.) Activation of the T cells D.) Stimulation of the B cells

B.) Rejection of transplanted tissue. Cell-mediated immunity has the negative effect of rejection of transplanted tissue. Activation of T cells and stimulation of B cells are the positive basis of the cell-mediated immunity.

A nurse is collecting data from a client who has systemic scleroderma. Which of the following findings should the nurse expect? A.) Excessive salivation B.) Skin tightening C.) Periorbital edema D.) Alopecia

B.) Skin tightening

A nurse is assisting in the care of a client who is receiving a transfusion of packed Red blood cells. The client develops itching and hives. Which of the following actions should the nurse take first? A.)Obtain Vital signs B.)Stop the transfusion C.)Notify the registered Nurse D.) Administer Diphenhyramine

B.) Stop the transfusion

A nurse is reinforcing health teaching about skin cancer with a group of clients. Which of the following risk factors should the nurse identify as the leading cause of non-melanoma skin cancer? A.) Exposure to the environmental pollutants B.) Sun exposure C.) History of viral illness D.) Scars from a severe burn

B.) Sun exposures

A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects? A.) Allergic response B.) Superinfection C.) Renal toxicity D.) Hepatotoxicity

B.) Superinfection

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A.)-Teach the patient to exercise daily. B.)-Teach the patient promoting factors to avoid. C.)-Tell the patient to have the cancer surgically removed now. D.)-Teach the patient which vitamins will improve the immune system.

B.) Teach the patient promoting factors to avoid.

Which precaution is most important for the nurse to teach the client who has chemotherapy-induced peripheral neuropathy? A.) Avoid taking aspirin or any aspirin-containing products. B.) Use a bath thermometer to check bath water temperature. C.) Do not use mouthwashes that contain alcohol or glycerin. D.) Bathe daily using an antimicrobial soap or gel.

B.) Use a bath thermometer to check bath water temperature.

A newly licensed nurse is caring for a client who is at risk for developing diabetes insipidus. Which of the following should be included in the client's plan of care?

Check urine specific gravity

19. In the nursing interventions for a patient receiving external radiation treatments for a malignancy, the nurse must remember to: a.) cleanse with soap and water the areas of entry or "ports" marked by the radiologist. b.) apply some form of ointment with a metallic base to the area of entry each time the patient goes for x-ray treatments. c.) instruct the patient to avoid irritating the "ports" by not lying on that part of the body and not wearing constricting clothing. d.) isolate the patient so he will not expose others to radiation.

C. instruct the patient to avoid irritating the "ports" by not lying on that part of the body and not wearing constricting clothing.

A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0-10 pain scale. What non pharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider? A.) Frequently reassess the patient's pain scores B.) Reassures the patient that the provider will come to the emergency department soon C.) Softly plays music that the patient find relaxing D.) Teaches the patient how to do yoga.

C.) Softly plays music that the patient find relaxing

The client receiving high-dose chemotherapy who has neutropenia asks the nurse whether he and his wife can have sexual intercourse while he is receiving chemotherapy. What is the nurse's best response? A.) "No, this activity will increase the side effects of the chemotherapy. B.) "No, the danger of impregnating your wife is too great. C.) "Yes, as long as you feel like it and use a condom. D) "Yes, if you do not have an infection."

C.) "Yes, as long as you feel like it and use a condom.

The nurse is making a home visit to a client receiving external radiation therapy on an outpatient basis. Further teaching is necessary when the nurse observes the client doing which of the following? A: Washing radiation site with plain water and patting skin dry B: Protecting skin with soft, loose clothing C: Applying lotion to irritated skin D: Inspecting skin for damage

C.) Applying lotion to irritated skinRationale: Lotion, deodorant, and powders should not be applied to the radiation site during the treatment period to avoid further irritation to the skin.

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? a.) Increasing shortness of breath b.) Diminished bilateral breath sounds c.) Change in mental status d.) Weight gain of 4 pounds in 1 day

C.) Change in mental status

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A.) Hypokalemia B.)Hypouricemia C.)Hypocalcemia D.) Hypophosphatemia

C.) Hypocalcemia

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy? A.) Gingival hyperplasia B.) Hirsutism C.) Pancytopenia D.) Weight gain

C.) Pancytopenia

A patient is undergoing immunotherapy on a pernnial basis. With this form of treatment, what should the patient receive? A.) Larger doses each week B.) Higher concentrations each week C.) Increased amounts and concentrations in 6-week cycles D.) The same amount and concentration each visit.

C.) Perennial therapy is most widely accepted, because it allows for a higher cumulative dose, which produces a better effect. Perennial therapy usually begins with 0.05ml of 1:10,000 dilution and increase to 0.5ml in a 6 week period.

A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopic cholecystectomy. Which of the following statements should the nurse make? A.)The pain results from lying in one position too long during surgery B.)The pain occurs as a residual pain from cholecystitis C.) The pain will dissipate if you ambulate frequently D.)The pain is caused from the nitrous dioxide injected into the abdomen

C.) The pain will dissipate if you ambulate.

A nurse is reinforcing teaching with a client who has leukemia and has developed thrombocytopenia. Which of the following instructions should the nurse include in the teaching? A.) Limit flossing your teeth to once a week. B.) Gently blow your nose if needed C.) Use an electric razor when shaving D.) Wear shoes that have a soft sole.

C.) Use an electric razor when shaving.

Which of the following is an example of immunocompetence? A.) A child that is immune to measles because of an inoculation. B.) A person who has seasonal allergies every fall C.)When the symptoms of a common cold disappear in 1 day. D.) A neonate having a natural immunity from maternal antibodies.

C.) When the symptoms of a common cold disappear in 1 day

Because the older adult has decreased production of saliva and gastric secretions, they are at risk for. A.) mouth ulcers. B.) fissures in corners of the mouth. C.) gastrointestinal infections. D.) bloating.

C.) gastrointestinal infections.Deficient saliva and gastric secretions make the older adult prone to gastrointestinal infections.

nurse is caring for a client is receiving hydromorphone HCL (a type of narcotic) via PCA pump and reports continuous pain of 6 on a scale from 0 to 10. Which of the following actions should the nurse take first?

Check the display on the PCA pump.

a nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect

Client reports of numbness in his hands

A nurse is caring for a client who is requesting prescription pain medication. Which of the following actions should the nurse perform first?

determine the location of the pain

A nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain management. The nurse enters the room to find the client asleep and his partner pressing the button to dispense another dose. Which of the following responses should the nurse make? A.) Next time you think he needs more medication, call me and I'll push the button B.) It's a good idea to help make sure your husband can sleep comfortably C.) Why do you think your husband needs more medication when he is asleep D.) Your husband should decide when more medication is needed.

D.) Your husband should decide when more medication is needed.

A nurse is caring for a client who is receiving chemotherapy for treatment of ovarian cancer and experiencing nausea. Which of the following actions should the nurse take? A.)Advise the client to lie down after meals B.)Instruct the client to restrict food intake prior to treatment C.)Provide the client with antiemetic 2 hr prior to the chemotherapy. D.)Encourage the client to drink a carbonated beverage 1 hr before meals.

D.) encourage the client to drink a carbonated beverage 1 hr before meals

A patient receiving head and neck radiation and systemic chemotherapy has ulcerations over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the nurse to teach the patient is to. a.) remove food debris from the teeth and oral mucosa with a stiff toothbrush. b.) use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c.) gargle and rinse the mouth several times a day with an antiseptic mouthwash. d.) rinse the mouth before and after each meal and at bedtime with a saline solution.

D.) rinse the mouth before and after each meal and at bedtime with a saline solution.

The nurse outlines for a patient who has asthma attacks from pollen that the process from exposure to symptoms follows a systematic sequence. what is the last physiologic response to allergic asthma attack A.) Release of histamine B.)Edema C.)Vasodilation D.) Activation of mast cells E.) Bronchospasm F.) Exposure to pollen

E.) Bronchospasm

A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is appropriate?

Encourage her to select a wig

A nurse is checking the lab results for a client who is at risk for diabetes mellitus. Which of the following lab results indicates to the nurse that the client is at risk for diabetes mellitus?

Fasting blood glucose 155 mg/dl; the client who has a fasting blood glucose level above 126 mg/dl is at risk for diabetes mellitus.

Which signs/symptoms would indicate to the nurse that a client is experiencing an anaphylactic reaction? Select all that apply.

Hives Stridor Dyspnea Urticaria Wheezing

The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis?

Increased calcium level

The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which as a risk factor associated with cancer?

Low-fat and high-fiber diets

What is the substance released by the T cells that stimulates the lymphocytes to attack an inflammation?

Lymphokine

A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?

Monitor the client for bleeding

The patient who had an asthma-like reaction to a desensitization shot was medicated with a subcutaneous injection of epinephrine. What effect should the nurse assure the anxious patient this will have?

Produce bronchodilation

A nurse is caring for a client who will receive brachytherapy to treat uterine cancer. The nurse should ensure the client understand that she will receive which of the following interventions?

Radioactive infusion or insertion into or near the tumor.

The nurse is assisting in caring for a client receiving chemotherapy. On review of the morning laboratory results, the nurse notes that the white blood cell count is extremely low, and the client is immediately placed on neutropenic precautions. The client's breakfast tray arrives, and the nurse inspects the meal and prepares to bring the tray into the client's room. Which action should the nurse take before bringing the meal to the client?

Remove the fresh orange from the breakfast tray.

The patient is scheduled for surgery late in the afternoon. His postoperative orders include PCA therapy. Which of the following nursing interventions is appropriate to perform?

Teach the patient about PCA before surgery and before preoperative medication administration.

The nurse is explaining about antigens and antibodies when the client asks where antibodies come from. Which is an appropriate response? Select all that apply.

Tears Spleen Saliva Blood serum Lymph nodes

nurse is reviewing the lab values for pt who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following lab values?

Thyroid Stimulating Hormone

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dl. Which of the following fings should the nurse expect?

Tingling of the Extremities

A nurse is caring for a client who has capillary blood glucose 48 mg/dl. Which of the following findings should the nurse expect to find?

Tremors; the finding is below the expected reference range.

Which interventions would apply in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply.

Use nonlatex gloves Use medications from glass ampules Do not puncture rubber stoppers with needles Keep a latex-safe supply cart available in the client's area

A nurse is performing teaching with a client who has newly diagnosed type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following manifestations of hypoglycemia? (Select all that apply).

Vertigo, Tachycardia, Moist,clammy skin

The nurse prepares to give a bath and change the bed linens on a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which should the nurse incorporate in the plan during the bathing of this client?

Wearing a gown and gloves

Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer?Select all that apply. a. Fatigue b. Changes in color of hair c. Change in taste d. Changes in skin of the neck e. Difficulty swallowing

a, c, d, e

The nurse teaches disease management to a group of clients with type I diabetes mellitus. Which of the following should the nurse teach as signs or symptoms associated with hypoglycemia? Select all that apply. a. Diaphoresis b. Flushing c. Pallor d. Polyuria e. Trembling

a. Diaphoresis c. Pallor e. Trembling

The nurse takes into consideration that when the antigen and antibody react, the complement system is activated which:

attracts phagocytes.

A nurse is teaching a client how to decrease nausea associated with chemotherapy and radiation. Which statement indicates an understanding of the teaching? a. I will eat smaller meals if I feel nauseated b. I will eat foods that are served at room temp c. I will drink more liquids with my meals d. I will increase the amount of unsaturated fats in my diet

b. I will eat foods that are served at room temp

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery? a.) Cure of the cancer b.) Relief of symptoms or improved quality of life c.) Allowing other therapies to be more effective d.) Prolonging the client's survival time

b. Relief of symptoms or improved quality of life

A nurse is applying a cold compress for a client who has pain and minor swelling in a sutured laceration in the forearm. Which of the following assessments should the nurse use to determine whether the treatment is effective? a. Inspect site for reduced swelling b. Monitor client's pulse rate c. Ask client to rate pain d. Have client perform ROM of affected arm

c. Ask client to rate pain

The nurse is teaching a student nurse about pain assessment scales. Which statement by the student indicates correct understanding?a.) "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." b.) "When patients say they don't need pain medication, they aren't in pain." c.) "Pain assessment scales determine the quality of a patient's pain." d.) "A patient's behavior is more reliable than the patient's report of pain."

c.) "Pain assessment scales determine the quality of a patient's pain."

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? a.) Administering a biological response modifier b.) Encouraging oral care with commercial mouthwash c.) Providing oral care with a disposable mouth swab d.) Maintaining NPO until the lesions have resolved

c.) Providing oral care with a disposable mouth swab

A nurse is caring for a client who has dysphagia following a stroke. Which of the following is the priority action for the nurse to take when feeding the client?

place the client in the upright position