Adult Health Exam 3

A nurse notices on a patients chart that there has been a Reed Sternberg cells. The nurse recognizes this as a manifestation of which of the following? A) Multiple myeloma B) Non- hodgkin's lymphoma C) Hodgkins lymphoma D) D.I.C

ANS: C) Hodgkins lymphoma

When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs? 1. During preparation, drugs may be absorbed through the skin or inhaled. 2. Many chemotherapeutic drugs are vesicants. 3. Chemotherapeutic drugs are frequently given through central venous access devices. 4. Oral and venous routes of administration are the most common.

ANS: 1. During preparation, drugs may be absorbed through the skin or inhaled.

For a patient who is receiving chemotherapy, which laboratory result is of particular importance? 1. White blood cell (WBC) count 2. Prothrombin time and partial thromboplastin time 3. Electrolyte levels 4. Blood urea nitrogen level

ANS: 1 WBC count is especially important, because chemotherapy can cause decreases in WBCs, particularly neutrophils (known as neutropenia), which leave the patient vulnerable to infection. The other tests are important in the total management but are less directly specific to chemotherapy in general. Focus: Prioritization

Which patient is at greatest risk for pancreatic cancer? 1. An elderly African-American man who smokes 2. A young white obese woman with gallbladder disease 3. A young African-American man with type 1 diabetes 4. An elderly white woman who has pancreatitis

ANS: 1. An elderly African-American man who smokes

Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention? 1. Platelet count 2. Electrolyte levels 3. Hemoglobin level 4. Hematocrit

ANS: 2 Electrolyte levels Feedback: Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to monitor to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome. Focus: Prioritization

Which laboratory result would the nurse expect in the client diagnosed with DIC? 1. A decreased prothrombin time (PT). 2. A low fibrinogen level. 3. An increased platelet count. 4. An increased white blood cell count

ANS: 2. A low fibrinogen level.

The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved. 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.

ANS: 3. The stools may be very dark, and this can mask blood.

A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis? 1. Diarrhea/Constipation related to altered bowel patterns 2. Deficient Knowledge related to the disease process and diagnostic procedure 3. Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea 4. Anxiety related to unknown outcomes and perceived threats to body integrity

ANS: 4 The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other diagnoses are relevant, but if the patient leaves the clinic the interventions may be delayed or ignored. Focus: Prioritization

The client is diagnosed with congestive heart failure and anemia. The HCP ordered a transfusion of two (2) units of packed red blood cells. The unit has 250 mL of red blood cells plus 45 mL of additive. At what rate should the nurse set the IV pump to infuse each unit of packed red blood cells? ____________

ANS: 74ml/hr Pumps are set at an hourly rate. The client in congestive heart failure should receive blood at the slowest possible rate to prevent the client from further complications of fluid volume overload. Each unit of blood must be infused within four (4) hours of initiation of the infusion. 250 mL + 45 mL = 295 mL 295 mL ÷ 4 = 73 3 /4 mL/hr, which rounded is 74 mL/hr

A patient ask a nurse what the difference between hodgkins lymphoma and non - hodgkins lymphoma. Which of the following responses would be correct ? A" Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin lymphoma typically begins in the upper body, Such as the chest" B) " Non- Hodgkins is distinguished by the reed sternberg cell and the Hodgkins is distingishable by multiple lymph nodes" C) " Non - hodgkins is distinguishable by proliferated abnormal blood cells and Hodgkins refers to non proliferated blood cells" D) " Non- hodgkins refers to a problem with cell production where as Hodgkinsis an issue with immune function"

ANS: A" Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin lymphoma typically begins in the upper body, Such as the chest"

A patient has stage 2 cancer and ask the nurse how the doctor decided what stage cancer she had. Which of the following responses by the nurse would answer this question? A) " They use the staging using the TNM to look at the size, and spread of the tumor then they look at grading which specifically looks at the cells and together that determines the stage of the cancer" B) " they analyze the type of cells using the TNM system. They then also look at the spread of the cancer." C) " After a biopsy of the cells they weigh them and the stage depends on the weight of the cells" D) " The staging is based on a sliding scale."

ANS: A) " They use the staging using the TNM to look at the size, and spread of the tumor then they look at grading which specifically looks at the cells and together that determines the stage of the cancer"

A nurse is preparing a patient for a bone marrow biopsy. Which of the following statments made by the nurse would be true regarding a bone marrow biopsy ? A) "It is used to get a sample of the most immature RBC,WBC and platlets" B) " The procedure will be done in your femer bone" C) " We will be collecting your stem cells and preserve them and then give them back to you later on" D) " This procedure is done before you go into the OR. We will take 2 unites of your blood and give you albumin."

ANS: A) "It is used to get a sample of the most immature RBC,WBC and platlets" Feedback: B- we take the sample in the illiac crest and the sternum C- this refers to autologous transplant the other type of transplant is allogenic and you do not get your own back you get it from a donor. D- This is called hemo-dilution

A patient has Sickel cell anemia and is having an acute attack. The nurse knows which of the following is the best treatment for this patient? A) administering lots of fluids B) give B12 C) Administer IV iron D) Give oral chemotherapy

ANS: A) administering lots of fluids

A patient with COPD is likely to have which findings on assessment? Select All That Apply A. increased AP diameter of chest B. sitting in a chair leaning forward with elbows on knees C. unintentional weight gain D. decreased appetite E. unexplained weight loss

ANS: A, B, D, E

A nurse recognizes Which are characteristics of asthma? Select All That Apply A. narrowed airway lumen due to inflammation B. increased eosinophils C. decreased breathing cycle D. intermittent bronchospasm E. loss of elastic recoil F. stimulation of disease process by allergies

ANS: A, B, D, F

A nurse recognizes which of the following symptoms are indicators of Multiple Myeloma? (select all that apply) A) An elevated Calcium level B) Anemia C) Night sweats D) Bone lytic lesion E) Renal failure

ANS: A,B,D,E

A patient is about to get a blood transfusion. Which of the following does the nurse need to do before giving blood? (Select all that apply) A) Assess base line vitals B) Prepare LR to be given during the transfusion C) Start an IV that is 20 gag or less D) Make sure the consent form is signed E) Have 2 licence nurses check the blood

ANS: A,D,E Feedback: B- Only normal saline should be given C- you must use a 20 gag needle or higher

In a severely anemic patient, you expect to find A. dyspnea and tachycardia. B. cyanosis and pulmonary edema. C. cardiomegaly and pulmonary fibrosis. D. ventricular dysrhythmias and wheezing.

ANS: A. dyspnea and tachycardia. Patients with severe anemia (hemoglobin <6 g/dL) exhibit the following cardiovascular and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction; tachypnea, orthopnea, dyspnea at rest.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? A) Wearing a lead apron during direct contact with the client B) Avoiding using soap on the irradiated areas C) Applying talcum powder to the irradiated areas daily after bathing D) Removing thoracic skin markings after each radiation treatment

ANS: Avoiding using soap on the irradiated areas

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client A) may be developing anemia. B) may be developing an infection. C) has leukopenia. D) has thrombocytopenia.

ANS: B

A patient has become status asthmatics. The nurse understands this as being which of the following? A) An allergic reaction B) A medical emergency C) A response to an exposure D) Caused by smoking

ANS: B

A patient is undergoing treatment for Saroidosis. Which of the following should the nurse be most concerned about? A) Weather triggering an attack B) The patient is at risk for an infection C) The patient may become non compliant to the treatment D) This illness will result in death because there is no cure

ANS: B Feed back: A- this refers to asthma C- this could be true because the steroid treatment is 12 months long, however, it is not the priority D- This is refering to Pneumoconoisis

An oncology patient has been found to have a low neutrophil count and a fever. Which of the following would the nurse be most concerned about for this patient ? A) Risk of bleeding B) Risk of infection C) Risk of Arrythmias D) Risk of renal failure

ANS: B Feed back: this patient has febrile neutropenia so because they are already immunocompromised the fact that they have even less WBC means that they are even more at risk for infection With tumor lysis syndrome a patient would have a risk for arrythmias and renal failure

A nurse notices a patient has Subcutaneous Emphysema. Which of the following describes what this patient is experiencing ? A) A puncture in the plural space B) Air trapped under the skin C) A collapsed lung that is filled with air D) A hypersensitivity reaction

ANS: B Feedback: A- can result from a rib fracture C- this is a pneumothorax D- is either asthma or sarcodosis

Which of the following lab values on a oncology patient would indicate tumor lysis syndrome? A) Calcium of 13 mg/dL B) Potassium of 6.5 mg/dL C) BUN level of 7 mg/dL D) A hematocrit of 45 %

ANS: B Feedback: With a tumor lysis syndrome the tumor ruptures and potassium is released

A patient has just got her results back from a bone marrow biopsy and the doctor tells her she has dysplasia. The patient is very concerned and ask the nurse what this means. Which of the following statements made by nurse would be correct? A) " This simply means that you have fewer cells then normal" B) " This means there has been a change in your cells, but it is reversible if we remove the stimuli" C) "Your cells have changed in shape and size and over all type, but this is reversible" D) " your cells are cancerous and this is not reversible"

ANS: B) " This means there has been a change in your cells, but it is reversible if we remove the stimuli" Feedback A- this is referring to Hypoplasia C- this is referring to metaplasia D- this is referring to anaplasia

A nurse is assessing a patient 10 mins into a transfusion and notices that the patients BP drops suddenly and their temperature goes up. and the patient is complaining of pain at the IV sight. The nurse knows these are symptoms of which of the following complications of a blood transfusion? A) febrile non hemolytic B) Acute Hemolytic C) TRALI D) TACO

ANS: B) Acute Hemolytic Feed back: A- they have a one degree rise in their temperature and have chills C- they would experience shortness of breath, be hypoxic, and chest X- ray would look like ARDS - likely to die D- they would have fluid overlaod (edema) and it occurs with elderly patients- give diuretics

A nurse is assessing angular cheiliosis, Glossitis, and koilonychia. The nurse would assess this patient for which of the following anemia's? A) Aplastic anemia B) Iron Deficiency C) Megablastic anemia D) Sickle cell anemia

ANS: B) Iron Deficiency Feedback: A- this occurs w hen the stem cells are damaged- puts you at risk of infection r/t decreased WBC C- Related to deficency in B12 or folate - they will have numbness and tingling D- this is related to abnormal RBC which can cause a blockage- biggest symptom is pain

Which of the following describes the Hematopoietic system? A) It comprises platelet aggregation, coagulation and fibrinolysis B)It includes all blood components and the organs involved in their development and production. C) It is our immune system D) It is the system that helps with blood circulation

ANS: B) It includes all blood components and the organs involved in their development and production. Feedback: A- This describes the Hemostatic system C - this describes the reticuloendothelial system

A patient is experiencing shortness of breath, coughing up blood and extremely swollen lymph nodes. After further inspection it is found this patient has sarcoidosis. Which of the follow does the nurse need to educate this patient on concerning his treatment plan? A) You will have to take Albuterol (Proventil) when you have an acute attack B) This steroid course is a long term treatment lasting 12 months C) bronchodilators will open up your air way D)We may need to give you magnesium IV while you are here in the hospital

ANS: B) This steroid course is a long term treatment lasting 12 months Feed back: Albuterol will be given in acute asthma attacks IV magnesium and bronchodialators are also a treatment for asthma

A nurse recognizes which of the following signs as being consistent with a diagnosis of Chronic bronchitis? (select all that apply) A) Frail patient B)Clubbing fingers C)barreled chest D) oxygen dependent E) mostly seen in patients that smoke

ANS: B,D,E

A nurse would expect which of the following patients as having an anemia? A. A patient who is admitted into the ER for a slightly fractured arm B. A patient with an advance stage renal failure C. A patient with type 2 diabetes D. A patient who is 3 days post op from a reverse ileostomy

ANS: B- because Deficiency in erythropoietin can cause anemia and erythropoietin is made in the kidneys

You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical manifestations are you most likely to observe when assessing this patient? A. Convex nails, bright red gums, and alopecia B. Brittle nails; smooth, shiny tongue; and cheilosis C. Tenting of the skin, sunken eyes, and complaints of diarrhea D. Pale pink tongue; dull, brittle hair; and blue mucous membranes

ANS: B. Brittle nails; smooth, shiny tongue; and cheilosis Specific clinical manifestations may be related to iron-deficiency anemia. Pallor is the most common finding, and glossitis (inflammation of the tongue) is the second most common; another finding is cheilitis (inflammation of the lips). The patient may report headache, paresthesias, and a burning sensation of the tongue, all of which are caused by lack of iron in the tissues

On auscultation, which finding suggests a right pneumothorax? A Bilateral inspiratory and expiratory crackles B Absence of breaths sound in the right thorax C Inspiratory wheezes in the right thorax D Bilateral pleural friction rub

ANS: B. In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent. None of the other options are associated with pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and a pleural friction rub may indicate pleural inflammation.

Which finding allows you to identify the patient's anemia as folic acid deficiency rather than cobalamin deficiency? A. Loss of appetite B. Lack of neuromuscular symptoms C. Red tongue D. Change in nail shape

ANS: B. Lack of neuromuscular symptoms

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? A A low respiratory rate B Diminished breath sounds C The presence of a barrel chest D A sucking sound at the site of injury

ANS: B. This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.

When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7 g/dL and hematocrit of 26%. You place highest priority on initiating interventions that can reduce A. thirst. B. fatigue. C. headache. D. abdominal pain.

ANS: B. fatigue. The patient with a low hemoglobin level and hematocrit is anemic and is most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation with which to carry out cellular functions

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A) Neutrophil B) Lymphoid stem cell C) Myeloid stem cell D) Monocyte

ANS: C

A nurse on an oncology floor is assessing her patient and noticess that the patient has jugular vein distention, lower extremity edema, and varicose vein on their left side. Which of the following would the expect this patient to have? A) Hypercalciema of malignancy B) Febrile neutropenia C) Superior vena cava syndrome D) Spinal cord compression

ANS: C Feed back: A- you would see weak muscles, decreased level of contentiousness and N/V B- you would see a fever and low neutrofil count D- you would see pain, muscle weakness, paralysis

A patient on the oncology floor is diagnosed with Vena Cava Syndrome. The nurse understands this diagnosis can cause which of the following ? A) Spinal code compression B) The patient has too much oxygenated blood being delivered to the heart C) There may be a back up of blood D) The patient is now at high risk for an infection

ANS: C Feedback: Vena Cava Syndrome this occurs when a tumor grows too

A nurse is assessing a patient 15 mins after a blood transfusion and notices that they have a one degree rise in their temperature and complains of being cold. Which of the following needs to be the nurses next action? A) Stop the transfusion B) Call a code blue C) Give tylenol D) do nothing, this is normal

ANS: C) Give tylenol Feedback: The ppatient is experiencing a febrile non hemolytic reaction

A male patient's X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from: A Cardiogenic pulmonary edema B Respiratory alkalosis C Increased pulmonary capillary permeability D Renal failure

ANS: C Increased pulmonary capillary permeability

A patient is experiencing Hypercalcemia of malignancy. The nurse knows which of the following should be used to fix this issue ? A) Calcium gluconate B)this can be mended by adding more dairy into ones diet C) Calcitonin D) Antibiotics

ANS: C you can also give bisphosphonate

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? A) Respiratory rate of 10 breaths/minute B) Pain and tenderness in calf area C) Crackles auscultated bilaterally D) Oral temperature of 97°F

ANS: C) Crackles auscultated bilaterally

A nurse notices on a patients chart that they have polycythemia. The nurse understands this as meaning which of the following? A) The patient has too few platelets B) The patient does not have enough vitamin K C) The patient has an increased number of RBC D) The patient has an increased number of WBC

ANS: C) The patient has an increased number of RBC Feedback: A- this is called thrombocytopenia B- Vitamin K deficiency D- This is an example of leukemia

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? A) "New hair growth will return without any change to color or texture." B) "Clients with alopecia will have delay in grey hair." C) "Wigs can be used after the chemotherapy is completed." D) "The hair loss is usually temporary."

ANS: D

An older adult patient experiences an asthma attack that is severe enough to warrant the use of a rescue drug. Which medication is best to use for the acute symptoms? A. Omalizumab (Xolair) B. Fluticasone (Flovent) C. Salmeterol (Serevent) D. Albuterol (Proventil)

ANS: D Albuterol (Proventil) The other three meds are for asthma prevention not an acute attack

A nurse recognizes which of the following as the etiology of Pneumoconiosis? A) It is a hypersensitivity response treated with steroids B) The bronchioles are inflamed making it difficult for the patient to breath C) It is caused by trauma and you will see a "white lung" on an X-Ray D) It is an inflammatory response caused by exposure and it will damage the alveoli

ANS: D Feedback: A- Refers to Sarcoidosis B- Refers to Asthma C- Refers to ARDS

A patient has lung cancer and it has now spread to the bones. Which of the following lab values would most concern the nurse regarding the patients condition ? A) Hemogobin of 43 % B) Potassium of 5.5 C) A WBC count of 6,000 D) Calcium level of 14

ANS: D Feedback: A high Calcium level could indicate Hypercalcemia of malignancy. Which could occur when cancer is spread to the bone.

A nurse recognizes which of the following as the etiology of acute respiratory failure ? A) Sepsis B) Hypersensitivity reaction C) inflammation related to exposure D) Hypoxemia

ANS: D) Hypoxemia Feedbakc: A- ARDS B- Asthma or Sarcoidosis C) Pneumoconiosis

A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? A) Activity intolerance related to fatigue B) Anxiety related to actual threat to health status C) Risk for infection related to retained secretions D) Impaired gas exchange related to airflow obstruction

ANS: D) Impaired gas exchange related to airflow obstruction

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: A Promote oxygen intake B Strengthen the diaphragm C Strengthen the intercostal muscles D Promote carbon dioxide elimination

ANS: D. Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing.

If you have a patient with lymphoblastic anemia. The nurse knows this patient will have an increase WBC and a decrease RBC as well as a decrease in platelets, which is common with all leukemias. The nurse knows, however, that which of the following signs and symptoms would signify a lymphoblastic anemia in particularly? A) Decreased immune function B) Increased plasma C) Pallor D) Increased creatin level

ANS: Decreased immune function

The client admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? 1. Oozing blood from the IV catheter site. 2. Sudden onset of chest pain and frothy sputum. 3. Foul-smelling, concentrated urine. 4. A reddened, inflamed central line catheter site.

ANS:1. Oozing blood from the IV catheter site.

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? 1. A 35-year-old pregnant client with placenta previa. 2. A 42-year-old client with a pulmonary embolus. 3. A 60-year-old client receiving hemodialysis 3 days a week. 4. A 78-year-old client diagnosed with septicemia.

ANS:4. A 78-year-old client diagnosed with septicemia.

For a patient with osteogenic sarcoma, which laboratory value causes you the most concern? 1. Sodium level of 135 mEq/L 2. Calcium level of 13 mg/dL 3. Potassium level of 4.9 mEq/L 4. Hematocrit of 40%

ANS:Calcium level of 13 mg/dL FEEDBACK: Potentially life-threatening hypercalcemia can occur in cancers with destruction of bone. Other laboratory values are pertinent for overall patient management but are less specific to bone cancers. Focus: Prioritization