MedSurg 1 Questions

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods

a. A bland, low-fiber diet

What features of cancer cells distinguish them from normal cells?

-Cells lack contact inhibition -Cells return to a previous undifferentiated state -New protein characteristics of embyronic stage emerge on cell membrane

A clinical nurse specialist is conducting an in-service for critical-care nurses regarding the administration of cyclic TPN. Which key point should be included in the in-service? A It is indicated for clients receiving continuous, stabilized TPN. B It is indicated for short-term parenteral nutrition. C It must be escalated to maintain rate. D The dose must be tapered to avoid abrupt changes in glucose levels.

A Cyclic TPN is used for long-term stabilized clients. Cyclic TPN is not routinely used for short-term therapy, and after clients receive cyclic TPN, there is no need to escalate or taper doses, because the glucose response has been stabilized.

A nurse is evaluating a client who has been receiving parenteral nutrition (PN). The nurse should identify a desirable client outcome of total PN therapy as: A weight gain of 1/2 lb/day. B capillary blood glucose level of 160 mg/dL. C serum sodium level of 127 mEq/L. D serum cholesterol level 225 mg/dL.

A Nutritional status should improve with total PN, as evidenced by a consistent weight gain. Option 2 is incorrect because the normal blood glucose level should be between 60 and 120 mg/dL. Option 3 indicates hyponatremia. Option 4 indicates an elevated cholesterol value.

A physician orders parenteral proteins for a client who is emaciated. A nurse orders the proteins from the pharmacy knowing that parenteral proteins are supplied as: A synthetic crystalline amino acids. B casein amino acids. C immunoglobulins. D albumin.

A Protein is a body-building nutrient that promotes tissue growth, repair, and the replacement of body cells. Parenteral proteins are elemental, providing a synthetic crystalline amino acid that does not cause an antigenic reaction.

A physician orders total parenteral nutrition for a critically ill client. Which medication/supplement may be safely added to the client's total parenteral solution? A Regular insulin, heparin, and H2 inhibitors B Iron, vitamin K, and cimetidine C Iron, heparin, and neutral protamine Hagedorn (NPH) insulin D Regular insulin, vitamin K, and H2 inhibitors

A The only medications that can be added to nutritional support for compatibility are regular insulin, heparin, or an H2 inhibitor.

As part of a client's health history, a nurse performs a nutritional assessment of the client. Which components should be included in the nurse's nutritional assessment? SELECT ALL THAT APPLY. A Dietary history B Anthropometric measurements C Physical examination D Computerized tomography (CT) scan of the abdomen

A B C Dietary history, anthropometric measurements, and physical examination are all components of the nutritional assessment, along with medical and social history, energy tests, bone radiology tests, and laboratory tests. CT does not provide information needed for nutritional support.

The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? SELECT ALL THAT APPLY. A Place the solution on an IV pump at the prescribed rate. B Monitor blood glucose every six (6) hours. C Weigh the client weekly,, first thing in the morning. D Change the IV every three (3) days. E Monitor intake and output every shift.

A B E

A patient on chemotherapy for 10 weeks started at a weight of 121 pounds. She now weighs 118 pounds and has no sense of taste. Which nursing intervention would be a priority?

Advise the patient to experiment with spices and seasonings to enhance the flavor of food

Trends in the incidence and death rates of cancer include the fact that:

African Americans have a higher death rate cancer than whites.

The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem? A) Anxiety B) Skin breakdown C) Depression D) Hallucinations

Ans: Depression Feedback: Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.

The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient? A) Medication should be taken when pain levels are low so the pain is easier to reduce. B) Pain medication can be increased when the pain becomes intense. C) It is difficult to control chronic pain, so this is an inevitable part of the disease process. D) The patient will likely benefit more from distraction than pharmacologic interventions.

Ans. Medication should be taken when pain levels are low so the pain is easier to reduce. Feedback: Better pain control can be achieved with a preventive approach, reducing the amount of time patients are in pain. Low levels of pain are easier to control than intense levels. Pain medication is used to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control pain is good, but it will not work if the patient is in so much pain that he cannot institute reliable alternative methods.

The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, "He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasn't just raised and raised." What would be the nurses' best response? A) "I didn't know that. I will speak to the doctor about your husband's pain control." B) "Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief." C) "Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts." D) "Does the increasing medication dosage concern you?"

Ans: "Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief." Feedback: Much pain associated with cancer is a direct result of tumor involvement. Conveying patient/family concerns to the physician is something a nurse does, but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until "it doesn't hurt anymore." The family member is obviously concerned.

The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurse's best response? A) "Over time you become more tolerant of the drug." B) "You may have become immune to the effects of the drug." C) "You may be developing a mild addiction to the drug." D) "Your body absorbs less of the drug due to the cancer."

Ans: "Over time you become more tolerant of the drug." Feedback: Over time, the patient is likely to become more tolerant of the dosage. Little evidence indicates that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.

An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurse's best response? A) "Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes." B) "We need to provide pain medications because it is the law, and we must always follow the law." C) "Unless there is strong evidence to the contrary, we should take the patient's report at face value.'" D) "It's not unusual for patients to misreport pain to get our attention when we are busy."

Ans: "Unless there is strong evidence to the contrary, we should take the patient's report at face value.'" Feedback: A broad definition of pain is "whatever the person says it is, existing whenever the experiencing person says it does." Action should be taken unless there are demonstrable extenuating circumstances. The other answers are incorrect.

A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention? A) A body-based modality B) A mind-body method C) A biologically based therapy D) An energy therapy

Ans: A mind-body method Feedback: Meditation is one of the recognized mind-body methods of nonpharmacological pain control. The other answers are incorrect.

You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient? A) Chronic B) Acute C) Intermittent D) Osteopenic

Ans: Acute Feedback: Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part. "Osteopenic" pain is not a recognized category of pain.

Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patient's orders specify an initial bolus dose. What is your priority assessment? A) Assessment for decreased level of consciousness (LOC) B) Assessment for respiratory depression C) Assessment for fluid overload D) Assessment for paradoxical increase in pain

Ans: Assessment for respiratory depression Feedback: A patient who receives opioids by any route must be assessed frequently for changes in respiratory status. Sedation is an expected effect of a narcotic analgesic, though severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.

You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of "three or so." You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain? A) Treat the patient on the basis of objective signs of pain and reassess him frequently. B) Call the physician for new orders because it is apparent that the pain medicine is not working. C) Believe what the patient says, reinforce education, and reassess often. D) Ask the family what they think and treat the patient accordingly.

Ans: Believe what the patient says, reinforce education, and reassess often. Feedback: As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The family's insights do not override the patient's self-report.

A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patient's pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain? A) Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications. B) Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention. C) Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. D) Cancer pain is often misreported by patients because of confusion related to their disease process.

Ans: Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. Feedback: Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer patients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.

You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do? A) Use a pain scale to assess the patient's pain, and let the patient know ibuprofen is available every 6 hours if she needs it. B) Do a complete assessment, and give pain medication based on the patient's report of pain. C) Check for allergies, use a pain scale to assess the patient's pain, and offer the ibuprofen every 6 hours until the patient is discharged. D) Provide medication as per patient request and offer relaxation techniques to promote comfort.

Ans: Check for allergies, use a pain scale to assess the patient's pain, and offer the ibuprofen every 6 hours until the patient is discharged. Feedback: One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.

You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patient's behavior? A) Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B) The patient is likely frustrated because she has to be in the hospital. C) The patient likely has an underlying psychiatric disorder. D) Chronic pain can cause intense emotional responses.

Ans: Chronic pain can cause intense emotional responses. Feedback: Regardless of how patients cope with chronic pain, pain that lasts for an extended period can result in depression, anger, or emotional withdrawal. Nowhere in the scenario does it indicate the patient is upset about the hospitalization or that she has a psychiatric disorder. Fibromyalgia is closely associated with chronic pain.

You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patient's plan of care. On what should the goals for the plan of care focus? A) Increase the patient's pain tolerance in order to achieve psychosocial benefits. B) Decrease the patient's need to work and increase his sleep to 8 hours per night. C) Evaluate other work options to decrease the risk of depression and ineffective coping. D) Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.

Ans: Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety. Feedback: Chronic pain may affect the patient's quality of life by interfering with work, interpersonal relationships, or sleep. Thus, the best set of goals would be to "decrease time lost from work to increase the quality of interpersonal relationships, and decrease anxiety." Increasing pain tolerance is an unrealistic and inappropriate goal; exercise could help, but would not be the focus of the plan of care. Decreasing the need to work does not address his pain. Evaluating other work options to decrease the risk of depression is a misdirected diagnosis.

The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patient's chart. This patient is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this patient? A) Depression B) Chronic illness C) Inadequate pain control D) Drug interactions

Ans: Drug interactions Feedback: Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this patient because of the patient's age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.

Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the patients' different perceptions of pain? A) Endorphin levels may vary between patients, affecting the perception of pain. B) One of the patients is exaggerating his or her sense of pain. C) The patients are likely experiencing a variance in vasoconstriction. D) One of the patients may be experiencing opioid tolerance.

Ans: Endorphin levels may vary between patients, affecting the perception of pain. Feedback: Different people feel different degrees of pain from similar stimuli. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these patients. The nurse should not assume the patient is exaggerating the pain because the patient is the best authority of his or her existence of pain, and definitions for pain state that pain is "whatever the person says it is, existing whenever the experiencing person says it does."

You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the patient's care, what variables should you consider? Select all that apply. A) How the presence of pain affects patients and families B) Resources that can assist the patient with pain management C) The influence of the patient's cognition on her pain D) The advantages and disadvantages of available pain-relief strategies E) The difference between acute and intermittent pain

Ans: How the presence of pain affects patients and families, Resources that can assist the patient with pain management, The advantages and disadvantages of available pain-relief strategies Feedback: Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patient's care.

A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control through the regular use of celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain? A) Distorting the action potential that is transmitted along the A-delta (δ) and C fibers B) Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord C) Blocking modulation by limiting the reuptake of serotonin and norepinephrine D) Inhibiting transduction by blocking the formation of prostaglandins in the periphery

Ans: Inhibiting transduction by blocking the formation of prostaglandins in the periphery Feedback: NSAIDs produce pain relief primarily by blocking the formation of prostaglandins in the periphery; this is a central component of the pathophysiology of transduction. NSAIDs do not act directly on the aspects of transmission, perception, or modulation of pain that are listed.

You are part of the health care team caring for an 87-year-old woman who has been admitted to your rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patient's care, what do you know about the negative effects of the stress associated with pain? A) Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults B) It is particularly harmful in the elderly who have been injured or who are ill. C) It affects only those patients who are already debilitated prior to experiencing pain. D) It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.

Ans: It is particularly harmful in the elderly who have been injured or who are ill. Feedback: The widespread endocrine, immunologic, and inflammatory changes that occur with the stress of pain can have significant negative effects. This is particularly harmful in patients whose health is already compromised by age, illness, or injury. Older adults are not immune to the negative effects of stress. Prior debilitation does not have to be present in order for stress to cause potential harm.

You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patient's history, the patient's pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient? A) Intravenous analgesia B) Long-term intrathecal or epidural catheter C) Oral analgesia D) Intramuscular analgesia

Ans: Long-term intrathecal or epidural catheter Feedback: For patients who have persistent, severe pain that fails to respond to other treatments or who obtain pain relief only with the risk of serious side effects, medication administered by a long-term intrathecal or epidural catheter may be effective. The other listed means of pain control would already have been tried in a patient with persistent severe pain that has not responded to previous treatment.

You are frequently assessing an 84-year-old woman's pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply? A) Monitor for signs of drug toxicity due to a decrease in metabolism. B) Monitor for an increase in absorption of the drug due to age-related changes. C) Monitor for a paradoxical increase in pain with opioid administration. D) Administer analgesics every 4 to 6 hours as ordered to control pain.

Ans: Monitor for signs of drug toxicity due to a decrease in metabolism. Feedback: Older people may respond differently to pain than younger people. Because elderly people have a slower metabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses of analgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact also corresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon. Frequency of administration will vary widely according to numerous variables

A patient's intractable neuropathic pain is being treated on an inpatient basis using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the patient, the nurse has returned to assess the patient and finds the patient unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug? A) Acetylcysteine B) Naloxone C) Celecoxib D) Acetylsalicylic acid

Ans: Naloxone Feedback: Severe opioid-induced sedation necessitates the administration of naloxone, an opioid antagonist. Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.

The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patient's medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patient's pain? A) Neuroplasticity B) Misperception C) Psychosomatic processes D) Neuropathy

Ans: Neuropathy Feedback: The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli; this does not likely contribute to the patient's pain. Similarly, psychosomatic factors and misperception of pain are highly unlikely.

A medical nurse is appraising the effectiveness of a patient's current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient? A) Primary caregiver B) Patient advocate C) Team leader D) Case manager

Ans: Patient advocate Feedback: If the intervention was ineffective, the nurse should consider other measures. If these are ineffective, pain-relief goals need to be reassessed in collaboration with the physician. The nurse serves as the patient's advocate in obtaining additional pain relief.

You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this patient, what variables should the nurse consider? Select all that apply. A) Patient's gender B) Patient's comorbid conditions C) Type of procedure be performed D) Changes in neurologic function due to the procedure E) Prior effectiveness in relieving the pain

Ans: Patient's comorbid conditions, Type of procedure be performed, Changes in neurologic function due to the procedure, Prior effectiveness in relieving the pain Feedback: The nursing care of patients who undergo procedures for the relief of chronic pain depends on the type of procedure performed, its effectiveness in relieving the pain, and the changes in neurologic function that accompany the procedure. The patient's comorbid conditions will also affect care, but his gender is not a key consideration.

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients' pain. What principle should guide the nurse's use of placebos in pain management? A) Placebos require a higher level of informed consent than conventional care. B) Placebos are an acceptable, but unconventional, form of nonpharmacological pain management. C) Placebos are never recommended in the treatment of pain. D) Placebos require the active participation of the patient's family.

Ans: Placebos are never recommended in the treatment of pain. Feedback: Broad agreement is that there are no individuals for whom and no condition for which placebos are the recommended treatment. This principle supersedes the other listed statements.

You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit? A) Teach the family the theory of pain management and the use of alternative therapies. B) Provide psychosocial family support during this emotional experience. C) Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. D) Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.

Ans: Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. Feedback: If PCA is to be used in the patient's home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.

The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacological pain control interventions into the patient's plan of care, the nurse should teach the patient which of the following? A) Nonpharmacological interventions must be provided by individuals other than members of the healthcare team. B) These interventions will not directly reduce pain, but will refocus him on positive stimuli. C) These interventions carry similar risks of adverse effects as analgesics. D) Reducing his use of analgesics is not the purpose of these interventions.

Ans: Reducing his use of analgesics is not the purpose of these interventions. Feedback: Patients who have been taking analgesic agents may mistakenly assume that clinicians suggest a nonpharmacolgical method to reduce the use or dose of analgesic agents. Nonpharmacological interventions indeed reduce pain and their use is not limited to practitioners outside the healthcare team. In general, adverse effects are minimal.

A nurse administers total parenteral nutrition (PN) to a client via a central catheter because PN has: A An osmolarity equal to blood plasma. B An osmolarity greater than 600 mOsm. C An osmolarity less than 300 mOsm. D A pH between 5 and 9.

B Solutions that provided total nutrients for the client must be administered through a central catheter because of the osmolarity greater than 600 mOsm. Solutions with dextrose percentages more than 10% are hypertonic and must be administered by central catheter. Most TPN solutions contain 50% dextrose.

The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? A) Remind the patient that he is indeed experiencing pain. B) Reinforce teaching about the pain scale number system. C) Reassess the patient's pain in 30 minutes. D) Administer an analgesic and then reassess.

Ans: Reinforce teaching about the pain scale number system Feedback: The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be done so the patient can correctly rate the pain. The nurse may also verify that the same scale is being used by the patient and caregiver to promote continuity. Although all answers are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.

The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching? A) Self-care and safety B) Autonomy and need C) Health promotion and exercise D) Dependence and health

Ans: Self-care and safety Feedback: The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.

A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks "why does it still feel like my leg is attached, and why does it still hurt?" The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process? A) The proliferation of nociceptors during times of stress B) Age-related deterioration of the central nervous system C) Psychosocial dependence on pain medications D) The abnormal reorganization of the nervous system

Ans: The abnormal reorganization of the nervous system Feedback: At any point from the periphery to the CNS, the potential exists for the development of neuropathic pain. Hyperexcitable nerve endings in the periphery can become damaged, leading to abnormal reorganization of the nervous system called neuroplasticity, an underlying mechanism of some neuropathic pain states. Neuropathic pain is not a result of age-related changes, nociceptor proliferation, or dependence on medications.

The nurse caring for a 79-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurse's management of the patient's pain? A) The elderly may require lower doses of medication and are easily confused with new medications. B) The elderly may have altered absorption and metabolism, which prohibits the use of opioids. C) The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication. D) The elderly may require a higher initial dose of pain medication followed by a tapered dose.

Ans: The elderly may require lower doses of medication and are easily confused with new medications. Feedback: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.

You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patient's subsequent care? A) The patient may want to investigate new alternative pain management options that are outside the United States. B) The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options. C) The patient may want to increase his exercise and activities significantly to create distractions. D) The patient may want to relocate to long-term care in order to have his ADL needs met.

Ans: The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options. Feedback: In some situations, especially with long-term severe intractable pain, usual pharmacologic and nonpharmacologic methods of pain relief are ineffective. In those situations, neurologic and neurosurgical approaches to pain management may be considered. Investigating new alternative pain-management options that are outside the United States is unrealistic and may even be dangerous advice. Increasing his exercise and activities to create distractions is unrealistic when a patient is in intractable pain and this recommendation conveys the attitude that the pain is not real. Moving into a nursing home so others may care for him is an intervention that does not address the issue of pain.

Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patient's first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments? A) The patient's electrolyte levels B) The patient's blood pressure C) The patient's allergy status D) The patient's hydration status

Ans: The patient's allergy status Feedback: Before administering medications such as narcotics for the first time, the nurse should assess for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are not what you need to assess prior to giving a first dose of narcotics.

A physician orders parenteral nutrition (PN) for a critically ill client. The client's PN is administered through a central line because PN is: A Isotonic B Hypertonic C Hypotonic D Atonic

B Solutions that provided total nutrients for the client must be administered through a central line because of the osmolarity of the solution. Solutions with dextrose percentages greater than 10% are hypertonic and must be administered by central line. Most PN contains 50% dextrose.

You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurse's aide (NA) tells you that she is concerned because the patient's resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1°F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patient's physiologic status? A) The patient's understanding of pain physiology B) The patient's serum glucose level C) The patient's white blood cell count D) The patient's rating of her pain

Ans: The patient's rating of her pain Feedback: The nurse's assessment of the patient's pain is a priority. There is no suggestion of diabetes and leukocytosis would not occur at this early stage of recovery. The patient does not need to fully understand pain physiology in order to communicate the presence, absence, or severity of pain.

The mother of a cancer patient comes to the nurse concerned with her daughter's safety. She states that her daughter's morphine dose that she needs to control her pain is getting "higher and higher." As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management? A) The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction. B) Frequently, female patients and younger patients need higher doses of opioids to be comfortable. C) The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment. D) There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.

Ans: There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug. Feedback: Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an "inevitable" risk.

You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning? A) They are typically more comfortable with underlying pain than patients without chronic pain. B) They often have a lower pain threshold than patients without chronic pain. C) They often have an increased tolerance of pain. D) They can experience acute pain in addition to chronic pain.

Ans: They can experience acute pain in addition to chronic pain. Feedback: It is tempting to expect that people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have had little experience with pain. However, this is not true for many people. The more experience a person has had with pain, the more frightened he or she may be about subsequent painful events. Chronic pain and acute pain are not mutually exclusive.

Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? A) To prevent respiratory depression from the opioid B) To eliminate the need for additional medication during the night C) To achieve better pain control than with one medication alone D) To eliminate the potentially adverse effects of the opioid

Ans: To achieve better pain control than with one medication alone Feedback: A multimodal regimen combines drugs with different underlying mechanisms, which allows lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects. This method also reduces, but does not eliminate, adverse effects of the opioid. This regimen is not motivated by the need to prevent respiratory depression or to eliminate nighttime dosing.

A patient is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this patient's nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors? A) Transduction B) Transmission C) Perception D) Modulation

Ans: Transduction Feedback: Transduction refers to the processes by which noxious stimuli, such as a surgical incision or burn, activate primary afferent neurons called nociceptors. Transmission, perception, and modulation are subsequent to this process.

You are the nurse caring for a postsurgical patient who is Asian-American who speaks very little English. How should you most accurately assess this patient's pain? A) Use a chart with English on one side of the page and the patient's native language on the other so he can rate his pain. B) Ask the patient to write down a number according to the 0-to-10 point pain scale. C) Use the Visual Analog Scale (VAS). D) Use the services of a translator each time you assess the patient so you can document the patient's pain rating.

Ans: Use a chart with English on one side of the page and the patient's native language on the other so he can rate his pain. Feedback: Of the listed options, a language comparison chart is most plausible. The VAS requires English language skills, even though it is visual. Asking the patient to write similarly requires the use of English. It is impractical to obtain translator services for every pain assessment, since this is among the most frequently performed nursing assessments.

You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem? A) When it results in inadequate relief from pain B) When dealing with withdrawal symptoms resulting from the tolerance C) When having to report the patient's addiction to her physician D) When the family becomes concerned about increasing dosage

Ans: When it results in inadequate relief from pain Feedback: Tolerance to opioids is common and becomes a problem primarily in terms of maintaining adequate pain control. Symptoms of physical dependence may occur when opiates are discontinued, but there is no indication that the patient's medication will be discontinued. This patient does not have an addiction and the family's concerns are secondary to those of the patient.

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? a. "Have you had a fever?" b. "Have you lost any weight?" c. "Has diarrhea been a problem?" d. "Have you noticed any hair loss?"

a. "Have you had a fever?"

A nurse is caring for a client receiving TPN. In addition to multiple vitamins, which medication might be anticipated that the nurse administer intramuscularly on a weekly basis? A Heparin 1000 units B Vitamin K 5 mg C Zinc 2.5 mg D Biotin 60 mg

B Heparin, zinc, and biotin can be added to the TPN solution. Vitamin K cannot be administered intravenously, so it must be given intramuscularly.

A physician orders a total nutrient admixture (TNA) solution for a client diagnosed with severe anorexia nervosa. A nurse administers the solution knowing that TNA consists of a combination of: A platelets, plasma, and white blood cells B fats, carbohydrates, and proteins. C fats, electrolytes, and trace elements D carbohydrates, proteins, and heparin.

B TNA are systems that hold combinations of dextrose, amino acids, and fat emulsions in one container. It is also referred to as all-in-one or three-in-one.

A nurse is reviewing the medical record for a client with a nursing diagnosis of Altered nutrition: Less than body requirements. Which assessment data is the best indicator for continued need of additional nutritional support? A Intake and output B Calorie count C Serum electrolytes D Trace element levels

B The best indicator of whether a client is taking in adequate oral nourishment following TPN is a calorie count. This gives an idea of the total calories consumed and the distribution of the client's diet in terms of protein, fat, and carbohydrate. Intake and output is useful as a measure of fluid balance, and the laboratory studies previously identified give an indication of electrolyte balance.

A client with pancreatitis has an order to receive parenteral nutrition with lipid infusions three times a week. The first transfusion of lipids is started slowly, but after a few minutes, the client reports back pain and becomes dyspneic. Which action should be taken by the nurse? A Take the client's vital signs. B Stop the infusion of lipids and notify the physician. C Give the client PRN pain medication and his bronchodilator. D Discontinue the I.V.

B The nurse should stop the infusion of lipids and notify the physician because the client is having an adverse reaction to the lipids.

A client is to receive peripheral parenteral nutrition. Which solutions can be administered peripherally? A 20% dextrose and 8.5% amino acids B 10% dextrose and 3.5% amino acids C 50% dextrose and 7% amino acids D 50% dextrose and 3.5% amino acids

B The solution of 10% dextrose and 3.5% amino acids may be administered peripherally. The other solutions must be administered through a central catheter because of the osmolarity of dextrose solutions greater than 10%.

A physician orders the peripherally inserted central catheter (PICC) team to insert a PICC for a client who is scheduled for chemotherapy. Which are advantages of PICCs? SELECT ALL THAT APPLY A Causes less body image disturbance B Eliminates the pain of frequent venipunctures C Decreases risk for pneumothorax and air embolism on insertion D Preserves peripheral vascular system in the upper extremity

B C D The advantages of a PICC include eliminating the pain associated with frequent venipuncture, decreasing the risk for pneumothorax and air embolism, and preserving the peripheral vascular system of the upper extremities. Because PICCs are external, they do have potential for causing concerns for the client regarding body image

A nurse is caring for a client who is diagnosed with a fatty acid deficiency. Which order should the nurse anticipate receiving from a physician to correct this deficiency? A Protein B 10% dextrose C Lipid emulsion D Trace elements

C Fats are delivered by infusion as lipid emulsions.

A nurse is instructed to add heparin to a client's TPN per a physician's order. What is the purpose of adding heparin to a TPN solution? A To enhance blood glucose levels B To thin the TPN solution so that it easily infuses C To decrease the incidence of subclavian vein thrombosis D To prevent gastric ulcers

C Heparin doses of 100 to 300 units/L have been ordered to decrease the incidence of subclavian vein thrombosis.

A client has a triple-lumen tunneled catheter and is receiving PN with daily infusions of lipids, as well as several other I.V. medications. How should a nurse infuse the lipids? A Into an injection port separate from the TPN solution B In the same line as the TPN, between the filter and the injection port C In the same line as the TPN, between the filter and the TPN solution D Using a 0.45-mm filter

C Lipids should be run below the filter to prevent the removal of essential elements. Lipids should be run only through a special 1.2-mm lipid filter.

A nurse is caring for a critically ill client who has been admitted to an intensive care unit. The nurse monitors the client's nutritional status. During times of stress, which element of metabolism is radically altered? A Fats B Proteins C Carbohydrates D Vitamin C

C The major purpose of carbohydrates is to provide energy. During the critical phase of illness or injury, carbohydrate metabolism is radically altered; thus, hyperglycemia is a hallmark of stress.

A nurse is preparing to infuse a parenteral nutrition (PN) admixture. Which filter should be used with total nutrition admixtures (three-in-one)? A 0.22 µm B 1.0 µm C 1.2 µm D 170 µm

C When lipids are added to nutritional support or administered by piggyback, they must be filtered with a 1.2-µm filter because of the fat molecules of the solution.

A nurse prepares to hang an infusion of parenteral nutrition (PN). Which fluids can be given concurrently through the same I.V. administration set as the PN? A Blood B Vitamin K 5 mg C Zinc 2.5 mg D Biotin 60 mg

D Fat emulsions are administered concurrently with total PN (TPN) and are filtered with a special 1.2-mm filter. Blood and blood products should not be given through the same line as TPN because they could coat the inner lumen of the catheter, restricting flow of the TPN. Medications are not routinely administered concurrently with TPN because they could be incompatible.

A 70 year old male patient has multiple myeloma. HIs wife calls to report that he sleeps most of the day, is confused when awake and complains of nausea and constipation. Which complication of cancer is this most likely caused by?

Hypercalcemia

A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on?

Maintaining the patients hope

The goals of cancer treatment are based on the principle that:

a combination of treatment modalities is effective for controlling many cancers

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings d. Exercises five times every week and does not consume alcoholic beverages

a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well-differentiated.

a. Cells are abnormal and moderately differentiated.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)? a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed.

a. Maintain hope. b. Exhibit a caring attitude. e. Be available to listen to fears and concerns.

What cancer is the highest cause of death in woman? a. lung b. colon c. breast d. brain

a. lung

To prevent fever and shivering during an ingusion of rutuximab (rituxan) the nurse should premedicate the patient with?

acetaminophen

The nurse counsels the patient receiving radiation therapy or chemotherapy that:

after successful treatment, a return to the persons previous functional level can be expected

Patients may reduce the risk of developing cancer using health promotion strategies. Identify strategies which can reduce the risk of developing cancer (select all that apply.). a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

all of the above

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? a. "Exercise every day for 30 minutes." b. "Follow smoking cessation recommendations." c. "Following a vitamin regime is highly recommended." d. "I recommend excision of the cancer as soon as possible."

b. "Follow smoking cessation recommendations."

Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.

b. Turn off the chemotherapy infusion.

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. Which question would best determine treatment measures for the patient's pain? a. "Where is the pain?" b. "Is the pain getting worse?" c. "What does the pain feel like?" d. "Do you use medications to relieve the pain?"

c. "What does the pain feel like?"

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."

c. "You can get a wig now to match your hair so you will not look different."

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? a. It is delivered via an Ommaya reservoir and extension catheter. b. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. c. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. d. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

c. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration.

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.

c. Avoid heat and cold to the treatment area.

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 the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d. Hypophosphatemia

c. Hypouricemia

The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? a. It will recur. b. It has metastasized. c. It is probably benign. d. It is probably malignant

c. It is probably benign.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? a. Bacteria b. Sun exposure c. Most chemicals d. Epstein-Barr virus

d. Epstein-Barr virus

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. Immunological surveillance

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a. "I understand the transplant procedure has no dangerous side effects." b. "After the transplant, I will feel better and can go home in 5 to 7 days." c. "My brother will be a 100% match for the cells used during the transplant." d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? a. "The cancer is found at the point of origin only." b. "Tumor cells have been identified in the cervical region." c. "The cancer has been identified in the cervix and the liver." d. "Your cancer was identified in the cervix and has limited local spread."

d. "Your cancer was identified in the cervix and has limited local spread."

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? a. Firm-bristle toothbrush b. Hydrogen peroxide rinse c. Alcohol-based mouthwash d. 1 tsp salt in 1 L water mouth rinse

d. 1 tsp salt in 1 L water mouth rinse

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? a. Morphine sulfate b. Ibuprofen (Advil) c. Ondansetron (Zofran) d. Acetaminophen (Tylenol)

d. Acetaminophen (Tylenol)

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

The primary protective role of the immune system related to malignant cells is:

surveillance for cells with tumor-associated antigens

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? a. Provide ice chips to soothe the irritation. b. Weigh the patient every month to monitor for weight loss. c. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. d. Provide high-protein and high-calorie, soft foods every 2 hours.

d. Provide high-protein and high-calorie, soft foods every 2 hours.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? a. Acute pain b. Hypothermia c. Powerlessness d. Risk for infection

d. Risk for infection

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? a. Weight gain of 6 lb b. Nausea and vomiting c. Urine specific gravity of 1.004 d. Serum sodium level of 118 mEq/L

d. Serum sodium level of 118 mEq/L

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? a. The medications the patient is taking b. The nutritional supplements that will help the patient c. How much time is needed to provide the patient's care d. The time the nurse spends at what distance from the patient

d. The time the nurse spends at what distance from the patient

The nurse is caring for 59-year-old woman who had surgery 1 day ago for removal of a malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at point is to use this opportunity to

let her communicate about the meaning of this experience

A characteristic of the stage of progression in the development of cancer is:

proliferation of cancer cells despite host control mechanisms

The nurse explains to a patient undergoing brachytherapy of the cervix that she:

requires the use of radioactive precautions during nursing care

The most effective method of administering a chemotherapy agent that is a vesicant is to:

use a central venous access device