AH TEST 2
The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client? A. "Thesesymptomsusuallyresultfromradiationtherapy;however,wewillcontinueto monitor your laboratory studies and test results." B. "These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer." C. "Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy." D. "Eventhoughitisuncomfortable,thisisagoodsign.Itmeansthatonlythecancercells are dying."
ANS: A Rationale: Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the client and should not be belittled. Radiation destroys both cancerous and normal cells.
A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care? A. Theclientwillbemonitoredcloselytodetectmalignantchanges. B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C. Small amounts of blood are likely to be present in the stools and are not cause for concern. D. Antacidsmaybediscontinuedwhensymptomsofheartburnsubside.
ANS: A Rationale: In the client with Barrett esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer, necessitating close monitoring. H2 receptor antagonists are commonly prescribed for clients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for clients with GERD, they should be taken as prescribed whether or not the client is symptomatic.
A medical nurse who is caring for a client being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this client. What is a priority psychosocial outcome for this client? A. Indicatesacceptanceofalteredappearanceanddemonstratespositiveself-image B. Freely expresses needs and concerns related to postoperative pain management C. Compensates effectively for alteration in ability to communicate related to dysarthria D. Demonstrateseffectivestressmanagementtechniquestopromotemusclerelaxation
ANS: A Rationale: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the client's appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Clients who have had head and neck surgery generally report less pain as compared with other postoperative clients; however, the nurse must assess each individual client's level of pain and response to analgesics. Clients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.
A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A. Liverfunctiontests(LFTs) B. Complete blood count (CBC) C. Platelet count D. Bloodureanitrogenandcreatinine
ANS: A Rationale: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count, and tests of renal function would not directly assess for liver disease.
A nurse is caring for a client who has undergone neck resection with a radial forearm free flap. The nurse's most recent assessment of the graft reveals that it has a bluish color and that mottling is visible. What is the nurse's most appropriate action? A. Documentthefindingsasbeingconsistentwithaviablegraft. B. Promptly report these indications of venous congestion. C. Closely monitor the client and reassess in 30 minutes. D. Repositiontheclienttopromoteperipheralcirculation.
ANS: B Rationale: A graft that is blue with mottling may indicate venous congestion. This finding constitutes a risk for tissue ischemia and necrosis; prompt referral is necessary.
A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom? A. Burningpainonswallowing B. Regurgitation of undigested food C. Symptoms mimicking a myocardial infarction D. Chronicparotidabscesses
ANS: B Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the client assumes a recumbent position. The client may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum.
A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A. Pruritis(itching) B. Nausea and vomiting C. Altered glucose metabolism D. Confusion
ANS: B Rationale: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and pruritus are less common adverse effects.
A nurse is caring for a client who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this client, what would the nurse be sure to include? A. Increasingcalciumintaketopromotebonehealing B. Avoiding chewing food for the specified number of weeks after surgery C. Techniques for managing parenteral nutrition in the home setting D. Techniquesformanagingagastrostomy
ANS: B Rationale: The client who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. Increased calcium intake will not have an appreciable effect on healing. Enteral and parenteral nutrition are rarely necessary.
Which nursing action best demonstrates primary cancer prevention? A. EncouragingyearlyPaptests B. Teaching testicular self-examination C. Promoting and providing vaccines D. Facilitatingscreeningmammograms
ANS: C Rationale: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as promoting vaccines that prevent cancer. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A. Diseaseprophylaxis B. Risk reduction C. Secondary prevention D. Tertiaryprevention
ANS: C Rationale: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the client after having been diagnosed with cancer.
A client has undergone rigid fixation for the correction of a mandibular fracture suffered in a fight. What area of care should the nurse prioritize when planning this client's discharge education? A. Resumptionofactivitiesofdailyliving B. Pain control C. Promotion of adequate nutrition D. Strategiesforpromotingcommunication
ANS: C Rationale: The client who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. The nature of this surgery threatens the client's nutritional status; this physiologic need would likely supersede the resumption of ADLs. Pain should be under control prior to discharge and communication is not precluded by this surgery.
The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A. Cognitivedeficits B. Impaired wound healing C. Cardiac tamponade D. Tumorlysissyndrome
B Rationale: Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis. Cardiac tamponade, cognitive effects, and tumor lysis syndrome are less commonly associated with combination therapy.
The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A. Monthlyself-breastexams B. Smoking cessation C. Annual colonoscopies D. Monthlytesticularexams
B Rationale: The leading causes of cancer death, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women. Smoking cessation is the health promotion initiative directly related to lung cancer.
