Concepts - Cellular Regulation

A nurse is assisting with the care of a client who has lung cancer and is scheduled for a lobectomy. The nurse should instruct the client to expect the use of which of the following equipment postoperatively. 1- A three-way urethral catheter ​2- A chest tube 3 - Electroencephalography (EEG) monitoring wires 4 - Continuous passive motion (CPM) machine

​2- A chest tube Rational 1- The nurse should expect a client who is postoperative following prostate resection to have a three-way urethral catheter. 2 - During a lobectomy, an incision is made in the chest wall for removal of a lung lobe. Therefore, the nurse should instruct the client to expect to have a pleural chest tube to drain air and fluid from the chest cavity and to promote lung expansion 3 - The nurse should expect a client to have EEG monitoring wires when measuring or monitoring brain wave function. 4- The nurse should expect a client who is postoperative following knee arthroplasty to have a CPM machine.

A nurse is assisting in planning an educational session regarding risk factors for skin cancer to a group of clients. Which of the following information should the nurse plan to include in the session Select all 1- ​Being dark-skinned ​2 - Age under 40 years ​3 - Overexposure to ultraviolet light ​4 - Chronic skin irritations ​5 - Genetic predisposition

​3 - Overexposure to ultraviolet light ​4 - Chronic skin irritations ​5 - Genetic predisposition Rational Being dark-skinned is incorrect. Light-skinned individuals are at greater risk for developing skin cancer. Age under 40 years is incorrect. Individuals between the ages of 30 and 60 are at the greatest risk for developing nonmelanoma skin cancers. Overexposure to ultraviolet light is correct. Overexposure to ultraviolet light is a risk factor for developing skin cancer. Rays from the sun are known to be carcinogenic and can result in malignant changes. Chronic skin lesions is correct. Chronic skin lesions are a risk factor for developing skin cancer. Clients are taught to monitor for a change in these chronic lesions as a precursor to a malignancy. Genetic predisposition is correct.Genetic predisposition is a risk factor for developing skin cancer, particularly malignant melanoma.

A nurse is reinforcing teaching to a client about skin cancer. Which of the following statements by the client indicates a need for further teaching? 1 - "Eating a high fiber diet will reduce my risk for developing skin cancer." 2 - "I should check my skin monthly for any changes." 3 - "I should avoid the use of tanning booths." 4 - "I should use sunscreen even on cloudy days."

1 - "Eating a high fiber diet will reduce my risk for developing skin cancer." Rational 1 - The nurse should inform the client that a high fiber diet is recommended to reduce the risk of colon cancer, not skin cancer. 2 - Regular skin examinations should be promoted to assist in the early detection of cancerous changes. 3 - Tanning booths should be avoided due to the increased risk of skin cancer due to ultraviolet light exposure. 4 - Sunscreen should be applied on a daily basis to reduce the risk of skin cancer

A nurse is reinforcing teaching with a client about the risk factors for skin cancer. Which of the following statements by the client indicates an understanding of the teaching? 1 - "Because I have a light complexion, I have a decreased risk for skin cancer." 2 - "I need to use sunscreen even in winter." 3 - "I used to lie in the sun all the time, but now I just go to the tanning bed." 4 - "My father was treated for melanoma, but skin cancer isn't related to genetics."

2 - "I need to use sunscreen even in winter." Rational 1- The client who has a dark complexion is at a decreased risk of developing skin cancer due to the increase in melanin in the skin, which protects from damaging ultraviolet rays. However, all clients should be aware of the risks of ultraviolet exposure. 2 - The client should use sunscreen daily to minimize the negative effects of ultraviolet rays. The vast majority of cases of skin cancer diagnosed each year are considered to be sun related. 3 - There is an increased incidence of skin cancer, such as melanoma, for the client who uses a tanning bed. 4 - The client who has a genetic history of skin cancer is at a greater risk for developing skin cancer, especially if there is an inherited susceptibility to skin cancer in the family.

A nurse is caring for an older adult client who has cancer and is receiving opioids for pain relief. The client has a new prescription for docusate PO daily. When collecting data from the client, which of the following therapeutic effects of docusate should the nurse expect? 1 - Decreased drowsiness 2 - Relief from constipation 3 - Relief from nausea 4 - Decreased cancer pain

2 - Relief from constipation Rational 1- Docusate does not affect the central nervous system and is not expected to decrease drowsiness. 2 - Constipation is a serious adverse effect of opioid medications. The intended outcome of docusate therapy is to relieve constipation by producing stool that is softer in consistency and easier for the client to pass. 3 - Docusate does not treat nausea. 4 - Docusate does not affect cancer pain.

A nurse is reinforcing teaching about TNM staging with a client who has cancer. Which of the following information should the nurse include in the teaching? 1 - "T4 indicates a tumor at its smallest size." 2 - "N0 indicates regional lymph node involvement." 3 - "M1 indicates tumor metastasis to a single site." 4 - "TIS indicates that a tumor has resolved."

3 - "M1 indicates tumor metastasis to a single site." Rational 1 -The nurse should identify that a T4 rating indicates a large tumor. T0 indicates no tumor and increasingly higher numbers indicate increased tumor size. 2 - The nurse should identify that an N0 rating indicates no lymph node changes. 3 - Following the TNM staging guidelines, the nurse should identify that the "M" indicates the degree of metastasis, with "0" indicating no metastasis, and increasing numbers (1, 2, 3) indicating metastasis to one or multiple distant sites. 4 - The nurse should identify that a TIS rating indicates carcinoma "in situ," or confined to the original tumor location.

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies? 1 - Vitamin C 2 - Vitamin K 3 - Vitamin B12 4 - Vitamin D

3 - Vitamin B12 Rational 1 - Vitamin C treats scurvy. A vitamin C deficiency is unlikely to cause megaloblastic anemia. 2 - Vitamin K helps reverse warfarin overdose. A vitamin K deficiency causes spontaneous bleeding and is unlikely to cause megaloblastic anemia. 3 - Clients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (vitamin B12) treats moderate vitamin B12 deficiencies. Clients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid. 4 - Vitamin D treats and prevents rickets. A vitamin D deficiency is unlikely to cause megaloblastic anemia.

A nurse is reinforcing teaching with a group of parents about malignant renal and intra-abdominal cancers of childhood. The nurse should include that which of the following cancers is the most common malignant renal and intra-abdominal tumor of childhood? 1 - ​Ewing sarcoma ​2 - Osteosarcoma ​3 - Neuroblastoma 4 - Wilms' tumor

4 - Wilms' tumor Rational 1 - ​Ewing sarcoma is the second most common malignant bone tumor in children and adolescents. It arises in the marrow spaces of the bones, such as the femur, tibia, fibula, ulna, humerus, pelvis, ribs, and skull. 2 - Osteosarcoma is the most frequent malignant bone cancer in children with a peak incidence between 10 to 25 years of age. 3 - ​Neuroblastoma is the most common malignant extracranial solid tumor in children. 4 - Wilms' tumor, or nephroblastoma, is the most common malignant renal and intra-abdominal tumor of childhood.

A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug? 1 - Sleep modifications 2 - Fluid modifications 3 - Driving modifications 4- Dietary modifications

4- Dietary modifications Rational 1 - There are no specific recommendations about sleep modifications that would affect a client taking warfarin. 2 - There are no specific recommendations about fluid intake that would affect a client taking warfarin. Clients taking drugs for heart failure might need to monitor fluid intake. 3 - There are no specific recommendations about operating a motor vehicle that would affect a client taking warfarin. Warfarin does not cause sedation or altered judgment or coordination. 4 - Warfarin is an anticoagulant drug that functions by inhibiting the action of vitamin K. Many foods, such as green, leafy vegetables, are rich in vitamin K. The client should maintain a consistent intake of vitamin K to avoid excesses or deficits and ensure the therapeutic effects of warfarin are consistent.

A nurse is reinforcing teaching to a client about how to perform fecal occult blood testing for screening of colorectal cancer. Which of the following statements by the client indicates a need for further teaching? 1 - "I will continue my low-dose aspirin therapy regimen." 2 - "I will refrain from eating raw fruits and vegetables." 3 - "I will avoid steak and other red meats." 4- "I will urinate before I collect a stool specimen."

1 - "I will continue my low-dose aspirin therapy regimen." Rational 1 - NSAIDs and aspirin interfere with this testing. This statement indicates a need for further teaching. 2 - Eating raw fruits and vegetables interferes with this testing. This statement indicates an understanding of teaching. 3 - Eating red meat interferes with this testing. This statement indicates an understanding of teaching. 4 - The client should void before collecting a stool sample to avoid contamination of the specimen. This statement indicates an understanding of teaching.

A nurse is reinforcing to a client who is at high risk for breast cancer and is prescribed tamoxifen citrate for prophylaxis. Which of the following statements should the nurse make regarding adverse effects on the medication? 1 - "Hot flashes are a common side effect of this drug." 2 - "Take this drug in the morning, as it can cause insomnia." 3 - "This drug will have to be taken for at least 6 months." 4- "You will need to take steps to prevent constipation while on this drug."

1 - "Hot flashes are a common side effect of this drug." Rational 1- The nurse should instruct the client that hot flashes are a common adverse effect of tamoxifen. 2 - The nurse should instruct the client that sleepiness could occur with tamoxifen. 3 - The nurse should inform the client that tamoxifen for breast cancer prophylaxis is usually prescribed for 5 years. 4 - The nurse should inform the client that nausea and vomiting, not constipation, are common adverse effects of tamoxifen.

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects. 1 - Bronchodilation 2 - Headache 3 - Edema 4 - Hypertension

2 - Headache Rational 1 - Alteplase, a thrombolytic drug, can cause bronchospasm, not bronchodilation. 2 - Alteplase, a thrombolytic drug, can cause intracranial bleeding. The nurse should monitor the client for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding. 3 - Alteplase, a thrombolytic drug, is unlikely to cause edema. Desmopressin is a drug that can cause this adverse effect because it causes fluid retention. 4 - Alteplase, a thrombolytic drug, can cause bleeding and hemorrhage, usually at sites of previous tissue damage. Severe and excessive bleeding can cause hypotension, not hypertension.

A nurse is evaluating client laboratory findings. The nurse should identify that an increase in a client's prostate-specific antigen (PSA) level can indicate which of the following conditions? 1 - Increased testosterone production 2 - Testicular torsion 3 - Orchitis 4 - Prostatitis

4 - Prostatitis Rational 1- PSA levels are not directly related to testosterone production. However, the nurse should recognize a client who has prostate cancer can experience impaired sexual function. 2- The nurse should suspect testicular torsion for a client who reports sudden scrotal pain following scrotal trauma, or with increased hormone levels. 3 - The nurse should suspect orchitis for a client who reports groin pain and edema following testicular trauma or who has an infection. 4 - The nurse should identify that an increased PSA indicates possible inflammation of the prostate, benign prostatic hyperplasia, or prostate cancer.

A nurse is caring for a client who is taking clopidorgrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions? 1 - Hyperuricemia 2 - Hyponatremia 3 - Lymphocytopenia 4 - Thrombocytopenia

4 - Thrombocytopenia Rational 1 - Clopidogrel, an antiplatelet drug, is unlikely to cause hyperuricemia, which is elevated uric acid levels. Filgrastim, a leukopoietic growth factor, is a drug that can cause hyperuricemia. 2 - Clopidogrel, an antiplatelet drug, is unlikely to cause hyponatremia. Desmopressin is a drug that can cause this adverse effect. Clopidogrel, however, can cause hypercholesterolemia. 3 - Clopidogrel, an antiplatelet drug, is unlikely to cause lymphocytopenia, neutropenia, or granulocytopenia. 4 - Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae.

A nurse is collecting data from a client who has cancer of the cervix. Which of the following manifestations should the nurse expect? 1 - Weight gain 2 - Oliguria 3 - Back pain 4 - Vaginal bleeding

4 - Vaginal bleeding Rational 1 - Unexplained weight loss is a manifestation of cervical cancer. 2 - Dysuria is a manifestation of cervical cancer. 3 - Pelvic and chest pain are manifestations of cervical cancer. 4 - The most common manifestation of cancer of the cervix is painless vaginal bleeding.

A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which fo the following drugs should the nurse expect to administer to the client? 1 - Filgrastim 2 - Deferoxamine 3 - Protamine 4 - Vitamin K

4 - Vitamin K Rational 1 - Filgrastim, a leukopoietic growth factor, stimulates neutrophil production in the bone marrow. It is ineffective for bleeding caused by an anticoagulant, such as warfarin. 2 - A chelating agent, such as deferoxamine, treats iron toxicity. It is ineffective for bleeding caused by an anticoagulant, such as warfarin. 3 - Protamine reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. It is ineffective for bleeding caused by an anticoagulant, such as warfarin. 4 - Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.

A nurse is reinforcing teaching with a client who has cancer and is receiving external radiation therapy. Which of the following statement made by the client indicates an understanding of the teaching? 1 - "I need to protect the area from sunlight." 2- "I'm going to apply skin lotion to the area every day." 3 - "I'll massage the area once per day." 4- "I'll wash the markings off after each therapy treatment."

1 - "I need to protect the area from sunlight." Rational 1 - To prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight. 2- The nurse should instruct the client to avoid the application of skin lotion, as this might remove the radiation site markings. Additionally, the cream might be irritating to the skin or cause the client to have an allergic reaction. 3 - The nurse should instruct the client that massage can cause friction to the radiated skin, which might lead to skin breakdown. 4 - The nurse should instruct the client that external radiation sites are marked to indicate the exact area to receive the radiation therapy. Washing off the markings is contraindicated.

A nurse is an outpatient clinic is caring for a client who reports bilateral knee pain after a hike in the mountains this past weekend. He tells the nurse that he is worried because his cousin died from bone cancer recently. Which of the following responses should the nurse make? 1 - "I wouldn't worry about that. It's unlikely that you have cancer." 2 - "Why do you think your pain isn't just a result of the hike?" 3 - "I completely understand why you're concerned about this." 4- "You seem worried. Let's talk about how you are feeling."

4- "You seem worried. Let's talk about how you are feeling." Rational 1 - This response illustrates the nontherapeutic communication technique of giving false reassurance. At this point the nurse cannot be sure that the client doesn't have bone cancer. 2 - This response illustrates the nontherapeutic communication technique of requesting an explanation. Asking "why" questions can be intimidating and might cause the client to become defensive. 3 - This response by the nurse illustrates the nontherapeutic communication technique of giving approval and agreeing with client. This implies that the client is correct in their thinking. 4 - This response illustrates the therapeutic communication technique of making observations. This technique causes the client to notice his behavior and describe his thoughts and feelings.

A nurse is reinforcing teaching with a client about cancer prevention and plans to address the importance of food high in antioxidants. Which of the following foods should the nurse include in the teaching? 1 - Cottage cheese 2 - Fresh berries 3 - Bran cereal 4 - Skim milk

2 - Fresh berries Rational 1 - The nurse should identify cottage cheese as a good source of calcium. 2 - The nurse should include fresh berries (blackberries, strawberries, blueberries, and cranberries), coffee, kale, and dark chocolate as food sources high in antioxidants. 3 - The nurse should identify bran cereal as a good source of fiber. 4 - The nurse should identify skim milk as a good source of calcium.

A nurse is collecting data from a client who is admitted to undergo a left lobectomy to treat lung cancer. The client tells the nurse that she is scared and wishes she has never smoked. Which of the following responses should the nurse make? 1 - "It's okay to feel afraid. Let's talk about what you are afraid of." 2 - "Don't worry. The important thing is you have now quit smoking." 3 - "I understand your fears. I was a smoker also." 4 - "Your doctor is a great surgeon. You will be fine."

1 - "It's okay to feel afraid. Let's talk about what you are afraid of." Rational 1 - It is the nurse's responsibility to acknowledge the client's statement, to encourage verbalization, and to explore the client's feelings. 2 - By telling the client not to worry because she has quit smoking, the nurse gives false reassurance and approval. This minimizes the client's feelings and concerns. 3 - Telling the client that the nurse understands the fears and disclosing personal information about smoking is inappropriate, since the nurse has not asked the client about her fears. In addition, it is inappropriate to disclose personal information to the client. 4 - Telling the client that she will be fine is false reassurance and it demeans the client's concerns.

A nurse in a provider's office is reinforcing teaching to a client who is at high risk for ovarian cancer. Which of the following statements by the client indicates an understanding of the teaching? 1 - "My doctor will perform pelvic exams to detect for ovarian cancer." 2 - "I will develop ovarian cancer If I have the BRCA1 gene." 3 - "A decreased CA125 level places me at greater risk for ovarian cancer." 4 - "I will have regular Pap tests to monitor for ovarian cancer."

1 - "My doctor will perform pelvic exams to detect for ovarian cancer." Rational 1 - This statement by the client indicates an understanding of the teaching. Routine pelvic examinations and detection of clinical manifestations are the means used for early diagnosis of ovarian cancer 2 - The nurse should reinforce to the client that inheriting the BRCA1 or BRCA2 gene places the client at risk for ovarian cancer, but is not a definitive diagnosis of cancer. Inheriting the genes also places a woman at risk for breast cancer. 3 - The nurse should reinforce to the client that elevation of the tumor marker CA125 is an assessment for ovarian cancer. The CA125 level is usually not elevated in the early stages of ovarian cancer. 4 - The nurse should reinforce to the client that cervical, not ovarian, cancer is detected by a Pap test.

A nurse is contributing to the development of a pamphlet about breast cancer awareness for a local health fair. Which of the following information provided by the nurse needs to be corrected? 1 - "Use the palm of your hand to feel for lumps using a patting motion." 2 - "Perform your breast self-examination each month 2 or 3 days after menstruation." 3 - "Check your breasts in a mirror for any change in size, contour, or dimpling." 4 - "You can examine your breasts in the shower with soapy hands."

1 - "Use the palm of your hand to feel for lumps using a patting motion." Rational 1- The nurse should include in the information to use the pads of the middle three fingers to perform breast self-examination because they are more sensitive to detecting changes. 2 - Female clients should perform a breast self-examination every month, 2 or 3 days after menstruation, when the breasts are less tender. If a client does not have regular periods or is postmenopausal, the nurse should instruct her to perform it on the same date each month. 3 - The nurse should instruct clients to check their breasts in a mirror looking for any change in size or contour, dimpling of the skin or spontaneous nipple discharge during breast self-examination. Any changes should be reported to the provider. 4 - Clients should examine their breasts while showering, using soapy hands to slide gently over the skin, which can make it easier to detect abnormalities.

A nurse is reinforcing preoperative teaching to a client who is to undergo a radical prostatectomy. Which of the following statements should the nurse include in the teaching? Select all 1 - "You may feel the need to urinate even though a catheter is in place." 2 - "Performing Kegel exercises following the surgery will help you to manage incontinence." 3 - "There is very little postoperative pain with this procedure." 4 - "You will be on a low-fiber diet following the surgery." 5 - "You should expect your urine to be blood-tinged for a few days following the surgery."

1 - "You may feel the need to urinate even though a catheter is in place." 2 - "Performing Kegel exercises following the surgery will help you to manage incontinence." 5 - "You should expect your urine to be blood-tinged for a few days following the surgery." Rational "You may feel the need to urinate even though a catheter is in place." is correct. Pressure from the taping of the catheter to the thigh or abdomen may cause the sensation of the need to void. "Performing Kegel exercises following the surgery will help you to manage incontinence." is correct. Urinary incontinence is a common complication following a radical prostatectomy. Kegel exercises can reduce the severity of the incontinence. "There is very little postoperative pain with this procedure." is incorrect. Along with incisional pain, the client may also experience pain from bladder spasms. Clients are often provided a patient-controlled analgesia pump for the first 24 hr postoperative period. "You will be on a low-fiber diet following the surgery." is incorrect. Straining with defecation can lead to postoperative bleeding. A high-fiber diet and a stool softener are often prescribed. "You should expect your urine to be blood-tinged for a few days following the surgery." is correct. The flow of bladder irrigation is maintained to keep the urine a reddish pink, which should clear to a pink tinge within 48 hr following surgery. Urine which turns bright red indicates bleeding and should be reported immediately.

A nurse on an oncology unit is reinforcing discharge teaching with an adolescent client who received a bone marrow transplant for leukemia. Which of the following pieces of information should the nurse include? Select all that apply 1 - "You should take your temperature at least once a day." 2 - "You may return to school if you feel strong enough." 3 - "Examine your feet every day." 4 - "Clean your toothbrush weekly with isopropyl alcohol." 5 - "Eat plenty of fresh fruits and vegetables."

1 - "You should take your temperature at least once a day." 3 - "Examine your feet every day." Rational "You should take your temperature at least once a day" is correct. Clients who are postoperative following bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38° C (100° F) should be reported immediately to the provider. "You may return to school if you feel strong enough" is incorrect. Clients who have had a bone marrow transplant are immunosuppressed. They should avoid crowds, such as those encountered at school, a mall, or a movie theater. They will also require time at home to recover and should limit their visitors to individuals who are healthy. "Examine your feet every day" is correct. A client who had a bone marrow transplant is immunosuppressed. The client should examine his feet daily to identify injuries that might increase the risk for infection. "Clean your toothbrush weekly with isopropyl alcohol" is incorrect. Alcohol can cause trauma and irritation to the gums and tissues. Rinsing the toothbrush in a weak bleach solution or placing in it in the dishwasher weekly are safer alternatives. "Eat plenty of fresh fruits and vegetables" is incorrect. Raw foods can carry bacteria that may lead to an increased risk of infection.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer? 1 - Alteplase 2 - Aspirin 3 - Clopidogrel 4 - Heparin

1 - Alteplase Rational 1 - Alteplase is a thrombolytic drug, meaning it can dissolve existing thrombi, whereas anticoagulant/antiplatelet drugs do not. An acute ischemic cerebrovascular event is often caused by the occlusion of a cerebral vessel by a thrombus. Administration of alteplase should be within 3 hr of the original onset of symptoms for the drug to be effective. 2 - While antiplatelet therapy with aspirin may be used prophylactically to reduce the risk of having an acute ischemic cerebrovascular event, it will not treat one that has already happened. Only thrombolytic drugs can dissolve existing thrombi and treat an acute ischemic cerebrovascular event. 3 - Clopidogrel is an antiplatelet drug and may be used prophylactically to reduce the risk of having an acute ischemic cerebrovascular event, but it will not treat one that has already happened. Only thrombolytic drugs can dissolve existing thrombi and treat an acute ischemic cerebrovascular event. 4 - Heparin is an anticoagulant drug that can prevent the formation of deep vein thrombosis or pulmonary embolism, but it is not prescribed to treat a thrombotic cardiovascular event.

A nurse is reviewing a client's admission laboratory values. The client has thrombocytopenia with a platelet count of 34,000/mm3. Which of the following actions should the nurse take? 1 - Apply pressure for 3 to 10 min following venipunctures. 2 - Have the client perform the Valsalva when toileting. 3 - Secure a warm cloth over ecchymosis for 25 to 30 min following injury. 4 - Check for the presence of WBCs in the urine.

1 - Apply pressure for 3 to 10 min following venipunctures. Rational 1 - Thrombocytopenia places the client at high risk for spontaneous or uncontrolled bleeding. Therefore, the nurse should plan to hold pressure to venipuncture sites for 3 to 10 min, or 15 to 20 min following an arterial stick. 2 - The nurse should instruct the client to avoid straining to have a bowel movement because it could cause bleeding. 3- The nurse should plan to apply ice following any bumps or injuries for 1 hr 4 - The nurse should check the client's urine for RBCs or occult blood.

A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take? 1 - Clarify the prescription with the provider. 2 - Administer the drug with an analgesic. 3 - Administer the required dose orally. 4 - Assess factor IX levels.

1 - Clarify the prescription with the provider. Rational 1 - Hyponatremia and fluid retention can occur with the administration of desmopressin, an antidiuretic hormone used in the treatment of hemophilia A. The client's sodium level is below the expected range of 136 to 145 mEq/L. The nurse should notify the provider of the client's current sodium level and clarify the prescription prior to administration. 2 - Filgrastim, a leukopoietic growth factor, stimulates neutrophil production in the bone marrow. It is possible that it could cause bone pain, requiring the concomitant administration of a mild analgesic. Desmopressin does not require the administration of an analgesic. 3 - Desmopressin is available for use in treating hemophilia A intravenously or via nasal spray. It is not administered orally for treatment of hemophilia. 4 - Desmopressin is used in the treatment of hemophilia A and stimulates the release of factor VIII. It does not have therapeutic effects on hemophilia B, which is a factor IX deficiency.

A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction 1 - Clopidogrel 2 - Heparin 3 - Warfarin 4 - Alteplase

1 - Clopidogrel Rational 1 - Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days). 2 - Heparin binds with antithrombin, increasing its ability to inactivate factor Xa and thrombin. This prevents the formation of fibrin. 3 - Warfarin inhibits vitamin K by preventing its activation. As a result, there is a decreased production of vitamin K dependent clotting factors VII, IX, X, and prothrombin. 4 - Alteplase is a thrombolytic drug. Thrombolytic drugs selectively convert plasminogen into the enzyme plasmin, which can actively breakdown the fibrin meshwork of a clot.

A nurse is reinforcing teaching with a cleint who has a new diagnosis of testicular cancer. Which of the following statements should the nurse include in the teaching? Select All 1 - Close male relatives are at increased risk for the disease. 2 - It typically occurs between ages 15 to 40. 3 - It occurs in both testicles equally. 4 - Impotence usually occurs after an orchiectomy. 5 - An early sign is scrotal warmth and redness.

1 - Close male relatives are at increased risk for the disease. 2 - It typically occurs between ages 15 to 40. Rational Close male relatives are at increased risk for the disease is correct. Testicular cancers are more common in clients with a family history of testicular cancer. Therefore, close male relatives are at increased risk. It typically occurs between ages 15 to 40 is correct. Testicular cancer occurs in the productive years and has significant economic, social, and psychological impact on the client and his family. It occurs in both testicles equally is incorrect. Testicular cancer is rarely bilateral. Impotence usually occurs after an orchiectomy is incorrect. Erectile dysfunction is a rare complication following orchiectomy. An early sign is scrotal warmth and redness is incorrect. Painless scrotal swelling, backache, and weight loss are early signs.

A nurse is reinforcing teaching with a client who has cancer about foods that prevent protein-energy malnutrition. Which of the following foods should the nurse include in the teaching? Select all 1 - Cottage cheese 2 - ​Milkshake ​3 - Tuna fish 4 - ​Strawberries and bananas ​5 - Egg and ham omelet

1 - Cottage cheese 2 - ​Milkshake ​3 - Tuna fish ​5 - Egg and ham omelet Rational Cottage cheese is correct. Cottage cheese is a good source of protein. Milkshake is correct. Milkshakes are a good source of protein. Tuna fish is correct. Tuna fish is a good source of protein. Strawberries and bananas is incorrect. The nurse should instruct the client that foods high in protein prevent protein-energy malnutrition. Although strawberries and bananas do provide essential nutrients, they are not protein-rich foods. Therefore; the nurse should not include this information in the teaching. Egg and ham omelet is correct. An egg and ham omelet is a good source of protein.

A nurse is caring for a client newly diagnosed with ovarian cancer. Which of the following reactions from the client should the nurse initially expect? 1 - Denial 2 - Bargaining 3 - Acceptance 4 - Anger

1 - Denial Rational 1 - According to evidenced-based practice, the nurse should expect the client to first exhibit behaviors of denial following a cancer diagnosis or with other type of loss. This initial stage of grieving is often a self-protective behavior used until the client tis ready to acknowledge and deal with the grief-causing issue. 2 - The nurse should expect the client to exhibit bargaining, where the client acknowledges the disease, but attempts to make a deal or trade in hopes of a cure. However, evidence-based practice indicates that the nurse should expect the client to demonstrate a different grief reaction first. 3 - The nurse should expect the client to exhibit acceptance, at the end of the grieving process, after working through other grief stages and finally resolving that the event is not changing. Therefore, evidence-based practice indicates that the nurse should expect the client to demonstrate a different grief reaction first. 4 - The nurse should expect the client to exhibit anger, which can be manifested by defensive behaviors towards the situation or others. However, evidence-based practice indicates that the nurse should expect the client to have a different grief reaction first.

A client who has metastatic bone cancer tells the nurse, "I want to go home to die." The client's family is concerned about meeting the client's care needs at home. Which of the following actions should the nurse take? 1 - Discuss a referral to home health and hospice care with the client and family. 2 - Contact the social worker to assist with nursing home placement. 3 - Talk with the provider about extending the client's hospital stay. 4 - Instruct the family about meeting the client's palliative care needs at home.

1 - Discuss a referral to home health and hospice care with the client and family. Rational 1 - The client has expressed a wish to go home. The nurse should discuss the availability of resources that can assist with the care of the client and determine the appropriateness of the use of the resources for the family. Home health and hospice care are both resources that could provide support for the care of the client at home. 2 - The client wishes to die at home, not in a long-term care facility. 3 - The client wishes to die at home, not in the hospital. 4 - Palliative care can be complex and can also exhaust family caregivers. It is naïve to presume that the nurse can provide all the information the family will need to manage this situation.

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include? Select all 1 - Eat iron-enriched foods. 2 - Spread the dosage across each day. 3 - Take the drug on an empty stomach. 4 - Report dark green or black stools. 5 - Increase dietary fiber intake.

1 - Eat iron-enriched foods. 2 - Spread the dosage across each day. 3 - Take the drug on an empty stomach. 5 - Increase dietary fiber intake. Rational Eat iron-enriched foods is correct. A client who has iron-deficiency anemia should increase iron intake by eating foods such as egg yolks, wheat germ, meat, and fish. Spread the dosage across each day is correct. Spreading out the iron intake throughout the client's waking hours allows the bone marrow to maximize the production of RBCs. Take the drug on an empty stomach is correct. Food reduces the absorption of ferrous sulfate. The client should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, they can take the drug with food. Report dark green or black stools is incorrect. The nurse should tell the client to expect dark green or black stools. However, it is not necessary to report this adverse effect. Increase dietary fiber intake is correct. Ferrous sulfate can cause constipation. The client should increase fiber and fluid intake and exercise more often or more intensely.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects? 1 - Hypertension 2 - Muscle pain 3 - Edema 4 - Dry mouth

1 - Hypertension Rational 1 - Epoetin, an erythropoietic growth factor, can cause hypertension. The nurse should monitor the client's BP before and during therapy and inform the provider if it increases. 2 - Epoetin, an erythropoietic growth factor, tends to result in adverse effects involving the cardiovascular and central nervous system and does not cause muscle pain. 3 - Epoetin alfa, an erythropoietic growth factor, is unlikely to cause edema. Oprelvekin, a thrombopoietic growth factor, is a drug that can cause edema and fluid retention. 4 - Epoetin, an erythropoietic growth factor, tends to result in adverse effects involving the cardiovascular and central nervous system and does not cause dry mouth.

A nurse is reinforcing teaching with a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching? 1 - Increase fluid intake by drinking bottled water. 2 - A salad bar is a healthy choice when dining out. 3 - Soft-boiled eggs are an appropriate source of protein. 4 - Eating at buffets is a good choice to increase caloric intake

1 - Increase fluid intake by drinking bottled water Rational 1 - The client who has neutropenia is at risk for foodborne illness. Bottled water prevents the client's exposure to pathogens that might be found in other water sources. 2 - The client who has neutropenia should avoid salad bars due to a higher risk of exposure to pathogens from raw foods, as well as from other individuals. 3 - The client who has neutropenia should avoid foods that are not fully cooked due to a higher risk of foodborne illness. 4 - The client who has neutropenia should avoid buffets due to a higher risk of foodborne illness and pathogen exposure.

A nurse is assisting with the development of an education program about skin cancer. Which of the following information should the nurse include in the presentation 1 - Individuals who have light skin are at greater risk for developing skin cancer." 2 - "Tanning bed use should be limited to once per week." 3 - "Basal cell carcinoma has a high rate of metastasis." 4 - "A family history of squamous cell carcinoma is a risk factor for developing skin cancer."

1 - Individuals who have light skin are at greater risk for developing skin cancer." Rational 1- Individuals who have light skin and those over the age of 60 are at increased risk for developing skin cancer. 2 - The use of tanning beds should be avoided due to the combined rate of skin exposure to sunlight and the damaging rays from tanning beds. 3 - Basal cell carcinoma involves changes to the basal layer of the epidermis and often goes unnoticed. The rate of metastasis is low, but damage to underlying tissue can progress. 4 - Chronic damage to the skin due to frequent injury or irritation is a risk factor for developing skin cancer, but a family history of squamous cell carcinoma is not. Squamous cell carcinoma occurs in the epidermis, can spread readily, and is highly metastatic.

A nurse is caring for a client who has advanced state prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? 1 - Leuprolide 2 - Cyclophosphamide 3 - Finasteride 4 - Tamoxifen

1 - Leuprolide Rational 1 - The nurse should expect the provider to prescribe leuprolide, which is a type of hormone therapy used to treat advanced prostate cancer. Leuprolide reduces androgen levels to decrease tumor growth, and causes chemical castration. 2 - The nurse should expect the provider to prescribe cyclophosphamide for clients who have other types of cancer, such as leukemia, multiple myeloma, lymphomas, as well as ovary, breast, and lung cancer. 3 - The nurse should expect the provider to prescribe finasteride for clients who have benign prostatic hypertrophy or to prevent prostate cancer for certain clients. 4 - The nurse should expect the provider to prescribe tamoxifen to prevent breast cancer for high risk clients, or as treatment for clients who have certain forms of breast cancer.

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage? 1 - Rapid pulse 2 - Yellowing of the sclera 3 - Elevated blood pressure 4- Pale-colored stools

1 - Rapid pulse Rational 1 - In the event of a moderate to severe hemorrhage, the volume of blood in the circulatory system decreases significantly, resulting in hypotension. Tachycardia is a compensatory mechanism of the heart that serves to combat the hypotension that results from the decreased volume of blood. Tachycardia can be detected by checking the client's pulse. 2 - Due to decreased blood volume, the nurse should expect to see pallor of the sclera, skin, and mucous membranes if hemorrhage occurs. The client might also have visible bruising or petechiae. 3 - Due to decreased blood volume, a reduction in blood pressure (hypotension) is an expected finding if hemorrhage occurs. The client might experience dizziness upon standing because the body cannot adjust blood pressure rapidly to compensate for the position change. 4 - The nurse should recognize that black, tarry stools, or stools with frank blood visible are indications of hemorrhage.

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications? 1 - Uncontrolled bleeding 2 - Myocardial infarction 3 - Respiratory depression 4 - Decreased renal perfusion

1 - Uncontrolled bleeding Rational 1 - Aspirin is a salicylate (antiplatelet) that irreversibly binds to and inhibits platelet activation. Because the lifespan of a platelet is 7 to 10 days, this is the average span of time needed after discontinuing antiplatelet therapy with aspirin before its effects are no longer present and the chance of an uncontrolled bleeding event is decreased. 2 - Although many clients are prescribed aspirin to reduce their chances of having a myocardial infarction (MI), the client's risk for an MI would not increase due to missing the single dose. 3 - Taking aspirin does not increase the risk of respiratory depression. Taking opioid analgesics can increase the risk of respiratory depression. 4 - Taking aspirin does not increase the risk of renal perfusion. Aspirin can cause gastrointestinal distress.

A nurse is reinforcing teaching with a group of clients about common findings that can indicate cancer. The nurse should instruct the clients to monitor for and report which of the following findings? Select all 1 - ​A nonhealing sore 2 - Unintended weight gain ​3 - Change in bowel pattern 4 - Unilateral calf tenderness ​5 - Nagging cough

1 - ​A nonhealing sore ​3 - Change in bowel pattern ​5 - Nagging cough Rational A nonhealing sore is correct. A client who has cancer might exhibit a nonhealing sore. Unintended weight gain is incorrect. The nurse should instruct the clients that unintended weight loss can indicate cancer. Change in bowel pattern is correct. A client who has cancer might exhibit a change in bowel pattern. Unilateral calf tenderness is incorrect. A client who has unilateral calf tenderness can have a venous thromboembolism. Nagging cough is correct. A client who has cancer might exhibit a nagging cough.

A nurse is assisting with teaching a community group about the early detection of colorectal cancer. Which of the following screening recommendations should the nurse include for adults 50 years of age and older? 1- Flexible sigmoidoscopy every 5 years. 2 - Fecal occult blood test every 2 years. 3 - Fecal occult blood test every 4 years. 4 - Flexible sigmoidoscopy every 8 years.

1- Flexible sigmoidoscopy every 5 years Rational 1 - The nurse should include this recommendation as part of routine screening for cancer for adults over 50 years old. 2 - The nurse should recommend adults over 50 years old have fecal occult blood testing annually. 3 - The nurse should recommend adults over 50 years old have fecal occult blood testing annually. 4 - The nurse should recommend adults over 50 years old have fecal occult blood testing more frequently.

A nurse is reinforcing discharge teaching to a client following open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching? 1 - "I will be able to take a tub bath in 1 week." 2 - "I will take acetaminophen if I have any pain." 3 - "I will use suppositories to prevent constipation." 4 - "I will regain my bladder control once the catheter is removed."

2 - "I will take acetaminophen if I have any pain." Rational 1 - The nurse should instruct the client to shower rather than take a tub bath for 2 to 3 weeks following an open radical prostatectomy. 2 - The nurse should teach the client to avoid aspirin and NSAIDs for at least 2 weeks following surgery to prevent the risk of bleeding. 3 - The nurse should instruct the client to use stool softeners, rather than suppositories, to control constipation. 4 - The nurse should inform the client that bladder control might not return immediately and practicing Kegel exercises can help with incontinence. Urinary incontinence can last for 1 to 2 years following surgery.

A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects? 1 - Phlebitis 2 - Dark, orange-colored stools 3 - Constipation 4 - Injection site pain

3 - Constipation Rational 1 - Ferrous sulfate is administered orally. Phlebitis could occur in clients receiving iron supplementation IV, not by mouth. Iron dextran, iron sucrose, and sodium ferric gluconate are iron formulations that can be administered IV. 2 - Oral iron supplementation is associated with dark green or black-colored stools. 3 - Oral iron supplementation is associated with constipation. The nurse should encourage the client to consume adequate amounts of fiber and fluids in their diet to minimize this effect. 4 - Ferrous sulfate is administered orally, not via intramuscular injection. Iron dextran is available for IM injection.

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide? 1- "The risk of renal toxicity is lessened when a combination of chemotherapy medications are used." 2 - "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." 3 - "The use of more chemotherapy medications will shorten the time you have to be in treatment." 4 - "The combination of chemotherapy medications will eliminate the potential for bone marrow suppression."

2 - "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." Rational 1 - A combination of chemotherapeutic agents does not lessen the incidence of renal toxicity. 2 - Different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply. 3 - A combination of chemotherapeutic agents does not ensure a shorter duration of treatment. 4 - It is not entirely possible to eliminate the suppression of bone marrow caused by chemotherapeutic medications. The extent of bone marrow suppression is dependent on the specific medications being administered.

A nurse is reinforcing postoperative discharge teaching with a client following a panhysterectomy for uterine cancer. Which of the following pieces of information should the nurse provide? 1 - "You will need to continue to use some form of birth control for 6 months." 2 - "You might experience manifestations of menopause." 3 - "Do not lift anything heavier than 15 pounds." 4 - "Pain or burning on urination is an expected outcome of this surgery."

2 - "You might experience manifestations of menopause." Rational 1 - The nurse should inform the client that, following a panhysterectomy, pregnancy is not possible and birth control is no longer required. 2 - The nurse should inform the client that a panhysterectomy includes the removal of the uterus and the ovaries, which might cause manifestations of menopause to occur. Manifestations of menopause include hot flashes, night sweats, and vaginal dryness. 3 - The nurse should inform the client to not lift anything heavier than 2.3 to 4.5 kg (5 to 10 lb). 4 - The nurse should inform the client that pain or burning on urination is not an expected outcome of a panhysterectomy and to report these to the provider. Such manifestations can indicate a urinary tract infection.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take? 1 - Shake the vial before using. 2 - Administer via IV bolus over 1 to 3 min. 3 - Dilute the drug first with D5W. 4 - Save the used vial for the next dose.

2 - Administer via IV bolus over 1 to 3 min. Rational 1 - Shaking the vial can damage the glycoprotein that comprises the drug, making it ineffective. 2 - Instructions for administering the drug include administering it via IV bolus over 1 to 3 min. 3 - Instructions for administering the drug include mixing it with 0.9% NaCl. The nurse should also examine the solution and discard it if it is cloudy or discolored. 4 - Instructions for administering the drug include using the vial only once and then discarding it.

A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction? 1 - Vitamin K 2 - Aminocaproic acid 3 - Protamine 4 - Deferoxamine

2 - Aminocaproic acid Rational 1 - Vitamin K reverses the effects of warfarin. It is unlikely to reverse the thrombolytic effects of alteplase. 2 - Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase. 3 - Protamine reverses the effects of heparin. It is unlikely to reverse the thrombolytic effects of alteplase 4 - Deferoxamine is a chelating agent that binds with iron to reverse iron toxicity. It is unlikely to reverse the thrombolytic effects of alteplase.

A nurse is caring for a client who has hemophilia A and is about to being taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions? 1 - Weight loss 2 - Edema 3 - Polyuria 4 - Bradycardia

2 - Edema Rational 1 - Desmopressin, an antidiuretic hormone, can cause hyponatremia and weight gain. The nurse should monitor serum sodium levels and daily weight for clients receiving the drug therapy. 2 - Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this drug. 3 - Desmopressin, an antidiuretic hormone, can reduce urine output. It is unlikely to cause polyuria. 4 - Desmopressin, an antidiuretic hormone, can cause a slight increase in blood pressure and tachycardia when administered in large IV doses, but it does not cause bradycardia.

A nurse in an oncology clinic is collecting data from a client who has early stage Hodgkin's lymphoma. Which of the following finding should the nurse expect? 1 - Bone and joint pain 2 - Enlarged lymph nodes 3 - Intermittent hematuria 4 - Productive cough

2 - Enlarged lymph nodes Rational 1 - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Bone pain might be a late manifestation sign of metastasis. Bone and joint pain are early manifestations of leukemia and multiple myeloma, not Hodgkin's lymphoma. 2 - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node, or nodes, which appear without a known cause. Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus. The disease can spread to adjacent lymph nodes and later might spread outside the lymph nodes to the lungs, liver, bones, or bone marrow. The spread of Hodgkin's lymphoma is usually in an ordered pattern. 3 - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Intermittent blood in the urine might be an indication of bladder cancer. 4 - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. A nonproductive cough might occur because of narrowed airways from swollen lymph glands. A productive cough might be an indication of lung cancer.

A nurse is assisting with teaching a client who has a history of smoking about recognizing early manifestations of laryngal cancer. The nurse should instruct the client to monitor and report which of the following manifestations of laryngeal cancer? 1 - Aphagia 2 - Hoarseness 3 - Tinnitus 4 - Epistaxis

2 - Hoarseness Rational 1 - Aphagia is a manifestation of a stroke. 2- Laryngeal cancer is often caused by chronic exposure to tobacco and alcohol. Persistent hoarseness is an early manifestation of cancer of the larynx because the presences of a tumor can impede the action of the vocal cords during speech. 3 - Tinnitus is a manifestation of an ear canal obstruction. 4 - Epistaxis is a manifestation of a nasal fracture or a bleeding disorder.

A nurse is collecting data from client who has received chemotherapy to treat lung cancer. Which of the following adverse effects should the nurse report to the provider? 1 - Low hemoglobin 2 - Manifestations of infection 3 - Fatigue 4 - Generalized urticaria

2 - Manifestations of infection Rational 1 - Chemotherapy can have several toxic effects, including low platelet counts (thrombocytopenia), but it does not generally affect hemoglobin. 2 - Chemotherapy to sites containing bone marrow (such as the sternum) can lower the white blood cell count (leukopenia), thus increasing the client's risk for infection. Screening the client for manifestations of infection should be reported to the provider. 3 - Fatigue is common and temporary following chemotherapy. It does not warrant reporting this to the provider. 4 - Chemotherapy does not cause hypersensitivity reactions, such as generalized urticaria. It can, however, cause local skin reactions, including erythema, desquamation, and ulceration to the area that received radiation.

A nurse is caring for a client who has metastatic cancer and has been taking morphine for several months to relieve sever pain. Which of the following prescriptions should the nurse expect when the client reports constipation unrelieved by laxative therapy? 1 - Naloxone 2 - Methylnaltrexone 3 - Pentazocine 4 - Diphenoxylate

2 - Methylnaltrexone Rational 1 - Naloxone, an opioid antagonist, is used to reverse opioid overdose. It is not prescribed to treat constipation caused by chronic opioid use. 2 - Methylnaltrexone treats opioid-induced constipation that is no longer relieved by laxative therapy. Because it does not cross the blood-brain barrier, it does not reverse pain relief or cause opioid withdrawal. 3 - Pentazocine is an opioid agonist-antagonist. It can cause opioid withdrawal when taken by a client who is dependent on opioids, such as morphine. 4 - Diphenoxylate is an opioid medication that is used to treat diarrhea, rather than constipation.

A nurse is reinforcing teaching with a client who asks which diagnostic test is the preferred method for detecting cervical cancer. Which is an appropriate response by the nurse? 1 - CA 125 2 - Papanicolaou test 3 - Transvaginal ultrasound 4 - An endometrial biopsy

2 - Papanicolaou test Rational 1- The CA 125 is used to detect ovarian cancer. 2 - The Papanicolaou (Pap) test is used to detect cervical cancer. 3 - A transvaginal ultrasound is used to detect endometrial cancer. 4 - Endometrial biopsy is used to detect endometrial cancer.

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions? 1 - Myocardial infarction 2 - Peptic ulcer disease 3 - Pancreatitis 4- Myasthenia gravis

2 - Peptic ulcer disease Rational 1 - Clients who have had a myocardial infarction can take clopidogrel; in fact, the drug prevents clot formation in clients who have recently had a myocardial infarction or a cerebrovascular accident. 2 - Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding. 3- Clients who have pancreatitis can take clopidogrel. However, the drug is contraindicated for clients who have hemophilia or other bleeding disorders. 4 - Clients who have myasthenia gravis can take clopidogrel. The drug is contraindicated for clients who have thrombocytopenia or intracranial bleeding.

A nurse is assisting in planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? 1 - Monitor visitors for manifestations of infection. 2 - Remind the client to use an electric razor. 3 - Encourage frequent rest periods. 4 - Instruct the client to rinse mouth daily with normal saline.

2 - Remind the client to use an electric razor. Rational 1- The client has thrombocytopenia, not neutropenia. Neutropenia, a decreased WBC count, places a client at risk for infection prohibiting visitors who might be ill. 2 - Thrombocytopenia is a decrease in the client's blood platelet count, which places the client at an increased risk of bleeding due to the blood's inability to clot. Therefore, the nurse should institute bleeding precautions, which includes the use of an electric razor. 3 - The client has thrombocytopenia, a decrease in the number of circulating RBCs, not iron-deficiency anemia. Iron-deficiency anemia necessitates the encouragement of frequent rest periods secondary to fatigue. 4- Stomatitis, an inflammation of the mucous membranes of the mouth, is not a manifestation of thrombocytopenia. The client who has stomatitis should use bland rinses and avoid commercial mouthwashes that contain alcohol, which might cause further breakdown to the oral tissue.

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness? 1 - Amylase level 2 - Reticulocyte count 3 - C-reactive protein 4 - Creatinine clearance

2 - Reticulocyte count Rational 1 - Folic acid, also called folate, is unlikely to alter amylase levels. Amylase is an enzyme that helps digest carbohydrates. Levels rise with pancreatic inflammation or injury or when taking drugs used to treat viral invasion. 2 - A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Clients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness. 3 - Folic acid, also called folate, is unlikely to alter C-reactive protein. Levels of this substance rise with inflammation and cardiovascular disease. 4 - Folic acid, also called folate, is unlikely to alter creatinine clearance, which is a test that helps determine kidney function. Creatinine clearance is altered in drugs that affect the renal output, such as diuretics and antidiuretic hormone.

A nurse is caring for a client who is taking ferrous sulfate to treat iron-deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication? 1 - Flumazenil 2 - Acetylcysteine 3 - Naloxone 4 - Deferoxamine

4 - Deferoxamine Rational 1 - Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. 2 - Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. Acetylcysteine binds to the toxic byproducts of acetaminophen metabolism to prevent liver toxicity. 3 - Naloxone, an opioid antagonist, reverses the effects of opioid narcotics. 4 - Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.

A nurse is reinforcing health teaching about skin cancer with a group of clients. Which of the following risk factors should the nurse identify as the leading cause of non-melanoma skin cancer 1 - Exposure to environmental pollutants 2 - Sun exposure 3 - History of viral illness 4 - Scars from a severe burn

2 - Sun exposure Rational 1 - The nurse should identify exposure to environmental pollutants as a risk factor for cancer due to their potential to change genetic DNA; however, evidence-based practice indicates there is another risk factor that is the leading cause of skin cancer. 2 - According to evidenced-based practice, the nurse should identify exposure to the sun as the leading cause of non-melanoma skin cancer. Ultraviolet light radiation from the sun can cause cancerous changes in the skin. Decreased ozone protection has increased the amount of radiation exposure and increased the risk of cancer for clients regardless of skin color 3 - The nurse should identify a history of viral illness as a risk factor for cancer due to the ability of a virus to alter the genetic material of a cell; however, evidence-based practice indicates there is another risk factor that is the leading cause of skin cancer. 4 - The nurse should identify a burn injury as a risk for skin cancer due to the skin's greater sensitivity to sunlight; however, evidence-based practice indicates there is another risk factor that is the leading cause of skin cancer.

A nurse is collection data from a client. Which of the following finding is the highest risk factor for at the client developing bladder cancer? 1 - The client is a hairdresser. 2 - The client uses tobacco. 3 - The client is over 60 years of age. 4 - The client has frequent urinary tract infections (UTIs).

2 - The client uses tobacco. Rational 1- The nurse should recognize that exposure to chemicals, such as those used in hairdressing, is a risk factor for developing bladder cancer; however, there is a greater risk to the client than chemical exposure. 2 - The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's tobacco use as being the greatest risk factor for developing bladder cancer. 3 - The nurse should recognize that being over the age of 60 is a risk factor for developing bladder cancer; however, there is a greater risk to the client than age. 4 - The nurse should recognize that a history of UTIs is a risk factor for developing bladder cancer; however, there is a greater risk to the client than frequent UTIs.

A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy? 1 - Thinning of the scalp hair 2 - Tingling of the hands and feet 3 - Reduced ability to concentrate 4 - Sores in the mucous membranes

2 - Tingling of the hands and feet Rational 1- Thinning of the scalp hair is alopecia, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. 2 - Several chemotherapeutic agents might cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and tingling of an extremity. 3- The reduced ability to concentrate reflects cognitive changes, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. 4 - Sores in the mucous membranes is mucositis, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy.

A nurse is caring for a client who has cancer and is receiving palliative care. Which of the following statements should the nurse identify as an indication that the client understands and accepts his prognosis? 1 - "I am thinking of getting a second opinion." 2- "I am hoping this will help relieve my discomfort." 3 - "This is making me stronger every day." 4 - "This is not working, and I plan to stop treatment."

2- "I am hoping this will help relieve my discomfort." Rational 1- Clients receiving palliative care are aware that there is no hope of cure or recovery and are unlikely to seek a second opinion 2 - Clients receiving palliative care are aware that the outcome is to relieve symptoms and provide the best possible quality of life. 3 - Clients receiving palliative care are aware that there is no hope for cure or recovery and the outcome is to maintain and support, not improve functional ability as they transition to other levels of care. 4 - Clients receiving palliative care are aware that there is no hope for cure or recovery and would accept ongoing support to prevent suffering and maintain the best possible quality of life.

A nurse is reinforcing preoperative teaching with a client who has colorectal cancer and is schedule to undergo placement of colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching? 1 - "It will be a relief to not have any further rectal pain." 2 - "I will need to sit on a rubber donut when I am out of bed in the chair." 3 - "I can have only liquids for 2 days before the surgery." 4 - "The colostomy will start working about 7 days after the surgery."

3 - "I can have only liquids for 2 days before the surgery." Rational 1 - Following placement of a colostomy with a perineal wound, rectal sensations such as pain and itching might occur even after healing of the client's surgical wound. 2 - The client should sit on foam pads or soft pillows and avoid the use of rubber donut devices, because of the increased pressure to the incisional site. 3 - The client should consume a full or clear liquid diet for 24 to 48 hr before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis. 4 - Following surgery, the client's colostomy should begin to function within 2 to 4 days.

A nurse is caring for a client who is receiving chemotherapy for treatment of ovarian cancer and experiencing nausea. Which of the following actions should the nurse take? 1 - Advise the client to lie down after meals. 2 - Instruct the client to restrict food intake prior to treatment. 3 - Provide the client with an antiemetic 2 hr prior to the chemotherapy. 4 - Encourage the client to drink a carbonated beverage 1 hr before meals.

4 - Encourage the client to drink a carbonated beverage 1 hr before meals. Rational 1 - The nurse should advise the client to not lie down for 2 hr after meals to reduce the risk for nausea. 2- The nurse should instruct the client to eat before treatment to reduce the risk of nausea. 3 - The nurse should administer an antiemetic 30 min to 1 hr prior to treatments, to reduce the risk of nausea and vomiting. Preventive treatment should start before the chemotherapy is given and continue for as long as the chemotherapy agent is likely to cause nausea. 4 - The nurse should instruct the client to drink a carbonated beverage 1 hr before or after meals to reduce the risk for nausea.

A nurse is providing teaching for a client who has an ileal conduit following bladder cancer. Which of the following statements by the client indicates a need for the nurse to provide additional teaching? 1 - "I will always have to wear a pouch." 2 - "I will need to measure my stoma each week." 3 - "I need to catheterize the stoma several times a day." 4 - "I need to cleanse around the stoma with soap and water."

3 - "I need to catheterize the stoma several times a day." Rational 1 - The pouch adheres to the body over the stoma using and adhesive wafer or disk. The client must wear a pouch with a conduit as it continually drains urine. 2 - The stoma needs to be measured at least once weekly 6 to 8 weeks after surgery and as needed if the client gains or loses weight. 3 - Ileal conduits collect urine, drain continually through a stoma, and do not require emptying with the use of a catheter. The goal of the ileal conduit is to divert the urine outside the body when the bladder is removed. The client will wear a bag or pouch over the stoma to collect the urine. Therefore, this statement by the client indicates a need for the nurse to provide additional teaching. 4 - Skin care must be meticulous to prevent impaired skin integrity and infection. Care of the stoma created from an ileal conduit is the same as caring for the stoma created from a colostomy or an ileostomy. The area around the stoma is cleansed with mild soap and water and then dried thoroughly.

A nurse is caring for a client who has been diagnosed with end-stage liver cancer. Which of the following statements by the client indicates that the client is in the denial phase of the grief process? 1 - "The doctor has been so good to me. I know he has tried everything he can. It is just my time." 2 - "I can't believe that doctor graduated from medical school! He doesn't know a thing about treating cancer." 3 - "The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." 4 - "Even though I am not hurting right now, I don't feel like I have the energy to get out of bed."

3 - "The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." Rational 1 - This client statement is an example of acceptance. 2 - This client statement is an example of anger. 3 - This client statement is an example of denial. The Five Stages of Grief may not be experienced in order, and the length of each stage will vary from person to person. In the denial stage, clients have difficulty believing a terminal diagnosis or loss. In the anger stage, clients lash out at other people or things. In the bargaining stage, clients negotiate for more time or a cure. In the depression stage, clients are saddened over the inability to change the situation. In the acceptance stage, clients accept what is happening and plan for the future. 4 - This client statement is an example of depression.

A nurse is caring for a client who has invasive breast cancer and is starting chemotherapy. She tells the nurse that she is worried about the adverse effects of the treatment. Which of the following responses should the nurse make? 1 - "I will have your doctor discuss the adverse effects with you." 2 - "Don't worry. You will be feeling better in no time." 3 - "What is it about the adverse effects that concerns you?" 4 - "I agree. Sometimes the adverse effects can be worse than the disease."

3 - "What is it about the adverse effects that concerns you?" Rational 1 - Offering to pass the client's concerns to someone else is dismissive. The nurse is demonstrating that she does not wish to discuss the client's concerns. 2 - False reassurance is a nontherapeutic communication technique. The client may stop sharing feelings if she feels that her concerns are not taken seriously. 3 - With this response, the nurse takes responsibility for answering the client's concerns rather than passing them to someone else. The nurse is demonstrating the therapeutic communication technique of exploring, as it invites the client to share her concerns. 4 - This response illustrates the nontherapeutic communication technique of agreeing, and might increase the client's concerns.

A nurse is reinforcing discharge teaching with a client who is postoperative following a high mastectomy for breast cancer. The client will be going home with 2 Jackson-Pratt drains. Which of the following pieces of information should the nurse include in the teaching? 1 - Cloudy drainage is normal. 2 - Showering is permitted before the drainage tubes are removed. 3 - Avoid wearing deodorant until the drains are removed and the incision heals. 4 - Do not begin exercising the arm until the provider removes the drainage tubes.

3 - Avoid wearing deodorant until the drains are removed and the incision heals. Rational 1 - The nurse should instruct the client that cloudy, malodorous drainage might indicate infection and should be reported to the provider. 2 - The nurse should instruct the client to take baths until the provider removes the drainage tubes and stitches. 3 - The nurse should instruct the client to avoid applying deodorants and talcum powder to the affected underarm until the drainage tubes are removed and the incision is healed. 4 - The nurse should instruct the client that normal use and nonstrenuous exercise is appropriate before the provider removes the drainage tubes. More strenuous exercise can begin following the removal of the drains.

A client tells a nurse that she tests positive for a mutant BRCA-1 gene. The nurse should recognize that this finding increases the client's risk for which of the following conditions? 1 - Kidney disease 2 - Alzheimer's disease 3 - Breast cancer 4 - Ovarian cancer

3 - Breast cancer Rational 1 - The nurse should recognize that there is no known genetic link to increased risk for kidney disease. 2 - While there is a genetic link to the development of Alzheimer's disease, the nurse should recognize the BCRA-1 gene does not affect Alzheimer's disease risk. 3 - The presence of the BCRA-1 or BRCA-2 gene can be used to determine breast cancer risk. These genes are present in clients who have an inherited form of breast cancer; however, not all clients who develop breast cancer have this gene. 4 - The nurse should recognize that a client who has ovarian cancer can have an elevated CA125 tumor marker.

A nurse is planning care for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care? 1 - Empty the collection pouch when it is 2/3 full. 2 - Expect urine outflow into pouch to begin 1 to 2 days following surgery. 3 - Change the collection pouch in the early morning. 4 - Cleanse skin under the collection pouch with hydrogen peroxide.

3 - Change the collection pouch in the early morning. Rational 1- The nurse should empty the collection pouch when it is 1/3 full to half full to prevent the excess weight of the urine causing the pouch to separate from the skin. 2- The nurse should expect no delay in urinary output following surgery. The nurse should monitor hourly urine output in the immediate postoperative period. Monitoring is then every 4 to 8 hr. 3 - The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced. 4 - The nurse should not use hydrogen peroxide to cleanse the skin around the stoma and under the collection pouch. The nurse should use soap and water for cleansing to decrease the risk of irritating the area.

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX therapy practically eliminates the risk for which of the following? 1 - HIV 2 - Cytomegalovirus 3 - Creutzfeldt-Jakob disease 4 - Anaphylaxis

3 - Creutzfeldt-Jakob disease Rational 1 - None of the factor IX products currently in use, plasma-derived or recombinant, carry a risk of acquiring HIV. However, plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19. 2 - None of the factor IX products currently in use, plasma-derived or recombinant, carry a risk of acquiring cytomegalovirus. However, plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19. 3 - Recombinant factor IX is safer than the plasma-derived formulation because it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. 4 - Both recombinant and plasma-derived factor IX carry a risk for anaphylaxis. The nurse should have epinephrine and diphenhydramine available and monitor clients who are receiving these products for an allergic reaction that could lead to anaphylaxis. Plasma-derived products carry a minimal risk of acquiring hepatitis A and parvovirus B19.

A nurse is monitoring a client who is receiving chemotherapy and has a platelet count of 22,000 mm3. Which of the following findings should the nurse identify as the priority? 1 - Anorexia 2 - Fatigue 3 - Ecchymosis 4 - Fever

3 - Ecchymosis Rational 1 - The nurse should investigate the cause of the client's decreased appetite and intervene to provide adequate nutrition and hydration to prevent constipation; however, another finding is the priority. 2 - The nurse should intervene to promote adequate rest for the client, and instruct the client to ask for assistance when out of bed; however, another finding is the priority. 3 - The greatest risk to this client is injury from bleeding due to a platelet count that is below the expected reference range; therefore, the priority intervention is to monitor for and report indications of bleeding, such as ecchymosis, immediately. 4 - The nurse should intervene to reduce the client's temperature, taking care not to administer medication that increases the risk of bleeding; however, another finding is the priority.

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects? 1 - Dusky nail beds 2 - Petechiae 3 - Enlarged spleen 4 - Swollen calf

3 - Enlarged spleen Rational 1 - Filgrastim, a leukopoietic growth factor, is unlikely to cause hypoxemia and dusky nail beds. However, it can cause fever, bone pain, and ECG changes. 2 - Filgrastim, a leukopoietic growth factor, is unlikely to cause petechiae. 3 - With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. The nurse should tell the client to monitor and report abdominal pain or fullness. 4 - Filgrastim, a leukopoietic growth factor, is unlikely to cause a blood clot, which would cause calf swelling. However, the drug can cause leukocytosis.

A nurse at a community health clinic is assisting with creating a brochure about testicular cancer. Which of the following information should the nurse include? 1 - Perform a testicular self-examination twice per year. 2 - Palpate the epididymis. 3 - Gently roll the testicles to feel for abnormalities. 4 - Use one hand to palpate the testicles.

3 - Gently roll the testicles to feel for abnormalities. Rational 1 - The client should perform a testicular self-examination once per month. 2 - The client should locate by feeling for, not palpating, the smooth epididymis on the tip and back of the testicle. 3 - The client should gently roll the testicles to feel for lumps, swelling, and tenderness. 4 - The client should use both hands when performing a testicular self-examination.

A nurse is caring for an older adult client who has colon cancer. The client asks the nurse several questions about his treatment plan. Which of the following actions should the nurse take? 1 - Tell the client to have a family member call the provider to ask what options he plans to recommend. 2 - Assure the client that the provider will tell him what is planned. 3 - Help the client write down questions to ask his provider. 4 - Provide the client with a pamphlet of information about cancer.

3 - Help the client write down questions to ask his provider. Rational 1 - This action implies that the client's concerns can wait and can suggest the client is not competent. This option imposes a communication block by placing the client's concerns on hold. 2 - This action blocks communication by placing the client's concerns on hold and giving false reassurance. 3 - To empower the client in decision-making, the nurse should help the client write down questions to ask the provider. In doing this, the nurse acts as a client advocate to address the client's specific questions in a concrete, measurable way. 4 - This action does not address the client's concerns about his specific treatment plan.

A nurse is caring for a client who is about to being taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective? 1 - PT 2 - WBC 3 - Hgb 4 - Platelets

3 - Hgb Rational 1 - Warfarin, not epoetin, increases PT and causes anticoagulation. 2 - Epoetin stimulates the production of RBCs, not WBCs. Therefore, the nurse should monitor Hgb and Hct levels to determine efficacy. 3 - Epoetin, an erythropoietic growth factor, increases the production of RBCs for clients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy. 4 - Epoetin can cause thrombocytosis, which is an excessive increase in platelet counts. This is an adverse effect of the drug and is not an indication of effective therapy.

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from chemotherapy? 1- Gingival hyperplasia 2 - Hirsutism 3 - Pancytopenia 4 - Weight gain

3 - Pancytopenia Rational 1 - Gingival hyperplasia, or overgrowth of gingival tissue in the mouth, is caused by poor oral hygiene, leading to bacterial plaque and tartar accumulation. It is not an adverse effect of chemotherapy. 2 - Hirsutism, or excessive body or facial hair, is generally caused from Cushing syndrome, especially in women. The nurse should expect to see alopecia, or hair loss, when the client receives chemotherapy. 3 - Bone marrow suppression, a deficiency of WBCs, RBCs, and platelet counts, is an expected adverse effect of chemotherapy 4 - The client might have an inability or lack of desire to eat, causing weight loss due to the adverse effects of chemotherapy, such as a metallic taste in the mouth, nausea, and vomiting.

A nurse is caring for a client who has an absolute neutrophil count (ANC) less than 1,000/mm3. Which of the following interventions should the nurse implement? 1 - Restrict all visitors. 2 - Increase the client's intake of raw produce. 3 - Report a temperature of 38.3° C (101° F) or greater. 4 - Insert an indwelling urinary catheter.

3 - Report a temperature of 38.3° C (101° F) or greater. Rational 1 - All visitors should be screened carefully. Visitors should be limited to healthy adults. 2 - Clients who have low WBC counts need to follow a low-bacteria diet. Any uncooked foods, such as raw fruits and vegetables, are removed from the diet because they contain large numbers of organisms and pose a risk for introducing of bacteria into the client's gastrointestinal system. 3 - An ANC of less than 2,000/mm3 indicates neutropenia. Neutropenia occurs in clients who are immunocompromised, are undergoing chemotherapy, or have a disorder that reduces the production of neutrophils. A client who has neutropenia is at an increased risk for infection. A major objective in caring clients who are neutropenic is protection from, and early recognition of, infection. A temperature greater than 37.8° C (100° F) is significant for a client who has neutropenia and indicates infection until proven otherwise. 4 - Invasive procedures pose a risk for injury and infection and should be avoided for clients who are immunocompromised.

A nurse is collecting data from a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at eh insertion site, and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first? 1 - Take a photograph of the peripheral IV site. 2 - Obtain and record the client's vital signs. 3 - Stop the infusion. 4 - Identify all medications administered through the IV site for the past 24 hr.

3 - Stop the infusion. Rational 1 - The nurse should take a photograph of the IV site for documentation of potential harm from extravasation; however, there is another action that is the priority. 2 - The nurse should take and record the client's vital signs following extravasation of a chemotherapy agent; however, there is another action that is the priority. 3 - The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. Many chemotherapy medications are vesicants that can cause extensive tissue damage if extravasation occurs; therefore, the nurse's first action should be to stop the infusion immediately. 4 - The nurse should identify all medications administered through the IV site for the past 24 hr; however, there is another action that is the priority.

A nurse in a health clinic is assisting in the planning of an educational program on skin cancer. Which of the following statements should be included in the presentation? 1 - Squamous cell carcinoma occurs most often on the face and trunk. 2 - Radiation therapy is the treatment of choice for metastatic skin cancer. 3 - Sun exposure as a child is a significant risk factor for skin cancer. 4 - Basal cell carcinoma is an aggressive cancer with a high rate of metastasis.

3 - Sun exposure as a child is a significant risk factor for skin cancer. Rational 1 - Basal cell carcinoma occurs most often on the face and trunk. Squamous cell carcinoma most frequently appears on the head and neck. 2 - Radiation therapy will not eliminate metastatic skin cancer, but can reduce the size of the tumor. Surgical removal of the tumor is required for metastatic skin cancer. Adjacent tissue and lymphatic structures may also need to be excised. 3 - Sunburn as a child is a significant risk factor for the development of skin cancer, with blue-eyed blondes and redheads as the most susceptible. 4- Basal cell carcinoma usually remains localized. Deep tissue malignant melanomas tend to metastasize through the lymphatic and circulatory systems.

A nurse is reinforcing teaching about breast self-examinations (BSE) with a client who has a regular menstrual cycle. The nurse should instruct the client to perform BSE at which of the following times? 1 - On the same day every month 2 - Prior to the beginning of menses 3 - Three to seven days after menses stops 4 - On the second day of menstruation

3 - Three to seven days after menses stops Rational 1 - The client should not perform breast self-examination on the same day every month because monthly hormone fluctuations can affect the sensitivity of breast tissue. 2 - The client should avoid performing breast self-examination just prior to menses because the breasts might be too tender to perform an effective examination. 3 - The client should plan to perform breast self-examination about 3 to 7 days after menstruation, when the breasts are least tender and not engorged. 4 - The client should avoid performing breast self-examination during menstruation because the breasts might be too tender to perform an effective examination.

A hospice nurse is reinforcing teaching about palliative care to the partner of a client who has end-stage liver cancer. Which of the following statements by the partner indicates an understanding of teaching? 1 - "I will do my best to try to get him to eat something." 2 - "I will lay him flat if his breathing becomes shallow." 3 - "I will use an electric blanket to keep him warm." 4 - "I will continue to talk to him even when he's sleeping."

4 - "I will continue to talk to him even when he's sleeping." Rational 1 - The nurse should reinforce to the partner that clients who are approaching death often refuse nourishment and should not be forced to eat or drink. 2 - The nurse should reinforce to the partner that clients who are approaching death should be positioned with the head elevated or on the side. 3 - The nurse should reinforce to the partner that clients should be covered with a blanket to keep the extremities warm, not an electric blanket. 4 - The nurse should reinforce with the partner that hearing is thought to be the last sense lost in the dying process; therefore, the partner should continue to softly communicate with the client.

A nurse is assisting with the admission of a client who is about to undergo surgery for benign prostatic hypertrophy. The client states, "I don't know what I will do if they discover I have cancer. "Which of the following responses should the nurse make" 1 - "Why do you think you might have cancer when your diagnosis is a benign condition?" 2 - "I have reviewed your history and I don't see any reason for you to worry about that." 3 - "I think that's something you need to discuss further with your doctor." 4 - "I'm hearing that you are concerned that you could have cancer."

4 - "I'm hearing that you are concerned that you could have cancer." Rational 1 - This response illustrates the nontherapeutic communication technique of requesting an explanation. Asking "why" questions can be intimidating and might cause the client to become defensive. 2 - This response illustrates the nontherapeutic communication technique of giving false reassurance. This belittles the client's concerns and may cause the client to stop sharing feelings. 3 - By offering to pass the client's concerns to someone else, the nurse is demonstrating that she does not wish to discuss the issue. This is a dismissive action and can cause the client to feel misunderstood or not supported. 4 - This response illustrates the therapeutic communication technique of seeking clarification and restating. It demonstrates the nurse's willingness to explore the client's fears and encourages communication

A nurse is caring for a client who has cancer. The client states that she wants to try nontraditional treatments instead of the chemotherapy recommended by her provider. Which of the following responses should the nurse make? 1 - "Using nontraditional treatments is not a good Idea. I'd rather you avoid that route." 2 - "A lot of people think nontraditional treatments will work, and they find out too late that they made the wrong choice." 3 - "Your doctor is very knowledgeable. If he prescribes chemotherapy, it's the best treatment for you." 4 - "Tell me more about your concerns about chemotherapy."

4 - "Tell me more about your concerns about chemotherapy." Rational 1- This response is an example of the nontherapeutic communication technique of disapproving. 2 - This response is an example of the nontherapeutic communication technique of minimizing the client's feelings. The client might also perceive a threat in the nurse's words. 3- This response is an example of the nontherapeutic communication technique of defending. 4 - Asking the client to talk more about her fears and her concerns encourages communication. It is an example of the therapeutic communication technique of exploring.

A nurse is assisting with a group therapy session for clients who are newly diagnosed with cancer. Which of the following statements should the nurse make? 1 - "Antidepressants are not the solution for your problems, but this therapy group definitely is." 2 - "I notice you keep clenching your fists. Please refrain from doing that during this meeting." 3 - "You need to work hard on resolving conflict with family and friends closest to you." 4 - "What do you mean when you say you cannot ever return to work?"

4 - "What do you mean when you say you cannot ever return to work?" Rational 1- This is a nontherapeutic response. Antidepressants may assist a client who is experiencing depression with a new diagnosis of cancer. In addition, therapy can offer assistance, but may or may not be a full solution to an identified problem. The client may need both medication and therapy to reach the best outcome. 2 - This is a nontherapeutic response and does not address the client's needs. This response may cause the client to become defensive and does not promote communication. 3 - This is a nontherapeutic response and may cause a defensive response rather than promote communication with support and empathy.. The clients in the group are currently dealing with a new diagnosis of cancer, and the focus of communication should be on supporting and exploring their concerns related to the diagnosis. 4 - This is an example of clarification, which is a therapeutic communication technique. Clarification asks the group member to expand and clarify what he/she means so as to create a better understanding during the group session.

A nurse is admitting a client who has multiple myeloma and a WBC of 2,2000/ mm"3. Which of the following foods should the nurse prohibit the family members from bringing to the client? 1 - Fried chicken from a fast food restaurant 2 - A case of canned nutritional supplements 3 - A factory-sealed box of chocolates 4 - A fresh fruit basket

4 - A fresh fruit basket Rational 1 - Thoroughly cooked food products should not harbor bacteria that could be a potential source of infection for a client who has neutropenia. 2 - Canned nutritional supplements are permissible for the client. Dispose of any amount leftover to prevent bacterial growth from contamination. 3 - A sealed box of candy should not harbor bacteria that could be a potential source of infection for a client who has neutropenia. 4 - Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin might harbor bacteria that can cause an infection. The nurse should prohibit these foods from entering the client's room.

A nurse in a provider's officer is collecting data from a client who has ovarian cancer. Which of the following manifestations should the nurse expect? 1 - Unexplained weight loss 2 - Urinary retention 3 - Diarrhea 4 - Abdominal bloating

4 - Abdominal bloating Rational 1 - The nurse should expect to find an increase in weight related to abdominal ascites, a late manifestation of ovarian cancer. 2 - The nurse should expect a report of urinary frequency, not retention, in a client who has ovarian cancer. 3 - The nurse should expect the client who has ovarian cancer to be experiencing constipation, not diarrhea. 4 - The nurse should expect the client who has ovarian cancer to manifest abdominal bloating.

A nurse is caring for a client who is being evaluated for endometrial cancer. Which of the following findings should the nurse expect the client to report 1 - Hot flashes 2- Recurrent urinary tract infections 3 - Blood in the stool 4 - Abnormal vaginal bleeding

4 - Abnormal vaginal bleeding Rational 1- Hot flashes are indicative of hormonal changes such as menopause. 2 - Urinary tract infections are related to the kidney function and can be related to not drinking enough water. 3- Blood in the stool can be a sign of gastrointestinal disease. 4 - The nurse should expect the client to experience abnormal vaginal bleeding, including postmenopausal bleeding and bleeding between normal periods. Abnormal vaginal bleeding is the most common finding in endometrial cancer in premenopausal women.

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome? 1 - Irregular cardiac rhythm 2 - Numbness in the hands 3 - Muscle cramps 4 - Facial edema

4 - Facial edema Rational 1 - Superior vena cava syndrome is a partial occlusion of the superior vena cava. It leads to alterations in client's vascular flow, not cardiac arrhythmias. 2 - Superior vena cava syndrome is a partial occlusion of the superior vena cava. Numbness in the client's hands is a manifestation of spinal cord compression that can result if cancer spreads to the spinal cord. 3 - Superior vena cava syndrome is a partial occlusion of the superior vena cava. Muscle cramps might indicate the client has syndrome of inappropriate antidiuretic hormone (SIADH), and might occur with cancer metastasis to the brain. 4 - Superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest, such as advanced lung and breast cancers and lymphoma. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected.

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia. When administering factor VIII, which of the following actions should the nurse take? 1 - Administer the powdered form orally. 2 - Premedicate with aspirin. 3 - Administer it via rapid IV bolus. 4 - Have emergency equipment ready.

4 - Have emergency equipment ready. Rational 1 - The powdered form of factor VIII is concentrated factor VIII. The nurse should dissolve it in a sterile solution and administer it via IV. 2 - Aspirin and first-generation NSAIDs are contraindicated for clients who have hemophilia A because they increase the risk for bleeding. 3 - The nurse should administer factor VIII slowly over 5 to 10 min. 4 - Factor VIII can cause a hypersensitive reaction and anaphylaxis. The nurse should monitor the client for hives, fever, wheezing, and difficulty breathing and have emergency equipment and drugs readily available.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase? 1 - Protamine 2 - Desmopressin 3 - Ferrous sulfate 4 - Heparin

4 - Heparin Rational 1- Protamine is responsible for reversing heparin's effects and would only be administered as an antidote to heparin in the case of an uncontrolled bleeding event. The nurse should not expect the client to take these simultaneously. 2 - Desmopressin is a form of antidiuretic hormone, which is prescribed for clients who have mild hemophilia A to treat bleeding from an injury or in preparation for surgery. 3 - Iron supplements, such as ferrous sulfate, are commonly prescribed for the treatment of iron-deficiency anemia. Iron plays a key role in hemoglobin's ability to bind and carry oxygen, but it is not directly involved in the formation of thrombi. 4 - Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation.

A nurse is reinforcing teaching with a client who has breast cancer and a new prescription for tamoxifen. The nurse should instruct the client that which of the following adverse effects is common when taking tamoxifen? 1 - Weight gain 2 - Hearing loss 3 - Hallucinations 4 - Hot flashes

4 - Hot flashes Rational 1- Nausea and vomiting are common adverse effects of tamoxifen, but weight gain is not an adverse effect the client should expect to experience. 2 - The nurse should instruct the client to watch for visual changes when taking tamoxifen. 3 - Headache is a common adverse effect of tamoxifen, but hallucinations are not an adverse effect the client should expect to experience. 4 - The nurse should tell the client that hot flashes and menstrual irregularities are common adverse effects of tamoxifen, which works, in part, by blocking estrogen receptors.

A nurse is caring for a client who is to start taking tamoxifen as a treatment for breast cancer. The nurse should instruct the client to expect which of the followings as an adverse effect of the medication? 1 - Euphoria 2 - Constipation 3 - Urinary retention 4 - Hot flashes

4 - Hot flashes Rational 1- The client should report depression or mood changes as an adverse effect of the medication. 2 - The client should report nausea and vomiting as an adverse effect of the medication. 3 - The client will not experience the adverse effect of urinary retention when taking tamoxifen. 4 - The client will experience hot flashes as an adverse effect of the medication because tamoxifen is an antiestrogen medication that blocks estrogen receptors.

A nurse is caring for a client who is about to beging taking aspirin to reduce the risk of cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms? 1 - Activating thromboxane A2 2 - Blocking adenosine diphosphate receptor agonists 3 - Suppressing specific clotting factors 4 - Inhibiting cyclooxygenase action in platelets

4 - Inhibiting cyclooxygenase action in platelets Rational 1 - Part of the process by which salicylates, such as aspirin, inhibit platelet aggregation involves preventing the activation of thromboxane A2, which would otherwise stimulate platelet aggregation and vasoconstriction. 2 - Part of the process by which drugs such as clopidogrel, not aspirin, inhibit platelet aggregation involves the irreversible blockade of adenosine diphosphate receptor agonists on the surface of platelets, preventing clotting. 3 - Warfarin, not aspirin, inhibits clotting by limiting the production of clotting factors VII, IX, X, and prothrombin. 4 - Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.

A nurse is collecting data from a female client who is undergoing screening for breast cancer. Which of the following factors place the client at an increased risk for developing breast cancer? 1 - Obesity 2 - Oral contraceptive use 3 - Alcohol use 4 - Over 50 years of age

4 - Over 50 years of age Rational 1 - Obesity places a client at a low but increased risk for developing breast cancer. 2 - Oral contraceptive use places a client at a low but increased risk of developing breast cancer. 3 - The risk from alcohol use is dose dependent. Consumption of 3 to 14 drinks a week causes a slight risk for developing breast cancer. 4 - A female client whose age is over 50 years has a high increased risk for developing breast cancer.

A nurse is collecting a health history for a client who has skin cancer. Which of the following findings in the client's history is the highest risk factor for developing skin cancer? 1 - Age over 60 2 - Genetic predisposition 3 - Light-skinned race 4 - Overexposure to sunlight

4 - Overexposure to sunlight Rational 1 - The nurse should recognize that a client being over the age of 60 is a risk factor for skin cancer; however, there is a greater risk factor than age for developing skin cancer. 2 - The nurse should recognize that a client having a genetic predisposition is a risk factor for skin cancer; however, there is a greater risk factor than genetic predisposition for developing skin cancer. 3 - The nurse should recognize that a client being of a light-skinned race is a risk factor for skin cancer; however, there is a greater risk factor than race for developing skin cancer. 4 - The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's overexposure to sun as being the greatest risk factor for developing skin cancer.