MedSurg Unit 2

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

ham and bacon

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching?

ill use hats to protect my head from the sun when my hair falls out

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?

indigestion

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

inf

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first?

initiate isolation precautions

growth-based classification of tumors

malignancy

A client with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by the diagnosis and the known complications of the disease. How can the client best make known their wishes for care as the disease progresses?

prepare an advance directive

What priority problems would be considered when planning care for a client diagnosed with breast cancer who is currently receiving both chemo and radiation therapies? Select all that apply. - imbalanced nutrition - activity intolerance - impaired skin integrity - disturbed body image - risk for infection

risk for infection, disturbed body image, imbalanced nutrition, act intolerance, impaired skin integrity

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client reports shortness of breath, nausea, and is restless. What is the nurse's priority action?

stop transfusion immediately

A client is diagnosed with an ischemic stroke. For which reason(s) would the nurse question the use of tissue plasminogen activator (tPA) for this client? Select all that apply. Prothrombin time 10 seconds Platelet count 95,000/mm3 Systolic blood pressure 198 mm Hg Diastolic blood pressure 120 mm Hg Received low-molecular weight heparin injections twice a day

systolic, diastolic, plt count, lmwh

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

tell me who or what gives you strength rationale: Spirituality is a personal belief system that focuses on a search for meaning and purpose of life. Assessment of people or things that provide strength to a terminally ill client is one way the nurse provides spiritually sensitive patient care. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors.

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?

there is a strong correlation between iron stores and hgb levels

When addressing a community group, the nurse identifies consumption of which substance(s) as a risk factor for the development of cancer? Select all that apply. tobacco, cruciferous vegs, organic grown vegs, alcohol, processed meats

tobacco, alcohol, processed meats

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

tumor pressure against normal tissues

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions?

use disposable razor when shaving

When communicating with a client who has sensory (receptive) aphasia, the nurse should

use short simple sentences

The client is to receive a unit of packed red blood cells. What is the nurse's first action?

verify consent form

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

wear disposable and protective clothing

Which interventions are appropriate for a client with increased intracranial pressure (ICP)? Select all that apply. Administering prescribed antipyretics Frequent oral care Elevating the head of the bed to 90 degrees Encouraging deep breathing and coughing every 2 hours Maintaining aseptic technique with an intraventricular catheter

Administering prescribed antipyretics, Maintaining aseptic technique with an intraventricular catheter, Frequent oral care

The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of

GVHD

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

I have difficulty breathing when walking 30 feet

The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective?

I will brush my teeth after every meal

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

I will receive this for the rest of my life

T0 means

No evidence of primary tumor

Which statement is true about malignant tumors?

They gain access to the blood and lymphatic channels.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

a hemolytic allergic rxn caused by an antigen rxn

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:

a+ to a-

The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition?

abd pain

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

acute chest syndrome

The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician?

add haloperidol to the clients tx plan

A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize?

adequate nutrition

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

admin antiemetics

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents?

admin factor VIII IV at first sx of bleeding

Which of the following, if left untreated, can lead to an ischemic stroke?

afib

A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply. marital status race occupation cig age

age, cig, occupation

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

allows for the nurse to facilitate the grieving process

Which is a sign or symptom of septic shock?

altered mental status

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

aluminum hydroxide

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome?

an aunt and uncle diagnosed with cancer

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

anger (exhibited by the "why me")

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

ask if taking bp has ever produced bleeding under the skin or in the arm joints

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse

assign client to private room

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions?

assisting in prioritizing activities

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

autologous

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

b12

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?

beans, dried fruits, leafy greens

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding

A nurse is caring for a client diagnosed with Guillain-Barré syndrome. The client states, "It's getting harder to take a deep breath." Which action by the nurse is most appropriate?

call the dr and prepare for intubation

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

cbc

Which of the following is an early sign of increasing intracranial pressure (ICP)?

change in LOC

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

closely observe client's skin for petechiae and bruising

A young client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). After reviewing the client's recent activities, what instruction should the nurse recommend to the client?

consult a health care provider about ingesting trimethoprim/sulfamethoxazole for a urinary tract infection.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take?

consult w the physician about d/c heparin

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

control

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?

creatinine

During a class on stroke, a junior nursing student asks what the clinical manifestations of stroke are. What would be the instructor's best answer?

depend on area, idk

which specific agents r associated w etiology of cancer?

dietary and genetic fx, hormonal and chemical agents, viruses

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

durable POA for health care

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms?

eat small amounts of bland, soft foods frequently

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia?

eliminate fresh fruits and vegs, avoid enemas and hand wash

The nurse is caring for a client with aphasia. Which strategy will the nurse use to facilitate communication with the client?

establishing eye contact

which term is used to describe the personal feelings that accompany an anticipated or actual loss?

grief

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood?

had a cold 1 month ago

When assessing a client with anemia, which assessment is essential?

health hx, including menstrual hx in women

what type of anemia results from RBC destruction

hemolytic

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?

hypochromic

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?

ig the doctor couldnt remove the entire tumor

A diagnostic test has determined that the appropriate diet for the client with a left cerebrovascular accident (CVA) should include thickened liquids. Which of the following is the priority nursing diagnosis for this client?

impaired swallowing

The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply.

infection, bleeding

A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. Which action by the nurse would be the most appropriate?

inform PCP that pt may have an infection

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

inspect skin frequently

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?

it may indicate deficiencies in essential nutrients

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

it removes a wedge of tissue for diagnosis

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings?

left sided CVA

a decrease in WBC

leukopenia

The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply. - eat spicy food - lip lubricant - use dental floss q24h - rinse mouth w NS - scrub tongue w firm-toothbrush

lip lubricant, use dental floss every 24 h, rinse mouth w NS

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

low ferritin level concentration

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

low h&h

The nurse is educating a client with myasthenia gravis about medications. The nurse is sure to include which of the following?

medications must be taken on time

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a bone marrow transplant?

monitor the client to prevent infection

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?

monitor to prevent sepsis

a client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate?

neuro involvement

A transcranial Doppler ultrasonography detects cerebral vasospasms in a client experiencing lethargy 8 days following a subarachnoid hemorrhage. The nurse anticipates which therapeutic intervention?

nimidopine PO

According to the TNM classification system, T0 means there is

no evidence of primary tumor

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

obtain the pain med and delay the bath and position change until the med reaches peak

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them:

onto the bedpan

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

pallor, tachy, sore tongue

Which type of surgery is being done when lesions that are removed are likely to develop into cancer?

prophylactic

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

provide time for pt to express her concerns

What intervention would not be included in aspiration precautions for a patient in the acute phase of a stroke?

raise HOB to 30 degrees when feeding

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron?

rich sources of vitamin C

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

stomatitis

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

the IV site is red and swollen

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

the child must inherit 2 defective genes, one from each parent

A client recently experienced a stroke with accompanying left-sided paralysis. His family voices concerns about how to best interact with him. They report the client doesn't seem aware of their presence when they approach him on his left side. What advice should the nurse give the family?

the client is unaware of his left side, you should approach him on the right side

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia?

the hair loss is usually temporary

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

the onset of a bacterial infection

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?

to detect abnormal sounds suggestive of acute chest syndrome and HF

T or F: petechiae are pinpoint hemorrhagic lesions often seen on a pt w thrombocytopenia

true

T or F: malignant tumors spread by way of blood and lymph channels to other areas of the body

true: malignant tumors spread by way of blood and lymph channels to other areas of the body. cells bear little resemblance to the normal cells of the tissue from which they arose

A client who has been demonstrating signs of impending death is awake, alert, and wants to see grandchildren after they attend school. Which action will the nurse take to support this client's request?

contact the family to ask for grandchildren to come visit the client

T or F: A patient is not radioactive after external beam radiation.

true

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

IDA

Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at

controlling seizures and increased ICP

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

dilute with another liquid and drink w a straw

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention?

direct pressure

a client w sickle cell anemia has

low hct

The nurse is caring for a client with aphasia. Which action will the nurse take when communicating with the client? Select all that apply. pause between phrases, speak in a normal tone of voice, face client when talking, use gestures when talking, talk over tv volume

pause between phrases, speak in a normal tone of voice, face client when talking, use gestures when talking

A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include?

place a pressure reducing mattress on clients bed

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

plt, prothrombin time, and aPTT

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

thrombocytopenia

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?

employs the Z-track technique

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

encourage family to express feelings and listen to them in frank communication

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

encourage fluid intake to dilute the urine

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following?

explore own feelings on mortality and death and dying

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?

extravasation