N240 Final- NCLEX Questions

The nurse is completing an assessment on a patient recently diagnosed with breast cancer. Which question would best help to elicit information about a possible risk factor for breast cancer? A. "At what age did you begin having periods?" B. "Do you have a significant other to help care for you?" C. "Have you had diagnostic testing for breast cancer previously?" D. "Do you have diabetes or heart disease?"

A. "At what age did you begin having periods?" Women who begin their menstruating before age 12 are at an increased risk of breast cancer. The other questions do not provide information about risk factors for breast cancer.

The nurse is explaining screening recommendations for prostate cancer to a patient. Which statement should the nurse include? A. "Early prognosis can lead to a 5-year, 100% survival rate." B. "Screening is only necessary for patients with a family history of prostate cancer." C. "To ensure a 90% survival rate, screening for prostate cancer should occur for all male patients at age 35." D. "Screening will occur at the onset of symptoms of prostate cancer."

A. "Early prognosis can lead to a 5-year, 100% survival rate." Patients who have cancer that is confined to the prostate have a 5-year survival rate of 100%. Even when the cancer has spread regionally, approximately 99% of patients are alive after 5 years. More than 92% of prostate cancer diagnoses are made at one of these stages.

A patient is preparing to receive interstitial radiation therapy for prostate cancer. The nurse has been teaching the patient the benefits of this procedure. Which patient statement demonstrates a need for further teaching? A. "I know that I will have impotence from this procedure." B. "I think this will enable me to walk better." C. "I'm looking forward to having less pain as a result of this therapy." D. "I'm hoping that this procedure will restore continence."

A. "I know that I will have impotence from this procedure." The patient would need further teaching to understand that interstitial radiation therapy has a lower risk of impotence than other treatments. Radiation therapy also has a palliative role for patients with metastatic prostate cancer; it can reduce the size of bone metastasis, assist in controlling pain, and restore function, such as continence or the ability to ambulate for patients with spinal cord compression.

The nurse is preparing a presentation about prostate cancer to men in a over-55-year-old community. Which statement should the nurse include to illustrate the greatest risk factor for the development of prostate cancer? A. "One in eight men age 70 and older is diagnosed with prostate cancer." B. "Genes do not mutate and cause prostate cancer until after age 55." C. "The prostate gland does not function until after age 40." D. "Prostate cancer does not happen until the level of testosterone decreases."

A. "One in eight men age 70 and older is diagnosed with prostate cancer." According to the American Cancer Society, approximately one in eight men age 70 and older are diagnosed with prostate cancer. Mutated genes associated with prostate cancer are present at birth. Increased, not decreased, testosterone is associated with prostate cancer. The prostate gland is functioning before the age of 40.

The nurse has instructed a patient recovering from a left radical mastectomy to prop the left arm up on pillows with the hand higher than the elbow and to report any signs of infection to the healthcare provider. Which other discharge instruction should the nurse provide to this patient? A. "Perform range-of-motion exercises to the left arm as reviewed." B. "Avoid using hot water on the right side." C. "Be sure to use lotion on the right side." D. "Wear your watch on your left arm."

A. "Perform range-of-motion exercises to the left arm as reviewed." A radical mastectomy also includes removal of lymph nodes. Because of this, the patient is at risk for lymphedema on the left side. The patient should be encouraged to perform range-of-motion exercises in the affected arm because exercise helps develop collateral drainage. A watch should not be worn on the left arm for the same reason. There is no special instruction for the right side, such as to avoid hot water on the right side or use lotion on the right side, but both should be emphasized for her left arm, the affected arm.

A 38-year-old African American man has been diagnosed with prostate cancer. He asks, "I thought prostate cancer was an 'old man's' disease. How did I get it?" Which explanation by the nurse is best? A. "This disease occurs more often in African American men than in others." B. "Your test results show you had a terrible virus last season." C. "You have had recurrent urinary tract infections." D. "You have had kidney stones in the past and this leads to cancer."

A. "This disease occurs more often in African American men than in others." Prostate cancer is the most common type of cancer among men and is the second leading cause of death in North America. This is a disease primarily of older men with approximately one in eight age 70 years and older. This disease occurs more often in African American men, at a rate greater than 60% higher than those seen in Caucasian American men. Asian Americans and Native Americans have the lowest incidence of prostate cancer.

A 75-year-old man has been diagnosed with stage I prostate cancer. He states, "My doctor is not being aggressive with my treatment." Which statement by the nurse is the best response? A. "Your tumor is growing slowly, so the recommendation to keep a close watch is accepted practice." B. "You may need to change healthcare providers if you are not comfortable with your treatment." C. "A radical prostatectomy is the next step; we're just waiting for the surgeon's availability." D. "Due to your age, there are a lot of risks for you with surgery, so I expect that is part of your healthcare provider's concern."

A. "Your tumor is growing slowly, so the recommendation to keep a close watch is accepted practice." The treatment of prostate cancer depends on the stage of the disease when the patient is diagnosed. Watchful waiting may be the treatment of choice for the patient with a slow-growing tumor or who is older with a limited life expectancy. It would be inappropriate to tell a patient he was too old, that surgery will happen next, or suggest changing healthcare providers.

A patient is admitted with squamous cell lung cancer. Which type of medication should the nurse anticipate administering to the patient for reducing airway obstruction? A. Bronchodilator B. Cholinergic C. Chemotherapy D. Analgesic

A. Bronchodilator The nurse should administer a bronchodilator to reduce airway obstruction. Cholinergic medications do not reduce airway obstruction. Chemotherapy attacks tumor cells, but does not directly reduce airway obstruction. Analgesic medications assist in controlling pain but do not reduce airway obstruction.

The nurse is teaching a patient with a new diagnosis of small-cell lung cancer about treatment options. Which should the nurse identify as the most expected treatment of choice for this type of cancer? A. Combination chemotherapy B. Brachytherapy C. Lobectomy D. Laser bronchoscopy

A. Combination chemotherapy The nurse needs to provide teaching about combination chemotherapy, which combines chemotherapy with radiation therapy and/or surgery. This is the treatment for small-cell carcinoma cancer because of the rapid growth, dissemination, and sensitivity to cytotoxic drugs of this type of cancer. Used in combination, chemotherapeutic drugs allow tumor cells to be attacked at different parts of the cell cycle and in different ways, increasing the effectiveness of therapy. Fifty percent of patients with tumors at early stages achieve complete tumor remission with combination chemotherapy.

A breast cancer support group asks the nurse to present information on current treatment options for breast cancer. Which information should the nurse include in the presentation concerning the primary treatment option for breast cancer? A. Conservative surgery combined with radiation, hormone therapy, or chemotherapy B. Initial lumpectomy followed by chemotherapy and additional surgery if needed C. Radiation therapy followed by intensive chemotherapy D. Hormone therapy combined with chemotherapy and surgery only if necessary

A. Conservative surgery combined with radiation, hormone therapy, or chemotherapy Conservative surgery (mastectomy) combined with radiation, hormone therapy, or chemotherapy is the current trend. The other approaches do not reflect the current primary treatment of breast cancer.

The nurse is teaching a patient about nonpharmacologic therapies to help lower the risk of prostate cancer. Which foods or supplements should the nurse promote in the patient's diet? A. Fruits and vegetables B. Dairy products C. Vitamin E supplements D. Processed meats

A. Fruits and vegetables Men should be informed that they can limit their risk of prostate cancer by consuming more fruits and vegetables and limiting dairy products and processed meats in their diet. Natural and over-the-counter supplements should not be assumed safe. For example, recent studies indicate an increase in prostate cancer for men who take vitamin E supplements.

A patient recovering from a lumpectomy for breast cancer is refusing trastuzumab because of not wanting to have chemotherapy. Which teaching should the nurse include about this medication? A. It is used to counteract specific genetic mutations that promote cancer growth B. It is considered a mild chemotherapeutic agent C. It is used to reduce production of estrogen D. It is the drug of choice to treat breast cancer in postmenopausal patients.

A. It is used to counteract specific genetic mutations that promote cancer growth Trastuzumab is considered a "targeted drug" and is used to stop the growth of breast tumors that express the HER2/neu receptor on their cell surface. This drug is a recombinant DNA-derived monoclonal antibody that binds to the receptor, inhibiting tumor cell proliferation. This medication does not reduce production of estrogen, nor is it indicated because is the patient is postmenopausal. This medication is not classified as chemotherapy.

The nurse is planning discharge teaching for a patient post-prostate cancer surgery. Which topic should be considered the priority? A. Manifestations of infection B. Joining a support group C. Importance of keeping appointments D. Radiation damage

A. Manifestations of infection For the patient with prostate cancer having a surgical procedure, the following topics are a priority in preparing the patient and family for home care: manifestations of infection and excessive bleeding, catheter care, wound care, and pain management. While the importance of keeping appointments, joining a support group, and concerns regarding radiation should be included, they are not the priority.

A patient is scheduled for surgery to remove a breast tumor and the surrounding margin of breast tissue. For which surgical intervention should the nurse provide teaching material to this patient? A. Segmental mastectomy B. Radical mastectomy C. Simple mastectomy D. Modified radical mastectomy

A. Segmental mastectomy Segmental mastectomy is the removal of the tumor and the surrounding margin of breast tissues. A radical mastectomy is the removal of the entire affected breast, the underlying chest muscles, and the lymph nodes under the arms. A simple mastectomy is the removal of the breast tissue only. A modified radical mastectomy is the removal of the breast tissue and lymph nodes under the arm, leaving the chest muscles intact.

The nurse teaching a colleague about the different types of lung cancer asks which type of lung carcinoma grows rapidly and spreads early. Which response by the colleague is accurate? A. Small-cell carcinoma B. Squamous cell carcinoma C. Large-cell carcinoma D. Adenocarcinoma

A. Small-cell carcinoma Small-cell lung carcinoma grows rapidly and spreads early. Adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma do not grow rapidly and spread early.

A patient recovering from a mastectomy is unwilling to learn about the dressing change needed for the surgical site. How should the nurse best address this situation? A. Tell the patient that it is normal to be afraid to look. B. Teach the patient's significant other to do the dressing change. C. Ask the patient's significant other to discuss the issue with the patient. D. Explain that to be discharged she has to be able to do the dressing change.

A. Tell the patient that it is normal to be afraid to look. Patients who have had a mastectomy may be afraid to look at the surgical incision. The best response by the nurse is to acknowledge that it is normal to be afraid to look, which can reassure the patient and decrease anxiety. Attempting to force the issue by stating that she has to be able to do it to be discharged can create more anxiety. Asking the significant other to discuss it with the patient or teaching the individual to do the dressing change does not address the current issue and would not be the best response.

A patient diagnosed with prostate cancer has received radiation therapy. Which home care instruction is most important for the nurse to provide the patient? A. Wear a condom during sexual content. B. Sleep with two pillows. C. Increase exercise as tolerated. D. Watch for urinary tract infections.

A. Wear a condom during sexual content. The patient with prostate cancer has different home care planning based on the type of treatment received. The patient with radiation therapy would watch for radiation damage to others and sleep in a room alone for a week after treatment. He would also avoid close contact with pregnant women, infants, and children, and wear condoms during sexual contact because ejaculate may be discolored. It would not be necessary to sleep with two pillows. Watching for urinary tract infections and increasing exercise are important; however, prevention of exposure to others would be the priority.

The nurse is caring for a patient with advanced prostate cancer. The patient is prescribed a steroidal antiandrogen, megestrol (Megace). For which disadvantage should the nurse prepare the patient regarding this medication? A. Weight gain B. Expense C. More likely to cause gynecomastia D. Increased risk of cardiovascular problems

A. Weight gain A steroidal antiandrogen such as megestrol (Megace) will cause the patient to gain weight. Estrogen compounds, such as diethylstilbestrol, will cause gynecomastia and place the patient at risk for cardiovascular problems. Nonsteroidal antiandrogens are very expensive.

After learning about the diagnosis of breast cancer, an older adult patient asks if a radical mastectomy is needed. Which response by the nurse provides the most current information concerning the surgical treatment of breast cancer? A. "Radical mastectomies are no longer performed; you will have some form of less destructive surgery." B. "Currently, surgery is more conservative and generally combined with other therapies such as chemotherapy." C. "If you want to ensure that all the cancer is removed, a radical mastectomy is the best option." D. "Unfortunately, due to your age, a radical mastectomy is the most likely choice."

B. "Currently, surgery is more conservative and generally combined with other therapies such as chemotherapy." Current trends are for more conservative surgery combined with chemotherapy, hormone therapy, or radiation depending on the stage of the tumor and the age of the patient. Thus, this is the most accurate statement concerning current approaches. The statements that a radical mastectomy is the only or best option are not valid, nor is the statement that they are no longer performed.

The nurse is reviewing discharge instructions with a patient recovering from a mastectomy for breast cancer. Which patient statement indicates that teaching has been successful? A. "To improve my stamina, I will plan on trying not to sit down too much during the day." B. "I am going to see when the support group meetings are so I can attend them." C. "I should avoid using the arm on the surgical side if possible for a while." D. "I will be certain to not lift my arms over my head."

B. "I am going to see when the support group meetings are so I can attend them." The patient should be encouraged to participate in a breast cancer support group as a source of education and support. Postmastectomy exercises include over-the-head activities such as wall climbing and using an overhead pulley. The affected side should be used for activities of daily living, such as eating, combing the hair, and face washing to maintain function and strength. The patient should be taught the importance of adequate rest periods.

A patient with inflammatory carcinoma of the breast asks about the prognosis because information on the Internet is frightening. Which response by the nurse provides accurate information concerning this type of breast cancer? A. "It is a rare type of cancer and involves infiltration of the skin around the nipple." B. "It is an atypical type of breast cancer and is systemic in nature." C. "It is a cancer that infiltrates the ducts of the breast." D. "It is the most common of the breast cancers but difficult to treat."

B. "It is an atypical type of breast cancer and is systemic in nature." Two atypical types of breast cancer are inflammatory carcinoma and Paget disease. Inflammatory cancer is a systemic disease and the most malignant form of breast cancer. The most common type of breast cancer is infiltrating ductal carcinoma.

A 68-year-old Asian American man with a 30-year history of smoking cigarettes has been diagnosed with adenocarcinoma. He states, "I know that my lung cancer came from my smoking habit. But I have a friend who never smoked, and he died from the same disease. Why did he get lung cancer?" Which response by the nurse is best? A. "There is a genetic make-up that causes more sensitivity to developing the disease early in life, even without exposure." B. "Lung cancer can develop from sources such as exposure to radiation or radon in the home, or even a work environment where you work with asbestos." C. "Lung cancer can be caused by smoking privately for many years. Maybe your friend smoked and you didn't know it." D. "Chronic respiratory conditions such as asthma cause an increased incidence for developing lung cancer."

B. "Lung cancer can develop from sources such as exposure to radiation or radon in the home, or even a work environment where you work with asbestos." Asbestos and radon exposure are other risk factors for the development of lung cancer. There is no genetic predisposition to developing the disease. Chronic respiratory conditions do not contribute to lung cancer. The suggestion of smoking privately is not an appropriate response to the patient.

A patient asks what can be done to detect breast cancer in the early stages. Which response by the nurse is best? A. "Mammograms are the only way to detect breast cancer early." B. "Performing monthly breast self-examinations in the first step." C. "Having an annual examination is the best approach to detect breast cancer in the early stages." D. "There is no way to detect breast cancer in the early stages."

B. "Performing monthly breast self-examinations in the first step." Early detection begins with monthly breast self-examinations, which women should do 3-5 days after their period starts. Postmenopausal women should conduct self-examinations on the same day each month. Mammograms and clinical examinations are not identified as the best approach for early detection of breast cancer.

The community health nurse is conducting a class on smoking cessation. One patient states, "I've been smoking for 30 years. I am too old to quit." Which statement by the nurse is most appropriate? A. "Former smokers have just as great a risk as smokers for different types of cancer." B. "Smoking cessation can reverse the damage it causes, so it is never too late to quit." C. "By quitting smoking, you will save your family from secondhand smoke." D. "I would recommend that you quit because it will save you money."

B. "Smoking cessation can reverse the damage it causes, so it is never too late to quit." The toxic substances in tobacco smoke are considered to be genotoxically weak, so stopping smoking reverses the damage the smoking has caused. The main purpose of quitting is not to save money. Although quitting will prevent exposure to secondhand smoke, the main purpose of quitting is to improve the health of the smoker. Former smokers have a less risk for cancer than smokers.

A patient states, "I will no longer be a woman," after learning of the need for a mastectomy to treat breast cancer. Which response by the nurse is the most appropriate? A. "They are doing wonderful things with plastic surgery these days." B. "Tell me more about your feelings." C. "Do you want to talk with the priest?" D. "You do not want your cancer to spread, do you?"

B. "Tell me more about your feelings." The nurse should assess the patient's current body image. Self-image is related to self-esteem. The nurse should discuss whether the patient's self-image has changed. Focusing on plastic surgery could minimize the patient's concerns. The other choices do not address the patient's concern.

The nurse is teaching colleagues about bronchogenic cancer. Which information should be included? A. Bronchogenic cancer begins in other organs that spread and invade lung tissue. B. Bronchogenic cancer frequently spreads via the lymph system to other organs. C. Bronchogenic cancer is only of the small-cell carcinoma type. D. Bronchogenic cancer does not metastasize to other organs.

B. Bronchogenic cancer frequently spreads via the lymph system to other organs. Bronchogenic cancer arises from all cell types. It begins in the lung mucosa and rapidly metastasizes via the lymph system to other organs. It arises from all the different cell types. Bronchogenic cancer begins as mucosal lesions in the lung and spreads via the lymph system to other organs and tissues.

The nurse is completing an assessment on an older adult patient who is newly diagnosed with breast cancer. Which factors should the nurse initially assess to develop an appropriate treatment approach? A. History of the current problem and living environment B. Functional level and overall health status C. Spiritual and religious beliefs D. Availability of supplementary insurance and caregiver support

B. Functional level and overall health status The population of older women with breast cancer requires a multifaceted approach. After diagnosis, assessment should include functional level and overall health status as well as knowledge of the disease, resources, and level of support. Spiritual and religious beliefs, history of the current problem, living environment, availability of supplementary insurance, and caregiver support may also be assessed, but functional level and overall health status should occur first.

The community health nurse conducts a teaching session for a group of community members on lung cancer. A member of the group asks the nurse, "What are the causes of lung cancer?" Which entity should the nurse not include as a risk factor for lung cancer? A. Asbestos B. Genetics C. Radon D. Smoking

B. Genetics There is no genetic predisposition to developing the disease. However, smoking, asbestos, and radon exposure are risk factors for the development of lung cancer.

A patient whose mother and sister have been recently diagnosed with breast cancer is scheduled for genetic testing. Which genetic test result indicates a fivefold increase in the risk for breast cancer? A. Changes and mutations in the SYR gene B. Harmful mutations in BRCA1 and BRCA2 suppression C. Presence of HER2 D. Mutation of the PALB2 gene

B. Harmful mutations in BRCA1 and BRCA2 suppression Patients with harmful mutations in BRCA1 or BRCA2 suppression have a five times higher likelihood of developing breast cancer. It also increases the risk of ovarian cancer. HER2 is a specialized protein that controls cancer growth and spread; it is found on some cancer cells such as breast and ovarian. The SRY and PALB2 genes have nothing to do with the development of breast cancer.

The nurse prepares an educational program on breast cancer for a community health fair. Which modifiable risk factor should the nurse include as being associated with the development of breast cancer? A. Having more than one child B. Hormone replacement therapy for more than 5 years C. Menstruation before the age of 12 years D. Breastfeeding

B. Hormone replacement therapy for more than 5 years A modifiable risk factor for developing breast cancer is using hormone replacement therapy for more than 5 years. Having no children, not more than one, is also a risk factor. Not breastfeeding, rather than breastfeeding, is a modifiable risk factor. Menstruation before the age of 12 years is non-modifiable.

A patient reports having a nontender lump in the left breast, accompanied by a burning sensation, slight nipple discharge, and irritation and scaliness of the nipple along with a 100°F fever for the past week or two. Which manifestation should the nurse identify as least likely to be associated with breast cancer? A. Scaliness of the skin B. Low-grade fever C. Burning sensation D. Nipple discharge

B. Low-grade fever A low-grade fever is not a common manifestation of breast cancer. Presence of a non-tender mass, scaliness, or irritation of the skin around the nipple; a burning, stinging, or prickling sensation in the breast; and discharge from the nipple are manifestations of breast cancer.

Which symptom should the nurse anticipate that the patient diagnosed with prostate cancer will experience? A. Blurred vision B. Nocturia C. Weight gain D. Weakness of upper extremities

B. Nocturia Urinary manifestations from prostate cancer depend on the size and location of the tumor as well as the stage of malignancy. Patients usually experience urinary symptoms similar to benign prostatic hyperplasia, which include urgency, frequency, hesitancy, dysuria, and nocturia. Patients with prostate cancer generally lose, not gain, weight. Patients with prostate cancer may have bilateral weakness of lower, not upper, extremities. Blurred vision is not a manifestation of prostate cancer.

The nurse is assisting the healthcare provider with a physical examination of a patient suspected of having cancer of the prostate. Which finding would support this diagnosis? A. Hypoactive bowel sounds B. Palpable mass felt on digital rectal exam (DRE) C. Cancer cells found in the urine D. Residual of 150 mL after voiding

B. Palpable mass felt on digital rectal exam (DRE) A DRE is done to palpate the prostate and should be done as part of a physical examination to assess prostate size, symmetry, firmness, and nodules. A digital rectal examination that reveals a prostate that is nodular and fixed in position is indicative of prostate cancer. Cancer cells are not found in the urine. Hypoactive bowel sounds are not related to the diagnosis of prostate cancer. Residual urine could be related to prostate cancer; however, 200 mL of urine is concerning, not 150 mL.

The nurse should understand that which site is the primary location of prostate cancer? A. Lower portion of the bowel B. Peripheral zone of prostate gland C. Neck of the urethra D. Prostate capsule

B. Peripheral zone of prostate gland Almost all prostate cancers are adenocarcinomas that develop in the peripheral zones of the prostate gland. This location increases the risk of spreading to the prostate capsule. Despite the location of the prostate gland, metastasis to the bowel is uncommon. As the tumor enlarges, it may compress the urethra and obstruct urine flow.

A 50-year-old patient who has been taking hormone replacement for 3 years reports that a younger sister has been diagnosed with breast cancer. Which recommendation should the nurse suggest to help prevent the development of breast cancer? A. Complete self-breast exams twice a month. B. Remain on hormone replacement therapy no more than 5 years. C. Monitor for signs and symptoms of ovarian cancer. D. Increase mammogram screenings to every year.

B. Remain on hormone replacement therapy no more than 5 years. Hormone replacement therapy of more than 5 years' duration is a risk factor for breast cancer. Mammograms, monitoring for signs and symptoms of ovarian cancer, and self-breast exams do not prevent the development of breast cancer—they help with early detection of breast cancer.

A patient has been diagnosed with stage IV prostate cancer and is scheduled for a radical prostatectomy. The patient's wife asks what this will involve. Which statement by the nurse accurately describes this procedure? A. Brachytherapy of the prostate gland B. Removal of the prostate, prostate capsules, seminal vesicles, and a portion of the bladder neck C. Removal of a portion of the prostate D. Removal of the prostate and epididymis

B. Removal of the prostate, prostate capsules, seminal vesicles, and a portion of the bladder neck Radical prostatectomy is the removal of the prostate, prostate capsules, seminal vesicles, and a portion of the bladder neck. Transurethral resection of the prostate (TURP) is a removal of a portion of the prostate. The epididymis is not removed as part of prostatectomy. Brachytherapy is radiation treatment for prostate cancer.

A patient with breast cancer is prescribed tamoxifen. Which information should the nurse include when teaching the patient about this medication? A. Tamoxifen has other off-label uses not associated with the treatment of breath cancer B. Tamoxifen is used to treat advanced breast cancer C. Tamoxifen can be used in female breast cancer patients only D. Tamoxifen is least effective in the treatment of male breast cancer

B. Tamoxifen is used to treat advanced breast cancer Tamoxifen is used to treat advanced breast cancer. It can be used for treating both female and male breast cancer patients. It has no off-label use.

The nurse is teaching a group of older adult patients about the etiology of prostate cancer. Which statement should the nurse include in this session? A. There has been no correlation between mutated genes and prostate cancer. B. The exact cause of prostate cancer is unknown. C. There is evidence that prostate cancer is an x-linked chromosomal disorder. D. There is no relationship of acquired gene mutations and prostate cancer.

B. The exact cause of prostate cancer is unknown. The exact cause of prostate cancer remains unknown, but researchers believe it to be linked to changes in the DNA of normal prostate cells. Men with inherited gene mutations have an increased risk of developing prostate cancer. Some studies have found a relationship between acquired gene mutations caused by increased hormone levels and inflammation and the development of prostate cancer. Prostate cancer is not an x-linked chromosome disorder.

The nurse is caring for a patient undergoing combined chemotherapy and radiation therapy for lung cancer. Which assessment leads the nurse to determine that the treatment is effective? A. The patient declines to discuss treatment and make decisions about care. B. The patient's oxygen saturation while walking the hall is 92%. C. The patient denies any grief or fears related to the diagnosis. D. The patient's respiratory rate is 28 breaths per minute.

B. The patient's oxygen saturation while walking the hall is 92%. Outcomes for patients with lung cancer include maintaining oxygen saturation during rest and during activity at a value greater than 90%, and maintaining a respiratory rate between 12 and 24 breaths per minute. Additional outcomes include expressing any grief and fear of the diagnosis and making informed decisions regarding treatment.

A client is discussing urinary incontinence with the nurse. The nurse suggests that the patient recovering from a radical prostatectomy for prostate cancer use a pad with a polymer gel inside his underwear. Which nursing diagnosis does this intervention address? A. Sexual Dysfunction B. Urinary Elimination: Impaired C. Fluid Volume: Imbalanced, Risk for D. Infection: Risk for

B. Urinary Elimination: Impaired Urinary incontinence is a disturbing complication following treatment for prostate cancer. Patients need to be taught how to control dampness and odor from incontinence. One method for occasional episodes is to use absorbent pads with a polymer gel to control odor. While sexual dysfunction is also a nursing diagnosis for patients who have undergone treatment for prostate cancer, this intervention does not relate directly to that problem. Imbalanced fluid volume and risk for infection may relate to any patient recovering from surgery, but they are not directly related to this intervention.

A patient with adenocarcinoma lung cancer is scheduled for a procedure to remove peripheral lung tissue. The healthcare provider explained the procedure, but the patient asked the nurse for further explanation. Which procedure would the nurse discuss with the patient? A. Laser bronchoscopy B. Wedge resection C. Lobectomy D. Mediastinoscopy

B. Wedge resection The nurse needs to discuss a wedge resection; this procedure will remove a small section of the peripheral lung tissue. A mediastinoscopy is used to visualize the mediastinum and to remove mediastinal tumors and lymph nodes. A laser bronchoscopy is used to resect tumors in the main bronchus. A lobectomy removes a single lung lobe, not just the peripheral lung tissue.

The vast majority of primary lung lesions are bronchogenic carcinomas. Which statement demonstrates the nurse's understanding of these primary lesions? A. "Bronchogenic carcinomas are tumors of the alveoli." B. "Bronchogenic carcinomas are primary tumors of the trachea that spread to the bronchi." C. "Bronchogenic carcinomas are tumors of the airway epithelium." D. "Bronchogenic carcinomas are also known as small-cell carcinomas."

C. "Bronchogenic carcinomas are tumors of the airway epithelium." Bronchogenic carcinomas are tumors of the airway epithelium. These tumors are further differentiated by cell type: small-cell carcinomas and non-small-cell carcinomas.

A patient tells the nurse, "The skin on my right breast is puckered up and looks like an orange peel." Which response by the nurse is most appropriate? A. "Have you used a new lotion recently?" B. "Do you have a history of skin problems?" C. "Have you discussed these findings with your healthcare provider?" D. "When was your last mammogram?"

C. "Have you discussed these findings with your healthcare provider?" Edema with dimpling of the skin that results in an orange peel look is often present with inflammatory carcinoma, the most malignant form of breast cancer. The patient needs to see a healthcare provider as soon as possible. The skin changes the patient is describing are more likely related to inflammatory breast cancer than a reaction to lotion. The patient's symptoms are most likely not related to skin problems. The patient needs to address the current situation. The date of the last mammogram is irrelevant concerning the patient's situation.

A patient recovering from a left modified radical mastectomy for breast cancer reports the incision as being red and feeling hard when light pressure is applied around the site. How should the nurse respond to this information? A. "As long as there is no drainage, you do not need to be concerned; just keep an eye on it." B. "You probably need to increase your water intake and make sure you are keeping your torso elevated." C. "It sounds like you might have an infection. Let's get you in to see the healthcare provider." D. "Some redness and hardness around the site is to be expected for a few days after surgery."

C. "It sounds like you might have an infection. Let's get you in to see the healthcare provider." Redness and hardness at the surgical site can indicate infection. The healthcare provider should be notified immediately if these symptoms occur. The other responses are not valid or appropriate based upon the patient's symptoms.

The nurse is caring for a patient who has lung cancer and will be undergoing her first radiation treatment the next morning. The patient asks the nurse "What is the purpose of radiation therapy in treating my cancer?" Which is the best response by the nurse? A. "Radiation therapy is a new experimental treatment designed to weaken cancer cells." B. "Radiation therapy encourages your body to become stronger to fight the cancer." C. "Radiation therapy uses high-energy x-rays to kill the cancer cells in your body." D. "Radiation therapy is used to wall off the cancer so that it cannot spread to other areas of your body."

C. "Radiation therapy uses high-energy x-rays to kill the cancer cells in your body." Radiation therapy uses x-rays to kill cancer cells or to slow their growth. The goal of treatment may be either cure or symptom relief (palliation). Before surgery, radiation therapy is used to debulk tumors. When cancer has spread by direct extension to other thoracic structures and surgery is not feasible, radiation therapy may be the treatment of choice. It does not make the body stronger. It is not an experimental therapy. It does not wall off the tumor, but shrinks it.

At which age should the nurse recommend screening to begin for a patient who is at low risk for prostate cancer? A. 45 years of age B. 35 years of age C. 50 years of age D. 40 years of age

C. 50 years of age According to the American Cancer Society, men at average risk should be screened at 50 years of age, while 45 years of age is the recommendation for individuals with a high risk, and 40 years is recommended for individuals with a hereditary risk of early diagnosis. However, 35 years of age is too early.

The nurse is caring for a patient who reports nausea and a sudden onset of acute perineal and back pain. The patient shares that there is a history of prostate cancer in his family. Which diagnostic test should the nurse anticipate for this patient? A. X-ray and biopsy B. White blood cell (WBC) count and urine drug screen C. Digital rectal examination D. Urinalysis with differential

C. Digital rectal examination Bone pain can indicate metastasis. A digital rectal examination (DRE) may reveal a prostate that is nodular and fixed, indicating cancer. Along with the patient's symptoms and history, the DRE is the only one of these tests that relates.

The healthcare provider is scheduled to perform a diagnostic test that will visualize and obtain a tissue sample of a patient's lung tumor. Which diagnostic test should the nurse anticipate the healthcare provider to perform? A. Pneumonectomy B. CT scan C. Bronchoscopy D. Chest x-ray

C. Bronchoscopy The nurse anticipates the healthcare provider will perform a bronchoscopy. A bronchoscopy is performed to visualize the tumor and to obtain a tissue specimen for diagnosis of the tumor type. A chest x-ray is a diagnostic test that provides the first evidence of lung cancer with evidence of changes on the film. Pneumonectomy is a surgical procedure, not a diagnostic test, that removes the entire lung. A CT scan is a diagnostic test that assists in determining the location of the tumor.

A 57-year-old patient with suspected breast cancer has no children, but has a sister with the disease. The patient was treated for Hodgkin disease prior to menopause at age 56. Currently the patient abstains from alcohol and exercises regularly to maintain a body mass index (BMI) of 22.5. Which modifiable risk factor should the nurse identify that increases the patient's risk for breast cancer? A. Regular physical activity B. BMI of 22.5 C. Having no children D. Abstaining from ETOH

C. Having no children Having no children is a modifiable risk factor for the development of breast cancer. Physical inactivity, not regular physical activity, increases risk. Obesity increases risk, but this patient's BMI is within normal range. Abstaining from alcohol reduces the risk of developing breast cancer.

A patient asks for strategies to reduce the risk of developing breast cancer. Which action should the nurse recommend to this patient? A. Continuing low-dose hormone therapy B. Limiting alcohol intake to two drinks per day C. Maintaining body weight within normal limits D. Performing monthly self-breast exams

C. Maintaining body weight within normal limits Maintaining body weight within normal limits can help to prevent breast cancer. Alcohol intake should be limited to one drink per day, not two, to reduce risk. Monthly self-breast exams do not prevent the development of breast cancer but aid in early detection. Hormone therapy should be limited regarding duration and dose.

The nurse is planning care for a patient admitted for lung cancer. Which nursing intervention addresses the potential problem of activity intolerance? A. Administering analgesics B. Providing chest physiotherapy C. Planning rest periods D. Placing the patient in a supine position

C. Planning rest periods Planning rest periods is an appropriate nursing intervention to address the potential problem of activity intolerance. Administering analgesics addresses the problem of pain. Providing chest physiotherapy is a nursing intervention that addresses the potential problem of breathing pattern, not activity intolerance. Placing the patient in a supine position will not address the potential problem of activity intolerance.

A patient with a suspicious lump in the breast is scheduled for a diagnostic mammogram. When explaining this test to the patient, which finding should the nurse state that the test will help confirm? A. Distinction between a fluid-filled cyst and a solid lesion B. Confirmation of cancerous changes C. Presence of cysts or masses D. Confirmation of a cystic mass or fibrocystic changes

C. Presence of cysts or masses A mammogram is used to diagnose the presence of cysts or masses. Breast ultrasound is used to differentiate between a fluid-filled cyst and a solid lesion. A biopsy is used to differentiate benign disorders of the breast from breast cancer.

The nurse is discussing breast cancer risks with a 25-year-old patient. Which finding should the nurse recognize as increasing the risk of developing breast cancer? A. History of radiation therapy to the chest as a young child B. Changes in the BRCA1 or BRCA2 gene C. Presence of dense breast tissue in a mammogram D. Close relative with breast cancer

C. Presence of dense breast tissue in a mammogram The presence of dense breast tissue in a mammogram increases the risk for a patient to develop breast cancer before age 45 due to the inability for early detection through imaging. Having a close relative with breast cancer, a history of radiation therapy to the chest as a young child, and changes in the BRCA1 or BRCA2 gene increase risk for all patients.

The nurse caring for a patient with lung cancer recognizes the importance of promoting effective cardiorespiratory function. Which intervention is appropriate for the nurse to include in the plan of care? A. Suction the patient every 15 minutes. B. Ambulate the patient 300 feet twice a day. C. Provide chest physiotherapy. D. Elevate the head of the patient's bed to 30 degrees.

C. Provide chest physiotherapy. Providing chest physiotherapy with percussion and postural drainage helps maintain airway patency and effective respirations, thereby promoting effective cardiorespiratory function. To promote breathing, elevate the head of the bed to 60 degrees. Suction the patient only as necessary, not every 15 minutes. Maintain activity levels to patient tolerance.

The nurse is conducting an education program at a community health center regarding the risk for prostate cancer. Which risk factor should the nurse include in the teaching? A. Diets low in saturated fat increase risk. B. Risk is highest in Native American men. C. Risk is highest in African American men. D. Men who have had a vasectomy have the lowest risk.

C. Risk is highest in African American men. Prostate cancer occurs more often in African American men at a rate greater than 60% higher than those seen in Caucasian American men. Diets low in saturated fats lower the risk of prostate cancer and men who have had a vasectomy are at a higher risk of prostate cancer.

The nurse is providing teaching to a patient regarding sexual dysfunction. Which collaborative therapy should the nurse prioritize? A. Kegel exercises B. Artificial urinary sphincter C. Sildenafil D. Hormone therapy

C. Sildenafil Sildenafil is used to treat erectile dysfunction. Kegel exercises and an artificial urinary sphincter are used for bladder function. Hormone therapy is used to treat prostate cancer.

The nurse is evaluating a patient with prostate cancer. Which observation by the nurse suggests that the patient is coping appropriately? A. The patient demonstrates urine elimination of 0.3 mL/kg/h. B. The patient is still incontinent of urine. C. The patient discusses his sexual function without being embarrassed. D. The patient keeps the pain of his cancer from his family.

C. The patient discusses his sexual function without being embarrassed. The patient with prostate cancer who successfully achieves the identified patient goals and outcomes would discuss sexual function without anxiety or discomfort. Other goals include managing pain at a tolerable level using a predetermined pain rating scale, listing strategies for managing urinary incontinence, and maintaining adequate urine output without complications related to altered urinary elimination. Not disclosing the cancer diagnosis to his friends or family is not reflective of adequate coping with the diagnosis of prostate cancer. Incontinence would be considered an alteration in urinary elimination. Urine elimination should be a minimum of 0.5 mL/kg/h.

The nurse is preparing to assess a 40-year-old patient diagnosed with prostate cancer. Which assessment is part of the health history? A. The patient's bladder for retention B. The patient's prostate according to digital rectal exam (DRE) C. The patient's risk factors for prostate cancer D. The patient's bladder for distention

C. The patient's risk factors for prostate cancer During the assessment phase of the nursing process, the nurse collects and documents data related to the patient's health history, medication regimen, and current health status. Components of the health history for a patient with prostate cancer may include risk factors, urinary elimination patterns, hematuria, and pain level. Components of a physical examination include a digital rectal examination and the assessment of the bladder for distention and retention.

The nurse performs a nursing assessment for a patient who may have lung cancer. Which finding in the patient's history and physical examination would support this diagnosis? A. Pulse oximetry reading of 92% B. Visual disturbances C. Unintentional weight loss D. Elevated blood glucose level

C. Unintentional weight loss Unintentional weight loss supports the diagnosis of lung cancer. Visual disturbances and elevated blood glucose levels are not expected findings in the assessment of a patient with lung cancer. A pulse oximetry reading of 92% is a normal finding and is not indicative of lung cancer.

Which statement by the nurse best explains to the patient the reason he had pain as the first sign of prostate cancer? A. "Gastrointestinal discomfort is the source of pain you feel." B. "Headaches are the most common cause of pain." C. "Bladder spasms are probably triggering your pain." D. "Bone metastasis is usually the cause of the pain you are feeling."

D. "Bone metastasis is usually the cause of the pain you are feeling." Men with early-stage prostate cancer usually have no symptoms. Pain from metastasis to bones is frequently the initial manifestation noted. Urinary manifestations depend on the size and location of the tumor and the stage of malignancy.

While teaching a community-based wellness class about breast health to young women, a participant asks, "What is the most common type of breast cancer?" Which response by the nurse provides the accurate information? A. "Inflammatory carcinoma and infiltrating ductual carcinoma occur with similar frequency" B. "Currently, there really is no one major type; many types are being seen." C. "It is hard to say, because cancer classification systems vary in the terminology that they use." D. "Infiltrating ductal carcinoma is the most common type of breast cancer."

D. "Infiltrating ductal carcinoma is the most common type of breast cancer." The most common type of breast cancer is infiltrating ductal carcinoma. Two atypical types of breast cancer are inflammatory carcinoma and Paget disease. The statements that there really is no major type and that classification systems vary are not accurate statements.

A patent has a high risk for breast cancer based upon genetic testing. Which recommendation related to alcohol use should the nurse include when teaching on ways to prevent the development of breast cancer? A. "Any alcohol use increases risk. Thus, you should not drink at all." B. "Alcohol use is okay as long as it is limited to wine or beer." C. "Alcohol intake should not exceed more than 8-10 drinks per week." D. "Limit alcohol intake to a maximum of one drink per day."

D. "Limit alcohol intake to a maximum of one drink per day." Alcohol is a known risk factor for breast cancer and should be limited to a maximum of one drink per day. There is no differentiation between hard liquor and beer or wine. Any alcohol use does not increase the risk because one drink per day is the recommended maximum. Consuming 8-10 drinks per week would be more than what is recommended and would increase the risk.

The nurse discusses the pathophysiological processes behind the development of breast cancer with a colleague. Which statement by the nurse best explains the pathophysiology behind the development of breast cancer? A. "The BRCA4 gene is one of the genes believed to cause breast cancer." B. "Abnormal cells grow without the influence of hormonal regulation." C. "Most commonly, the underlying pathophysiological change is inflammation." D. "The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue."

D. "The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue." The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue. The BRCA1 and BRCA2 genes are involved in tumor suppression. Breast tumor growth is usually hormone dependent. Inflammatory carcinoma is not the most common type; it is infiltrating ductal carcinoma. previous

A patient diagnosed with prostate cancer asks the nurse about sexual function. Which statement by the nurse would be most appropriate? A. "Be sure to take iron supplements to keep up your strength as you go through therapy." B. "Symptoms of impotence will subside eventually." C. "Restrict fluids so you won't have to go to the bathroom often or during sex." D. "Therapy may affect sexual function, so make sure to talk about any issues with your partner."

D. "Therapy may affect sexual function, so make sure to talk about any issues with your partner." For the patient with prostate cancer, nursing interventions are aimed at facilitating urinary elimination, improving communication related to sexual function, and promoting effective pain management. The nurse teaches the patient about the actual or potential effects of therapy on sexual function and encourages the patient to discuss sexual function without anxiety or discomfort. Iron supplementation is only indicated for a patient with iron deficiency anemia and would not aid with sexual function. The symptoms of impotence may not improve over time. The patient should not restrict fluids to decrease urination.

The nurse is teaching a patient about the pathophysiology of paraneoplastic syndromes. Which patient statement indicates an understanding of the teaching? A. "They are problems that I will experience from the pressure of the tumor on surrounding body parts." B. "They are symptoms that will only affect my nervous system." C. "They are symptoms in other parts of my body but will not be a result of my lung cancer." D. "They are symptoms that I will have in other parts of my body, but will be caused from the tumor in my lungs."

D. "They are symptoms that I will have in other parts of my body, but will be caused from the tumor in my lungs." Patients with lung tumors are at risk for paraneoplastic syndromes. These are manifested in multiple body systems and result from the action of tumor cell products on other body systems. They do not put pressure on surrounding tissues; pressure on surrounding tissues causes pain. Small-cell lung cancers have paraneoplastic properties. Paraneoplastic syndromes can affect any body system.

Which symptom should the nurse consider a systemic clinical manifestation of lung cancer? A. Hemoptysis B. Proteinuria C. Weight gain D. Anorexia

D. Anorexia Anorexia is a systemic clinical manifestation of lung cancer. Weight loss, not gain, would be seen with lung cancer. Hemoptysis is a local manifestation of lung cancer. Proteinuria is not a clinical manifestation of lung cancer.

The nurse is providing care to a patient recovering from a radical mastectomy. Which intervention should the nurse include in plan of care to help prevent infection? A. Use sterile technique to change dressings and IV tubing. B. Assess surgical dressings once per shift for bleeding, drainage, color, and odor. C. Abduct and elevate the affected arm higher than the elbow. D. Assess the drainage system; note the color and amount of drainage.

D. Assess the drainage system; note the color and amount of drainage. To prevent infection, the nurse should assess the drainage system for patency and adequate suction, noting the color and amount of drainage. Dressings should be assessed every 4 hours for the first 24 hours, not once per shift. The arm should be elevated to promote optimal circulation, but it should not be abducted. Sterile technique is not required for dressing or IV tubing changes; aseptic technique can be used.

For which test should the nurse prepare a patient to diagnose the type of lung cancer tumor? A. Bronchoscopy B. CT scan C. Pulmonary function tests D. Biopsy and cytologic examination

D. Biopsy and cytologic examination Biopsy and cytologic examination are the only tests that can identify the type of cancer cells present in a tumor. Bronchoscopy allows direct visualization. CT provides an image. Pulmonary function tests provide no information regarding the tumor itself.

The nurse is caring for a patient who has lung cancer. The nurse creates a teaching plan about brachytherapy for the patient. Which information should the nurse to include? A. Brachytherapy allows more radiation to escape to the surrounding tissues than other forms of radiation therapy. B. Brachytherapy occurs when an external beam of radiation is directed to the primary tumor site. C. Brachytherapy cannot be used if surgery is to be performed. D. Brachytherapy uses a radioactive source that is implanted in the body to deliver a high dose of radiation to the tumor.

D. Brachytherapy uses a radioactive source that is implanted in the body to deliver a high dose of radiation to the tumor. Brachytherapy is a method of delivering radiation to a tumor site by implanting a radioactive source in the body near the tumor. It allows the healthy surrounding tissues to receive less radiation exposure than external beam therapy. It can be used in conjunction with surgery or alone.

The nurse schedules education sessions for college students on actions to take for early detection of breast cancer. Which instruction should the nurse include? A. Visit the healthcare provider twice per year for manual breast exams. B. Begin mammograms at age 30. C. Limit oral contraceptive use as is possible. D. Conduct monthly self-examination of the breasts.

D. Conduct monthly self-examination of the breasts. Early detection begins with monthly breast self-examinations, which women should do 3-5 days after their period starts. The nurse's role in patient self-examinations is to assess and encourage patients to do them and to provide instructions as necessary. Mammograms beginning at age 30 and visits to the provider twice a year are not recommended to detect breast cancer early. Limiting oral contraceptive use, not early detection, can help prevent the development of breast cancer.

The nurse is teaching a patient with lung cancer about systemic manifestations. Which manifestation associated with the gastrointestinal (GI) system should the nurse include in the teaching session? A. Fatigue B. Hemoptysis C. Bone pain D. Dysphagia

D. Dysphagia Dysphagia, or difficulty swallowing, is associated with the GI system. This may be caused by pressure of the tumor on the esophagus or trachea. Fatigue and bone pain are systemic manifestations that are not associated with the GI system. Hemoptysis is a respiratory manifestation.

The nurse caring for a patient after resectional lung surgery for a diagnosis of lung cancer recognizes the importance of helping the patient manage fatigue and activity intolerance. Which intervention is appropriate for the nurse to include in the patient's plan of care? A. Discouraging family involvement in patient care B. Clustering care activities so that all are completed at one time C. Placing needed objects at places where the patient needs to move and reach for them D. Instructing the patient to sit while showering

D. Instructing the patient to sit while showering Sitting while showering conserves energy, reduces oxygen demand, and allows the patient to remain independent. Planning rest periods between activities and placing objects within the patient's reach reduces oxygen demand and fatigue. Allowing family members to assist in care helps the patient to conserve energy.

The nurse is completing a health history for a young patient. Which risk factor should the nurse consider that would increase the risk of breast cancer in a woman under the age of 45 years? A. Presence of co-morbid conditions B. Mother diagnosed with ovarian cancer at age 72 C. Appearance of non-dense breast tissue in a mammogram D. Male relative with breast cancer

D. Male relative with breast cancer The risk of breast cancer in young women under the age of 45 is increased if a male relative has had breast cancer. A female relative diagnosed with ovarian cancer before age 45, not 72, would increase the risk of breast cancer in a younger female. The appearance of dense breast tissue would increase the risk for this age group. The presence of co-morbid conditions does not increase the risk for younger women.

The nurse notes that a patient has found a lump in the right breast. Which diagnostic test should the nurse expect to be prescribed? A. Breast ultrasound B. Biopsy C. X-ray D. Mammogram

D. Mammogram A mammogram is used to diagnose the presence of cysts or masses. Breast ultrasound is used to differentiate between a fluid-filled cyst and a solid lesion. A biopsy is used to differentiate benign disorders of the breast from breast cancer. An x-ray is contraindicated because it does not diagnose soft tissue pathologies such as a cyst or mass.

The nurse is interviewing a patient who states he fears he may have prostate cancer. The nurse should ask the patient if he has experienced which symptom? A. Less frequency urination during day B. Stronger urine stream C. Weight gain D. Pain on urination

D. Pain on urination Urinary manifestations from prostate cancer depend on the size and location of the tumor as well as the stage of malignancy. Patients usually experience urinary symptoms similar to benign prostatic hyperplasia, which include urgency, frequency, hesitancy, dysuria, and nocturia. Patients with prostate cancer generally lose, not gain, weight.

A patient with breast cancer has metastasis to the bones. Which therapy should the nurse expect to be prescribed to prevent fractures in this patient? A. Chemotherapy B. Calcium supplementation C. Hormone therapy D. Radiation

D. Radiation Radiation may be used to help prevent fractures for patients with breast cancer and bone metastasis. The other options do not help prevent fractures in those with cancer in the bones.

In order to be able to use an artificial urinary sphincter, the patient must be able to use the pump that is implanted in which part of the body? A. Stomach B. Thigh C. Penis D. Scrotum

D. Scrotum An artificial urinary sphincter is implanted in the scrotum. The patient must have adequate cognitive function to be able to recognize when a problem occurs and must be able to manipulate the pump.

Which action should the nurse implement to facilitate urinary elimination for a patient with prostate cancer? A. Assess the effects of incontinence on the patient's lifestyle. B. Interview the patient about pretreatment sexual function. C. Assess the intensity, location, and quality of pain. D. Teach the patient how to do Kegel exercises.

D. Teach the patient how to do Kegel exercises. Teaching Kegel exercises promotes restoration of continence, as do methods to manage stress incontinence. Pretreating sexual dysfunction would not help with urinary incontinence. Assessing for pain would be related to a metastasis of prostate cancer. Assessing the effects of the incontinence would not address the need to correct the incontinence.

True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs.

FALSE....tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc.

Red blood cells are very for vital survival. Which statement below is NOT correct about red blood cells? A. "Red blood cells help carry oxygen throughout the body with the help of the protein hemoglobin." B. "Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems." C. "Red blood cells help remove carbon dioxide from the body." D. "Red blood cells are suspended in the blood's plasma."

The answer B. Extreme loss of red blood cells leads to anemia which can cause a patient to experience shortness of breath (there is a decreased ability to carry oxygen throughout the body), tachycardia, fatigue, pale skin color etc. Suppressed immune system can be from LOW white blood cells, and clotting problems can be from LOW platelets.

As the nurse you know that there is a risk of a transfusion reaction during the administration of red blood cells. Which patient below it is at most RISK for a febrile (non-hemolytic) transfusion reaction? A. A 38 year old male who has received multiple blood transfusions in the past year. B. A 42 year old female who is immunocompromised. C. A 78 year old male who is B+ that just received AB+ blood during a transfusion. D. A 25 year old female who is AB+ and just received B+ blood.

The answer is A. A febrile transfusion reaction is where the recipient's WBCs are reacting with the donor's WBCs. This causes the body to build antibodies. It is most COMMON in patients who have received blood transfusion in the past. Option B is at risk for GvHD (graft versus host disease). Option C is wrong because this places the patient at risk for a hemolytic transfusion reaction (not febrile). The patient is receiving incompatible blood. However, option D is not the patient at MOST risk compared to option A. Note the patient is receiving compatible blood. Note the patient is receiving compatible blood in this option.

What solution or solutions below are compatible with red blood cells? A. Normal Saline B. Dextrose Solutions C. Any medications with normal saline D. No solutions are compatible with blood

The answer is A. Only NORMAL SALINE is compatible with blood.

A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification? A. PPD (Mantoux test) B. Chest X-ray C. QuantiFERON-TB Gold (QFT) D. Sputum culture

The answer is A. Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.

A patient started receiving their first unit of blood at 1000. It is now 1010 and the patient is reporting itching, chills, and a headache. In addition, the patient's temperature is now 99.8'F from 98'F. Your next nursing action is: A. Stop the transfusion B. Notify the physician C. Decrease the rate of the transfusion D. Reassure the patient that this is normal and will resolve in 30 minutes.

The answer is A. The patient is possibly having a transfusion reaction. FIRST, the nurse should STOP the transfusion and then disconnect the IV tubing at the access site and replace it with NEW tubing. In addition, have normal saline infusing to keep the vein open. THEN the nurse will notify the physician and blood bank.

A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in ___________________ precautions and will always wear _____________________ when providing patient care? A. droplet, respirator B. airborne, respirator C. contact and airborne, surgical mask D. droplet, surgical mask

The answer is B. A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (as referred to as an N95 mask.....a surgical mask does NOT work with this condition).

A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that: A. The patient will need to immediately be placed in droplet precautions and started on a medication regime. B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided. C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection. D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.

The answer is B. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.

Before starting a blood transfusion the nurse will perform a verification process with __________. This will include? A. any available personnel; physician's order, patient's identification, blood bank's information, expiration date of blood B. licensed personnel only (another RN); physician's order, patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, assess the bag of blood for damage or abnormal substances C. blood bank; patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, bag of blood for damage or abnormal substances D. licensed personnel only (another RN); blood compatibility, physician order, expiration date

The answer is B. The nurse will verify with another licensed personnel (another RN) the physician's order, patient's identification and blood bank's information, patient's blood type and donor's type along with the Rh factor, expiration date, assess the bag for damage or abnormal substances BEFORE starting the transfusion.

A patient is ordered to receive 2 units of packed red blood cells. The first unit was started at 1400 and ended at 1800. You send for the other bag of red blood cells. As the nurse you know it is priority to: A. obtain signed informed consent for the second unit of blood from the patient B. obtain a new y-tubing set for this unit of blood C. type and crossmatch the patient D. hang a new bag of dextrose to transfuse with the blood

The answer is B. The patient has already received 1 unit of blood and another unit is needed. It took 4 hours for the first unit to transfuse and the nurse needs to obtain new y-tubing for the next unit of blood. Y-tubing sets are only good for 4 hours. Some hospitals require new tubing sets with each unit transfusion or after 4 hours....always check your hospital's protocol.

According to the American Association of Blood Banks, what is the recommended hemoglobin level for a blood transfusion? A. 5-7 g/dL B. 7-8 g/dL C. 4-7 g/dL D. 9-10 g/dL

The answer is B. This is the recent recommendation for by the AABB (7-8 g/dL).

Your patient is having a transfusion reaction. You immediately stop the transfusion. Next you will: A. Notify the physician. B. Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. C. Collect urine sample. D. Send the blood tubing and bag to the blood bank.

The answer is B. This question wants to know your NEXT nursing action. AFTER stopping the transfusion, the nurse will DISCONNECT the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. This will limit any more blood from entering the patient's system. THEN the nurse will notify the MD and blood bank.

You're providing care to a 36 year old male. The patient experienced abdominal trauma and recently received 2 units of packed red blood cells. You're assessing the patient's morning lab results. Which lab result below demonstrates that the blood transfusion was successful? A. Hemoglobin level 7 g/dL B. Platelets 300,000 µl C. Hemoglobin level 15 g/dL D. Prothrombin Time 12.5 seconds

The answer is C. Hemoglobin levels are used to assess the effectiveness of a blood transfusion. A normal Hgb level for a MALE is 14 to 18 g/dL. For a FEMALE, the level is 12 to 16 g/dL.

Which statement is correct regarding mycobacterium tuberculosis? A. This bacterium is an anaerobic type of bacteria. B. It is an alkali bacterium that stains bright red during an acid-fast smear test. C. It is known as being an aerobic type of bacteria. D. It's an acid-fact bacterium that stains bright green during an acid-fast smear test.

The answer is C. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED.

A patient with O+ blood received A+ blood. The patient is at risk for? A. Febrile transfusion reaction B. None: O+ and A+ are compatible blood types C. Hemolytic transfusion reaction D. Allergic transfusion reaction

The answer is C. O+ and A+ are NOT compatible blood types. Patients with O+ can only receive blood from others with O blood. This patient is at risk for a hemolytic reaction. This is where the immune system is killing the donors RBCs. The antibodies in the recipient's blood match the antigens on the donor's blood cells....the patient has been mistyped!!

Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear? A. N95 mask B. Surgical mask C. No special PPE is needed D. Face mask with shield

The answer is C. Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.

Your patient needs 1 unit of packed red blood cells. You've completed all the prep and the blood bank notifies you the patient's unit of blood is ready. You send for the blood and the transporter arrives with the unit at 1200. You know that you must start transfusing the blood within _________. A. 5 minutes B. 15 minutes C. 30 minutes D. 1 hour

The answer is C. The blood must be started within 30 minutes.

Before initiating the blood transfusion, you obtain the patient's baseline vital signs, which are: heart rate 100, blood pressure 115/72, respiratory rate 18, and temperature 100.8'F. Your next action is to: A. Administer the blood transfusion as ordered. B. Hold the blood transfusion and reassess vital signs in 1 hour. C. Notify the physician before starting the transfusion. D. Administer 200 mL of the blood and then reassess the patient's vital signs.

The answer is C. The patient has an elevated temperature. Any temperature greater than 100'F (before the administration of the blood) the physician should be notified.

A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in _________ so the results can be interpreted? A. 24-48 hours B. 12-24 hours C. 48-72 hours D. 24-72 hours

The answer is C. The patient should report back in 48-72 hours. If they fail to, the test must be repeated.

The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this? A. Collect 2 different sputum specimens 12 hours apart B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night) C. Collect 3 different sputum specimens on 3 different days D. Collect 2 different sputum specimens on 2 different days

The answer is C. This is how an AFB sputum culture is collected.

A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician? A. Patient reports a change in vision. B. Patient reports a metallic taste in the mouth. C. The patient has ringing in their ears. D. The patient has a persistent dry cough.

The answer is C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity.

Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order? A. Calcium level B. Vitamin B6 level C. Uric acid level D. Amylase level

The answer is C. This medication can increase uric acid levels which can lead to gout. The patient's signs and symptoms are classic findings in a gout attack.

A patient taking Isoniazid (INH) should be monitored for what deficiency? A. Vitamin C B. Calcium C. Vitamin B6 D. Potassium

The answer is C. This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.

What blood type is known as the "universal recipient"? A. Type A B. Type B C. Type AB D. Type O

The answer is C. Type AB is known as the universal recipient.

A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result? A. 5 mm induration B. 15 mm induration C. 9 mm induration D. 10 mm induration

The answer is D. 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.

A donor has AB- blood. Which patient or patients below can receive this type of blood safely? A. A patient with O- blood. B. A patient with A- blood. C. A patient with B- blood. D. A patient with AB- blood.

The answer is D. Donors with AB type blood can only donate to others who have the AB type blood, in this case AB- blood. However, they are the universal recipients in that they can receive blood for every blood type but can only donate to their same exact blood type.

A patient who needs a unit of packed red blood cells is ordered by the physician to be premeditated with oral diphenhydramine and acetaminophen. You will administer these medications? A. 15 minutes before starting the transfusion B. Immediately after starting the transfusion C. Right before starting the transfusion D. 30 minutes before starting the transfusion

The answer is D. For ORAL medications you will administer the medications 30 minutes before starting the transfusion.

A patient is receiving 1 unit of packed red blood cells. The unit of blood will be done at 1200. The patient is scheduled to have IV antibiotics at 1000. As the nurse you will: A. Stop the blood transfusion and administer the IV antibiotic, and when the antibiotic is done resume the blood transfusion. B. Administer the IV antibiotic via secondary tubing into the blood transfusion's y-tubing. C. Hold the antibiotic until the blood transfusion is done. D. Administer the IV antibiotic as scheduled in a second IV access site.

The answer is D. If any IV medications will be needed while the blood is transfusing, the nurse will need to start another IV access site. The nurse would NEVER administer the IV antibiotic in the same tubing as the blood product or stop the transfusion. Remember blood is time sensitive and must be transfused within 4 hours. Also, holding the antibiotic is not correct because antibiotics are time sensitive as well and must be administered at the scheduled time to maintain blood levels.

As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is: A. Incorrect medication ordered B. Increase in tuberculosis cases nationwide C. Incorrect route of drug ordered D. Noncompliance due to duration of medication treatment needed

The answer is D. Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.

You've started the first unit of packed red blood cells on a patient. You stay with the patient during the first 15 minutes and: A. run the blood at 100 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. B. run the blood at 20 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. C. run the blood at 200 mL/min and then decrease the rate after 15 minutes, if tolerated by the patient. D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient.

The answer is D. The blood will be started on an infusion pump at 2 mL/min, and if the blood is tolerated by the patient, it will be increased AFTER 15 minutes. Remember the blood must be transfused within 2-4 hours....most bags are 250 to 300 mL. During the first 15 minutes is when the patient is most likely to have a transfusion reaction. Running the blood slowly during the first 15 minutes allows the patient to receive the LEAST amount of blood possible if a reaction does occur.

You're gathering supplies to start a blood transfusion. You will gather? A. PVC free tubing and dextrose B. Polyethylene-line tubing and 0.9% Normal Saline C. Y-tubing with in-line filter and dextrose D. Y-tubing with in-line and 0.9% Normal Saline

The answer is D. This is the type of tubing and solution you will use to transfuse blood. Normal Saline is the ONLY solution used to transfuse blood!!

A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient's? A. hearing B. mental status C. vitamin B6 level D. vision

The answer is D. This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately.

You note your patient's sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding? A. Ethambutol B. Streptomycin C. Isoniazid D. Rifampin

The answer is D. This medication will cause body fluids to turn orange.

What blood type is known as the "universal donor"? A. Type A B. Type B C. Type AB D. Type O

The answer is D. Type O is known as the universal donor.

Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction: A. Sweating B. Chills C. Hives D. Poikilothermia E. Tinnitus F. Headache G. Back pain H. Pruritus I. Paresthesia J. Shortness of Breath K. Nausea

The answers are A, B, C, F, G, H, J, and K. As the nurse you want to educate the patient to report signs and symptoms associated with blood transfusion reactions, which would include: sweating, chills, hives, headache, back pain, pruritus (itching), shortness of breath, and nausea.

A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when: A. She has 3 negative sputum cultures B. Her signs and symptoms improve C. She has completed the full medication regime D. Her chest x-ray is normal E. She has been on tuberculosis medications for about 3 weeks

The answers are A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.

A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has B+ blood. As the nurse you know the patient can receive what type of blood? Select all that apply: A. B- B. A+ C. O- D. B+ E. O+ F. A- G. AB+ H. AB-

The answers are A, C, D and E. The patient must receive blood from either a donor that has O or B blood. Since the patient is B+ (Rh factor is positive), they can receive both negative or positive blood. So, the patient can receive B-, B+, O-, and O+ blood.

Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition: A. "The patient will not need treatment unless it progresses to an active tuberculosis infection." B. "The patient is not contagious and will have no signs and symptoms." C. "The patient will have a positive tuberculin skin test or IGRA test. D. "The patient will have an abnormal chest x-ray." E. "The patient's sputum will test positive for mycobacterium tuberculosis."

The answers are B and C. The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB.

You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education? A. Cough for a minimum of 6 weeks B. Night sweats C. Weight gain D. Hemoptysis E. Chills F. Fever G. Chest pain

The answers are B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).

You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis: A. Diabetes B. Liver failure C. Long-term care resident D. Inmate E. IV drug user F. HIV G. U.S. resident

The answers are C, D, E, and F. Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors.