Passpoint Exam 2 nu 201
Hyperplasia
- increase in number of cells -____________ of the gums is a clinical manifestation of AML.
KUB radiographic
A ________________ examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances.
The cells could cause various conditions and help identify a problem early.
A client asks the nurse to explain the meaning of her abnormal Papanicolaou (Pap) smear result of atypical squamous cells. The nurse should tell the client that an atypical Pap smear means that what has occurred?
cottage cheese-like discharge
A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?
injury related to the decreased platelet count
A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?
Foley catheter draining urine at 10 mL/hour A complication of vaginal hysterectomy would be injury to the ureters resulting in decreased urinary output.
A nurse is assessing a client in the recovery room who has had a vaginal hysterectomy. Which assessment finding should the nurse bring to the healthcare provider's immediate attention?
Notify the healthcare provider. The client is exhibiting signs and symptoms of sepsis and must be treated immediately.
A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that the client has warm, flushed, dry skin; a heart rate of 110 beats per minute; and a temperature of 101.8° F (38.8° C). Which is the nurse's next best action?
It is possible for the client to be contagious. Drug-resistant gonorrhea is possible and the client should be retested and/or seen by the healthcare provider at the end of the antibiotic therapy.
A nurse is caring for a male client who has gonorrhea. Which statement indicates that the client needs additional instruction? "It is not possible to be contagious as long as I take all of my antibiotics as prescribed."
"I'll ask any future partners if they have ever been diagnosed with genital herpes."
A nurse is teaching a client about prevention of genital herpes. What statement indicates the teaching was successful?
painless hematuria
A physician orders cystoscopy and random biopsies of the bladder for a client who reports _________________. Test results reveal carcinoma in situ in several bladder regions.
danazol
Adverse effects of __________________ include headaches, dizziness, irritability, and decreased libido. Masculinization effects, such as deepened voice, facial hair, and weight gain, also may occur.
lower UTIs
Dysuria, suprapubic pain, and urine retention may occur in
energy
Improved ____________ is associated with treatment for iron deficiency anemia.
infection fluid accumulation
Surgery: Redness, warmth, and swelling are all signs of __________. Treatment with antibiotics is usually indicated. Infection usually increases __________________ and could worsen the lymphedema. Warm compresses could also increase fluid accumulation. It is critical that the client not delay treatment.
purulent, foul-smelling drainage
Symptoms of gonorrhea in men include ______________________ from the penis and painful urination.
- Simple rinses with saline or baking soda solution are effective and moisten the oral mucosa - No Commercial mouthwashes and lemon-glycerin swabs contain glycerin and alcohol - Brushing after each meal is recommended, but every 4 hours may be too traumatic - soft-bristle toothbrush
client with acute leukemia who has mucositis
dribbling, hesitancy, and urinary retention
The symptoms of BPH are related to obstruction as a result of an enlarged prostate. Difficulty in starting the urinary stream is a common symptom, along with _____________________.
loose-fitting, cotton underwear
To prevent urinary tract infections, clients should be encouraged to wear ___________________ to decrease the formation of a warm, moist environment. Clients should void whenever they feel the urge or at least every 4 to 6 hours during the day.
2 consecutive hours
Urine output is maintained at a minimum of 30 mL/hr in adults. Less than this for _________________________ should be reported to the health care provider. A low-grade fever is expected in healing and is the natural inflammatory response to surgery. Moderate drainage can be observed, and the blood pressure is still within normal parameters.
Avoid odor-producing foods, such as onions, fish, eggs, and cheese. Drink at least 3,000 mL of fluid each day.
A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse include in the discharge instructions? Drink at least 3,000 mL of fluid each day. Minimize daily activities. Keep urine alkaline to prevent urinary tract infections. Avoid odor-producing foods, such as onions, fish, eggs, and cheese. Wear snug clothing over the stoma to encourage urine flow into the drainage bag.
Wash the perineum with warm water and soap, cleaning from front to back.
A client is at risk for acute pyelonephritis. The nurse should instruct the client about which health promotion behaviors that will be most effective in preventing pyelonephritis?
assessing present voiding patterns
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
notify the health care provider. The nurse should first notify the health care provider of extreme amounts of emesis because further treatment may be warranted.
A client receiving chemotherapy experiences episodes of severe nausea and has vomited more than 1,000 mL of clear fluid in the past 4 hours. The nurse should first:
becomes bright red.
A client, who had a transurethral resection of the prostate (TURP), has a three-way indwelling urinary catheter with continuous bladder irrigation. In which circumstance should the nurse increase the flow rate of the continuous bladder irrigation?
diabetes mellitus
A history of previous births does not necessarily predispose a client to urinary tract infections. Clients with a history of renal calculi are not necessarily at risk for developing urinary tract infections unless the renal calculi recur. Clients with ___________________ are at a higher risk for developing urinary tract infections, but this risk can be decreased by maintaining good control over blood glucose levels.
low-grade fever, chills, tachycardia
A nurse is assessing a client with lymphoma who reports distress 9 days after chemotherapy. Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms?
documentation of indwelling urinary catheter insertion in clients educational initiatives for individuals responsible for insertion client and family education about insertion and use of indwelling catheters surveillance related to hand hygiene practices
A nurse is working as part of a process improvement team focusing on activities to prevent catheter-associated urinary tract infections (CAUTIs). Which activity would the team most likely address? Select all that apply.
Kegel exercises
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?
The client reports bladder spasms and the urge to void.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
ascending infection from the urethra
Although various conditions may result in cystitis, the most common cause is an _____________________. Strictures and urine retention can lead to infections. Systemic infections are rarely causes of cystitis.
laboratory analysis
Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual, and ____________________ is required to determine when that has been accomplished.
cryopreservation
Because of the high risk of infertility with chemotherapy, pelvic irradiation, and retroperitoneal lymph node dissection that may follow an orchiectomy, ___________________ of sperm is completed before treatment is started and should be discussed with the client.
fresh fruits and vegetables
Clients who undergo chemotherapy or radiation must avoid all __________________________, and all foods should be cooked to avoid bacterial contamination.
Obtain calorie dense foods for snacks. Have family prepare and deliver favorite meals. Eat small portions of each food group. Eat slowly and in a relaxed atmosphere.
The home health nurse is caring for a client receiving chemotherapy. The client reports anorexia and has a weight loss of 15 pounds (6.8 kilograms) over 6 weeks. Which client teaching would be helpful? Select all that apply.
50
The incidence of prostate cancer increases after age ________. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly.
"I understand that I will need to consume adequate amounts of fluids each day." "It is important to observe the color and odor of my urine." "Redness around the stoma should be reported to my physician."
The nurse is caring for a client with a cystectomy and ileal conduit (urostomy) for prior bladder cancer. Which statements by the client would indicate that teaching has been effective? Select all that apply.
Bubble baths and limiting fluid intake Antibiotics
____________________ increase the risk of developing a urinary tract infection. _____________ should be used on a short-term basis because the risk of antibiotic resistance may lead to breakthrough infections with increasingly virulent pathogens.
Phenazopyridine
____________________ may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain.
Minimizing urinary catheter use and duration
___________________________________ of use in all clients, particularly those at higher risk for CAUTI or mortality from catheterization such as women, older adults, and clients with impaired immunity, will reduce the opportunity for infection.
"I'll only need chemotherapy treatment before receiving my bone marrow transplant."
allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?
4 to 6 weeks
After vasectomy, a sperm analysis will be performed every ________________. A sperm-free analysis is necessary before the man can be considered sterile.
"Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers."
A client asks the nurse why taking folic acid is so important before and during pregnancy. What should the nurse tell the client?
- promoting strict hand hygiene - may be placed in a private room with positive pressure - avoid rectal trauma, which may occur with suppositories or enemas - No routine antipyretic therapy, because this could mask a fever
A client being treated for leukemia has an absolute neutrophil count of 400 cells/mm3
Abnormal ileal conduit
A dusky appearance of the stoma indicates decreased blood supply; a healthy stoma would appear beefy-red. Protrusion indicates prolapse of the stoma. Sharp abdominal pain and rigidity suggest peritonitis.
uncontrolled diabetes immunosuppression due to cancer human immunodeficiency virus (HIV) infection
A female client with which condition would be at risk for increased severity of vulvovaginal candidiasis? Select all that apply.
irregular vaginal bleeding
A menopausal woman is taking hormone replacement therapy. What warning sign of endometrial cancer should the nurse instruct the client to report to her health care provider?
20 to 25 days
Clients who undergo bone marrow transplantation typically remain hospitalized for ________________
adverse effects of the chemotherapy
Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the __________________.
affected kidney
Costovertebral tenderness occurs on the side of the _________________ in pyelonephritis.
bereavement period.
Hospice care focuses on supportive care for the client and family. Care for the family may continue throughout the ____________________ Hospice care involves care of the client at home as well as in an inpatient setting. Although professional care is provided in hospice, family members, volunteers, and unlicensed nursing personnel (UAP) also participate in the care of the client.
topical, sublingual, and parenteral
If fentanyl is taken orally it is greatly affected by the first pass effect, which deactivates the medication. By using _______________________ routes, the first pass effect is avoided and dosing is more effective and predictable. Opioids can cause nausea whether taken orally or parenterally and this varies between individuals and the type of opioid being used.
primary prevention secondary prevention tertiary prevention
Immunizing an infant is an example of __________________, which aims to prevent health problems. Administering digoxin to treat heart failure and obtaining a Pap test for screening are examples of ________________________, which promotes early detection and treatment of disease. Using occupational therapy to help a client cope with arthritis is an example of ______________________, which aims to help a client deal with the residual consequences of a problem or to prevent the problem from recurring.
Huber needle
Implanted ports are designed for intermittent access; for the port to be last accessed 7 days ago is within accepted standards. There are no signs or symptoms of an infection at the site. Therefore, the nurse does not need to contact the healthcare provider or complete an incident report. The nurse should access the port with a ________________, which is designed for use in implanted ports. As the port is without signs and symptoms of complications, it should be utilized for the chemotherapy versus a peripheral line.
can persist for several months.
In discussing home care with a client after transurethral resection of the prostate (TURP), what should the nurse tell the male client about dribbling of urine after this surgery?
tumor lysis syndrome tx
Increased I.V. fluids will flush the cellular debris from the system while increasing urine volume and restoring alkalinity, and allopurinol will decrease production of uric acid. Fluids should not contain potassium.
40 years
Most cases of prostate cancer are adenocarcinomas. An adenocarcinoma is palpable on rectal examination because it arises from the posterior portion of the gland. Although the PSA is not a perfect screening test, the American Cancer Society and the Canadian Cancer Society recommend an annual rectal examination and blood PSA level for all men age 50 years and older, or starting at age _______________ if the client is of African descent, or if there is family history of prostate cancer. A colonoscopy is performed to diagnose colon cancer, not prostate cancer. Regular sexual activity does not prevent cancer of the prostate.
Oliguria and hypotension
Nine days after chemotherapy, it is expected for the client to be immunocompromised. The clinical signs and symptoms of shock. Low-grade fever, tachycardia, and chills may be early signs of shock. The client with signs and symptoms of impending septic shock may not have decreased oxygen saturation levels. ________________ are late signs of shock. Urine output can be initially normal or increased.
neutropenia, clients receiving chemotherapy
Reverse or protective isolation is used for clients with diseases and conditions in which there is increased susceptibility to infection such as clients with ______________________________, severely immunocompromised clients, and burn clients.
"I could have trouble getting pregnant."
The nurse teaches 17-year-old girl with has a severe gonorrheal infection about her disease. The nurse realizes that the girl understands the implications of her disease when the client makes which statement?
Hand hygiene
Using sterile technique to help to reduce CAUTI is not necessary. ______________ immediately before and after insertion or any manipulation of the catheter device or site is sufficient.
negative bereavement
Variables that are most predictive of ______________________outcomes include anger and self-reproach, low socioeconomic status, lack of preparation for death, and lack of family support.
permanent sterilization procedure
Vasectomy is considered a _________________ and requires microsurgery for anastomosis of the vas deferens to be completed.
C
Vitamin ______ potentiates the absorption of iron and is also associated with blood clotting or collagen formation.
Hematuria
_____________ occurs in urinary tract infections, renal calculi, and bladder cancer, to name some of the most common causes.
Painful red papules
_____________________ on the shaft of the penis may be a sign of the first stage of genital herpes.
Mucositis
is an inflammation of the oral mucosa caused by radiation therapy.
Condoms
- Condom should always be placed over the erect penis before sex - Some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom - The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise, semen may escape from the condom, providing an opportunity for possible fertilization. - Rather than having the condom pulled tightly over the penis before sex, space should be left at the tip of the penis to allow the condom to hold the sperm.
applicator of radioactive material placed in the vagina:
- Shouldn't receive a complete bed bath while the applicator is in place - shouldn't be bathed below the waist because doing so puts the nurse at risk for radiation exposure - remain on strict bed rest - head of her bed may be raised to a 30- to 45-degree angle - nurse should check the applicator's position every 4 hours to ensure that it remains in the proper place.
caring for a client with urinary calculi of unknown origin
- Strain the urine to obtain the stone and send it for analysis - Urinary calculi are very painful and require pain medication - Client needs to increase fluid to flush out the stone
Chemotherapy & anorexia (weight loss)
- eat nutritious meals and snacks which are nutrient dense - The smell of food often nauseates the client; thus, having the family prepare the foods may increase the tolerance - Eating slowly and in a relaxed atmosphere - clients are often better able to tolerate cool or cold meals (salads, sandwiches)
Hospice care
- focuses on controlling symptoms and relieving pain at the end of life - A multidisciplinary team provides the care - After the client's death, hospice provides bereavement care to the grieving family - provided based on need, - may be provided in a variety of settings, such as freestanding hospice centers, the home, a hospital, or a long-term care facility. - is provided under the direction of a healthcare provider, who is a key member of the hospice team.
A client receiving chemotherapy
- needs to avoid people who have been vaccinated recently, especially by a live virus. - avoid activities that could cause trauma and bleeding. - wash her hands frequently - would avoid crowded places as well as people with colds during flu season because she/he has a reduced ability to fight infection - Fresh fruits and vegetables would be avoided because they can harbor bacteria that cannot be removed easily by washing - Signs and symptoms of infection, such as a sore throat, fever, and a cough, are reported immediately to the health care provider.
discharge plan with a client who is receiving chemotherapy
- obtain as much rest as need - avoid people who have a cold or the flu - report a fever to the HCP - should avoid large crowds - client should eat a well-balanced diet - change some foods if the client has side effects of the chemotherapy and may need to obtain more calories.
which is adjustment in plan of care for a neutropenic client
- protect the client from infection - limiting roommates/visitors and transmission of hospital acquired infections - discussing pegfilgrastim therapy to stimulate the body to make white blood cells
It is important that the client with mucositis
- receive meticulous mouth care, including flossing - Mouth care should be provided before and after each meal, at bedtime, and more frequently as needed - Extremes of temperature should be avoided in food and drink - Half-strength hydrogen peroxide is too harsh to use on irritated tissues.
Chemotherapy may cause
- suppression of the immune system, resulting in a reduction in the WBC count and placing the client at risk for infection - Decreased hemoglobin (Hgb) indicates anemia. - A decreased platelet count would indicate thrombocytopenia, and platelets would be prescribed
Combination chemotherapy is
- used to interrupt cell growth cycle at different points - used to decrease resistance - used to minimize the toxicity from using high doses of a single agent
Tumor Lysis Syndrome (TLS)
-oncologic emergency with rapid lysis of malignant cells -usually the result of chemotherapy or sometimes radiation -may occur 24 hours-7 days after antineoplastic therapy is initiated -develops when chemotherapy or irradiations causes the destruction of a large number of rapidly dividing malignant cells -intracellular contents are rapidly released into the bloodstream
Monitor daily platelet counts.
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last two 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?
monitoring vaginal bleeding
A client diagnosed with cancer of the cervix in situ is scheduled to have a conization. Which is a priority during the 1st 24 postoperative hours?
Hepatic impairment. Left ventricular failure. Complete hair loss within 3 to 4 weeks. Red discoloration of urine.
A client has been diagnosed with breast cancer and is scheduled to begin treatment with the antineoplastic drug doxorubicin hydrochloride. Which side effects would the nurse anticipate? Select all that apply.
Reassign the client to a private room. Obtain a dosimeter badge for all staff members. Place a mark on the floor that is 6 ft (2 m) from the bed. Place a radiation precaution cart outside of the room.
A client is scheduled to have radiation seeds implanted into a cancerous tumor. Which preparation should the nurse complete before the client returns to the care area? Select all that apply.
Measure the circumference of both calves and note the difference.
A client recovering from an abdominal hysterectomy has pain in her right calf. What should the nurse do next?
costovertebral tenderness
A client with a history of cystitis is admitted to the hospital with a diagnosis of pyelonephritis. The nurse should assess the client for which symptom?
Prevent feelings of isolation.
A client with advanced Hodgkin's disease is admitted to hospice because death is imminent. What is the most important nursing goal at this time?
The stoma appears dusky. The stoma protrudes from the skin. The client experiences sharp abdominal pain with rigidity.
A client with bladder cancer undergoes surgical removal of the bladder with construction of an ileal conduit. Which assessment findings indicate that the client is developing complications?
nephrotoxic injury secondary to use of contrast media
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure?
mucositis xerostomia stomatitis
A client with laryngeal cancer has undergone a laryngectomy and is now receiving radiation therapy to the head and neck. The nurse would monitor the client for which adverse effects of external radiation? Select all that apply.
I.V. fluids to increase urine output and allopurinol to inhibit uric acid
A client with leukemia received induction chemotherapy 2 days ago and is now reporting severe diarrhea, decreased urination, cardiac dysrhythmias, and paresthesia with tetany. Laboratory reports reveal hyperkalemia, hyperuricemia, and hypocalcemia. Which action would the nurse anticipate?
Tolerance develops from taking opioids over an extended period. It is characterized by the need for an increased dose to achieve the same degree of analgesia.
A client with pancreatic cancer has been receiving morphine via a subcutaneous pump for 2 weeks. The client is requiring an increased dose of the morphine to manage the pain. How should the nurse document this finding?
"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of a factor that allows the vitamin to be absorbed."
A client with pernicious anemia asks why she must take vitamin B12 injections forever. Which is the nurse's best response?
absence of paresthesia The nurse assesses the client to determine the effectiveness of the monthly dose of vitamin B12, which is to reverse the deficiency and the related symptoms.
A client with pernicious anemia is receiving vitamin B12. The nurse should evaluate the client for which expected outcome of vitamin B12?
Do a breast examination and report the results to the physician. This concern warrants the nurse's performing an examination and reporting the results to the physician. Although pain is not common with breast cancer, it can be a symptom.
A postmenopausal woman is worried about pain in the upper outer quadrant of her left breast. The nurse's best course of action is to:
vaginal discharge that has a fishy odor abdominal pain a temperature above 101ºF (38.3ºC)
A young adult woman tells the nurse she has a slight yellow vaginal discharge. The nurse should tell the client to contact her health care provider if she has which additional symptoms? Select all that apply.
severe pain.
Acute pain is a priority nursing diagnosis for the client with pelvic inflammatory disease because the disease is associated with ___________
lower urinary tract soap and warm water, and cleansing from front to back
Acute pyelonephritis usually begins with a bacterial infection of the ____________________ via the ascending urethral route; most infections are due to gram-negative bacilli, such as Escherichia coli, normally found in the gastrointestinal tract. Thorough perineal care using __________________________________, decreases the likelihood that organisms will be introduced into the urinary tract and ascend upward toward the kidneys.
1 to 3 months
After intracavity radiation, some vaginal bleeding occurs for ________________.
3 months later
At the time a client receives a progestin injection, a follow-up appointment should be made for __________________. The nurse should emphasize the need to adhere to the medication schedule to prevent an unplanned pregnancy. One of the most common reasons for failure of this contraceptive is lack of adherence to the appointment schedule for injections every 3 months.
reproductive-age women
Bacterial vaginosis is the most common vaginal infection in _________________________, and up to 50% of women may be asymptomatic.
bladder infection
Because of the structure of the female genitourinary tract, bacteria causing infection can be introduced into the urethra and travel to the bladder to cause a ________________. One cause of a bladder infection is improper hygiene during toileting. Keeping the perineum as clean as possible diminishes the possibility of bladder infections due to contamination.
unintentional weight loss fever and drenching night sweats enlarged, painful lymph nodes, spleen, and liver decreased reaction to skin sensitivity tests (anergy) susceptibility to viral infections.
Clients with CLL develop
future partners about their health history.
Clients with genital herpes should inform their partners of the disease to help prevent transmission, and the client should be advised to ask
Petechiae, epistaxis
Clients with thrombocytopenia are at risk for bleeding. _______________ (small red or purple spots on the skin) and _____________ (nose bleeds) are both signs of bleeding.
saliva substitute
Head and neck radiation can cause the complication of stomatitis and decreased salivary flow. A _______________ will assist with dryness, moistening food, and swallowing. Meticulous mouth care is needed; however, alcohol and vigorous brushing will increase irritation.
renal colic
If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as _____________. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention.
skeletal destruction
In multiple myeloma, neoplastic plasma cells invade the bone marrow and begin to destroy the bone. As a result of this ____________________, pain can be significant. There is no cure for multiple myeloma.
- contact with animals must be avoided - will experience fatigue and will have to pace activities with rest periods - oral hygiene will have to be provided by using a warm saline gargle instead of brushing the teeth and gums - should report a temperature of 100° F (37.8° C) or higher
Induction therapy teaching
sexually transmitted infection.
Infection of the urethra, or urethritis, is usually caused by a
hematuria urinary frequency and dysuria
Intravesical instillation of BCG commonly causes _____________. Other common adverse effects of BCG include __________________. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain.
nephrotoxic injury
Intrinsic renal failure results from damage to the kidney, such as from ____________________ caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury.
listening to the partner's wishes, communicating and sharing feelings, and being aware of what is important to the spouse
It is common for a spouse to ask what to do to be supportive of a dying partner. Hope-fostering actions include ______________________________________.
immature white blood cells
Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of _________________________.
steady blood level of analgesics
Maintaining a _______________________________ is beneficial for the client with chronic cancer pain. Administering analgesics on a regular basis helps to control pain more efficiently. It may also be necessary for the client to have additional doses of medication ordered to be administered for breakthrough pain. Intravenous analgesics are more effective at controlling pain as they are more predictable in their distribution than many oral medications.
transurethral resection
Maintaining catheter patency during the immediate postoperative period after a _________________ is a priority because postoperative bleeding can occlude the catheter. Catheter occlusion can lead to urine retention, pain, bladder spasm, and the need to replace the catheter.
anal and vaginal
Male condoms are recommended for ________________ intercourse to prevent sexually transmitted infections. Care should be used to avoid injury to the delicate rectal mucosa, and lubrication maybe necessary for comfort with vaginal and anal intercourse.
HSV-2 (genital herpes)
Managing stressful life events can decrease the incidence of outbreaks of __________. Occlusive ointments should not be applied. Antiviral therapies will not cure herpes, but they can manage symptoms and decrease the incidence of outbreaks. Clients with HSV-2 should use condoms to prevent HSV transmission. Cells can be shed at other times, not only when the vesicles are weeping.
vitamin and mineral deficiencies
Many ________________________ can result in anemia. All of these vitamins and minerals need to be assessed, preferably through a nutrition assessment. Deficiencies of vitamins A, B6, and C result in a small cell, microcytic anemia. Folate and vitamin B12 deficiencies result in a large cell, macrocytic anemia. Iron, copper, and vitamin E deficiencies can also result in anemia.
cured
Many women do not seek treatment because they are unaware that they have gonorrhea. They may be symptom-free or have only very mild symptoms until the disease progresses to pelvic inflammatory disease. It can be __________ with the proper treatment.
asymptomatic or experience mild symptoms
Many women who acquire gonorrhea are ______________________ that are easily ignored. They are not necessarily more reluctant than men to seek medical treatment, but they are more likely not to realize they have been affected. Gonorrhea is easily transmitted to all women and can result in serious consequences, such as pelvic inflammatory disease and infertility.
500
Neutropenia occurs when the absolute neutrophil count falls below 1,000 cells/mm3; a value of less than __________ cells/mm3 reflects a severe risk of infection.
cotton avoid
Normal variations in female vaginal discharge should be clear to white, not frothy or purulent. STI: The client should be instructed to wear _________ underwear and ________ pantyhose, wet gym clothes, and tight-fitting garments, such as jeans, so that air can circulate.
confirms multiple myeloma
Presence of Bence Jones protein in the urine almost always __________________ _____________; however, absence of the protein doesn't rule out the disease. Serum creatinine level may be increased (above 1.2 mg/dl in men and 0.9 mg/dl in women). Serum calcium levels are above 10.2 mg/dl (2.55 mmol/L) in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.
transrectal ultrasound, CBC, and BUN and creatinine levels
Prostate cancer: A ___________________ are usually done after diagnosis to identify the extent of the disease and potential metastasis
intake of fluids
Pyelonephritis usually begins with colonization and infection of the lower urinary tract via the ascending urethral route, and the client should have an adequate _______________ to promote the flushing action of urination.
Radiation teaching
Radiated skin is sensitive to the sun and cold temperatures, so it should be protected. Heat should not be applied; the irradiated area should be protected from temperature extremes. Only mild soaps should be used. No lotions, perfumes, or oils should be applied to the area without the consent of the radiologist. Such preparations can increase the skin irritation that results from radiation treatments.
dry mouth oral mucous membranes sense of taste
Radiation of the head and neck often produces _____________ (xerostomia), irritation of the _______________ (stomatitis, mucositis), and diminished ________________ (dysgeusia).
ileal conduit UTI kidney stones
The charge nurse should assign the agency nurse to the client who had an ____________-, the older adult client with a _____, and the adolescent with ___________. Their conditions have lesser acuity.
most acute clients
The charge nurse should assign the experienced nurse to the ________________: the middle-age kidney-transplant recipient, the older adult client in acute renal failure, the older adult client with urinary sepsis, the older adult client just admitted for acute stroke, the young adult client with suspected kidney stones, and the middle-age client with suspected pyelonephritis.
low acuity and stable
The charge nurse should assign the new nurse to the middle-aged client newly diagnosed with bladder cancer awaiting surgery, as this client has a condition common to the genitourinary floor and is of ________________. The charge nurse should assign the agency nurse to the client who had an ileal conduit. That condition has lesser acuity. The charge nurse should assign the experienced nurse to the most acute clients: the middle-age kidney-transplant recipient.
assess reasons acknowledge the client's declination strict hand hygiene
The client is having ongoing chemotherapy. The nurse should _________________ for wanting to continue peripheral chemotherapy and _______________________ of a PICC line. The nurse will need to continue teaching about infections and the need for ___________________ remains the same in or out of the hospital and regardless of which venous access is used. The health care provider prescription needs to reflect site of method of delivery.
fluid balance
The client is six hours post-open hysterectomy. Intravenous fluids are infusing at 125 mL/hr, urinary catheter has drained 170 mL since surgery, and the client reports pain as a 3 out of 10. What is the nurse's priority concern?
destruction and breakdown
The client likely has tumor lysis syndrome, which occurs when a person with cancer (such as leukemia) initiates treatment, causing the rapid ___________________ of large numbers of cells.
prone to infection
The client with Hodgkin's lymphoma who has had radiation therapy is _______________; therefore, the primary goal is to prevent infection. The nurse instructs the client to perform frequent hand hygiene, avoid crowded areas, and report a temperature over 100°F (37.7°C).
Lactobacillus
The client's discharge may be a symptom of bacterial vaginosis, a clinical syndrome resulting from the replacement of the normal vaginal _______________ species with overgrowth of anaerobic bacteria that cause a cluster of symptoms.
difficulty starting the urinary stream
The nurse is assessing a client who has benign prostatic hypertrophy (BPH). The nurse should determine if the client has which symptom?
Perform a depression screening assessment with the client.
The nurse is caring for a client who has begun to lose hair from chemotherapy treatment. The client appears withdrawn and answers questions in one-word statements, which is a change from previous behavior. What is the nurse's priority response?
educate confidentiality judgmental
The nurse should ______________ the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client ________________ unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is ____________; everyone is entitled to health care regardless of his health habits.
incontinent external catheters
The nurse should avoid the use of urinary catheters for clients who are ________________; a bladder training program and frequent use of the toilet are preferred; _________________ may be used if necessary in incontinent clients. The nurse should not clean the periurethral area with antiseptics; cleansing the meatal surface during daily bathing or showering is appropriate.
external-beam radiation therapy
The pregnant granddaughter is in no danger from ____________________, and the granddaughter would pose no health threat to the client. Anyone with possible communicable illnesses should not visit. A family with four children may pose a threat because of the large number of people visiting.
"Have you considered that you provide hope by listening and supporting what is important to her?"
The spouse of a client on hospice care expresses frustration to the nurse and states, "My spouse wants me to 'have hope' during this time, but I don't know what that means I should do." What is the nurse's most appropriate response?
white discharge Yellow-green Gray-white
The symptoms of Candida albicans include itching and a scant __________________ that has the consistency of cottage cheese. _______________ discharge is a sign of Trichomonas vaginalis. ____________ discharge and a fishy odor are signs of Gardnerella vaginalis.
immunity against
There is no _____________ gonorrhea and, if exposed again, the girl can again become infected. Although a condom may provide some protection against contracting gonorrhea, it is not an adequate protection against the condition and will not help clear up an existing infection. It is only with proper antibiotic administration that the condition can be eradicated.
withdrawn and minimizes interaction with the nurse
This client may be experiencing clinical depression, which is common in clients undergoing treatment for cancer. The client is _____________________________, which can indicate depression. The nurse should assess the client using a validated depression screening tool, including assessing for suicidality.
benign prostate enlargement
Transurethral resection of the prostate (TURP) is a common surgical procedure used to treat male clients with ____________________.
severe diarrhea, decreased urination, cardiac dysrhythmias, and paresthesia with tetany hyperuricemia hyperkalemia hyperphosphatemia renal failure hypocalcemia
Tumor Lysis Syndrome (TLS): The syndrome results in the signs and symptoms __________________________
24 hours
Uncontrolled vaginal bleeding is the priority concern during the 1st _____________ after conization of the cervix. This is best monitored by keeping an accurate pad count, which assesses the extent of bleeding. Hourly vital signs and strict bed rest are unnecessary unless complications develop..
lunch
Urinary incontinence, although common in the elderly is not a normal part of aging. Not drinking after ___________ can lead to dehydration. Stress incontinence is related to detrusor muscle weakness and not dementia or Alzheimer's disease. Leaving a light on in the bathroom at night appropriately addresses possible safety/fall concerns.
Use condoms at all times during sexual intercourse.
What is most important for the nurse to teach a client newly diagnosed with genital herpes?
voiding pattern
What is the most important assessment for the nurse to make when administering tamsulosin to a client with benign prostatic hyperplasia (BPH)?
helping the client walk
Which nursing measure would most likely relieve postoperative gas pains after abdominal hysterectomy?
Acute pain.
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
petechiae epistaxis (bleeding from the nose)
Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply.
antifungal agents
White patches and ulcers in the mouth and throat suggest Candidiasis, which is common in immunocompromised clients and in those receiving radiation therapy. It is treated with _____________________, as well as by offering yogurt and frequent medicated mouthwash rinses. Oral intake should be encouraged to maintain hydration. Weight loss may occur if left untreated;
fallopian tubes
With a severe gonorrheal infection, scarring of the ____________ may occur, and becoming pregnant may be difficult or impossible. If the girl's partner is not treated, she can be reinfected.
condylomata acuminata
Women with _________________ are at risk for cancer of the cervix and vulva. - Yearly Pap smears are very important for early detection. - is a virus, there is no permanent cure - can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.
candidiasis
Women with underlying medical conditions, such as uncontrolled diabetes and HIV infection or cancer-causing immunosuppression, correlate with an increasing severity of _____________.
Urethritis profuse, purulent discharge and dysuria
__________ is usually the initial clinical manifestation of gonorrhea in men. The symptoms include a ________________________. Complications are uncommon, but they include prostatitis and sterility.
Dyspareunia (painful intercourse)
_____________ is the occurrence of pain in the labial, vaginal, or pelvic areas during or after sexual intercourse. It may be caused by inadequate vaginal lubrication in the menopausal woman.
Combination chemotherapy
___________________ means that multiple drugs are given to interrupt the cell growth cycle at different points, to decrease resistance to a chemotherapy agent, and to minimize the toxicity associated with use of a high dose of a single agent (i.e., by using multiple agents with different toxicities).
Normal saline
___________________ solution is used for administering blood transfusions. Lactated Ringer's solution or dextrose solutions may cause blood clotting or RBC hemolysis. Current guidelines do not indicate a "no priming" method without NSS.
Dysuria and a mucopurulent urethral
_____________________ discharge characterize gonorrhea in men. Gonococcal symptoms are so painful and bothersome for men that they usually seek treatment with the onset of symptoms.
Nausea, vomiting, and a foul vaginal discharge
_______________________ are common adverse effects of internal radiation therapy for cervical cancer. A foul-smelling discharge may develop from the destruction and sloughing of cells. Vaginal discharge may persist for some time.
embolus
the client has severe pain and numbness in her left leg. : The client is likely suffering from an _______________ as a result of abdominal surgery. The nurse should inspect the left leg for color and temperature changes associated with tissue perfusion.
S/S of anemia
- Fatigue, shortness of breath, pale skin, and dried, cracked lips, tongue, and mouth. - (normal: 12-17) hemoglobin is 9 g/dL (90 g/L), -(normal 4-5) red blood cell count is 3.5 million cells/mm3 (3.5 × 1012/L)
The client is demonstrating signs of anemia and should
- increase the iron in the diet - should maintain an adequate fluid intake of about 3,000 mL per day - beef, lamb, and iron-rich vegetables are more important in the diet at this time.
Bence Jones protein in the urine
A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include
Assess the patency of the urethral catheter.
A client who had transurethral resection of the prostate (TURP) 2 days earlier has lower abdominal pain. What should the nurse do first?
"The radioactive material is controlled and stays with the source; once the material is removed, no radioactivity will remain."
A client who is to have a vaginal radium implant tells the nurse she is concerned about being radioactive. The nurse should tell the client:
promoting regular flossing of teeth
A client who is undergoing radiation therapy develops mucositis. Which action should be included in the client's plan of care?
Avoid people who have recently received live vaccines. Avoid activities that may cause bleeding. Wash hands frequently. Avoid crowded places such as shopping malls.
A client who's receiving chemotherapy for breast cancer develops myelosuppression. Which instructions would the nurse include in the client's discharge teaching plan? Select all that apply.
middle-aged male middle-aged female older male who uses a wheelchair
A group of visitors arrives to visit a client in radiation precautions. Which visitor(s) should the nurse prohibit from entering the client's room?.
vessel irritation or extravasation
A major concern with IV administration of cytotoxic agents is __________________. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of blood return when administering vesicant or non-vesicant chemotherapy due to the risk of extravasation.
destruction of spermatozoa before they enter the cervix
A nulliparous client says that she and her husband plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
supporting the client's emotional status The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.
A nurse is providing in-service education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?
to help the client and the client's family manage the terminal illness
A nurse refers a client with terminal cancer to a local hospice. What is the goal of this referral?
6 hours
After intravesical chemotherapy, the client must treat the urine as a biohazard; this involves disinfecting the urine and the toilet with household bleach for ___________ following a treatment. the client can use the toilet, but must disinfect the urine with bleach.
expressing the client's angry feelings to the nurse
An 18-year-old client is recently diagnosed with leukemia. What is the most appropriate short-term goal for the nurse and client to establish?
sexually transmitted infection.
An 18-year-old female takes birth control pills and is sexually active with her boyfriend. She has a purulent vaginal discharge that is sometimes frothy. What nursing judgment should the nurse make about this finding?
ileal conduit discharge instruction
An adequate fluid intake aids in the prevention of urinary calculi and infection. Odor-producing foods can produce offensive odors that may impact the client's lifestyle and relationships. Lack of activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow.
White patches
CHEMO: _________________ on the tongue and oral mucosa indicate oral candidiasis and the adolescent should report the presence of this to their physician but should not attempt to remove them.
baking soda and water or normal saline solution
Chemo teaching: - Use a soft bristle brush. - Rinsing the mouth every 2 to 4 hours with a nonirritating solution, such as __________________ helps prevent stomatitis. - client should avoid commercial mouthwashes with alcohol, which may dry out the mucous membranes.
chemotherapy complications
DIC, pancytopenia (deficiency of all blood cells), and mucositis are possible ________________
assess the client's bladder.
Eight hours after an abdominal hysterectomy, the client has not voided and says to the nurse, "I don't think I can urinate." The nurse should first:
pain management, emotional support, and comfort measures
Palliative care for the client with advanced cancer includes ______________________________.
neuropathy paresthesia
Pernicious anemia is caused by a lack of vitamin B12. Primary symptoms include _______________ with _______________ of hands and feet.
prerenal failure
Poor perfusion to the kidneys may result in _________________.
fluids and a soft diet
Radiation therapy: Antispasmodics are used to help reduce diarrhea. Encouraging ________________________ will help with anorexia. Antiemetics should be given before the onset of vomiting. Frequent mouthwashes are indicated to prevent mycosis.
esophagitis with dysphagia
Radiation-induced _________________________ is particularly common in clients who receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum and is within the field of primary treatment.
pregnant adults or children
Safety precautions used in caring for a client receiving radiation include prohibiting visits by ___________________
iron deficiency anemia
Signs of ________________________ include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache.
vaginal pH
Spermicidal agents work by destroying the spermatozoa before they enter the cervix. In addition, some spermicides alter the _____________- to a strong acidic environment, which is not conducive to survival of spermatozoa. The diaphragm or condom is a barrier.
blood clots
TURP: The lower abdominal pain is most likely caused by bladder spasms. A common cause of bladder spasms after TURP is _________ obstructing the catheter; therefore, the nurse's first action should be to assess the patency of the catheter.
testicular self-examination
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include
what she can eat and drink before admission
The client will have an abdominal hysterectomy tomorrow. Which information will be most important for the nurse to give to the client prior to admission to the hospital?
Strain urine. Medicate for pain.
The nurse is caring for a client with urinary calculi of unknown origin. Which interventions would be appropriate for this client? Select all that apply.
Prevent infection.
The nurse is developing a care plan for a client who has had radiation therapy for Hodgkin's lymphoma. What is the primary goal of care for this client?
abdominal hysterectomy
Urinary control may not return for 6 to 8 hours after surgery due to the effects of anesthesia and bladder manipulation during surgery. Urine retention is common; voiding a small amount of urine after surgery may be indicative of urine retention. The nurse should further assess for bladder distention by palpating and percussing the bladder and should intervene with catheterization as appropriate.
intrinsic factor
Vitamin B12 absorption depends on ____________________, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption
Achieve effective management of bone pain.
Which nursing goal is appropriate for the nurse to make with a client who has multiple myeloma?
Thrombocytopenia cystitis
________________ (reduced platelet count) and leukopenia (reduced white blood cell count) may occur with systemic radiation; ________ may occur with radiation of the genitourinary system.
Intermittent, painless
________________ vaginal bleeding is a classic symptom of cervical cancer
guidelines apply to peripheral and central venous lines:
- Assess the insertion site for signs of infiltration, such as swelling and redness - central venous lines may be long-term venous access devices - difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. - client cough or move position may change the status of the line if it is temporarily against a vessel wall - Occlusion warrants more thorough evaluation via X-ray study to verify placement if the status is questionable and may require a declotting regimen. - should not administer any drug if the IV line is not open or does not have an adequate blood return.
Clients with ALL are at risk for infection
- Place the client in a private room - Strict hand-washing procedures should be enforced and will be the most effective way to prevent infection - not necessary to have the client wear a mask - staff does not need to wear gloves - can have visitors; however, they should be screened for infection and use hand-washing procedures.
Process improvement activities related to catheter-associated urinary tract infection (CAUTI)
- documentation of indwelling urinary catheter insertion - training of personnel who insert such catheters - initiation and completion of patient and family education - hand hygiene surveillance - documentation of the necessity for catheterization and a review of its ongoing need - monitoring of insertion techniques - use and maintenance of closed urinary drainage systems - no routine orders for irrigation, cultures, or changing of catheters
radiation therapy skin care
- use an electric razor on any skin areas that are receiving radiation - skin should be cleaned daily with a mild soap, not harsh antibacterials. - Lotion should be removed from the skin before any treatment and then reapplied after the treatment. -The radiated skin area needs to be kept clean, dry, and open to air.
iron replacement and change of diet
A 4-year-old child is seen at the clinic for a mild iron deficiency anemia caused by a poor diet. The parents ask the nurse what type of treatment to expect. What is the most appropriate response by the nurse? Because the main etiological factor is diet, treatment would focus on addressing the iron deficiency in the diet, rather than more drastic options such as blood transfusion, bone marrow transplant, splenectomy, and steroid therapy.
Sexual dysfunction can be a side effect of radiation therapy. Preoccupation and worry about sexual function can cause impotence.
A 40-year-old client who has completed radiation therapy for testicular cancer tells the nurse that he is unable to achieve an erection. Which responses are appropriate? Select all that apply.
Assess color and temperature of the left leg.
A 45-year-old client had a complete abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago. The client's abdominal dressing is dry and intact. While sitting up in the chair, the client has severe pain and numbness in her left leg. What should the nurse do first?
fever Anorexia and dyspnea
A _____________ is a result of a decreased white blood cell count. ________________________ (shortness of breath) are a result of a decreased red blood cell count. Bone pain is a result of stress on the bone related to the unrestricted proliferation of the leukemic blast cells.
high-fat, low-fiber
A _______________ diet is a risk factor for colorectal cancer
frothy, purulent vaginal discharge
A _____________________ in a sexually active female client is typically caused by a sexually transmitted infection such as trichomonas. Other diseases, such as chlamydia, may also be present. Both the client and the boyfriend need treatment after the disease is determined.
middle-aged stable client with bladder cancer awaiting surgery
A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is starting the first day on the unit. An agency nurse and an experienced nurse are also present. The charge nurse should assign the new graduate nurse to the care of which client?
vitamins B6 and B12, folate, iron, and copper
A client has extreme fatigue and is malnourished, and laboratory tests reveal a hemoglobin level of 8.5 g/dL (85 g/L). The nurse should specifically ask the client about the intake of food low in which nutrients?
"You are unfamiliar with what to say to your mother if asked about her dying?" "Let's talk about your mother's illness and how it may progress so you are prepared." "You sound like you have some questions about your mother dying. How can I help?" "Tell me how you're feeling about your mother dying."
A client has just been diagnosed with terminal cancer and is being transferred to home hospice care. The client's child tells the nurse, "I don't know what to say if my mother asks me if she is going to die." Which responses by the nurse are appropriate? Select all that apply.
Assess the client's reasons for treatment preference. Respect the client's treatment choice for care. Reinforce the need for strict hand hygiene in the hospital.
A client is admitted to the hospital for ongoing chemotherapy but insists it be administered peripherally, declining a peripherally inserted central catheter (PICC) insertion. What action(s) will the nurse perform with the client? Select all that apply.
Eat foods with good sources of iron.
A client is admitted with fatigue, shortness of breath, pale skin, and dried, cracked lips, tongue, and mouth. The hemoglobin is 9 g/dL (90 g/L), and red blood cell count is 3.5 million cells/mm3 (3.5 × 1012/L). What should the nurse instruct the client to do?
<1,000
A client is at moderate risk for infection when the ANC is __________ (1 × 109/L)
Reducing stressful life events may decrease the incidence of herpetic outbreaks.
A client is diagnosed with genital herpes (herpes simplex virus type 2, or HSV-2). What information should the nurse give to the client about managing this health problem?
The nurse needs to identify coping mechanisms in order to support the spouse.
A client with stage IV pancreatic cancer is admitted to hospice. The spouse breaks down crying, stating "I just don't know what I will do if my partner dies!" What is the best response by the nurse?
an expected effect of the radiation therapy.
A client, who had intracavity radiation treatment for cervical cancer 1 month earlier, reports small amounts of vaginal bleeding. This finding most likely represents
See the health care provider immediately.
A middle-aged female with a history of breast-conserving surgery, axillary node dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen. Which action should the nurse suggest?
140,000 to 400,000/µl
A normal platelet count is ___________________________ in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia).
Cover the client with warmed blankets.
A nurse is assessing a client when she returns from same-day surgery for a dilatation and curettage. The nurse checks preoperative vital signs at 0830 to compare them with the current vital signs at 2230 (see chart). What should the nurse do first?
"You should leave a light on in your bathroom at night."
A nurse is attending a seminar at the local senior center. The nurse knows the presenter has a good understanding of genitourinary changes in the elderly when the presenter makes which statement?
Educate the client about why it's important to inform sexual contacts so they can receive treatment.
A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
The focus of care is on controlling symptoms and relieving pain. A multidisciplinary team provides care. Bereavement care is provided to the family.
A nurse is caring for a terminally ill cancer client who is being transferred to hospice care. Which information regarding hospice care would the nurse include in the teaching plan? Select all that apply.
Bladder UTI is mostly causes by bad hygiene
A nurse is instructing a female client on the proper hygiene of wiping after toileting from front to back in order to prevent contamination of the urethra. Which area of the genitourinary tract is most prone to infection requiring treatment due to improper hygiene?
- placing an infection control sign on the door requiring a mask/gown/glove - placing a sign on the door to keep the door closed at all times - assuring that visitors have no temperature or flu-like symptoms - using SBAR communication to recommend pegfilgrastim
A nurse is reviewing updated laboratory data stating that the oncology client has an absolute neutrophil count of less than 1000 mm3 following the third infusion of chemotherapy. Which interventions would be added to the plan of care? Select all that apply.
increasing age exposure to chemical pollutants long-term exposure to the sun genetics immunosuppression
A nurse is teaching a client about skin cancer. Which risk factors for skin cancer should the nurse explain? Select all that apply.
"I'll use hats to protect my head from the sun when my hair falls out."
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?
Provide information on free screening programs. Provide education on breast cancer self exams.
A public health nurse is teaching a class for social workers serving at-risk clients from lower socioeconomic backgrounds about breast cancer prevention. A learner asks what can be done to better help these clients on a daily basis. The nurse advises that the most effective way of helping clients is to do what? Select all that apply.
disposable gown and gloves
Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a __________________ when preparing and administering chemotherapy.
thrombophlebitis
After abdominal pelvic surgery, the client is especially prone to __________________. Measuring calf circumference can help detect edema in the affected leg. The calf should not be rubbed or palpated because a clot could be loosened and travel to the lungs as a pulmonary embolism.
fluid volume deficit
All abdominal surgery clients have a potential for _________________________. Post-op urine output should be at least 30 mL/hr; the output of 170 mL in six hours is slightly under this minimally accepted amount. Pain is sufficiently treated
fever and petechiae
An adolescent client is admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the most urgent nursing intervention?
advance directives
By federal law, all clients entering a hospital or hospice program are offered the chance to make an ______________________, so that their wishes will be known and followed in an emergency. Worry about extraordinary means being taken can be discussed with the client later, but the client needs to be informed that the directive is a federal requirement to protect the client's autonomy.
once a day closed adequate fluid intake 2 weeks.
CAUTI: The nurse should provide meticulous perineal care at least ________________, maintain a __________ drainage system, and encourage the client to obtain an ________________. It is not necessary to change the catheter daily. It is recommended that long-term use of an indwelling urinary catheter be evaluated carefully and other methods considered if the catheter will be in place longer than ______________. It is not necessary to request a prescription for antibiotics as the client does not currently have an infection.
hypercalcemia
Calcium is released when bone is destroyed, causing _______________. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.
prostate gland
Cancer of the _________________ is the second leading cause of cancer death among American and Canadian men and is the most common carcinoma in men older than age 65. Incidence of prostate cancer is higher in men of African descent, and onset is earlier. Most prostate cancers are adenocarcinoma. Prostate cancer is usually multifocal and slow growing and can spread by local extension, by lymphatics, or through the bloodstream. PSA >4 ng/mg is diagnostic; a free PSA level can help stratify the risk of elevated PSA levels. Metastatic workup may include skeletal X-ray, bone scan, and computed tomography or magnetic resonance imaging to detect local extension, bone, and lymph node involvement. The urine does not have prostate cancer cells.
RBCs, white blood cells, and platelets.
Chemotherapy can cause myelosuppression, which is a decreased number of _________________________
thrombocytopenia anemia neutropenia
Children with acute lymphocytic leukemia have a reduced platelet count (___________________), reduced red blood cell count (____________), and reduced white blood cell count (________________) because of unrestricted proliferation of immature white blood cell. Chemotherapy is used to treat leukemia and contributes to thrombocytopenia, neutropenia, and anemia.
soap and water and keep the area dry
Clients receiving radiation experience dryness or redness in the area of the radiation. The nurse instructs the client to wash the area with _______________________. The client does not apply lotion, shave, or cover the area.
granulocytopenia
Deficiency of granulocytes (white blood cells). Clients with ALL are at risk for infection due to ______________________.
febrile neutropenia
Development of a fever while neutropenic, known as ____________________, is an oncological emergency.
RBC platelet
Diagnosis of AML is based on blood work indicating low ___________ count and low ____ count.
anger
Diagnosis of a serious illness would be a shock to anyone but particularly a young person. Feelings of _________ are normal and should be expressed. Gaining an intellectual understanding of his illness would also be necessary, but such learning will not take place if the client's feelings have not been addressed.
acute cervicitis urinary tract infections. Douching mild soap and water 6 hours but no longer than 24 hours period
Diaphragm should not be used if the client develops _______________, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with an increased incidence of ______________________ __________________ after the use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with ________________ after each use. A diaphragm should be left in place for at least ______________________________ after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this _____________.
energy level white blood cell count
Diarrhea may occur with radiation to the abdomen. Decreased ________________ and decreased _____________________ are potential complications of radiation therapy.
24 to 48
Douching within _____________ hours before a Pap (Papanicolaou) smear may wash away cells and secretions needed for accurate test results. The test should be scheduled for a time when the client is not menstruating. The client may bathe as desired. No bowel preparation is needed.
perineal exercises pads few months
Dribbling of urine can occur for several months after TURP. The nurse should teach the client __________________ to strengthen sphincter tone. The client may need to use ______ for temporary incontinence. The client should be reassured that continence will return in a __________ and will not be a chronic problem
"There is no way to know whether you have cancer until the surgeon performs a biopsy." "Are you saying you think you have cancer?" "If it's cancer, prostate cancer has a very high cure rate."
During an admission assessment, a nurse asks why a client is being admitted to the facility. The client responds, "The physician found a lump in my prostate gland. I guess I have cancer." Which response by the nurse would be most therapeutic? Select all that apply.
fluid quantities and allopurinol
During chemotherapy for leukemia, tumor lysis syndrome may occur as cell destruction releases intracellular components, resulting in hyperuricemia. Large ________________________ therapy help reduce the amount of uric acid that results from tumor lysis syndrome but don't stop the cell lysis.
emotional support.
Even though the time of death cannot be predicted, some clients appear to "wait" until family members are away from the bedside to die. The family does not need to hear how the client is no longer in pain and at rest. The family needs ________________ The family should not be permitted to feel guilty for leaving the client. The family should take rest periods away from the bedside in order to provide the best support to the client.
rest and meal planning
Fatigue is a common symptom of leukemia due to red blood cell suppression the client should be told about the need for ___________________
white blood cells and thrombocytes
Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal _________________________ by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks.
red meats, beets, and cabbage
Foods such as ________________________ are good sources of iron.
radiation syndrome
General signs and symptoms of ________________ include nausea, vomiting, anorexia, and malaise.
red meat, egg yolks, whole wheat breads, seafood, nuts, legumes, iron-fortified cereals, and green, leafy vegetables
Good sources of dietary iron include _____________________________________. Fresh fruits and milk products contain only small amounts of iron. White bread isn't a good iron source
lymph nodes bone marrow
Hodgkin's disease (Hodgkin's lymphoma) is a disease of the ________________ and can affect _____________, often resulting in decreased WBCs.
physical, emotional, and spiritual needs
Hospice care services provide palliative care and also address the client's ____________________________. The focus of the care is on the care on the client and family. Hospice care services can begin 6 months before the illness is terminal and can be renewed depending on the course of the disease. Hospice care collaborates with the client's health care provider (HCP), but the HCP does not direct the care. Not all hospice clients want to die at home, nor is it a requirement to be at home to receive hospice care.
supportive care for terminally ill clients and their families
Hospices provide ______________________________. Hospice care does not focus on teaching family how to care for clients in the home. Hospice care does not aim to educate the client and family about cancer and its treatment. It is also not a faith-based service, although people who have religious or spiritual beliefs can integrate their practices and beliefs into their hospice care.
leave the room and notify the radiation therapy department
If a radioactive implant becomes dislodged, the nurse should immediately __________________________. The nurse shouldn't attempt to handle the implant or remain in the room with the implant.
Unintentional weight loss.
In assessing a client in the early stage of chronic lymphocytic leukemia (CLL), the nurse should determine if the client has:
bone marrow transplantation
Most clients receive chemotherapy before undergoing ___________________________. Most women older than age 26 can't bear children after undergoing treatment because they experience the early onset of menopause.
intrinsic factor in the stomach
Most clients with pernicious anemia have deficient production of _____________________. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of red blood cells in this condition.
"It's okay to be scared. What is it about cancer that you are afraid of?"
On the night before a 58-year-old wife and mother is to have a lobectomy for lung cancer, she remarks to the nurse, "I'm so scared of this cancer. I should've quit smoking years ago. Now I've brought all this fear and sadness on myself and now my family." How should the nurse respond to the client?
prostate-specific antigen
PSA stands for __________________, which is used to screen for prostate cancer.
Talking about death is an uncomfortable situation.
Paraphrasing the child's question allows the child to elaborate on thoughts and feelings. It is also important to assess the child's knowledge base so the child feels prepared to talk with the client. Conveying information clearly and openly can alleviate fears and strengthen the individual's sense of control. Encouraging verbalization of feelings helps build a therapeutic relationship based on trust and reduces anxiety.
emotional support
Radiation or chemotherapy may cause sexual dysfunction. Libido may only be temporarily affected, and the client should be provided with _______________. Impotence after cancer is not necessarily permanent. Impotence is not associated with imbalanced or improper nutrition.
Nausea and vomiting, anorexia, mucosal ulceration, and diarrhea.
Radiation therapy can cause adverse effects such as _____________________________________
vaginal radium implant
Radioactivity affects tissues but does not make them radioactive. Once the radioactive source is removed, no radioactivity remains. The client receiving sealed internal radiotherapy is not discharged until the radioactive source is removed. With cervical implants, there is no way to shield the area above the waist from radiation.
teenagers and young adults
STIs are most prevalent among ________________________, and nearly two thirds of all STIs occur in people younger than 25 years. The incidence of STIs is increasing due to multiple sex partners and sexual activity at a younger age. STIs affect men and women of all backgrounds and economic levels.
radiation implants
Safety precautions when caring for a client receiving ________________ include assigning the client to a private room and obtaining a dosimeter badge for all staff who will be caring for the client. Because a distance of 6 ft (2 m) should be maintained by all visitors, placing a mark on the floor to identify this distance should be completed before the client returns to the room. A radiation cart should be placed outside of the room that includes a posting that explains the radiation safety precautions. Pregnant staff members should not be assigned to the client, so they would not need a radiation shield.
granulocytes
Some clients with chronic myelogenous leukemia can have WBC counts as high as 500,000/mm3 (500x109/L). This is due to the high number of ______________ that are counted on the WBC test, even though these cells are not functioning as normal WBCs.
Pap smear
The _____________ identifies atypical cervical cells that may be present for various reasons. Cancer is the most common possible reason, but not the only one. The Pap smear does not show abnormal viral cells unless specific gene typing is done for human papillomavirus. An adequate smear provides accurate diagnostic data; the false-positive rate is only about 5%.
ambulation
The _________________ of the client diagnosed with renal calculi may safely be delegated to the UAP. The registered nurse should care for the clients with a suprapubic catheter draining burgundy-colored urine. The client returning from anesthesia unit requires assessment, and assessment is not within the scope of practice for the UAP. The UAP would also not be permitted to perform bladder irrigation.
tamsulosin
The alpha-adrenergic blocker ___________________ relaxes the smooth muscle of the bladder neck and prostate, so the urinary voiding symptoms of BPH are reduced in many clients.
Open-ended questions
The best approach for a client who is fearful about having surgery is to allow the client opportunities to express her fears. ______________________ should elicit the client's individual and specific fears. This then gives the nurse the opportunity to provide clarification, information, and support and possibly to offer other resources.
scope of practice
The care of the client who is having radiation treatments and requires skin care at the site that involves bathing and application of a nonmedicated moisturizer is within the _____________________for the UAP. Discharge planning, assessing drainage, and changing wet-to-dry dressings are nursing care activities that must be performed by a licensed nurse.
comfort and pain management
The care provided to allow natural death is based on patient ____________________ instead of extension of a person's life. Thus, the management of pain, as well as other symptoms, is the established strategy for managing humane and evidence-based palliative care. Since this is the rationale for providing the treatment, this is the best response to the decision maker's concern.
maintain catheter patency.
The client has a continuous bladder irrigation after a transurethral resection. A major goal related to the irrigation is to:
Instruct the client on the need to lie still. Administer analgesics as ordered. Monitor vital signs and assess site for bleeding and drainage.
The client receives a diagnosis of rule out leukemia and the healthcare provider performs a bone marrow biopsy. What should the nurse do post biopsy? Select all that apply.
Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of their lungs, not their head.
The client requires additional teaching if they mention that they will lose the hair on their head as a result of radiation therapy of lungs.
lesions lesions
The client should be taught to abstain from sexual intercourse while ____________ are present. Condoms should be used at all times as the virus can be shed without ____________ present. Multiple partners would promote the spread of genital herpes. There is no vaccine available to prevent genital herpes. Although periodic examinations should be advised, a urologist does not necessarily need to be seen when lesions occur.
body temperature
The client's ____________________ dropped 2.5° F (1.4° C) from the preoperative to postoperative phase. The client lost heat during the preoperative period. The client has not had time to regain the heat she has lost and should not be discharged postoperatively until her postoperative vital signs, which include body temperature, are closer to her preoperative vital signs. The client's pulse rate, respiratory rate, and blood pressure have compensated according to the client's hypothermic state and will reflect changes as the client warms up.
"The reason for providing pain medication is to alleviate pain and suffering."
The decision maker for a dying client on hospice care expresses to the nurse that all treatment, including pain medication, should be stopped to allow for natural death to occur. Based on the principles of palliative care, what is the nurse's best explanation about the plan of care for this client?
exercise
The discomfort associated with gas pains is likely to be relieved when the client ambulates. The gas will be more easily expelled with _________. Offering a hot beverage, providing extra warmth, and applying an abdominal binder are not recommended and could aggravate the discomfort of postoperative gas pains.
staying with the family while they view the body.
The family may go to great lengths to ensure that their loved one will not die alone. However, despite the best intentions and efforts of the family and clinicians, the client may die at a time when no one is present. If the client dies while family members are not present, the family may express feelings of guilt and will need emotional support. This would be provided by _________________________
Stay with the family while they view the body.
The family of a client receiving hospice care takes a dinner break only to learn that the client died while they were absent from the bedside. What should the nurse do to console the family at this time?
focuses on supportive care for the client and family.
The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family?
anemia Platelet production WBC
The induction therapy will cause __________, and the client will experience fatigue and will have to pace activities with rest periods. __________________ will be decreased, and the client will be at risk for bleeding tendencies; oral hygiene will have to be provided by using a warm saline gargle instead of brushing the teeth and gums. The client will be at risk for infection owing to the decrease in _________ production and should report a temperature of 100° F (37.8° C) or higher.
infection-free at the beginning
The notion that genital herpes is only transmittable when visible lesions are present is false. According to the Centers for Disease Control and Prevention, long-term monogamous relationships help prevent the spread of herpes, but the client is protected only if the partner is __________________ of the relationship. Anyone not already in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.
"I will rinse my mouth every 2-4 hours with baking soda and water."
The nurse developed a plan of care for an adolescent who is receiving chemotherapy for lymphoma and has developed stomatitis. What statement made by the adolescent demonstrates understanding of the education provided from the plan of care?
urinary output > 30 mL per hour mucus threads in the urine The client will not have painful urination and gross hematuria. The client should have continuous urination, not absence of urine (anuria).
The nurse is caring for a client with bladder cancer with an ileal conduit. What is a characteristic of the urine in the ostomy immediately postoperatively? Select all that apply.
Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain.
The nurse is collaborating with the healthcare provider to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan would be most appropriate for managing the client's pain?
Rest as needed. Avoid people with colds or flu. Contact the health care provider (HCP) if a fever develops.
The nurse is developing a discharge plan with a client who is receiving chemotherapy to treat lymphoma. What should the nurse include in the plan?
"Expect blood in your urine in the first couple of days following the procedure."
The nurse is providing preoperative instructions to a client who is having a transurethral resection of the prostate. What should the nurse tell the client?
Prostate cancer is usually multifocal and slow growing. Most prostate cancers are adenocarcinoma. The incidence of prostate cancer is higher in men of African descent, and the onset is earlier. A prostate specific antigen (PSA) lab test greater than 4 ng/mg will need to be monitored.
The nurse is teaching a client newly diagnosed with prostate cancer. Which points should be included in the instruction? Select all that apply.
information firsthand
The nurse may contact the client's spiritual advisor if the client so desires. The nurse can listen to the client, but spiritual support is best provided by someone proficient in that field, such as a spiritual advisor. It would be appropriate for the nurse to contact the clergy of another faith only if no other resources were available and if the client consented. The nurse should speak with the client and get the ____________________, researching the admission history only if that is not possible.
"Keep the area covered when you go outdoors."
The nurse plans to teach a client who is receiving radiation therapy how to care for the skin at the radiation site. What should the nurse tell the client?
8-hour period
The nurse should suspect that a client has urine retention when she is unable to void in an_____________. Before calling the health care provider for a prescription to catheterize the client, the nurse should assess the client's bladder for distention. The nurse would need to gather data about the client's ability to void before calling the surgeon. Increasing fluid intake is not indicated at this time in this situation.
docusate sodium
The nurse should withhold administering ____________________, a stool softener, and document that the woman has had loose stools. The nurse is responsible for assessing contraindications and adverse effects of medications, and administering the medication when the client already has loose stools is unsafe. The assessment should also include auscultation of bowel sounds and inquiry about gas pains, but the stool softener should still be withheld.
"I cannot wait to get home to my cat!" The nurse identifies that the client does not understand that contact with animals must be avoided because they carry infection and the induction therapy will destroy the client's white blood cells (WBCs)
The nurse understands that the client who is undergoing induction therapy for leukemia needs additional instruction when the client makes which statement?
Normal ileal conduit
Urinary output greater than 30 mL/hr is a normal sign of adequate renal perfusion. Stomal edema is a normal finding during the first 24 hours after surgery. Because mucous membranes are used to create the conduit, mucus in the urine is expected.
100,000/mm3
WBC count (leukocyte count) normally has an upper normal range of about 11,000/mm3 (11x109/L). White counts above ____________ (100x109/L) indicate a pathology such as leukemia is present.
contracting STDs
Wearing a condom during intercourse considerably reduces the risk of ________________. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and limiting the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs.
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
What education should the nurse give to a male client older than age 50 to help ensure early identification of prostate cancer?
Verify patency of the line by the presence of a blood return at regular intervals. Inspect the insertion site for swelling, erythema, or drainage. If unable to aspirate blood, reposition the client and encourage the client to cough. Contact the health care provider about verifying placement if the status is questionable.
When caring for a client with a central venous line, which nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply.
may not cause symptoms until serious complications occur.
When educating a female client with gonorrhea, what should the nurse emphasize? In women, gonorrhea:
client with a white blood cell count (WBC) of 600 µL with a granulocyte count of 100 µL
Which clients will the nurse place in reverse isolation? Select all that apply.
Diaphragms should not be used if the client develops acute cervicitis.
Which information would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning?
cervical cancer Papanicolaou tests 9 to 26
Women who have HPV are much more likely to develop _______________ than women who have never had the disease. Cervical cancer is now considered a sexually transmitted disease. Regular examinations, including __________________, are recommended to detect and treat cervical cancer at an early stage. Girls and women as well as boys and men (around ages____________ depending on the vaccine) should receive a vaccine to prevent HPV.
Folic acid 600 to 800
_________ supplementation is recommended to prevent neural tube defects and anemia in pregnancy. Deficiencies increase the risk of hemorrhage during delivery as well as infection. The recommended dose prior to pregnancy is 400 mcg/day; while breastfeeding and during pregnancy, the recommended dosage is ______________ mcg/day.
Rashes
___________ on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis
Flank pain
_____________ is most commonly related to pyelonephritis.
Enlarged, painless
_______________ lymph nodes are a clinical manifestation of Hodgkin's lymphoma
Cauliflower-like warts
_______________ on the penis are a sign of human papillomavirus
Breast cancer prevention
_______________ programs can best serve at-risk clients from lower socioeconomic backgrounds by developing screening and educational programs tailored to their needs. Without increasing educational awareness and screening, access to insurance, access to health care, and support services do not help these women. According to the American Cancer Society (Canadian Breast Cancer Foundation), research shows that without better screening and education programs, clients with low incomes are more likely to die from cancer than those with higher incomes.
Douching
________________ may disrupt the normal flora of the vaginal lactobacilli and change the pH, which could result in overgrowth of other bacteria.
Gonorrhea
________________ must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.
Nausea and fatigue
_________________ are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.
Tubal ligation 2 to 3
_________________, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse __________ days after the procedure.
Endometrial cancer
__________________ has very few warning signals; irregular bleeding may be the only sign. Any irregular bleeding in a menopausal woman should be investigated, and an endometrial biopsy may be prescribed.
Vaginal itching, confusion, and high fever
_____________________ are not typical adverse effects of radiation therapy for cervical cancer.
Barrier contraceptives
_______________________ must be used to protect against STIs. Birth control pills and douching are not effective for prevention of STIs. Prophylactic antibiotics are not used to prevent the acquisition of STIs.
Fluid status
abdominal hysterectomy _______________ is closely monitored in the operating room An urge to void usually indicates a full bladder. Leaving the bladder distended can stretch the bladder muscle, thus making it more difficult to void.
do not
acute lymphocytic leukemia: Swollen glands and lethargy may be uncomfortable, but they ________ require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen
Risk factors associated with skin cancer
age, exposure to chemical pollutants, exposure to the sun, genetics, and immunosuppression. As individuals age, the risk of developing skin cancer increases. Long-time exposure to the sun and exposure to chemical pollutants (nitrates, coal, tar, etc.) increases the risk of skin cancer. Individuals who have less skin pigmentation (e.g., fair, blue-eyed people) have a higher risk of skin cancer because they tend to incur sunburns rather than tan. Family history plays a role in cancer. Regardless, immunosuppressed individuals are at a higher risk for the development of any type of cancer, as the body's defenses are not functioning properly.
conization of the cervix
excision of a cone of tissue from the cervix performed to remove a lesion from the cervix or to obtain tissue for biopsy
chemicals heat or cold
external beam radiation therapy: The nurse should instruct the client to avoid applying ______________ (such as a deodorant) or _______________ (such as with a heating pad or ice pack) to the area being treated. The client should be encouraged to use the extremity to prevent muscle atrophy and contractures.
"I will practice safe sex at all times." "The medication may cause nausea and vomiting." "The infection can affect my heart or bloodstream."
gonorrhea teaching
8 hours
hysterectomy: It is a priority that the client knows she will not be able to eat or drink for __________ before admission. The clothing she should wear to the hospital and the type of medication she will receive are important, but not the priority. Information on exercise and resumption of normal activities can be included in the discharge teaching.
Doxorubicin
is used in combination with other medications to treat many types of cancers. Primary side effects of this drug include cardiac changes (including left ventricular failure and arrhythmias), complete hair loss within 3 to 4 weeks of receiving the drug, hepatic impairment and red discoloration of the urine.
tamoxifen therapy,
it is important to see the gynecologist regularly because the medication puts the client at risk of developing cancer in other parts of the body. may cause symptoms of menopause and gastrointestinal (GI) symptoms. As a result of administered antineoplastic agents, the client should freeze her eggs if wanting to conceive later in her life.
pegfilgrastim
pegylated granulocyte colony-stimulating factor that is FDA-approved to decrease the risk of patients developing febrile neutropenia when receiving myelosuppressive chemotherapy regimens
daily laboratory results
signs and symptoms of thrombocytopenia: The nurse should monitor _____________________ as this is objective data that will alert the nurse to decreasing platelet counts. Relying on the client to report bleeding or bruising may result in the late discovery of the decreased platelet count.
incontinence episodes urine expressed
stress incontinence: The primary goal of nursing care is to decrease the number of __________________ and the amount of __________________ in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. Without surgical intervention, it may not be possible to eliminate all episodes of incontinence.
It is important to see the gynecologist regularly. The medication will cause menopause. The client should freeze her eggs. This medication puts the client at risk for cancer in other parts of the body.
tamoxifen
postrenal failure
Obstruction of the urinary collecting system may cause .
Common adverse effects of allopurinol
- Gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea - A rash is another potential adverse effect. - A potentially life-threatening adverse effect is bone marrow depression.
Teaching: care of the ostomy
- increased intake of fluids will keep the urine dilute and will help flush out bacteria - Observing the color and amount of urine will help determine whether output is adequate. - Reporting redness will identify early symptoms of an infection - ileal conduit is permanent--the bladder has been removed. - diet high in protein is not recommended for problems with the urinary system because it can damage the kidneys
red to pink instilled fluid, plus the client's urine output
After TURP, urine normally appears ___________, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute. The amount of returned fluid should correspond to the amount of __________________, which reflects catheter patency.
2 to 3 days 1 to 3 days
TURP commonly results in blood from the surgery in the urine for the first few days; the urine will become clear within _____________. Peripheral IV access can be expected. Clients are instructed to anticipate hospitalization for ___________. Because the procedure is performed transurethrally (via the urethra), there is no outward incision.
tube
Disconnecting the __________ from the catheter bag could introduce organisms into the urinary system, causing a urinary tract infection.
increased brighter red
During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be _________________ when the drainage becomes ____________. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so that clots do not plug it.
Frequency Oliguria Anuria Obstruction of urine flow
Enlargement of the prostate causes which of the following to occur?
acute urinary retention or bladder outlet obstruction, accurate measurement of urinary output in a critically ill patient, and aid in in healing of open sacral or perineal wounds
It is inappropriate to use an indwelling urinary catheter to check for residual urine in the bladder; bedside ultrasonic bladder scanning should be used instead. Appropriate uses of an indwelling catheter include cases of ___________________________________________ in incontinent patients.
incontinence
Kegel exercises are noninvasive and are recommended as the initial intervention for ________________. Self-catheterization may be used as a temporary measure but isn't a primary intervention
renal lithiasis
Stone formation (calculi) in the kidney.
bladder cancer awaiting surgery recently had a prostatectomy with bladder irrigation renal insufficiency
The charge nurse should assign the new nurse to the elderly client newly diagnosed with ______________________, the elderly client who ___________________, and the elderly client with ______________. These clients have conditions common to the genitourinary floor.
N/V after chemo
The client needs intervention now to provide basic comfort (relief of nausea and vomiting) and to prevent problems associated with excessive fluid loss through emesis (electrolyte imbalance, dehydration). Administering antiemetic medication is important, but the severity of the client's nausea and amount of vomiting are important information to share with the health care provider for additional intervention.
amount of bleeding
The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the _____________ that is expected after the procedure.
assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding
The guidelines for initiating bladder retraining include ____________________________. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.
Provide perineal care at least once a day. Maintain a closed drainage system. Encourage the client to drink 3,000 mL of fluids a day.
What should the nurse do to prevent catheter-associated urinary tract infection?
activities of daily living and basic care activities
When delegating care, the nurse should consider the skill level of the UAP and the needs of the client. The UAP is able to assist with ______________________.
gloves
When handling any of the client's fluids during the administration of chemotherapy, UAPs should wear ___________ to prevent exposure to any chemotherapeutic toxin contained in the excreta. Some agencies require personnel to wear a double set of gloves, while others use gloves designed to protect health care workers from contact with body fluids from a client receiving chemotherapy.
sterile syringe and needle catheter port
When obtaining a urine specimen from an indwelling catheter, a __________________ should be used to access the _________________ that allows removal of urine from the closed system. This technique preserves sterility of the system and the urine specimen.
Epoetin alfa
____________ is used to treat low red blood cell counts (anemia) caused by chemotherapy.
Indwelling catheters
_____________ are considered to be a major contributor to nosocomial infections. Any client with an indwelling catheter is at high risk for developing a urinary tract infection.
Stasis of urine
__________________ in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.
