RN CELLULAR REGULATION PREP U QUESTIONS

When instructing clients about self-breast examination, which of the following findings should they report to their healthcare provider? Select all that apply. You selected: • Round movable masses that enlarge with menses • Bloody discharge from one of the nipples • Fixed nodular mass with skin dimpling Correct Explanation: Slight consistent asymmetry of bilateral body parts such as extremities, eyes, ears, breasts, and testes is normal. Conditions that require further evaluation include any change, such as a nipple discharge that is anything other than milk. A fixed nodular mass with dimpling of the overlying skin is a common sign of breast cancer. Round, freely movable masses that change with the menstrual cycle may indicate fibrocystic breasts, which is a benign condition that should be monitored after diagnosis, as it is harder to identify cancerous changes in lumpy breasts.

When instructing clients about self-breast examination, which of the following findings should they report to their healthcare provider? Select all that apply. You selected: • Round movable masses that enlarge with menses • Bloody discharge from one of the nipples • Fixed nodular mass with skin dimpling Correct Explanation: Slight consistent asymmetry of bilateral body parts such as extremities, eyes, ears, breasts, and testes is normal. Conditions that require further evaluation include any change, such as a nipple discharge that is anything other than milk. A fixed nodular mass with dimpling of the overlying skin is a common sign of breast cancer. Round, freely movable masses that change with the menstrual cycle may indicate fibrocystic breasts, which is a benign condition that should be monitored after diagnosis, as it is harder to identify cancerous changes in lumpy breasts.

A client with atrial fibrillation has been receiving warfarin. The INR is 4.5. What is the next action the nurse should take?

Withhold the next scheduled dose

A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

a) water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

A client with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should: You selected: administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning.

administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. Explanation: When Cushing's syndrome is suspected, a 24-hour urine collection for free cortisol is performed.

The most significant sign of acute renal failure is: You selected: decreased urine output.

decreased urine output. Explanation: A sudden change in urine output is typical of acute renal failure. Most commonly, the initial change is greatly decreased urine output. Later in the course of acute renal failure, the client may have marked diuresis (nonoliguric failure). A high body temperature or sudden increase in blood pressure is not typically associated with acute renal failure. Urine specific gravity usually is within a low-normal range because the kidneys have difficulty concentrating urine.

The nurse is caring for a 12-year-old child admitted for vaso-occlusion related to sickle cell disease. What interventions will the nurse expect to implement? Select all that apply.

• Administration of oxygen • Administration of toradol intravenously • Administration of hydromorphone for pain

Which of the following clients are at an increased risk of developing Kaposi's sarcoma skin lesions? Select all that apply.

• Client with acquired immunodeficiency syndrome (AIDS) • Male client of Mediterranean/Jewish ancestry • Client status post a liver transplant Explanation: Clients with a compromised immune system (such as transplant clients or those with AIDS) are at an increased risk of developing Kaposi's sarcoma. Kaposi's sarcoma is also more prevalent among males of Mediterranean or Jewish ancestry, although in a less severe form. Clients with type 1 diabetes mellitus or females of European ancestry are not at an increased risk.

A multidisciplinary oncology team of physicians, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply.

• Decreased RBCs • Decreased platelets • Decreased white blood cells

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.

• Have family prepare and deliver favorite meals • Eat small portions of each food group • Obtain calorie dense foods for snack • Eat slowly and in a relaxed atmosphere

A client with iron deficiency anemia is having trouble selecting food from the hospital menu. Which foods should the nurse suggest to meet the client's need for iron? Select all that apply.

• eggs • brown rice • dark green vegetables

A female with uterine fibroids has dysmenorrhea and menorrhagia. After reviewing the laboratory reports, the nurse should report which results to the health care provider (HCP)? Select all that apply.

• hemoglobin, 9.0 g/dL (90 g/L) • hematocrit, 27.1% (0.27) Explanation: A woman with uterine fibroids and dysmenorrhea is at risk for iron deficiency anemia. The hemoglobin and hematocrit indicate the likelihood that the fibroids causing heavy menstrual blood loss have resulted in anemia. A hemoglobin of less than 12 g/dL (120 g/L) in women is considered low. The white blood cell count and potassium levels are within normal parameters, and normocytic red blood cells are normal.

A nurse is teaching a client about skin cancer. Which risk factors for skin cancer should the nurse explain? Select all that apply.

• increasing age • exposure to chemical pollutants • long-term exposure to the sun • genetics • immunosuppression

The nurse at the gynecologic clinic is teaching the client about the results of her Papanicolaou test, which demonstrated dysplasia. Which represents the nurse's best intervention?

Explain the results show alteration in the size and shape of cells, which requires follow-up.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

Intrinsic factor Explanation: Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum.

The normal number of WBCs in the blood is 4,500-10,000 white blood cells per microliter (mcL).

Less than 4,500 is considered neutropenia and places the client at risk for infection

A nurse is teaching a community program on breast self-examination (BSE). The nurse demonstrates the proper procedure for palpating each breast. In what sequence would the following actions be performed for proper self-examination? All options must be used.

Lie down with one arm behind the head. Place the hand over the breast to be examined (use the right hand for the left breast and vice versa). Use the finger pads of the three middle fingers and touch the breast. Use a circular motion to feel the breast tissue (with light, medium, and firm pressure). Palpate the breast in a perpendicular motion, going across the breast from one side to another and top to bottom. Explanation: Although the American Cancer Society (ACS) states that monthly BSEs are optional, it remains an important way to discover early breast changes. BSE is a standard procedure described by national organizations designed to ensure palpation of all breast tissue. Examination can begin when lying down, in the shower or standing before a mirror. The examination also includes a visual inspection of the breasts while pressing the hands firmly against the hips and examining the underarms of each breast with the arms slightly raised.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

Pulse Explanation: An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly.

A nurse is administering an IV antineoplastic agent when the client says, "My arm is burning by the IV site." What should the nurse do first?

Stop infusing the medication. Explanation: Antineoplastic agents can cause severe tissue damage if they extravasate; therefore, the nurse immediately stops the infusion and then notifies the primary care provider. If extravasation has occurred, it may be appropriate to apply ice packs to the site. Ice packs cause desired vasoconstriction; warm, moist packs cause vasodilation. Ice packs should not remain in place for more than 15 to 20 min because rebound vasodilation can occur; the ice packs are removed for a short time and then reapplied as needed.

The upper outer quadrant is the area of the breast in which most breast tumors are found.

This area should be palpated thoroughly.