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. 41. The nurse suspects an oncology emergency and assesses the patient for additional signs and symptoms of __1__ . The priority nursing assessment is __2__. __3__ would be an ominous sign for this oncology emergency. The first nursing action is to __4__. LOOK AT CHART

1 - superior vena cava syndrome 2 - patency of airway 3 - stridor 4 - place patient in a Fowler's position

The client diagnosed with cancer of the head of the pancreas has had a Whipple procedure (pancreatoduodenectomy). Which discharge instructions should the nurse teach the client?

1. "Administer insulin subcutaneously." The Whipple procedure removes the islet cells of the pancreas, thus creating diabetes. The client must be knowledgeable about how to treat diabetes and administer insulin.

2. A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain?

1. "An Illustrated Guide to the Analgesic Ladder" Analgesic drugs are the first-line treatment for cancer pain management. If pain is not controlled by medication, other options are available, including radiation, surgery, and nerve blocks.

The client participating in an investigational protocol calls the clinic and tells the nurse that the medications have made them "sick to my stomach all night." Which statement is the nurse's best response?

1. "Come to the clinic to see the HCP. You may be reacting to the drug." The HCP should assess the client to determine if the side effect of nausea can be controlled. In any event, the side effects experienced by the client must be documented by the HCP. This is the nurse's best response.

The client receiving mitotic inhibitors (plant alkaloids) for cancer reports to the clinic nurse being "so clumsy lately that I can't even pick up a dime." Which statement is the nurse's best response?

1. "Have you also noticed a difference in your bowel movements?" This may indicate a potential life-altering complication of chemotherapy. The client may have nerve damage caused by the mitotic inhibitors or plant alkaloid medications. The intestinal nerves may also be compromised, causing decreased peristalsis.

The nurse is assessing the client before initiating the seventh round of chemotherapy. Which question is most important for the nurse to ask the client before beginning treatment?

1. "Have you experienced any difficulty swallowing or had a temperature?" counts of WBCs and other clinical manifestations relating to the chemotherapy should be assessed. difficulty swallowing could indicate mouth inflammation (stomatitis) or ulcerations.

The nurse on an oncology unit is administering morning investigational protocol medications. To which client stating the following should the nurse question administering medications?

1. "I'm not sure I want to continue this treatment." The nurse should question administering this medication. The client has the right to withdraw from a protocol at any time.

21. The nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation?

1. "Last night my back really hurt, and I had trouble sleeping." Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms are later signs.

The client diagnosed with cancer tells the clinic nurse, "I am so afraid that I will die a horribly painful death." Which statement is the nurse's best response?

1. "Pain does not occur for everyone, but if it does, your HCP can prescribe medications to control it." The nurse should inform the client about pain control options. After the client has accurate information, the nurse can address the fear, if it still exists.

The client receiving chemotherapy for a diagnosis of non-Hodgkin's lymphoma asks the nurse, "Why do I need to take steroids? I've heard they can cause problems." Which statement is the nurse's best response?

1. "Steroids suppress replication of lymphoid tissue and cause cell death." Steroid medications are particularly useful in treating lymphomas because they exert direct toxicity on lymphoid tissue by suppressing cancer cell mitosis and lymphocyte dissolution.

The client diagnosed with a brain tumor is prescribed dexamethasone. Which instructions should the nurse teach? Select all that apply.

1. "Take the medication with food." 2. "The medication may increase appetite." 3. "Do not abruptly stop taking the medication."

39. The nurse is interviewing a patient who was treated several months ago for breast cancer. The patient reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain. Which patient comment is cause for greatest concern?

1. "The NSAIDs are really not relieving the back pain." Primary cancers (lung, prostate, breast, and colon) may metastasize to the spine. In spinal cord compression, back pain is a common early symptom. Later symptoms include weakness, loss of sensation, urinary retention or incontinence, and constipation.

The 60-year-old female client has taken hormone replacement therapy (HRT) to control menopausal symptoms for the last 9 years. Which statement by the nurse indicates the client's risk for developing breast cancer?

1. "The risk increases each year the client is taking HRT." Risk of developing breast cancer increases each year the client takes HRT. Current research also implicates HRT in the development of cardiovascular disease

Hormone Therapy The 45-year-old female client with a family history of breast cancer asks the nurse, "Is there anything I can do to improve my chances of not getting breast cancer like my sister and mother?" Which statement is the nurse's best response?

1. "There are medications and lifestyle changes to reduce the risk." Lifestyle modifications such as consuming a low-fat diet and avoiding obesity are also recommended to reduce risk of breast cancer.

The client, after receiving darbepoetin, calls the clinic nurse and reports aching in the back and legs. Which statement is the nurse's best response?

1. "This is an expected side effect of the medication and can be treated." Bone marrow Hyperstimulation is the probable cause of the aches and should be treated with OTC pain medications.

Comprehensive Questions The postchemotherapy client calls the clinic nurse and reports having mouth ulcers that make it difficult to eat. Which statement is the nurse's best response?

1. "Try swishing a teaspoon of antacid in your mouth before meals." This is a suggestion to alleviate pain caused by mouth ulcerations resulting from chemotherapy.

CH 12 pharm The client has received chemotherapy 2 days a week every 3 weeks for the past 8 months. The client's current laboratory values are populated in the chart below.Which information should the nurse teach the client? Select all that apply.

1. "Use an electric razor when shaving." 2. "Be careful when using sharp objects such as scissors." 3. "Use a soft-bristled toothbrush when brushing teeth."

The client diagnosed with cancer tells the nurse that they hate feeling "doped up" during the day but need pain medication to rest at night. Which statement is the nurse's best response?

1. "We could try to balance your pain medications with sleeping medications to help you get comfortable at night." Sleep medications (sedatives or hypnotics) are better options to induce sleep that the client needs at night. A combination of pain relief and sleep medication might be needed to allow the client to rest.

47. Patients are listed in the left-hand column. In the right- hand column write in the number to indicate the order of priority for care; 1 being the first and 5 being the last.

1. 17-year-old adolescent who is alert and oriented. He was admitted 2 days ago for treatment of meningitis. He reports a continuous headache that is partially relieved by medication. 2. 65-year-old man who underwent total knee replacement surgery 2 days ago. He is using the patient-controlled analgesia (PCA) pump frequently and occasionally asks for a bolus dose. 3. 53-year-old woman who is demanding and frequently calls for assistance. She was admitted for investigation of functional abdominal pain and is scheduled for diagnostic testing this morning. 4. 82-year-old woman with advanced Alzheimer disease who requires total care for all activities of daily living. She will be transferred to a long-term care facility in a few days after arrangements are finalized. 5. 26-year-old man who was admitted with chest pain secondary to a spontaneous pneumothorax. Today, the chest tube will be removed and the PCA pump will be discontinued. 53124

28. People at risk are the target populations for cancer screening programs. According to the latest screening recommendations from the American Cancer Society, which of these asymptomatic patients need extra encouragement to participate in cancer screening? Select all that apply.

1. A 25-year-old African-American woman who is sexually inactive, for a Pap test 3. A 45-year-old African-American man, to talk with the health care provider (HCP) about prostate cancer 4. A 55-year-old white American man who smokes, to talk with the HCP about a lung cancer screening 5. A 50-year-old white American woman, for colon cancer screening

17. The nurse is considering seeking clarification for several prescriptions of pain medication. Which patient circumstance is the priority concern?

1. A 35-year-old opioid-naïve adult will receive a basal dose of morphine via IV patient-controlled analgesia. The nurse would consider questioning all of the medication prescriptions, but the opioid-naïve adult has the greatest immediate risk because use of a basal dose has been associated with an increased incidence of respiratory depression in opioid-naïve patients.

33. The nurse is working with a health care provider who prescribes opioid doses based on a specific pain intensity rating (dosing to the numbers). Which patient circumstance is cause for greatest concern?

1. A 73-year-old frail female patient with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10. prescribing opioid medication based solely on pain intensity should be prohibited because there are many other factors to consider (e.g., age, health conditions, medication history, respiratory status). Age, small body mass, and underlying respiratory disease put the 73-year-old patient at greatest risk for overmedication and respiratory depression

20. The oncoming day shift nurse has just received the handoff report from the night shift nurse. List the order of priority for assessing and caring for the following patients, with 1 being first and 4 being last.

1. A patient who developed tumor lysis syndrome around 5:00 AM 2. A patient who is currently pain free but had breakthrough pain during the night 3. A patient scheduled for exploratory laparotomy this morning 4. A patient with anticipatory nausea and vomiting for the past 24 hours 1324

40. Which assessment finding is the most critical and needs to be addressed first?

1. A patient with small cell lung cancer has tracheal deviation after a pulmonary resection. All of these conditions warrant calling the health care provider (HCP). Nevertheless, tracheal deviation is a symptom of tension pneumothorax, which is a medical emergency, and the nurse may have to intervene before the rapid response team or the HCP can arrive

10. According to recent guidelines from the American Pain Society in collaboration with the American Society of Anesthesiologists, which pain management strategies are important for postsurgical patients? Select all that apply.

1. Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications 2. Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures 3. Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the patient has risk for cardiac complications or prolonged ileus 4. Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies

The nurse is caring for a client diagnosed with cancer. At 1000 the client is reporting pain and nausea. Based on the medication administration record (MAR), which intervention should the nurse implement?

1. Administer 2 mg of morphine combined with 10 mg of prochlorperazine IV. Prochlorperazine (Compazine) and morphine are compatible in the same syringe. The nurse could administer both medications in one syringe over 5 minutes safely.

32. A patient with terminal liver cancer is receiving end-of-life-care. The patient is weak and restless and her skin is mottled and cool. Dyspnea develops, and she appears anxious and frightened. What would the nurse do first?

1. Administer an as needed dose of morphine elixir. Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the subjective sensation of air hunger.

The client calls the nursing station and requests pain medication. When the nurse enters the room with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which intervention should the nurse implement?

1. Administer the client's prescribed pain medication. Clients have to adjust to living with pain and try to be as normal as possible. This is a classic picture of chronic pain. Pain is whatever the client says it is and occurs whenever the client says it does. The nurse should not judge the client; the nurse should administer pain medication

The client diagnosed with chronic pain is prescribed morphine sulfate controlled release and liquid morphine. Which statement best describes how to administer the medications?

1. Administer the controlled release morphine at prescribed intervals and the liquid morphine PRN. Morphine sulfate controlled release is a sustained-release formulation and is administered routinely every 6 to 8 hours to control chronic pain. Roxanol is administered sublingually to treat breakthrough pain.

The nurse working on a medical unit is caring for a client diagnosed with metastatic breast cancer and is receiving capecitabine. Which intervention should the nurse implement? Select all that apply.

1. Administer the medication orally 30 minutes after breakfast. 2. Assess the soles of the feet and palms of the hands for blistering. 3. Monitor the client's white blood cells.

The client on the medical unit diagnosed with anemia is a Jehovah's Witness and the HCP orders erythropoietin. Which intervention should the nurse implement?

1. Administer the medication subcutaneously. The nurse should administer the medication. Erythropoietin (Procrit) is administered subcutaneously.

19. When staff assignments are made for the care of patients who are receiving chemotherapy, which consideration related to chemotherapeutic drugs is the most important?

1. Administration of chemotherapy requires precautions to protect self and others. Chemotherapy drugs would be given by nurses who have received additional training in how to safely prepare and deliver the drugs and protect themselves and others from potential toxic exposure.

The nurse is preparing to administer 0900 medications on an oncology floor. Which medication should the nurse administer first?

1. An antiemetic to a client who might become nauseated Anticipatory nausea and vomiting are very difficult to control. The nurse needs to medicate the client to prevent nausea. This client should be medicated first.

. 8. Which patient is at greatest risk for pancreatic cancer?

1. An older African-American man who smokes Pancreatic cancer is more common in African-Americans, men, and smokers.

The female client had a left breast biopsy that revealed breast carcinoma. The following laboratory data reports estrogen and progesterone influence on the tumor. Which medications should the nurse discuss with the client?

1. Antiestrogen and progesterone hormone medications Suppressing or removing the ability to produce these hormones slows tumor growth. Anti-estrogen and progesterone hormone medications would accomplish this

The nurse is reviewing laboratory data of a male client receiving chemotherapy. Which intervention should the nurse implement?

1. Assess for an infection. client has a low WBC count This count, far below the normal count, puts the client at risk for infection.

The client diagnosed with a solid tissue tumor is scheduled to receive chemotherapy. The client's current laboratory values are populated in the chart below. Which intervention should the nurse implement first?

1. Assess the client's temperature and lung sounds. This client's laboratory data indicates a significant risk for infection. The nurse should assess the client for any clinical manifestations of an infection.

42. Nursing actions are listed in the left-hand column. In the right- hand column, indicate the order in which the nurse will perform the nursing actions. LOOK AT CHART

1. Assess vital signs, including pulse, respirations, blood pressure, and temperature. 2. Assess responsiveness and level of consciousness. 3. Obtain a blood glucose reading; give glucose as needed per protocol. 4. Assess previous electrolyte values and ammonia level; analyze need for repeat laboratory tests. 5. Notify health care provider using SBAR. 6. Apply pulse oximeter assess oxygen saturation; administer oxygen as needed. 7. Attach patient to the cardiac monitor; observe for cardiac dysrhythmias. 8. Examine for signs of trauma, particularly head injury. 9. Assess for neurologic changes, repeat Glasgow Coma and compare findings to baseline. 261379843

23. In the care of patients with pain and discomfort, which task is most appropriate to delegate to unlicensed assistive personnel (AP)?

1. Assisting the patient with preparation of a sitz bath The AP can assist the patient with hygiene issues and knows the principles of safety and comfort for the sitz bath

6. The nurse is caring for a patient with esophageal cancer. Which task could be delegated to assistive personnel (AP)?

1. Assisting with oral hygiene Oral hygiene is within the scope of duties of the AP

The client had a right upper lobectomy for a lung cancer diagnosis and returns to the intensive care unit with a patient-controlled analgesia (PCA) pump for pain control. Which intervention should the nurse implement first?

1. Check the HCP orders against the settings. The nurse should compare the settings to the HCP orders before the other steps.

The nurse is working in a clinic that uses investigational protocols to determine the effectiveness of new medications. Which information regarding use of placebo medications should the nurse teach the clients?

1. Clients in the control group will receive a medication that does not help the disease. Clients in investigational studies are informed that there are control groups that receive an inert medication for comparison to the medication group to determine the medication's statistical effectiveness in treating the disease being studied.

Complete the sentence by choosing from the list of options. The HCP has prescribed hormone suppression therapy to the client diagnosed with prostate cancer. The nurse knows that the scientific rationale for this medication administration is to ____________________

1. Decrease cellular growth. Gender-specific cancers may replicate better in the presence of hormones specific to that sex. Suppressing the androgens produced in the testes results in a reduction in the tumor growth rate.

The client is participating in a clinical trial for a new antineoplastic agent. Which statement is the purpose of Phase I of the clinical trial?

1. Determine optimum dosing, scheduling, and toxicity of the medication. Determining optimum dosing, scheduling, and toxicity of a medication is the purpose of a Phase I clinical trial.

The client diagnosed with cancer has developed diarrhea after the third round of chemotherapy. Which intervention should the clinic nurse implement?

1. Discuss adding a fiber supplement to the client's diet. Clients experiencing diarrhea need to add bulk to the diet in the form of fiber supplements or dietary intake to decrease the liquid nature of the stools.

At 1000, the client diagnosed with cancer and receiving chemotherapy is reporting unrelieved nausea. Which intervention should the nurse implement?

1. Discuss the nausea medications with the HCP. The client is having unrelieved nausea, and the night nurse has already tried to control the nausea with all medication that the HCP has ordered. It is time to notify the HCP to discuss alternative medications or increase the dosage of ondansetron (Zofran).

21. A patient is crying and grimacing but denies pain and refuses opioid medication because "my brother is a drug addict and has ruined our lives." Which intervention is the priority for this patient?

1. Encourage expression of fears and past experiences. This patient has strong beliefs and emotions related to the issue of the brother's addiction. First, encourage expression. This indicates to the patient that the feelings are real and valid.

The client receiving doxorubicin for breast cancer has developed alopecia. Which information is most helpful for the nurse to provide the client?

1. Encourage the client to purchase a wig that matches her hair. Doxorubicin (Adriamycin) is an antineoplastic agent that can cause alopecia. Wearing a wig that matches the client's hair color and style will allow the client to appear in public without others making comments about her hair loss.

The nurse on an oncology floor is administering morning medications. Which medication should the nurse question?

1. Erythropoietin to a client diagnosed with chronic lymphocytic leukemia Erythropoietin (Epogen or Procrit) is a biologic response modifier that stimulates the bone marrow to produce more cells. Stimulation of bone marrow is questioned when the cancer is in the bone marrow.

27. According to recent guidelines from the Center for Disease Control and Prevention for prescribing/using opioid medication for chronic pain, which prescriptions would the nurse question because of the increased risk for opioid overdose? Select all that apply.

1. Extended-release/long-acting (ER/LA) transdermal fentanyl for a patient with fibromyalgia 2. Time-scheduled ER/LA oxycodone for a patient with chronic low back pain 3. As-needed (PRN) morphine for arthritis pain for an elderly patient with sleep apnea 4. 90 morphine milligram equivalents/day for a patient who has a hip fracture 5. ER/LA methadone PRN for a patient with headache pain

The nurse is reviewing the laboratory report of a client diagnosed with cancer. Which biologic response modifier medication should the nurse question?

1. Filgrastim Filgrastim (Neupogen), a biologic response modifier, is administered to increase WBC production. It is discontinued when the WBC is 10,200

The client diagnosed with cancer has received several treatments of combination chemotherapy. The client's current laboratory values are populated in the chart below.

1. Filgrastim Filgrastrim (Neupogen) is a hematopoietic growth factor that stimulates WBC production. This client has a low WBC count and thus is at risk for an infection.

Investigational Protocol The client is scheduled to receive an investigational medication for cancer treatment. Which is the nurse's first intervention?

1. Find information on administration procedures and side effects. The nurse must know what the drug is, how it works in the body, and the potential side effects to assess before administering any medication, especially an investigational medication.

The client with an implanted port has completed the chemotherapy medications and is ready for discharge. Which intervention should the nurse take to prepare the client for discharge?

1. Flush the port with saline followed by heparin. Instilling heparin into the port, reservoir, and catheter will help prevent clot formation in the catheter.

38. The patient is prescribed a fentanyl patch for persistent severe pain. Which patient behavior most urgently requires correction?

1. Frequently likes to sit in the hot tub to reduce joint stiffness All of these behaviors require correction; however, heat can increase the release of medication from the patch and result in a sudden overdose.

8. A patient with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal antiinflammatory drugs. Which medication will the nurse advocate for first?

1. Gabapentin Gabapentin is an antiepileptic drug, but it is also used to treat diabetic neuropathy. Corticosteroids are for pain associated with inflammation.

The nurse assesses excoriated, contaminated skin surrounding the colostomy stoma of a client diagnosed with colon cancer. Which intervention should the nurse implement first?

1. Gently cleanse the area with mild soap and water. The skin barrier paste will not adhere to fecal-contaminated skin. The nurse should first gently cleanse the skin. Mild soap acts as an abrasive to remove feces and old barrier paste.

The client diagnosed with chronic kidney disease is prescribed erythropoietin. Which intervention should the nurse implement? Select all that apply.

1. Have the client take acetaminophen for pain. 2. Monitor the client's CBC. 3. Teach the client to pace activities. 4. Inform the client not to drive for 90 days.

The client had a Whipple resection (pancreatoduodenectomy) for pancreatic cancer and has arterial blood gas values populated in the chart below. Which medication should the nurse prepare to administer?

1. IV insulin by continuous infusion Clients after islet cell removal are at risk for diabetes mellitus complications. The blood gas results indicate metabolic ketoacidosis, and the treatment is continuous infusion of regular insulin.

Which discharge instructions should the nurse provide for the client diagnosed with cancer taking hydrocodone with acetaminophen as needed (PRN) for pain?

1. Increase the fluid intake and roughage in the diet. Hydrocodone slows peristalsis. The client should increase fluids and roughage in the diet to prevent constipation.

The HCP has ordered two units of packed red blood cells (PRBC) for the client diagnosed with cancer and anemia. Which interventions should the nurse implement? Rank in order of performance.

1. Initiate the transfusion at 10 mL per hour. 2. Assess the client's lung sounds. 3. Place the blood on an infusion pump. 4. Run the transfusion at a 4-hour rate. 5. Check the blood with another nurse. 25314

The male client diagnosed with prostate cancer is receiving a leuprolide implant. Which procedure is the correct method of administration?

1. Insert the 16-gauge needle at a 30-degree angle into the abdomen. The drug is formulated in a pellet that is dispensed through a 16-gauge needle under the skin on the abdomen

Surgery for Cancer The client has had an implanted port placed to receive chemotherapy. When the nurse attempts to access the device, there is no backflow of blood, and the nurse meets resistance when flushing. Which intervention should the nurse take to access the implanted port?

1. Instill a prescribed amount of urokinase into the port. Urokinase is a thrombolytic. Instilling a small amount into the lumen of the implanted port and allowing the medication to sit in the catheter may dissolve the clot.

The 39-year-old female client diagnosed with breast cancer is prescribed tamoxifen. Which information is most important for the nurse to teach the client?

1. It is essential to see the gynecologist regularly. Tamoxifen acts as an estrogen agonist on receptors in the uterus, causing proliferation of endometrial tissue that may result in endometrial cancer. For this reason, the client must see the gynecologist regularly.

42. Which instruction would the nurse give to the unlicensed assistive personnel (AP) related to the care of a patient who has received ketamine for analgesia?

1. Keep the environment calm and quiet. A calm and quiet environment helps to reduce the psychomimetic effects (e.g., hallucinations/delusions, anxiety).

The client diagnosed with prostate cancer has had prostate surgery using spinal anesthesia. Which safety precaution should the postanesthesia care nurse use?

1. Keep the head of the bed elevated until feeling returns to the legs. Keeping the head of the bed slightly elevated will prevent paralysis from occurring.

The client taking chemotherapy has developed a white, patchy area on the tongue and buccal mucosa. Which medication is the best treatment for this condition?

1. Ketoconazole to swish and swallow Ketoconazole (Nizoral) is an antiinfective medication that treats yeast infections. White, patchy areas in the mouth indicate oral candidiasis, a yeast infection. The correct administration procedure is to have the client swish the medication around in the mouth and then swallow the medication to treat esophageal areas.

The client about to receive chemotherapy is reporting nausea and nervousness. Based on the MAR, which of the PRN medications should the nurse administer?

1. Lorazepam IVP Lorazepam (Ativan), a benzodiazepine, is a sedative-hypnotic with antiemetic and antianxiety properties.

3. A person who is receiving chemotherapy is approaching the nadir period. Which instruction will the team leader give to the LPN/LVN?

1. Monitor the neutrophil count; be vigilant for signs/symptoms of infection. therefore the LPN/LVN would be instructed to monitor the neutrophil count and watch for signs of infection.

13. The nurse is caring for a postoperative patient who reports pain. Based on recent evidence-based guidelines, which approach would be best?

1. Multimodal strategies Multimodal therapies for postoperative patients include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies. This approach is thought to be the most important strategy for pain management for most postoperative patients.

34. Which nursing action is the best example of the principle of nonmaleficence as an ethical consideration in pain management?

1. Patient seems excessively sedated but continues to ask for morphine, so the nurse conducts further assessment and seeks alternatives to opioid medication. Nonmaleficence is to prevent harm. If the patient is excessively sedated, the nurse knows that giving additional opioid medication could do more harm than good, so the nurse would conduct further assessments and seek alternative options for pain relief.

15. Which patients must be assigned to an experienced RN? Select all that apply.

1. Patient who was in an automobile crash and sustained multiple injuries 3. Patient who has returned from surgery and has a chest tube in place 5. Patient with a severe headache of unknown origin 6. Patient with chest pain who has a history of arteriosclerosis

The client receiving IV chemotherapy was nauseated and vomited twice the day before. Which intervention should the nurse implement?

1. Premedicate the client before each meal. The client may tolerate meals after receiving an antiemetic medication 30 minutes before each meal. The nurse can administer a PRN medication before each meal or request a routine medication order from the HCP.

The client diagnosed with cancer notifies the nurse of pain that is "11" on the pain scale but cannot localize it to a specific area or describe when it began. Which intervention should the nurse implement?

1. Prepare to administer the prescribed narcotic pain medication. The nurse should administer pain medication without further delay.

Today's laboratory report values for a client receiving chemotherapy are populated in the chart below. Which intervention should the nurse implement?

1. Prepare to transfuse 10 units of platelets. Thrombocytopenia is defined as a platelet count of less than 100,000. This client's platelet count is 13,000. The nurse should prepare to infuse platelets to prevent hemorrhage.

2. According to Centers for Disease Control and Prevention (CDC) guidelines for opioid use for patients with chronic pain, which actions are part of the nurse's responsibility related to the current opioid crisis? Select all that apply.

1. Recognize that negative attitudes toward substance abusers is a barrier to patient compliance. 3. Learn to recognize the signs and symptoms of opioid overdose and the proper use of naloxone. 4. Use a tone of voice and facial expression that convey acceptance and understanding of patients who are addicted.

The client receiving chemotherapy has developed stomatitis. Which referral should the nurse implement?

1. Refer to a dietician. Stomatitis is a buccal mucosa inflammation. A dietitian can help the client by providing foods the client can swallow without too much chewing and simultaneously receive adequate nutrition.

Biologic Response Modifier Which instruction(s) should the nurse teach the client receiving oprelvekin? Select all that apply.

1. Report any edema of arms, legs, or both. 2. Inform the HCP if vision becomes blurred. 3. Store the medication in the refrigerator.

Complete the sentence by choosing from the list of options. The health-care provider (HCP) prescribed interferon alfa-2b to a client diagnosed with hepatitis C. The nurse knows that the scientific rationale for this medication administration is to / 1. Reprogram virus-infected cells to inhibit virus replication. interferon alfa-2b (Intron A) reprograms virus-infected cells to inhibit viral replication. This is the reason that it is useful in treating hepatitis.

1. Reprogram virus-infected cells to inhibit virus replication. interferon alfa-2b (Intron A) reprograms virus-infected cells to inhibit viral replication. This is the reason that it is useful in treating hepatitis.

The registered nurse (RN) is caring for clients on an oncology unit. Which task is an appropriate delegation or assignment by the nurse? Select all that apply.

1. Request the unlicensed assistive personnel (UAP) to measure and record the client output. 2. Assign a new graduate nurse to care for a client receiving PRBCs. 3. Delegate care of a seriously ill client taking an investigational drug to a RN. 4. Ask the UAP to reposition the client receiving an investigational drug.

The nurse is accessing a newly implanted port IV line. Which interventions should the nurse implement? Rank in order of performance.

1. Set up the sterile field and don sterile gloves. 2. Cleanse the skin with antiseptic skin prep. 3. Palpate the port rim with two fingers. 4. Insert a noncoring needle between the fingers. 5. Explain the procedure to the client and wash hands. 51234

The client diagnosed with ovarian cancer had an extensive bowel resection and is receiving total parenteral nutrition (TPN). Which laboratory data should the nurse monitor daily?

1. Sodium, potassium, and glucose levels TPN solution contains high concentrations of glucose, proteins, lipids, and electrolytes.

The nurse is preparing to administer a vesicant antineoplastic medication through a peripheral IV catheter. Which intervention is the priority intervention?

1. Start new IV access before starting administration. When administering a vesicant medication into a peripheral IV line, the nurse must know that the vein is patent and that there is little likelihood of extravasation occurring. This phenomenon involves the leaking of minute amounts of medication into the tissue because the catheter has been in the vein too long, and an insertion site enlargement has occurred. The nurse should start a new IV site.

Chronic Pain The client diagnosed with terminal cancer is experiencing significant pain. Which information is most important for the hospice nurse to teach the client and significant other?

1. Take pain medications at the onset of pain before it becomes severe. The nurse should teach the client to take the pain medications as soon as the client begins to feel uncomfortable. Waiting to take the medication can make it difficult to get the pain under control.

30. In the care of a patient with neutropenia, what tasks would the nurse delegate to assistive personnel (AP) to perform? Select all that apply.

1. Taking vital signs every 4 hours 2. Reporting temperature of more than 100.4°F (38°C) 4. Gathering the supplies to prepare the room for protective isolation 6. Practicing good hand-washing technique Measuring vital signs and reporting on specific parameters, practicing good hand washing, and gathering equipment are within the scope of duties for an AP.

The nurse is preparing a client for discharge with intractable pain and a home infusion pump with narcotic medication. Which information should the nurse include? Select all that apply.

1. Teach the client about phlebitis or infection findings. 2. Refer the client to a home health agency. 3. Discuss infusion pump use. Because this client will be monitoring the IV injection site, the nurse should teach the client about clinical manifestations of phlebitis (for a peripheral IV) or infection and what to do if they occur.

The nurse on a medical unit is caring for a client diagnosed with advanced HER2-negative breast cancer and prescribed everolimus. Which should the nurse teach the client?

1. Teach the client to notify the HCP if developing lung problems or wheezing. The oral antineoplastic medication everolimus (Afinitor) can result in severe lung issues for the client.

The client diagnosed with cancer reports frequent nausea. Which information is most important for the nurse to discuss with the client?

1. Teach the client to take an antiemetic 30 minutes before meals. To prevent nausea, the client should take an antiemetic 30 minutes before attempting to eat. Maintaining the client's nutritional status is the most important

The client has received the second dose of chemotherapy and is ready for discharge. Which information should the nurse teach the client?

1. Tell the client to notify the HCP of a temperature of 100°F (37.7°C). The client could be developing an infection

The client diagnosed with AIDS is prescribed megestrol. Which data indicates the medication is effective?

1. The client ate 90% of the meals served. A medication side effect is an increased appetite. It is prescribed in unlabeled use for improving the appetite in clients diagnosed with AIDS under the name of Appetrol.

The client is scheduled to receive anakinra. Which data should make the nurse question administering the medication?

1. The client has a temperature of 100.4°F (38°C). Anakinra (Kineret) is an immune modulator. This medication suppresses the immune system and should not be administered to anyone with an infection. A temperature greater than 100°F (37.7°C) indicates an infection.

The client diagnosed with cancer is being prepared for surgery. Which information should the outpatient surgery nurse convey to the surgeon immediately?

1. The client has been taking clopidogrel every day. Clopidogrel (Plavix) is an antiplatelet medication the client has been taking. It should be discontinued at least 7 days before surgery.

Which statement is the primary reason to enroll a client in an investigational protocol for cancer treatment?

1. The client has failed conventional treatment, and there is a poor prognosis. If the client has received conventional therapy and has not responded well, the HCP may suggest an investigational protocol. Usually, this means the client has a poor prognosis before an investigational protocol is discussed.

The client has received five treatments of combination chemotherapy for a diagnosis of lung cancer. Which data indicates the medications are effective?

1. The client reports being able to ambulate around the block. The client being able to tolerate activity indicates the client has adequate lung capacity. This indicates the lung cancer has not enveloped the entire lung field and that medications are effective. Lung cancer has a poor prognosis, and the treatment goal is to improve or maintain quality of life

. Which statement by the client receiving adjunct chemotherapy for a breast cancer diagnosis warrants immediate intervention by the nurse?

1. The client reports numbness and tingling in her feet. This client may have metastasis to the spinal column, and this information should be immediately reported to the HCP for emergency evaluation. The client could become paralyzed.

The client admitted with intractable pain from an osteosarcoma diagnosis is being discharged. Which information should the nurse emphasize with the client?

1. The client should plan to have an adequate medication supply on weekends and holidays. Narcotic prescriptions need to be issued electronically in most situations. The client should try to anticipate when the medication needs to be refilled, or they may run out over a weekend or holiday.

The nurse administered narcotic pain medication to a client diagnosed with cancer then assessed the client 30 minutes later. Which data indicates the medication was effective?

1. The client states that the pain has gone down 5 points on the scale. Because pain is whatever the client says it is and occurs whenever the client says it does, a client's report of reduced pain indicates the medication is effective.

The client diagnosed with a solid tissue tumor is prescribed darbepoetin. Which data should the nurse monitor?

1. The client's blood pressure Darbepoetin (Aranesp) is a hematopoietic growth factor that stimulates RBC production. When the Hct level rises, it can increase blood pressure.

The postmenopausal client diagnosed with breast cancer is placed on anastrozole. Which data indicates the medication is effective?

1. The client's bone and lung scans are negative. Anastrozole (Armidex) is an aromatase inhibitor. Aromatase inhibitors are used to treat postmenopausal breast cancer. Two prime metastasis sites for breast cancer are the lungs and bones. Negative findings in these areas indicate the medication is effective.

The nurse is administering medications on a medical unit. Which medication should the nurse administer first?

1. The investigational medication that must be administered at a specific time Any medication that requires specific timing should be administered at the time required. This medication has priority.

The nurse is caring for clients on an oncology unit. Which medication should the nurse administer first?

1. The scheduled dose of leucovorin Leucovorin (folinic acid), a rescue factor, is used as a rescue medication for certain drugs. Rescue medications are precisely timed to prevent life-threatening complications.

9. When an analgesic is titrated to manage pain, what is the priority goal?

1. Titrate to the smallest dose that provides relief with the fewest side effects. The goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until the pain is controlled. Downward titration occurs when the pain begins to subside.

The nurse is preparing to administer pegfilgrastim. Which interventions should the nurse implement when administering this medication? Select all that apply.

1. Use a 1-mL 5/8-inch syringe needle and administer it in the deltoid muscle. 2. Hold the medication 24 hours before or after chemotherapy. 3. Monitor the client's WBC count and the absolute neutrophil count.

The terminally ill client reports that the pain is getting progressively worse despite hourly IV narcotic pain medication administered in increasingly higher doses. Which intervention should the nurse implement?

1. Use therapeutic communication to discuss the client's concerns. . Therapeutic communication techniques are designed to allow the client to verbalize feelings.

The nurse working in an outpatient clinic is screening clients for inclusion in an investigational medication protocol for rheumatoid arthritis (RA). Which screening questions should the nurse include? Select all that apply.

1. Which medications has the client been prescribed for arthritis? 2. Which herbs and over-the-counter (OTC) medications have the client taken? 3. Does the client have any other immune system disease?

17. For a patient who is receiving chemotherapy, which laboratory result is of particular importance?

1. White blood cell count (WBC): 3000/mm³ (3 × 10⁹/L) Chemotherapy can decrease WBCs, particularly neutrophils (known as neutropenia). This leaves the patient vulnerable to infection. Normal range for WBC is 5000 to 10,000/mm³ (5-10 × 10⁹ /L).

45. Question: Based on the American Society for Pain Management Nursing recommendations for "As needed" (PRN) range prescriptions for opioid analgesics, for which prescriptions, does the nurse need to seek clarification from the health care provider?

1. ______ Ms. A is a 35-year old female admitted for an acute episode of cholelithiasis. Prescribed: Morphine 1 to 15 mg IV every 2 hours PRN pain 3. ______ Mr. C is a 55-year old male with acute pancreatitis. He has a history of alcohol and substance abuse. Prescribed: Morphine 1 to 3 mg IV every 4 hours PRN pain 4. ______ Mrs. D is an 83-year old female with an ankle fracture. She has dementia and is unable to maintain elevation of the ankle. Prescribed: Meperidine 25 to 50 mg PO PRN pain 6. ______ Mr. F is a 25-year old male. He has extensive abrasions on the left side of the body sustained in a motorcycle accident. No other obvious trauma detected in the emergency department. Prescribed: Oxycodone 9 mg PO every 12 hours; Hydrocodone with acetaminophen 5/325 PO 1 to 2 tablets every 4 to 6 hours PRN pain; acetaminophen 500 mg 2 tablets PO every 6 to 8 hours PRN pain 7. ______ Ms. G is a 57-year old female who had a hysterectomy yesterday for uterine prolapse. She is opioid naive and has no preexisting health conditions other than prolapse of the uterus. Prescribed: Fentanyl 50 to 100 mcg IV every 2 hours PRN for severe pain 8. ______ Mr. H is a 68-year old male; he has pain associated with postherpetic neuralgia. Prescribed: Morphine 2 to 3 mg IV every 4 hours PRN pain

30. A patient with pain disorder and depression has chronic low back pain. He states, "None of these doctors has done anything to help." Which patient statement is cause for greatest concern?

2. "I'm so sick of this pain. I think I'm going to find a way to end it." This statement could be a veiled suicide threat, and patients with pain disorder and depression have a high risk for suicide.

38. The oncoming nurse hears in the handoff report that the patient with cancer received an as needed oral dose of lorazepam. Which question is the oncoming nurse most likely to ask the off-going nurse in relation to the medication?

2. "Were you able to determine what was making the patient so anxious?" If the trigger factors for anxiety are identified, the nursing staff can plan nonpharmaceutical interventions. Lorazepam is a benzodiazepine, and it is not a first-line drug for cancer pain. It can be used for anxiety, insomnia, alcohol withdrawal, and muscle spasms and may be used in combination with antiemetics for cancer-induced nausea and vomiting.

10. Which patient with a health problem related to gastrointestinal (GI) cancer would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?

2. A patient who needs enemas and antibiotics to control GI bacteria Administering enemas and antibiotics is within the scope of practice of LPNs/LVNs

7. A patient had radiation therapy 3 months ago and recently the health care provider prescribed epoetin. Which instruction will the home health nurse give to the home health aide related to this new therapy?

2. Allow the patient to rest between care activities until energy improves. The patient needs to rest between activities because of fatigue caused by anemia. This can show up 3 to 4 months after radiation therapy. Epoetin is given to improve low hemoglobin and red cell factors.

. 34. A patient with uterine cancer is being treated with intracavitary radiation therapy. The assistive personnel (AP) reports that the patient insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the priority action?

2. Assess for dislodgment; use forceps and a lead container to retrieve and store as needed. If the radiation implant has obviously been expelled (e.g., is on the bed linens), use a pair of forceps to place the radiation source in a lead container.

19. A patient received as-needed morphine, lorazepam, and cyclobenzaprine. The unlicensed assistive personnel (AP) reports that the patient has a respiratory rate of 10 breaths/min. Which action is the priority?

2. Assess the patient's responsiveness and respiratory status. The AP has correctly reported findings, but the nurse is ultimately responsible to assess first and then determine the correct action.

24. For a patient with osteogenic sarcoma, which laboratory value causes the most concern?

2. Calcium level of 13 mg/dL (3.25 mmol/L) The normal range for calcium is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L). Potentially life-threatening hypercalcemia can occur in cancers with destruction of bone.

36. Which assessment finding strongly suggests that the patient with cancer is having incident pain?

2. Demonstrates protectiveness of right arm whenever moving or standing up Incident pain is pain that is associated with an event, such as walking, position change, or coughing. In this case, movement is the incident that causes pain and the patient's reaction to protect the arm.

16. Which postoperative patient is manifesting the most serious negative effect of inadequate pain management?

2. Develops venous thromboembolism because of immobility caused by pain and discomfort thromboembolism is the most serious because it can lead to pulmonary embolism, which is an immediate life-threatening concern.

. 27. After chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory result requires particular attention?

2. Electrolyte levels Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome.

31. A primary nursing responsibility is the prevention of lung cancer by assisting patients in the cessation of smoking or other tobacco use. Which task would be appropriate to assign to an LPN/LVN?

2. Explain how to apply a nicotine patch An LPN/LVN is versed in medication administration and able to teach patients standardized information.

29. A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which treatment does the nurse anticipate that the health care provider will prescribe first?

2. Fluid restrictions Hyponatremia is a concern; therefore fluid restrictions would be prescribed.

4. After assessing the patient's pain patterns, the nurse determines that frequent breakthrough cancer pain is occurring. Which member of the health care team is the nurse most likely to contact first?

2. Health care provider (HCP) to review medication, dosage, and frequency Frequent breakthrough pain suggests that the around-the-clock dosing needs reevaluation, so the nurse would contact the HCP and advocate for a change of medication or dose or frequency.

25. For a cognitively impaired patient who cannot accurately report pain, which action would the nurse take first?

2. Obtain baseline behavioral indicators from family members. Complete information should be obtained from the family during the initial comprehensive history taking and assessment.

25. The nursing supervisor has advised the charge nurse that there is a new admission who needs a private room. The charge nurse must review the conditions and statuses of patients who are currently on the unit to determine who could be moved and placed the same room. Which two cancer patients could be cohorted?.

2. Patient B underwent debulking of a tumor to relieve pressure 4. Patient D had a laminectomy for spinal cord compression

35. The nurse is assessing a patient who has been receiving opioid medication via patient-controlled analgesia. Which early sign alerts the nurse to a possible adverse opioid reaction?

2. Patient is more difficult to arouse. Most adverse opioid events are preceded by an increased level of sedation.

28. Which patients can be appropriately assigned to a newly graduated RN who has recently completed orientation? Select all that apply.

2. Patient on the second postoperative day who needs pain medication before dressing changes 5. Patient who is reporting pain at the site of a peripheral IV line 6. Patient with a kidney stone who needs frequentas-needed pain medication

20. The patient is diagnosed with an acute migraine by the health care provider (HCP). For which situation is it most important to have a discussion with the HCP before medication is prescribed?

2. The HCP is considering subcutaneous sumatriptan, and the patient took ergotamine 3 hours ago. Sumatriptan should not be used if ergotamine, dihydroergotamine, or another triptan medication has been used in the past 24 hours because of the additive effect of narrowing of the blood vessels that could result in damage to major organs (e.g., stroke or myocardial infarction).

9. Patients receiving chemotherapy are at risk for thrombocytopenia related to the therapy or cancer disease process. Which actions for bleeding precautions can be delegated to assistive personnel? Select all that apply.

2. Use paper tape on fragile skin, if tape is needed. 3. Use a soft toothbrush or oral sponge. 5. Handle gently to reduce bruising. 6. Avoid overinflation of blood pressure cuffs.

The client receiving an investigational medication protocol must be hydrated with at least 1,000 mL of IV fluid in the 4 hours immediately before infusion of the investigational medication. At which rate would the nurse set the pump?

250ml

22. Which instruction would the nurse give to the assistive personnel (AP) about caring for a patient who is experiencing "chemo brain"?

3. "Calmly give explanations if the patient seems forgetful." The AP would be instructed to remain calm and give clear and simple directions. In chemo brain, patients experience mental cloudiness with memory problems.

5. During the handoff report, the oncoming day shift nurse hears that the cancer patient is on around-the-clock dosing of morphine but that end-of-dose pain might be occurring. Which question is the most important to ask the night shift nurse?

3. "Did you notify the health care provider (HCP) and were changes prescribed?" The most important question is whether the HCP was notified and if any changes were made to address the patient's pain.

12. The patient with cancer needs an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement is cause for greatest concern?

3. "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death." The nurse would assess what the patient means by having "control over my own life and death." This could be an indirect statement of suicidal intent.

29. A patient's spouse comes to the nurse's station and says, "He needs more pain medicine. He is still having a lot of pain." Which response is best?

3. "Please tell him that I will be right there to check on him." Responding to the patient and family in a timely fashion is important.

32. The nurse is caring for a young man with a history of substance abuse who had exploratory abdominal surgery 4 days ago for a knife wound. There is a prescription to discontinue the morphine via patient-controlled analgesia and to start oral pain medication. The patient begs, "Please don't stop the morphine. My pain is really a lot worse today than it was yesterday." Which response is best?

3. "Show me where your pain is and describe how it feels compared with yesterday." Assessing the pain is the priority in this acute care setting because there is a risk of infection or hemorrhage.

11. When a patient stoically abides with his parent's encouragement to "tough out the pain" rather than risk an addiction to opioids, the nurse recognizes that the sociocultural dimension of pain is the current priority for the patient. Which question will the nurse ask?

3. "What do you believe about pain medication and drug addiction?" Beliefs, attitudes, and familial influence are part of the sociocultural dimension of pain.

37. For which of these patients is IV morphine the first-line choice for pain management?

3. A 56-year-old patient reports breakthrough bone pain related to multiple myeloma. The patient with cancer needs morphine for symptom relief. For obstetric patients, morphine can suppress fetal respiration and uterine contractions, so regional or epidural methods are preferred.

12. Which patient is most likely to receive opioids for extended periods of time?

3. A patient with progressive pancreatic cancer Cancer pain generally worsens with disease progression, and the use of opioids is more generous.

35. The charge nurse discovers that two nurses have switched patient assignments because Nurse A does "not like to take care of patients with prostate cancer." Which action would the charge nurse take first?

3. Ask Nurse A to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues. First, the charge nurse identifies the reason for the switch. After the underlying issue is discovered, a plan can be made to assist Nurse A (e.g., referral to counseling or in-service training).

. 43. The health care provider (HCP) prescribes 7 mg morphine IV as needed. The nursing student prepares the medication and shows the syringe (see figures below) to the nursing instructor. Which action would the nursing instructor take first?

3. Ask the student to demonstrate the calculations and steps required to prepare the dose.

. 16. A newly hired nurse, who has 2 years of medical-surgical experience but limited experience caring for patients with cancer, seems to be consistently under-medicating the patients' pain. What would the supervising nurse do first?

3. Assess the new hire's understanding and beliefs about cancer pain and treatments. First, the supervising nurse assesses the newly hired nurse's knowledge and beliefs about cancer pain and treatment.

33. During report, the float nurse hears that the patient is receiving IV vincristine that will finish within the next 15 minutes. The IV site is intact, and the patient is not having any problems with the infusion. The float nurse is not certified in chemotherapy administration. What is the priority action?

3. Contact the charge nurse and discuss the lack of chemotherapy certification. Contact the charge nurse about the patient assignment. All nurses can assess patients, IV sites, and infusions; however, chemotherapy medications require special expertise

22. A patient's opioid therapy is being tapered off, and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?

3. Diaphoresis Diaphoresis is one of the early signs that occurs between 6 and 12 hours after withdrawal. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours after withdrawal.

23. A patient who has breast cancer is receiving immunotherapy in the form of trastuzumab, a monoclonal antibody (MoAb). Which medication side effect is the patient most likely to experience?

3. Flu-like symptoms Flu-like symptoms are the most common side effects of the MoAbs.

40. For a postoperative patient, the health care provider (HCP) prescribed multimodal therapy, which includes acetaminophen, nonsteroidal antiinflammatory drugs, as-needed (PRN) opioids, and nonpharmaceutical interventions. The patient continuously asks for the PRN opioid, and the nurse suspects that the patient may have a drug abuse problem. Which action by the nurse is best?

3. Give the opioid because the patient deserves relief and drug abuse is unconfirmed. The nurse is weighing benefit against harm. If the patient is a drug abuser, the medication given in the hospital is not harming him. If the patient is not a drug abuser, then withholding the medication causes him to suffer pain because of unconfirmed suspicions.

18. For care of a patient who has oral cancer, which task would be appropriate to assign to an LPN/LVN?

3. Giving antacids and sucralfate suspension as prescribed Giving medications is within the scope of practice of the LPN/LVN.

36. The charge nurse of a long-term care facility is reviewing the methods and assessment tools that are being used to assess the residents' pain. Which nurse is using the best method to assess pain?

3. Nurse C uses the same numerical rating scale every day for the same resident. Pain assessment is very complex, but the consistent use of the same assessment tool is the best method.

15. For a patient receiving the chemotherapeutic drug vincristine, which side effect would be reported to the health care provider (HCP)?

3. Paresthesia Paresthesia is a side effect associated with some chemotherapy drugs, such as vincristine

18. Which patient has the most immediate need for IV access to deliver analgesia with rapid titration?

3. Patient who is having an acute myocardial infarction with severe chest pain The patient with an acute myocardial infarction has the greatest need for IV access and is likely to receive morphine, which will relieve pain and increase venous capacitance.

Leadership Ch 1 1. Based on the principles of pain treatment, which consideration comes first?

3. Patient's perception of pain must be accepted The patient must be believed, and his or her experience of pain must be acknowledged as valid. The data gathered via patient reports can then be applied to the other options in developing the treatment plan.

. 11. A community health center is preparing a presentation on the prevention and detection of cancer. Which task would be best to assign to the LPN/LVN?

3. Prepare a poster on the seven warning signs of cancer. The LPN/LVN will know the standard seven warning signs and can educate through standard teaching programs.

13. For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to assistive personnel (AP)?

3. Reporting the amount and type of food consumed from the tray The AP can observe the amount that the patient eats (or what is gone from the tray) and report to the nurse.

39. The home health nurse discovers that an older adult patient has been sharing his pain medication with his daughter. He acknowledges the dangers of sharing, but states, "My daughter can't afford to see a doctor or buy medicine, so I must give her a few of my pain pills." Which member of the health care team would the nurse consult first?

3. Social worker to help the family locate resources for health care If the social worker can help the family to find affordable alternatives, then the father is more likely to stop giving his medication to the daughter.

26. An athletic young man with pain, a low-grade fever, and anemia was recently diagnosed with Ewing sarcoma. The surgeon recommended amputation of the right lower leg for an operable tumor. The nurse discovers the patient preparing to leave the hospital "to go on a long hiking trip." What is the priority nursing concept to consider at this time?

3. Stress and coping The patient is not coping with the recent diagnosis of cancer and stressful prospect of losing his leg. His decision to go hiking may be a form of denial or possibly a veiled suicide threat

37. Which question is the home health nurse most likely to ask to evaluate the efficacy of a bisphosphonate medication that was prescribed for a patient with cancer?

4. "Has the medication relieved the bone pain that you reported?" Bisphosphonate medications are used for patients with cancer to relieve bone pain associated with primary bone cancer or metastasis and to reduce the risk of fractures. They also lower the calcium level in the blood.

4. The team is providing emergency care to a patient who received an excessive dose of opioid pain medication. Which task is best to assign to the LPN/LVN?

4. Applying oxygen per nasal cannula as ordered The LPN/LVN is well trained to administer oxygen per nasal cannula. This patient is considered unstable; therefore the RN should take responsibility for administering drugs and monitoring the response to therapy

5. What is the best way to schedule medication for a patient with constant pain?

4. Around-the-clock If the pain is constant, the best schedule is around-the-clock to provide steady analgesia and pain control. The other options may require higher dosages to achieve control.

41. An inexperienced new nurse compares the medication administration record (MAR) and the health care provider's (HCP's) prescription for a patient who has a patient-controlled analgesia (PCA) pump for pain management. Both the MAR and prescription indicate that larger doses are prescribed at night compared with doses throughout the day. Who would the new nurse consult first?

4. Ask the charge nurse if this is a typical dosage for nighttime PCA. The nurse has taken the first correct step and compared the MAR to the HCP's original prescription. Because the nurse is new, the charge nurse would be the best resource.

3. On the first day after surgery, a patient who is on a patient-controlled analgesia pump reports that the pain control is inadequate. Which action would the nurse take first?

4. Assess the pain for location, quality, and intensity. Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.

24. The health care provider (HCP) prescribed a placebo for a patient with chronic pain. The newly hired nurse feels very uncomfortable administering a placebo. Which action would the new nurse take first?

4. Contact the charge nurse for advice and suggestions. Administering placebos is generally considered unethical. (There are circumstances, such as clinical drug research, where placebos are used, but patients are aware of that possibility.) The charge nurse is a resource person who can help clarify the situation and locate and review the hospital policy.

14. A newly graduated RN has correctly documented dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. What action should the charge nurse take first?

4. Give praise for documenting dose and time and discuss documentation deficits. When supervising a new RN, good performance should be reinforced first and then areas of improvement can be addressed.

26. A patient with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medication. What is the charge nurse's initial action?

4. Have a conference with the staff nurses to assess their care of this patient. The charge nurse must assess the performance and attitude of the staff in relation to this patient.

7. The home health nurse is interviewing an older patient with a history of rheumatoid arthritis who reports "feeling pretty good, except for the pain and stiffness in my joints when I first get out of bed." Which member of the health care team would be notified to aid in the patient's pain?

4. Home health aide to help patient with a warm shower in the morning One of the common features of rheumatoid arthritis is joint pain and stiffness when first rising. This usually resolves over the course of the day. A nonpharmaceutical measure is to take a warm shower (or apply warm packs to joints if pain is limited to one or two joints).

31. A patient has severe pain and bladder distention related to urinary retention and possible obstruction; insertion of an indwelling catheter is prescribed. An experienced unlicensed assistive personnel (AP) states that she is trained to do this procedure. Which task can be delegated to this AP?

4. Measuring the urine output after the catheter is inserted and obtaining a specimen Measuring output and obtaining a specimen are within the scope of practice of the AP.

Leadership Ch 2 1. The patient who is receiving chemotherapy describes a burning sensation in the leg, which the health care provider diagnoses as neuropathic pain secondary to the therapy. The nurse is most likely to question the prescription of which drug?

4. Morphine Morphine is usually not prescribed for neuropathic pain because pain relief response is poor.

6. Which patient is at greatest risk for respiratory depression when receiving opioids for analgesia?

4. Opioid-naïve adolescent with an arm fracture and cystic fibrosis At greatest risk are older adult patients, opioid-naïve patients, and those with underlying pulmonary disease. The adolescent has two of the three risk factors.

14. An older patient needs treatment for severe localized pain related to postherpetic neuralgia secondary to chemotherapy. The nurse is most likely to question the prescription of which type of medication?

4. Tricyclic antidepressant tricyclics should be avoided for older adults because of side effects, such as confusion or orthostatic hypotension.

46. Scenario: The nurse is caring for a 73-year old patient who was admitted for dehydration and observation for compartment injury. The patient fell between the toilet and the wall. His right arm was pinned underneath his body, for several hours before he was discovered by a neighbor. Fractures and other obvious injuries were ruled out in the emergency department. Patient received 400 mg ibuprofen for pain in the right arm.

Assess the location, quality, and intensity of pain ANTICIPATED Assess for 5Ps (pain, pallor, pulselessness, paralysis, paresthesia) ANTICIPATED Elevate right arm above the level of the heart CONTRAINDICATED Apply an ice pack wrapped in a towel CONTRAINDICATED Assess urine color and output ANTICIPATED Wrap the forearm with an elastic bandage CONTRAINDICATED Obtain an order for an x-ray of the arm NONESSENTIAL Notify health care provider for unrelieved pain and paresthesia ANTICIPATED

Which client should the nurse question receiving epoetin alfa?

Client MA with essential HTN Epoetin alfa (Epogen or Procrit) is a biologic response modifier that stimulates RBC production.

The client diagnosed with cancer reports anorexia. Which medication might the nurse discuss with the HCP that might increase the client's appetite?

Megestrol acetate Megestrol acetate (Megace, Appetrol) is an antineoplastic agent found to have appetite-increasing properties in some clients. It is given in an oral suspension.

44. Scenario: The nurse is caring for a patient who had abdominal surgery yesterday. The patient is restless and anxious and says that the pain is getting worse (8 out of 10) despite morphine via patient-controlled analgesia. Physical assessment findings include: T 100.3°F (37.9°C), P 110 beats/min, R 24 breaths/min, and BP 110/70 mm Hg. The abdomen is rigid and tender to the touch with hypoactive bowel sounds. The nurse tries to make the patient comfortable, and he is willing to wait until the next scheduled dose of pain medication. Escalating or unrelieved pain and a rigid, tender abdomen could signal hemorrhage or infection. A slightly elevated temperature is normal after surgery because of the body's response to tissue damage, however, the nurse would monitor for an upward trend that could indicate infection. A pulse rate of 110 beats/min could be caused by pain, postoperative dehydration, elevated temperature, or blood loss (initially the pulse increases to compensate for blood loss). A blood pressure of 110/70 mm Hg would be compared to baseline and examined for trends; 110/70 mmHg suggests blood loss if patient's BP is generally higher. Which information would the nurse include in the assessment component of the SBAR (situation, background, assessment, recommendation) report to the HCP?

The patient is restless and anxious and says that the pain is getting worse (8 out of 10) despite morphine via patient-controlled analgesia. Physical assessment findings include: T 100.3°F (37.9°C), P 110 beats/min, R 24 breaths/min, and BP 110/70 mm Hg. The abdomen is rigid and tender to the touch with hypoactive bowel sounds