Test 3 (Immune & Cancer)

Nursing management & interventions for RA based on?

-Self care deficits (ADLs) --> PT & OT -Joint function --> ROM, swimming --> lose function due to immobility due to pain from inflammation -Sleep disturbances --> leads to fatigue --> can't sleep because of pain -Infection control --> from side effects of meds

A 25-year-old client taking hydroxychloroquine (Plaquenil) for SLE reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. *Visual changes (retinal degeneration) is a side effect of hydroxychloroquine, educate patient to have visual exams frequently*

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. *Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness*

The pt is diagnosed with early cancer of prostate. Which assessment data would the pt report? 1. Urinary urgency and frequency. 2. Retrograde ejaculation. 3. Low back and hip pain. 4. States that he has not had any problems.

4. Asymptomatic in early stages. Screenings detect it. As the tumor grows the pt has urinary symptoms, low grade and hip pain can be found when metastasis occurs.

A patient who has underwent a bone marrow transplant is at most risk for what?* A. Bleeding and infection B. Congestive heart failure C. Liver failure D. HIV

A

Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms: a. yearly after age 40. b. after the birth of the first child and every 2 years thereafter. c. after the first menstrual period and annually thereafter. d. every 3 years between ages 20 and 40 and annually thereafter.

A

Which patient is at greatest risk for pancreatic cancer? A. An elderly AA man who smokes B. A young white obese woman with gallbladder disease C. A young AA man w. type 2 DM D. An elderly white woman who has pancreatitis

A Most likely in *AA, males, and smokers*. Others: *ETOH use*, DM, obesity, hx of pancreatitis, exposure to chemicals, *high fat diet, age (65-84)*, genetics

A nurse is assisting in developing a plan of care for a client with immunodeficiency. The nurse understands that which problem is a priority for the client? A. Infection B. Inability to cope C. Lack of information about the disease D. Feeling uncomfortable about body changes Infection

A Rationale: The client with immunodeficiency has inadequate or an absence of immune bodies and is at risk for infection. The priority problem is infection.

Of the 8 chemotherapy medications, which are vesicants?

Adriamycin, Vincristine, Bleomycin, 5 Fluorouracil

A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? a. Persistent nausea b. Rash c. Indigestion d. Chronic ache or pain

Answer C. Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. *Change in bowel or bladder habbits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast, testicles, or elsewhere Indigestion or difficulty swallowing Obvious change in size, colour, shape, or thickness of a wart, mole, or mouth sore Nagging cough or hoarseness*

Which of the following foods should a client with leukemia avoid? 1. White bread 2. Carrot sticks 3. Stewed apples 4. Medium rare steak

Answer: 2. Carrot sticks A low-bacteria diet would be indicated with excludes raw fruits and vegetables.

1. Which of the following conditions is not a complication of Hodgkin's disease? 1. Anemia 2. Infection 3. Myocardial Infarction 4. Nausea

Answer: 3. Myocardial Infarction Complications of Hodgkin's are pancytopenia, nausea, and infection. Cardiac involvement usually doesn't occur.

17. Nurse Ruffa is providing dietary instructions to the client with systemic lupus erythematosus. Which of the following dietary items would the nurse instruct the client to avoid? A. Cantaloupe B. Turkey C. Broccoli D. Steak

Answer: D. Steak The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake.

The client with AIDS has a CD4 +T-cell count of 175 cu.mm/liter. The nurse is aware that: A. He is relatively free of HIV. B. He is at risk for opportunistic infections. C. He is likely to be asymptomatic. D. He is in remission with his disease.

B

Which two pts could potentially be placed together as roommates? A. A pt w/ a neutrophil count of 1000 B. A pt who underwent debulking of a tumor to relieve pressure C. A pt who just underwent BMT D. A pt who has undergone larinectomy for spinal cord compression

B & D Debulking of tumor & laminectomy are pallaitive procedures. Pt w/ low neutrophils & pt who has had a BMT need protective isolation.

Other than ESR, CRP, CBC, ANA, what labs are especially important to monitor in SLE?

BUN, creatinine *50% of pts with SLE have renal involvement --> leads to HTN*

For a pt who is receiving vincristine, which side effect should be reported to the physician? A. Fatigue B. N/V C. Parasethesia D. Anorexia

C *Parasthesia (due to neurotoxicity) is a SE of vincristine*. Fatigue, N/V, and anorxiea are common SEs of many chemo drugs. For pts with these SEs: rest periods (fatigue), antiemetics (N/V), small & frequent meals containing high protein & high calorie foods (anorexia)

A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a) cyanosis b) arm edema c) periorbital edema d) mental status changes

C Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

AIDS diagnosis

CD4 below 200 and/or OI

GI complications of AIDS

Chronic diarrhea --> weight loss, N/V, appetite suppression, f&e imbalance, dehydration, perianal infection, weakness

Goal of treatment for RA?

Control inflammation Inflammation leads to pain which leads to decrease joint function because of immobility, sleep disturbances due to pain so pt does not sleep

AIDS: Non nucleoside reverse transcriptase inhibitor (NNRTI) nappy wants us to know

Delavirdine SE: Stevens Johnson rash

In RA, ESR & CRP would be?

Elevated

Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? 1. Faster growing cells are less susceptible to chemotherapy. 2. Non-dividing cells are more susceptible to chemotherapy 3. Faster growing cells are more susceptible to chemotherapy 4. Slower growing cells are more susceptible to chemotherapy.

Faster growing cells are more susceptible to chemotherapy

Which sign or symptom is the most reliable early indicator of infection in a client with neutropenia? Fever Chills Dsypnea Diaphoresis

Fever

Important to monitor in JIA

Growth & development, self esteem

First line treatment of SLE

Hydroxychloroquine

The DMARD nappy wants us to know for SLE?

Hydroxychloroquine SE: visual changes --> frequent eye exams (get a baseline), renal toxicity

Side effects of corticosteroids

Infection Hyperglycemia Weigh gain Calcium depletion Remember to taper off

GI complications in AIDS can lead to *severe weakness & malnutrition*, what pt ed/nursing management should be done for this?

Look at skin for infection or breakdown Assist in self care (ADLs) Encourage small frequent high protein high calorie meals

The DMARD nappy wants us to know for RA?

Methotrexate SE: hepatotoxicity --> no ETOH -Pregnant women can not take --> contraceptive use -If there is renal insufficiency --> lower dose

A nurse is explaining to a patient that about a 7-10 days after receiving chemotherapy, it is important to not do anything that would increase risk of infection because their ANC will be at its lowest. What is this called?

Nadir Takes an additional 7-14 days to recover.

At the time of diagnosis of Hodgkin's lymphoma, which of the following areas is often involved? 1. Back 2. Chest 3. Groin 4. Neck

Neck

Diet for patients with inflammation disorder

Plant based

Complication of inflammation disorder described as pain on inspiration

Pleuritis

Additional support for pts with AIDS

Psychosocial support

Which inflammation disorder is symmetrical? SLE or RA

RA

Non adherence of AIDS drugs leads to? What are some factors that lead to non adherence?

Resistance A. Active substance abuse B. Depression C. Lack of social support D. Treatment fatigue

Which inflammation disorder can lead to early atherosclerosis?

SLE

Inflammation disorder that has irreversible organ damage.

SLE Can spread to lung, heart, brain, kidney

Which inflammation disorder has CNS involvement?

SLE Depression, mental status changes, mood disturbances, psychosis (late)

What do DMARDs do?

Slow progression

Chemo meds are is a measured in?

Square meters Formula: Square root of ((Kg [weight] x cm [height]) divided by 3600)

T or F: Pancytopenia is an adverse effect of chemotherapy.

True -Adverse effects such as neutropenia, thrombocytopenia, and anemia occur from chemotherapy. -Neutropenia: most significant, ANC falls leading to increased risk of infection. Precautions-mask on pt when leaving room, dedicated equipment. Pat ed-avoid crowds, take temp daily, avoid food sources such as (fresh fruits & veggies, undercooked meat, fish, eggs; pepper, paprika), avoid fluids sitting in room temp over an hour -Anemia: monitor fatigue, Hgb, antianemic meds -Thrombocytopenia: monitor bleeding, avoid NSAIDs, electric razors, soft toothbrush, blah blah blah

Prophylaxis after exposure

Wash, report, screening, meds w/in 2 hours

SLE may present as RA but what procedure can determine if its not RA?

X-ray --> in RA there is joint damage

AIDS: Nucleoside reverse transcriptase inhibitor (NRTI) nappy wants us to know

Zidovudine SE: BM suppression (pancytopenia monitor liver enzymes

Two classes of AIDS meds nappy wants us to know

nucleoside reverse transcriptase inhibitor (NRTI) non nucleoside reverse transcriptase inhibitor (NNRTI)

The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for this client? 1. The client will maintain reproductive ability. 2. The client will verbalize feelings of body-image changes. 3. The client will have no deterioration of organ function. 4. The client's skin will remain intact and have no irritation.

3

The client infected with HIV might be prescribed several medications to control replication of the AIDS virus. The combination of drug therapy is known by the abbreviation: A. ELISA B. RIPA C. IFA D. HAART

D

Following chemo, a pt is being closely monitored for tumor lysis syndrome. Which lab value requires particular attention? A. Platelets B. Electrolytes C. Hgb D. Hematocrit

B Tumor lysis syndrome can result in severe electrolyte imbalances and potential renal failure.

Modes of transmission for HIV

Blood, semen, vaginal secretion, amniotic fluid, breast milk Blood biggest one

A pt w/ hep C has been prescribed interferon alfa-2a injections for the last month. Which info gathered during a home visit is the most important to communicate to the HCP? A. Pt has persistent N/V B. Pt injects the med into the thigh by the IM route C. Pt's temp is 99.7 D. Pt reports chronic fatigue, muscle aches, and anorexia

A N/V is a common adverse effect but persistent N/V can lead to dehyrdration and F&E imbalances

A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus? (Select all that apply.) A. Perinatal exposure B. Pregnancy C. Monogamous sex partner D. Older adult woman E. Occupational exposure

A D E

You assess a 24 yr old pt who is considering methotrexate therapy. Which info is most important to communicate to the HCP? A. Pt has many concerns about the safety of the drug B. Pt has been trying to get pregnant C. Pt takes daily multivitamin D. Pt says that she has taken methotrexate in the past

B *Methotrexate is a teratogenic & should not be used by pts who are pregnant. The physician needs to discuss the use of contraception during the time the pt is taking methotrexate.*

After interviewing a pt who is considering starting HAART, which pt info concerns you the most? A. The pt has been HIV positive for 8 years & has never taken any drug therapy for the HIV infection B. The pt tells you, "I have never been very consistent about taking medications." C. The pt is sexually active w/ multiple partners and says "I always use a condom" D. The pt has many questions & concerns regarding the effectiveness and safety of the medications

B *Non-adherence can lead to resistance* & the emergence of more virulent forms of the virus.

A client had undergone radiation therapy (external). The expected side effects include the following apart from: A. Hair loss B. Ulceration of oral mucous membranes C. Constipation D. Headache

Answer: C. Constipation Diarrhea not constipation is the side effect of radiation therapy.

In staging and grading neoplasm TNM system is used. TNM stands for: A. Time, neoplasm, mode of growth B. Tumor, node, metastasis C. Tumor, neoplasm, mode of growth D. Time, node, metastasis

B

Patients with SLE have organ involvement, who may be called upon to help in care

Organ specialists

Most common opportunistic infection of AIDS

PCP low grade fever, chest pai, malaise, non-productive cough, dyspnea

Complication of inflammation disorder described as sub sternal chest pain

Pericarditis

On a visit to the clinic, a client reports the onset of *early* symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3 *Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.*

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3 *Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.*

The client diagnosed with an acute exacerbation of SLE is being discharged with a prescription for an oral steroid which will be discontinued gradually. Which statement is the scientific rationale for this type of medication dosing? 1. Tapering the medication prevents the client from having withdrawal symptoms. 2. So thyroid gland starts working, because this medication stops it from working. 3. Tapering the dose allows the adrenal glands to begin to produce cortisol again. 4. This is the health-care provider's personal choice in prescribing the medication.

3 --> *circulatory collapse if corticosteroids are stopped abruptly*

The school nurse is preparing to teach a health class to ninth graders regarding sexually transmitted diseases. Which information regarding acquired immunodeficiency syndrome (AIDS) should be included? 1. Females taking birth control pills are protected from becoming infected with HIV. 2. Protected sex is no longer an issue because there is a vaccine for the HIV virus. 3. Adolescents with a normal immune system are not at risk for developing AIDS. 4. Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV.

4

You are monitoring a pt who is at risk of spinal cord compression related to tumor growth. Which pt statement is most likely to suggest an early manifestation? A. "Last night my back really hurt, and I had trouble sleeping." B. "My leg has been giving out when I try to stand." C. "My bowels are just not moving like they usually do." D. "When I try to pass urine, I have difficulty starting the stream."

A Back pain is an early sign of SCC, the others are later signs.

A pt w/ SLE is admitted to the hospital for evaluation and management of acute joint inflammation (unilateral). Which info obtained in the admission lab testing concerns you the most? A. Elevated BUN level B. Increased C-reactive protein C. Positive ANA test result D. Positive LEC preparation

A *A high number of pts w/ SLE develop nephropathy*, so an increase in BUN may indicate a need for a change in therapy or for further diagnostic testing such as creatinine or renal biopsy.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 500/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

ANS: D More assessment of the patient's *psychosocial* status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.

A patient receiving chemotherapy is about to receive adriamycin via IV. What indications of extravasation would cause the nurse to immediately stop administration? (SA) A. Resistance to flow of IV fluid B. Swelling, pain, or redness at site C. Absence of blood return D. Pain in upper arm, upper back, chest, neck, or jaw if using central line

All of them The line should be a brand new dedicated line that must have a blood return Extravasation: the leakage of certain drugs into subq tissue that causes tissue ulceration, necrosis, damage to underlying tendons, nerves, and blood vessels

The decision to begin antiretroviral therapy is based on: A. The CD4 cell count B. The plasma viral load C. The intensity of the patient's clinical symptoms D. All of the above

Answer: D. All of the above *A person's CD4 count is an important factor in the decision to start ART*. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections.

Most common manifestation for SLE

Photosensitivity rashes: malar (butterfly rash), discoid lesions (erythematous, scaling plaques, alopecia)

A pt has been prescribed adriamycin, what adverse effects would the nurse monitor and inform the patient about? (select all) A. Cardiomyopathy B. Neurotoxicity C. Cardiotoxicity D. GI bleed E. High emetic potential

A C E A patient who is taking adriamycin is usually on around the clock antiemetics, MUGA scan is used to measure cardio toxicity (how much damage is done to the heart)

If left untreated, RA can lead to?

*Joint deformities*, disability

The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply. 1. Use a sunscreen of SPF 30 or greater when in the sunlight. 2. Notify the HCP immediately when developing a low-grade fever. 3. Some dyspnea is expected and does not need immediate attention. 4. The hands and feet may change color if exposed to cold or heat. 5. Explain the client can be cured with continued therapy.

1 2 4 *Fever is the first sign of exacerbation.* Raynaud's phenomenon is a condition in which the digits of the hands and feet turn red, blue, or white in response to heat or cold and stress. It occurs with some immune inflammatory processes.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. *Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection.* Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. *Methotrexate is considered teratogenic.*

The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding? 1. The client is fortunate not to have contracted HIV from an infected needle. 2. The client must be repeatedly exposed to HIV before becoming infected. 3. The client may be in the primary infection phase of an HIV infection. 4. The antibody test is negative because the client has a different flu virus.

3

Joe is prescribed 5 fluoracil, what adverse effects would the nurse educate Joe about? A. Hepatotoxicity B. Epistaxis C. Neurotoxicity D. Agranulocytosis E. Steven's Johnson disease

A B D E SE: Hepato/renal function, epistaxis, GI bleed, Steven's Johnson disease, agranulocytosis, anaphylaxis

A nurse is providing a patient with education about external radiation therapy, what may be included in this? A. Avoid spicy, salty, acidic foods B. Apply ointment to the radiation area if becomes itchy C. Do not remove or wash off radiation tattoo D. Gently wash skin over irradiated area with mild soap and water, dry with a patting motion E. Do not expose irradiated skin to sun or a heat source

A C D E Avoid spicy, salty, acidic foods due to mucositis. Do not apply powders, ointments, lotions, deodorants, or perfumes to irradiated skin

Which of the following is the most common adverse effect of chemotherapy? A. N/V within 24 hours B. Alopecia C. Mucositis D. Anemia

A Although all of them are adverse effects of chemotherapy, N/V within 24 hours is the most common. It may persist up 24-48 hours after, delayed may last up to a week. Antiemetic medication may be used for 1st week after chemo.

The client has undergone mastectomy. The nurse interprets that the client is making the best adjustment to the loss of the breast if which of the following behaviors is observed? a ) participating in the care of the surgical drain b) reading the postoperative care booklet c) refusing to look at the wound d) asking for pain medication when needed

A The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that would be in place for a short time after discharge. Asking for pain medication is also an action-oriented option, but it does not relate to acceptance of the loss of the breast. Reading the postoperative care booklet is useful, but is not the best of the options presented here. Refusing to look at the wound indicates no adaptation to the loss.

You have just received morning report, which of the following pts would be the priority patient? A. A pt who developed tumor lysis syndrome around 5 am B. A pt with frequent reports of breakthrough pain over the last 24 hours C. A pt scheduled for exploratory laparotomy this morning D. A pt with anticipatory N/V for the past 24 hours

A Tumor lysis syndrome is an emergency involving electrolyte imbalances & potential renal failure.

For a pt receiving chemo, which lab result is of particular importance? A. WBC B. PT & PTT C. Electrolytes D. BUN

A WBC is especially important because chemo can cause a decrease in WBC causing *neutropenia*, which leaves pt vulnerable to infection.

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply a) radiation b) chemotherapy c) increased fluid intake d) serum sodium levels e) decreased oral sodium intake f) medication that is antagonistic to antidiuretic hormone

A, B, D, F Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. *Modes of transmission: blood, breast milk, amniotic fluid, vaginal secretions, semen*

The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? A. Fresh fruit salad B. Orange sherbet C. Strawberry yogurt D. French fries

Answer: C. Strawberry yogurt Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.

The nurse is teaching a 17-year old client and the client's family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? 1. Fever 2. Chills 3. Tachycardia 4. Dyspnea

Answer: 1. Fever Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE), which result is most important to communicate to the health care provider? a. Elevated blood urea nitrogen (BUN) and creatinine b. Positive lupus erythematosus cell prep c. Positive antinuclear antibodies (ANA) d. Decreased C-reactive protein (CRP)

Answer: A Rationale: *The elevated BUN and creatinine levels indicate possible lupus nephritis* and a need for a change in therapy to avoid further renal damage. The positive LE cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.

A client taking a chemotherapeutic agent understands the effects of therapy by stating: A. "I will avoid eating hot and spicy foods." B. "I should stay in my room all the time." C. "I should limit my fluid intake to about 500 ml per day." D. "I should notify the physician immediately if a urine color change is observed."

Answer: A. "I will avoid eating hot and spicy foods." The client should prevent hot and spicy food because of the stomatitis side effect. The client should avoid people with infection but should not isolate himself in his room all the time. Fluid intake should be increased. Urine color change is normal.

Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? A. Pain at the incisional site B. Arm edema on the operative side C. Sanguineous drainage in the Jackson-Pratt drain D. Complaints of decreased sensation near the operative site

Answer: B. Arm edema on the operative side Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.

A client with acquired immunodeficiency syndrome has a respiratory infection from Pneumocystis jiroveci and a nursing diagnosis of Impaired Gas Exchange written in the plan of care. Which of the following indicates that the expected outcome of care has not yet been achieved? A. Client has clear breath sounds B. Client now limits his fluid intake C. Client expectorates secretions easily D. Client is free of complaints of shortness of breath

Answer: B. Client now limits his fluid intake The status of the client with a diagnosis of Impaired gas exchange would be evaluated against the standard outcome criteria for this nursing diagnosis. These would include the client stating that breathing is easier and is coughing up secretions effectively, and has clear breath sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.

What should a male client over age 52 do to help ensure early identification of prostate cancer? a. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. b. Have a transrectal ultrasound every 5 years. c. Perform monthly testicular self-examinations, especially after age 50. d. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

Answer A The incidence of prostate cancer increases after age 50. 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. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases

A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs)

Answer A. The liver is one of the five most common cancer metastasis sites. *The others are the lymph nodes, lung, bone, and brain*. The colon, reproductive tract, and WBCs are occasional metastasis sites.

A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first? a. Stand as far away from the implant as possible and call for help. b. Pick up the implant with long-handled forceps and place it in a lead-lined container. c. Leave the room and notify the radiation therapy department immediately. d. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

Answer B If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.

A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client? a. She should have had a baseline mammogram before age 30. b. She should eat a low-fat diet to further decrease her risk of breast cancer. c. She should perform breast self-examination during the first 5 days of each menstrual cycle. d. When she begins having yearly mammograms, breast self-examinations will no longer be necessary.

Answer B. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman's risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)? a. White, cottage cheese-like patches on the tongue b. Yellow tooth discoloration c. Red, open sores on the oral mucosa d. Rust-colored sputum

Answer C. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a. Duodenal ulcers b. Hemorrhoids c. Weight gain d. Polyps

Answer D Other RFs: second hand smoke, IBD, low fiber diet, ETOH abuse, family hx, high fat diet, age (highest incidence above 85)

Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? 1. 30 minutes before the initiation of therapy. 2. With the administration of therapy. 3. Immediately after nausea begins. 4. When therapy is completed.

Answer: 1. 30 minutes before the initiation of therapy. Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.

Which of the following types of leukemia carries the best prognosis? 1. Acute lymphoblastic leukemia 2. Acute myelogenous leukemia 3. Basophilic leukemia 4. Eosinophilic leukemia

Answer: 1. Acute lymphoblastic leukemia Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children. Basophilic and eosinophilic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis.

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? 1. Assess level of consciousness 2. Assess temperature 3. Assess bowel sounds 4. Assess skin turgor

Answer: 1. Assess level of consciousness A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.

A client with acquired immunodeficiency syndrome is prescribed with Zidovudine (Azidothymidine). Which of the following laboratory results should the nurse monitor while on this medication? A. Throat swab gram stain. B. Complete blood count. C. Random blood sugar. D. Blood uric acid.

Answer: B. Complete blood count. *Zidovudine can cause bone marrow suppression leading to low WBC (neutropenia), platelets (thrombocytopenia), and RBCs (anemia).*

Which of the following complications are three main consequences of leukemia? 1. Bone deformities, spherocytosis, and infection. 2. Anemia, infection, and bleeding tendencies 3. Lymphocytopoiesis, growth delays, and hirsutism 4. Polycythemia, decreased clotting time, and infection.

Answer: 2. Anemia, infection, and bleeding tendencies The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone deformities don't occur with leukemia although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn't a feature in leukemia. Mature cells aren't produced in adequate numbers. Hirsutism and growth delay can be a result of large doses of steroids but isn't common in leukemia. Anemia, not polycythemia, occurs. Clotting times would be prolonged.

Which of the following tests in performed on a client with leukemia before initiation of therapy to evaluate the child's ability to metabolize chemotherapeutic agents? 1. Lumbar puncture 2. Liver function studies 3. Complete blood count (CBC) 4. Peripheral blood smear

Answer: 2. Liver function studies Liver and kidney function studies are done before initiation of chemotherapy to evaluate the child's ability to metabolize the chemotherapeutic agents. A CBC is performed to assess for anemia and white blood cell count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells. A lumbar puncture is performed to assess for central nervous system infiltration.

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions? 1. Viral factors 2. Stress 3. Low-fat and high-fiber diets 4. Exposure to radiation

Answer: 3. Low-fat and high-fiber diets Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer.

The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? 1. Ambulation three times a day 2. Monitoring temperature 3. Monitoring the platelet count 4. Monitoring for pathological factors

Answer: 3. Monitoring the platelet count Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if leukopenia is present. Options 1 and 4, although important in the plan of care are not related directly to thrombocytopenia.

The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states that which of the following is characteristic of the disease? 1. Presence of Reed-Sternberg cells 2. Involvement of lymph nodes, spleen, and liver 3. Occurs most often in the older client 4. Prognosis depends on the stage of the disease

Answer: 3. Occurs most often in the older client Hodgkin's disease is a disorder of young adults. Options 1, 2, and 4 are characteristics of this disease.

In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions? 1. Provide emotional support 2. Provide nutritional support 3. Provide pain control 4. Prepare the client's will

Answer: 3. Provide pain control The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort. Preparing the client and his family for the impending death and providing emotional support is also important but shouldn't be the primary focus until the pain is under control. Nutritional support may be provided, but as the terminal phase advances, the client's nutritional needs greatly decrease. Nursing care doesn't focus on helping the client prepare the will.

A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? 1. Apply sunscreen only after going in the water. 2. Avoid peak exposure hours from 9am to 1pm 3. Wear loosely woven clothing for added ventilation 4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

Answer: 4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure. A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided.

A client with leukemia has neutropenia. Which of the following functions must be frequently assessed? 1. Blood pressure 2. Bowel sounds 3. Heart sounds 4. Breath sounds

Answer: 4. Breath sounds Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won't help detect pneumonia.

One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is: 1. Underlying liver disease 2. Brain metastasis 3. Intravenous heparin therapy 4. Sepsis

Answer: 4. Sepsis Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinical DIC; however, sepsis is the most common cause.

When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with a. a warm bath followed by a short rest. b. a 10-minute routine of isometric exercises. c. stretching exercises to relieve joint stiffness. d. active range-of-motion (ROM) exercises.

Answer: A Rationale: *Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning*. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.

April is diagnosed with systemic lupus erythematosus. Which instruction would be included in the teaching plan for the client? A. "Wear large-brimmed hats when exposed to the sun." B. "Use tanning beds instead of sunbathing outside." C. "Remove all rugs, curtains, and dust-collecting items in home." D. "Carry injectable epinephrine at all times in case of exacerbation."

Answer: A. "Wear large-brimmed hats when exposed to the sun." The client diagnosed with systemic lupus erythematosus needs to modify his lifestyle. This includes avoiding sun and ultraviolet light exposure, especially between the hours of 10 a.m. and 4 p.m. The client also should wear tightly woven clothing. Regardless of of the source, exposure to ultraviolet light, even by means of tanning beds, should be strictly avoided. Removing all dust-collecting items in the home is appropriate for client diagnosed with asthma. Carrying injectable epinephrine is appropriate for a client who is allergic to insect stings or certain foods.

The classic symptoms that define breast cancer includes the following except: A. "pink peel" skin B. Solitary, irregularly shaped mass C. Firm, nontender, nonmobile mass D. Abnormal discharge from the nipple

Answer: A. "pink peel" skin Classic symptoms that define breast cancer includes: Firm, nontender, nonmobile mass. Solitary, irregularly shaped mass. Adherence to muscle or skin causing dimpling effect. Involvement of the upper outer quadrant or central nipple portion. Asymmetry of the breasts. "Orange peel" skin. Retraction of nipple. Abnormal discharge from nipple.

A cervical *radiation implant (brachytherapy)* is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? A. Bed rest B. Out of bed ad lib C. Out of bed in a chair only D. Ambulation to the bathroom only

Answer: A. Bed rest *The client with a cervical radiation implant should be maintained on bed rest* in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.

A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? A. Biopsy of the tumor B. Abdominal ultrasound C. Magnetic resonance imaging D. Computerized tomography scan

Answer: A. Biopsy of the tumor A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy.

During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous membranes, and listleness. Which nursing diagnosis focuses attention on the client's most immediate problem? A. Deficient fluid volume related to diarrhea and abnormal fluid loss B. Imbalanced nutrition: less than body requirements related to nausea and vomiting C. Disturbed thought processes related to central nervous system effects of disease D. Diarrhea related to the disease process and acute infection

Answer: A. Deficient fluid volume related to diarrhea and abnormal fluid loss Based on the client's assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the client's fluid status. Although imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time.

Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? A. The NA assists the patient to use dental floss after eating. B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. C. The NA adds baking soda to the patient's saline oral rinses. D. The NA puts fluoride toothpaste on the patient's toothbrush.

Answer: A. The NA assists the patient to use dental floss after eating. Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? A. The patient's visitors bring in some fresh peaches from home. B. The patient ambulates several times a day in the room. C. The patient uses soap and shampoo to shower every other day. D. The patient cleans with a warm washcloth after having a stool.

Answer: A. The patient's visitors bring in some fresh peaches from home. Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says, a. "I should expect to have a low fever all the time with this disease." b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." c. "I should try to ignore my symptoms as much as possible and have a positive outlook." d. "I can expect a temporary improvement in my symptoms if I become pregnant."

Answer: B Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? A. "I have frequent muscle aches and pains." B. "I rarely have the energy to get out of bed." C. "I take acetaminophen (Tylenol) every 4 hours." D. "I experience chills after I inject the interferon."

Answer: B. "I rarely have the energy to get out of bed." Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.

Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? A. Limit the time with the client to 1 hour per shift B. Do not allow pregnant women into the client's room C. Remove the dosimeter badge when entering the client's room D. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client

Answer: B. Do not allow pregnant women into the client's room Radiation precations: -*Limit visitors to 30 minutes a day and stand 6 feet away from patient at all times* -Perform medication & meal preparation outside of the patients room -Put the patient in a room that is lead-lined -*Prohibit children and pregnant women from visiting* -Have all staff members wear dosimeter badges -Others: portable lead shields or aprons, private room, posting appropriate notices about radiation safety precautions, metal forceps & lead lined container in room for dislodged implant

A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and neck lymph node involvement. The client is in what stage of breast cancer? A. Stage I B. Stage II C. Stage III D. Stage IV

Answer: B. Stage II Stage I - tumor size up to 2 cm. Stage II - tumor size up to 5 cm with axillary and neck lymph node involvement. Stage III - tumor size is more than 5 cm with axillary and neck lymph node involvement. Stage IV - metastasis to distant organs (liver, lungs, bone and brain).

Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? A. Hemoglobin of 10 g/L B. WBC count of 1700/µl C. Platelets of 65,000/µl D. Serum creatinine level of 1.2 mg/dl

Answer: B. WBC count of 1700/µl Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.

The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to A. provide foods that are highly spiced to stimulate the taste buds. B. avoid presenting foods for which the patient has a strong dislike. C. add strained baby meats to foods such as soups and casseroles. D. teach the patient to eat whatever is nutritious since food is tasteless.

Answer: B. avoid presenting foods for which the patient has a strong dislike. The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? a. The patient has experienced a recent 5-pound weight loss. b. The patient's erythrocyte sedimentation rate (ESR) has increased. c. The patient's blood glucose is 166 mg/dl. d. The patient has no improvement in symptoms.

Answer: C Rationale: *HYPERGLYCEMIA is a side effect of prednisone. Corticosteroids increase appetite and lead to WEIGHT GAIN*. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication.

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care? a. Institute seizure precautions. b. Reorient to time and place PRN. c. Monitor intake and output. d. Place on cardiac monitor.

Answer: C Rationale: *Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function*. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrists, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time is to a. maintain a positive self-image. b. perform activities of daily living independently. c. achieve satisfactory control of pain. d. make a successful adjustment to disease progression.

Answer: C Rationale: The focus during an acute exacerbation of RA is to manage pain effectively. The other outcomes are appropriate long-term outcomes.

Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy? A. Analgesics before meals B. Saline rinses every 2 hours C. Aspirin every 4 hours D. Bland diet

Answer: C. Aspirin every 4 hours Radiation therapy makes the platelet count decrease. Thus, nursing responsibilities should be directed at promoting safety by avoiding episodes of hemorrhage or bleeding such as physical trauma and aspirin administration. Analgesics are given before meals to alleviate the pain caused by stomatitis. Bland diet and saline rinses every 2 hours should also be done to manage stomatitis.

Which intervention should the nurse implement when caring for a client diagnosed with Pneumocystis carinii pneumonia related to acquired immunodeficiency syndrome who is crying over the loss of friends and family members because they will not talk to him anymore? A. Advising the client not to worry, and telling him everything will be alright B. Asking the health care provider for a psychiatric consult to assess the client's mental functioning C. Sitting down and listening to the client's concerns and frustrations D. Telling the client that the friends probably were not true friends anyway

Answer: C. Sitting down and listening to the client's concerns and frustrations Crying is evidence that the client is beginning to express concerns to the nurse. In response, active, nonjudgmental listening would most appropriate because is aids in the development of a trusting relationship. Advising the client not to worry or saying that everything will be alright provides false reassurance, which does not help the client cope. Further assessment is needed to determine whether a psychiatric consult should be considered. Telling the client that the friends were not true friends discounts the client's feeling and hinders the development of a therapeutic relationship.

An HIV-positive client who has been started on highly active antiretroviral therapy (HAART) came back for a follow-up checkup. Which of the following will be the most helpful in determining the response to the therapy? A. Rapid HIV antigen test. B. Western Blot analysis. C. Viral load test. D. White blood cell count.

Answer: C. Viral load test. *A viral load test helps provide information on the health status and how well antiretroviral therapy (ART - treatment with HIV medicines) is controlling the virus.* Options A and B monitors the presence of antibodies to HIV, so these tests will yield a positive result after the patient is infected with HIV even if the drug therapy is effective. Option D will be used to assess the impact of HIV on immune function but will not directly measure the effectiveness of the medicines.

Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover: A. cancerous lumps. B. areas of thickness or fullness. C. changes from previous self-examinations. D. fibrocystic masses.

Answer: C. changes from previous self-examinations. Women are instructed to examine themselves to discover changes that have occurred in the breast.

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. When the patient has a follow-up visit 1 month later, the nurse recognizes that the patient's response to the treatment may be best evaluated by a. blood glucose testing. b. liver function tests. c. serum electrolyte levels. d. C-reactive protein level.

Answer: D Rationale: *C-reactive protein is a marker for inflammation (along with CSR)*, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored for patients receiving steroids.

For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan? A. "Follow a low-protein, high-carbohydrate diet." B. "Eat three large meals per day." C. "Include unpasteurized dairy products in the diet." D. "Follow a high-protein, high-calorie diet."

Answer: D. "Follow a high-protein, high-calorie diet." Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-cooked meats.

Mr. Mc Princeton who is diagnosed with rheumatoid arthritis (RA) complains about joints that always hurt, saying, "I just feel like staying in bed all day." Which discharge instruction would be aimed at maintaining as such function as possible? A. "Refrain from exercise because it only aggravates the disease process." B. "Apply elastic bandages to all joints to increase the pain threshold." C. "Maintain a supine position most of the day to prevent the stress of weight bearing." D. "Promote aquatic (water) exercises to enhance joint mobility."

Answer: D. "Promote aquatic (water) exercises to enhance joint mobility." Water exercises are excellent because water promotes buoyancy, which eases joint movement. Persons with RA should maintain an active exercise program to strengthen and preserve muscle movement. Heat or cold applications, which promote circulation and reduce swelling, may help relieve pain, but elastic bandage wraps most likely would not be helpful.

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT: A. Reduce HIV-associated morbidity and prolong the duration and quality of survival B. Restore and preserve immunologic function C. Maximally and durably suppress plasma HIV viral load D. Elimination of HIV entirely from the body

Answer: D. Elimination of HIV entirely from the body. Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? A. Blood urea nitrogen (BUN) B. Serum phosphate C. Serum potassium D. Uric acid level

Answer: D. Uric acid level Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count below 200/µL and/or presence of opportunistic infection C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µL

B

Which of the following statements is FALSE about antiretroviral therapy (ART)? A. ART increases survival rate. B. ART completely cures AIDS C. ART reduces HIV-transmission. D. ART reduces hospitalization.

B

George has an exacerbation of SLE and has been prescribed prednisone for *4 days*, which medical order should you question? A. Discontinue prednisone after today's dose B. Give a "catch up" dose of varicella vaccine C. Check the pt's C-reactive protein D. Administer ibuprofen 500 mg PO

B *Varicella is a live vaccine, pts using corticosteroids should not be given live vaccines. Corticosteroids should be gradually tapered off when patients are taking them for a long time*, but tapering is not necessary for short term use

A nurse is assisting in developing a plan of care for a pregnant client with acquired immunodeficiency syndrome (AIDS). The nurse determines that which of the following is the priority concern for this client? A. Inability to care for self at home B. Development of an infection C. Lack of available support services D. Isolation

B Acquired immunodeficiency syndrome decreases the body's immune response, making the infected person susceptible to infections. Opportunistic infections are a primary cause of death in people affected with AIDS. Therefore preventing infection is a priority of nursing care. Although the concerns in options 1, 3, and 4 may need to be addressed at some point in the care of the client, these are not the priority.

You are caring for a female pt with a uterine cancer who is being treated w/ brachytherapy,. The UAP reports that the pt insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the priority action? A. Assess the UAP's knowledge; explain the rationale for strict bed rest B. Assess for dislodgement; use forceps to retrieve and a lead container to store as needed C. Assess the pt's knowledge of the treatment and her willingness to participate D. Notify the physician about the potential or confirmed dislodgement of the radiation implant

B If a radiation implant has obviously been expelled (i.e., is on the bed linens), use a pair of forceps to place the radiation source in a lead container.

A patient with AIDS has a negative result on the TB skin test (Mantoux). Which action will you anticipate next? A. Obtain a chest radiograph & sputum smear B. Tell the pt that the TB test results are negative C. Teach the pt about the anti-TB drug isoniazid D. Schedule TB testing again in 12 months

B Pts with AIDS may be unable to produce an immune response, so a negative TB skin test does not completely rule out TB diagnosis

Before administering a chemotherapy medication, the nurse informs the patient that they need to give him a test dose for anaphylaxis, what medication is the nurse talking about? A. Interferon B. Bleomycin C. Vincristine D. Epoetin

B SE: pulmonary toxicity, phlebitis, skin reactions (redness, darkening of the skin, stretch marks on the skin, skin peeling, thickening of the skin, ulceration

Richard just began taking a chemotherapy medication, a few days after beginning he has been having suicidal ideations. What medication has an adverse effect of this? A. Methotrexate B. Vincristine C. 5 Fluoracil D. Interferon

B Side effects: Neurotoxicity (foot drop), leukopenia, thrombocytopenia, weight loss, hair loss Give medication with lots of fluids

A pt develops SIADH. After reporting weight gain, weakness, and N/V to the physician, you would anticipate which initial order of the tx of this pt? A. A fluid bolus B. Fluid restrictions C. Urinalysis D. Na-restricted diet

B The patient is holding on to fluids. Hyponatremia is a concern therefore fluid restrictions would be ordered. Diet may need to include Na supplements.

A patient is undergoing an allogenic stem cell transplant, they are administered a medication that helps prevent graft vs host infection. What are the side effects of this medication? (select all) A. Cardio toxicity B. GI bleed C. Hepatotoxicity D. Hypertension E. Heart failure

B C The medication used for graft vs host is methotrexate , she emphasized GI bleed and hepatotoxicity, no pregnancy Others: pancytopenia, acute renal failure

Patients receiving chemo are at risk for thrombocytopenia, which actions are needed for pts who must be placed on bleeding risk? (SA) A. Provide mouthwash w/ ETOH for rinsing B. Use paper tape on fragile skin C. Gently insert suppositories D. Provide a soft toothbrush or oral sponge E. Avoid aspirin or aspirin-containing products F. Avoid overinflation of blood pressure cuffs G. Pad sharp corners of furniture

B, D, E, F, G Mouthwash should not include ETOH, because it has drying effect making mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended.

A 78-year-old male is receiving chemotherapy and states his appetite has left. Which of the following meals would be the best for this client? Cereal with berries and milk Toast, gelatin, and cookies Steak and house fries Baked chicken, black beans, and cottage cheese

Baked chicken, black beans, and cottage cheese *Optimal nutrition includes a high protein, high calorie*. Cereal, toast, gelatin, and cookies are high in carbohydrates, and are not balanced with enough protein. Steak provides adequate protein, but this meal is too high in fat and low in nutrients.

Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

C

A client reports to the health care clinic to obtain testing regarding human immunodeficiency virus (HIV) status after being exposed to an individual who is HIV positive. The test results are reported as negative, and the client tells the nurse that he feels so much better knowing that he had not contracted HIV. The nurse explains the test results to the client, telling the client that: A. There is no further need for testing. B. A negative HIV test is considered accurate. C. A negative HIV test is not considered accurate during the first 6 months after exposure. D. The test should be repeated in 1 week.

C Rationale: A test done for HIV should be repeated. There might be a *window period of 4 wks to 6 months* after the infection occurs and before antibodies appear in the blood. Therefore a negative HIV test is not considered accurate during the first 6 months after exposure.

The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the health care provider's prescriptions. Which of the following medications would the nurse expect to be prescribed? A. Antibiotic B. Antidiarrheal C. Corticosteroid D. Opioid analgesic

C Treatment of SLE is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatory drugs, corticosteroids, and immunosuppressants. The incorrect options are not standard components of medication therapy for this disorder.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client? A. Fatigue B. Weakness C. Weight gain D. Enlarged lymph nodes

D. Enlarged lymph nodes Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

The nurse has just taken a report and is preparing for the day's activities. Which client with AIDS should be seen first? A. The client with Kaposi's sarcoma B. The client with oral leukoplakia C. The client with vaginal candidiasis D. The client with Pneumocystis carinii pneumonia

D

A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the following is one of the initial characteristic sign of systemic lupus erythematous? A. Weight gain B. Subnormal temperature C. Elevated red blood cell count D. Rash on the face across the bridge of the nose and on the cheeks

D *Skin lesions or rash on the face across the bridge of the nose and on the cheeks (BUTTERFLY RASH) is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.*

Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from: A. Avoiding the use of ointments, powders and lotion to the area B. Using soft cotton fabrics for clothing C. Washing the area with a mild soap and water and patting it dry not rubbing it. D. Expose area to direct sunshine or cold.

D Avoid exposure to direct sunshine or cold

Your pt with RA is taking prednisone & naproxen (NSAID) to reduce inflammation & joint pain. Which symptom is the most important to communicate to the HCP? A. RA symptoms are worse in the morning B. Dry eyes C. Round & moveable nodules just under the skin D. Dark-colored stools

D Both of these meds have an adverse effect of GI bleed, dark-colored stools (melena) are indicative of GI bleed

An HIV-positive pt who has been started on HAART is seem in the clinic for follow up. Which test is most helpful in determining response to therapy? A. CD4 B. CBC C. Total lymphocyte count D. Viral load

D Decrease in viral load means therapy is working

A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a) headache b) dysphagia c) constipation d) electrocardiographic changes

D Hypercalcemia is a late manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

Which client is at the highest risk for systemic lupus erythematous (SLE)? A. An Asian male B. A white female C. An African-American male D. An African-American female

D RFs: *environmental, female, genetics*, AA

A nurse is collecting data on a client who complains of fatigue, weakness, malaise, muscle pain, joint pain at multiple sites, anorexia, and photosensitivity. Systematic lupus erythematosus (SLE) is suspected. The nurse further checks for which of the following that is also indicative of the presence of SLE? A. Emboli B. Ascites C. Two hemoglobin S genes D. Butterfly rash on cheeks and bridge of nose

D Rationale: SLE is a chronic inflammatory disease that affects multiple body systems. A butterfly rash on the cheeks and on the bridge of the nose is a classic sign of SLE. Option 3 is found in sickle cell anemia. Options 1 and 2 may be found in many conditions but are not associated with SLE.

A client with acquired immunodeficiency syndrome (AIDS) has difficulty swallowing. The nurse has given the client suggestions to minimize the problem. The nurse determines that the client has understood the instructions if the client verbalized to increase intake of foods such as: A. Raw fruits and vegetables B. Hot soup C. Peanut butter D. Puddings

D Rationale: The client is instructed to avoid spicy, sticky, or excessively hot or cold foods. The client also is instructed to avoid foods that are rough, such as uncooked fruits or vegetables. The client is encouraged to take in foods that are mild, nonabrasive, and easy to swallow. Examples of these include baked fish, noodle dishes, well-cooked eggs, and desserts such as ice cream or pudding. Dry grain foods such as crackers, bread, or cookies may be softened in milk or another beverage before eating.

A 28 year old female patient asks you when it is best to perform a self breast exam. Your response is the following:* A. It is best to perform a self breast exam on the same time every month of the day. B. It is best to perform a self breast exam on the day after ovulation. C. It is best to perform a self breast exam every 6 months on the 1st day of bleeding. D. It is best to perform a self breast exam 7 to 10 days after menses.

D Self breast exams should be performed 7 to 10 day after the start of menses (the patient's period...this is the first day of bleeding). Breast tissue is soft at this time due to hormone levels.

The nurse caring for a client who is HIV positive is stuck with the stylet used to start an IV. Which intervention should the nurse implement *first*? 1. Flush the skin with water and try to get the area to bleed. 2. Notify the charge nurse and complete an incident report. 3. Report to the employee health nurse for prophylactic medication. 4. Follow up with the infection control nurse to have lab work done.

The answer is 1 because it should be done first Rationales: *1*. The nurse should attempt to flush the skin and get the area to bleed. It is hoped this will remove contaminated blood from the body prior to infecting the nurse.* 2. The nurse should notify the charge nurse after flushing the area and trying to get it to bleed. 3. This should be done within four (4) hours of the exposure, not before trying to rid the body of the potential infection. 4. This is done at three (3) months and six (6) months after initial exposure.

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue d. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? a. Droplet precautions b. Contact precautions c. Airborne precautions d. Standard precautions

d. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.