Unit 3 Review Questions - NRSG357

The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a) "After the transplant, I will feel better and can go home in 5 to 7 days." b) "Before the transplant, I will have chemotherapy and possible full-body radiation." c) "My brother will be a 100% match for the cells used during the transplant." d) "I understand the transplant procedure has not dangerous side effects."

"Before the transplant, I will have chemotherapy and possibly full-body radiation." -Hematopoietic stem cell transplantation (HSCT) requires eradication of disease or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a) "Can you tell me what has been helpful to you in the past when coping with stressful events?" b) "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" c) "Do you have any concerns about body image changes?" d) "How long ago were you diagnosed with this cancer?"

"Can you tell me what has been helpful to you in the past when coping with stressful events?" -Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? a) "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present" b) "The brain tumor measures about 1 to 2 cm and no distant metastasis" c) "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in you body" d) "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation"

"The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis" -T1 means that the tumor is increasing in size to about 2cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.

Carol is an active adult. Her weight is 150 lbs. What health promotion teaching would be important for Carol. Select all that apply: a) Empty the bladder every 6 hours (every 4 hours is recommended) b) Evacuate the bowel daily c) Wipe the perineal area from back to front d) Urinate before and after intercourse e) Drink at least 2000 mL daily f) Drink up to 1500 mL daily g) Include all sources of fluids and add 1000 mL daily

-Evacuate the bowel daily -Urinate before and after intercourse -Drink at least 2000 mL daily

Which client is most likely to receive opioids for extended periods of time? a) A client with fibromyalgia b) A client with phantom limb pain c) A client with progressive pancreatic cancer d) A client with trigeminal neuralgia

A client with progressive pancreatic cancer -Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? a) Explain that this occurs in some clients and is usually permanent b) Inform the client that a small glass of wine may help her relax c) Protect the client from infection d) Allow the client an opportunity to express her feelings

Allow the client an opportunity to express her feelings

The nurse is assessing a patient that presents to the emergency department. The patient reports frequency and burning when urinating. The nurse performs percussion to determine if there is tenderness that indicates the presence of an ascending urinary tract infection. Which area should be percussed? a) Tail of Spence b) Suprapubic Point c) McBurney's Point d) Costovertebral angle

Costovertebral angle

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? a) Jaundice and flank pain b) Costovertebral angle tenderness and chills c) Burning sensation on urination d) Polyuria and nocturia

Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis -Option A: Jaundice indicates gallbladder or liver obstruction -Option C: A burning sensation on urination is a sign of lower urinary tract infection

The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a) Teach the patient about the seven warning signs of cancer b) Plan to monitor the patient's carcinoembryonic antigen (CEA) level c) Discuss risks associated with cigarette smoking during each patient encounter d) Teach the patient about annual chest x-rays for lung cancer screening

Discuss risks associated with cigarette smoking during each patient encounter -Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk.

A woman with no history of UTI who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a) Obtaining a clean-catch midstream urine specimen for culture and sensitivity b) No treatment with medication unless she develops fever, chills, and flank pain c) Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days d) Need to have a blood specimen drawn for a complete blood count and kidney function tests

Empirical treatment with trimethoprim-sulfamethoxazole (Bactrim) for 3 days -Unless a patient has a history of current UTIs or a complicated UTI, Bactrim or nitrofurantoin is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment, but symptomatic UTIs should always be treated.

A patient with multiple myeloma is receiving palliative radiation therapy as an intervention for pain management. The nurse expects a worsening of which symptom with this therapy: a) Fatigue b) Radiation dermatitis c) Weight gain d) Enlarged lymph nodes

Fatigue

When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7 g/dL and hematocrit of 26%. You place highest priority on initiating interventions that can reduce: a) Thirst b) Fatigue c) Headache d) Abdominal pain

Fatigue -The patient with a low hemoglobin level and hematocrit is anemic and is most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation with which to carry out cellular functions.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a) Hospitalization is required for several weeks after the stem cell transplant b) The transplant procedure takes place in a sterile operating room to minimize the risk of infection c) Donor bone marrow is transplanted through a sternal or hip incision d) Transplant of the donated cells can be very painful because of the nerves in the tissue lining of the bone

Hospitalization is required for several weeks after the stem cell transplant. -The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV-line, so the transplant is not painful, nor is an operating room or incision required.

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? a) Drug toxicity b) Polycythemia c) Infection d) Dose-limiting side effects

Infection -Polycythemia is a slow-growing blood cancer in which the bone marrow makes too many red blood cells

A patient with breast cancer is receiving teletherapy, dose 4200cGy (160 cGy/day). After 8 sessions, the nurse observes hyperemia of skin on irritated area. The nurse documents the finding as: a) Allergy to radiation b) Epidermaloma c) Psoriasis d) Radiation dermatitis

Radiation dermatitis

An 82-year-old woman asks the nurse what can be the cause of her frequent urinary tract infections? a) Longer length of urethra b) Large capacity of bladder c) Relaxation of pelvic floor and bladder muscles d) Tight muscular support at the urinary sphincter

Relaxation of pelvic floor and bladder muscles -The short urethra of women allows easier ascension and colonization of bacteria in the bladder than occurs in men, and the urethra does not lengthen with age. The bladder capacity of men and women is the same but decreases with aging. With aging, the urinary sphincter weakens. Relaxation of female urethra, bladder, vagina, and pelvic floor muscles may contribute to stress and urge incontinence and urinary tract infections

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? a) Testing of stool specimens for occult blood b) Teaching about the importance of dietary fiber c) Referring clients for colonoscopy procedures d) Giving vitamins and mineral supplements

Testing of stool specimen for occult blood -Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants. Client education is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care is best performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing personnel.

The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: a) Rupture of the bladder b) The development of a vesicovaginal fistula c) Extreme stress caused by the diagnosis of cancer d) Altered perineal sensation as a side effect of radiation therapy

The development of a vesicovaginal fistula -A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options A, C, and D.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a) The patient ambulates around the room b) The patient cleans with a warm washcloth after having a stool c) The patient's visitors bring in fresh peaches d) The patient uses soap and shampoo to shower every other day

The patient's visitors bring in fresh peaches -Fresh, thinned-skin fruits 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 prevent skin breakdown and infection.

While caring for a 72-year-old man who has an indwelling catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestation is the patient likely to experience? a) Cloudy urine and fever b) Urethral burning and bloody urine c) Vague abdominal discomfort and disorientation d) Suprapubic pain and slight decline in body temperature

Vague abdominal discomfort and disorientation

As a shift leader making out patient assignments for the oncoming shift, how would you assign care of a patient that has had a sealed radiation source placed? a) You decide to rotate staff and assign a nurse who has not provided care for the patient b) You decide to assign the same nurse who had the patient yesterday to continue providing quality care c) You decide to assign one nurse to care for all the patients undergoing sealed radiation therapy to provide continuum of care d) None of the options are correct. Sealed radiation therapy has no special staffing restrictions.

You decide to rotate staff and assign a nurse who has not provided care for the patient