Cancer/Immune

When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? (Select all that apply.) Physical Assessment Findings Diagnostic Findings Medications Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremors Na: 115 K: 4.2 Creatinine: 0.8 ondansetron (Zofran) cyclophosphamide (Cytoxan) A.) Hyponatremia B.) Mental status changes C.) Azotemia D.) Bradycardia E.) Weakness

Hyponatremia Mental status changes Weakness Antidiuretic hormone (ADH) is secreted or produced ectopically, resulting in water retention and sodium dilution. Dilutional hyponatremia results from ADH secretion, causing confusion and changes in mental status. Weakness results from hyponatremia. Azotemia refers to buildup of nitrogenous waste products in the blood, typically from renal damage. Bradycardia is not part of the constellation of symptoms related to SIADH; tachycardia may result from fluid volume excess.

Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment plan? A.) "I may lose my hair during this treatment." B.) "I must be positioned in the same way during each treatment." C.) "I will have a radioactive device in my body for a short time." D.) "I will be placed in a semiprivate room for company."

"I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? (Select all that apply.) A.) Assess for fever. B.) Observe for bleeding. C.) Administer pegfilgrastim (Neulasta). D.) Do not permit fresh flowers or plants in the room. E.) Do not allow the client's 16-year-old son to visit. F.) Teach the client to omit raw fruits and vegetables from the diet.

-Assess for fever -Administer pegfilgramtim (Neulasta) -Do not permit fresh flowers or plants in the room -Teach the client to omit raw fruits and vegetables from the diet Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms. Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well; however, very small children, who may get frequent colds and viral infections, may pose a risk.

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.) A.) Explain to the client that the colostomy is only temporary. B.) Encourage the client to participate in changing the ostomy. C.) Obtain a psychiatric consultation. D.) Offer to have a person who is coping with a colostomy visit. E.) Encourage the client and family members to express their feelings and concerns.

-Encourage the client to participate in changing the ostomy. -Offer to have a person who is coping with a colostomy visit. -Encourage the client and family members to express their feelings and concerns. Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication. Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

1. The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse? a. Cloudy urine b. Urinary hesitancy c. Post-void dribbling d. Weak urinary stream

ANS: A Cloudy urine could indicate infection due to possible urine retention and should be a priority action. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, post-void dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.

A client has a urinary catheter and continuous bladder irrigation after a transurethral resection of the prostate this morning. The amount of bladder irrigation solution that has infused over the past 12 hours is 1000 mL. The amount of fluid in the urinary drainage bag is 1725 mL. The nurse records that the client has had ____ mL urinary output in the past 12 hours. (Ignatavicius & Workman, p.1505)

725 mL (Ignatavicius & Workman, p.1505)

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate? A.) A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B.) A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C.) A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D.) A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia. The clients with acute lymphocytic leukemia and chemotherapy-induced nausea are complex clients requiring a nurse certified in chemotherapy administration. The client with tumor lysis syndrome has complicated needs for assessment and care and should be cared for by an RN with more oncology experience.

1. A client who had a hysterectomy has a 200-mg dose of ciprofloxacin (Cipro) ordered to infuse in 30 minutes. At what rate should the nurse infuse the medication if the pharmacy provides 200 mg in a 100-mL bag of normal saline? (Record your answer using a whole number.) ___ mL/hr

ANS: 200 mL/hr 100 mL 2 = 200 mL/hr.

10. A 34-year-old client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered to confirm testicular cancer? a. Alpha-fetoprotein (AFP) b. Prostate-specific antigen (PSA) c. Prostate acid phosphatase (PAP) d. C-reactive protein (CRP)

ANS: A AFP is a glycoprotein that is elevated in testicular cancer. PSA and PAP testing is used in the screening of prostate cancer. CRP is diagnostic for inflammatory conditions.

7. A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormonereleasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Aredia). Which statement by the nurse is most appropriate? a. The treatment reduces testosterone and prevents bone fractures. b. The medications prevent erectile dysfunction and increase libido. c. There is less gynecomastia and osteoporosis with this drug regimen. d. These medications both inhibit tumor progression by blocking androgens.

ANS: A Lupron, an LH-RH agonist, stimulates the pituitary gland to release luteinizing hormone (LH) to the point that the gland is depleted of LH and testosterone production is lessened. This may decrease the prostate cancer since it is hormone dependent. Lupron can cause osteoporosis, which results in the need for Aredia to prevent bone loss. Erectile dysfunction, decreased libido, and gynecomastia are side effects of the LH-RH medications. Antiandrogen drugs inhibit tumor progression by blocking androgens at the site of the prostate.

13. The nurse is teaching an uncircumcised 65-year-old client about self-management of a urinary catheter in preparation for discharge to his home. What statement indicates a lack of understanding by the client? a. I only have to wash the outside of the catheter once a week. b. I should take extra time to clean the catheter site by pushing the foreskin back. c. The drainage bag needs to be changed at least once a week and as needed. d. I should pour a solution of vinegar and water through the tubing and bag.

ANS: A The first few inches of the catheter must be washed daily starting at the penis and washing outward with soap and water. The other options are correct for self-management of a urinary catheter in the home setting.

4. The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the client? a. There should be no problem with a glass of wine with dinner each night. b. I am so glad that I weaned myself off of coffee about a year ago. c. I need to inform my allergist that I cannot take my normal decongestant. d. My normal routine of drinking a quart of water during exercise needs to change.

ANS: A This client did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a client with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent overdistention of the bladder. Decongestants also need to be avoided to lower the chance for urinary retention.

A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects

ANS: A Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the client's own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.

The nurse working with oncology clients understands that which age-related change increases the older client's susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves

ANS: A As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.

A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon.

ANS: A Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client's ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.

A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline

ANS: A Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate.

12. A client has scheduled brachytherapy sessions and states that she feels as though she is not safe around her family. What is the best response by the nurse? a. You are only reactive when the radioactive implant is in place. b. To be totally safe, it is a good idea to sleep in a separate room. c. It is best to stay a safe distance from friends or family between treatments. d. You should use a separate bathroom from the rest of the family.

ANS: A In brachytherapy, the surgeon inserts an applicator into the uterus. After placement is verified, the radioactive isotope is placed in the applicator for several minutes for a single treatment. There are no restrictions for the woman to stay away from her family or the public between treatments.

A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority? a. Blood pressure b. Lung assessment c. Oral mucous membranes d. Skin integrity

ANS: A Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority

A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort

ANS: A Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.

6. A nurse is caring for four postoperative clients who each had a total abdominal hysterectomy. Which client should the nurse assess first upon initial rounding? a. Client who has had two saturated perineal pads in the last 2 hours b. Client with a temperature of 99 F and blood pressure of 115/73 mm Hg c. Client who has pain of 4 on a scale of 0 to 10 d. Client with a urinary catheter output of 150 mL in the last 3 hours

ANS: A Normal vaginal bleeding should be less than one saturated perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage, which is a priority. The other clients also have needs, but the client with excessive bleeding should be assessed first.

2. The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which statement by the client indicates a lack of understanding? a. I need to change my tampon every 8 hours during the day. b. At night, I should use a feminine pad rather than a tampon. c. If I dont use tampons, I should not get TSS. d. It is best if I wash my hands before inserting the tampon.

ANS: A Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus. All of the other responses are correct: use of feminine pads at night, not using tampons at all, and washing hands before tampon insertion are all strategies to prevent TSS. DIF: Applying/Application REF: 1485

A nurse reads on a hospitalized client's chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18.

ANS: A The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary.

A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega)

ANS: A The client's hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count.

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the client's gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the client's job risks.

ANS: A This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.

2. The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy. Which statements by the client indicate a need for further teaching? (Select all that apply.) a. I should not have any problems driving to see my mother, who lives 3 hours away. b. Now that I have time off from work, I can return to my exercise routine next week. c. My granddaughter weighs 23 pounds, so I need to refrain from picking her up. d. I will have to limit the times that I climb our stairs at home to morning and night. e. For 1 month, I will need to refrain from sexual intercourse.

ANS: A, B Driving and sitting for extended periods of time should be avoided until the surgeon gives permission. For 2 to 6 weeks, exercise participation should also be avoided. All of the other responses demonstrate adequate knowledge for discharge. The client should not lift anything heavier than 10 pounds, should limit stair climbing, and should refrain from sexual intercourse.

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. "Chemo" gloves b. Facemask c. Isolation gown d. N95 respirator e. Shoe covers

ANS: A, B, C The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or "chemo" gloves), a facemask, and a gown. An N95 respirator and shoe covers are not required.

A client's family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the client's right to know and ask for their assistance. d. Have the unit manager take over the care of this client and family. e. Tell the family that this secret will not be kept from the client.

ANS: A, B, C The client's right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the client's right to know and ask the family how best to proceed. The nurse should not abdicate responsibility for this difficult situation by transferring care to another nurse. Simply telling the family that he or she will not keep this secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not.

3. A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.) a. Recent prostatectomy b. Long-term hypertension c. Diabetes mellitus d. Hour-long exercise sessions e. Consumption of beer each night

ANS: A, B, C, E Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise is related to this problem.

3. The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer. What possible risk factors would the nurse assess? (Select all that apply.) a. Smoking b. Multiple sexual partners c. Poor diet d. Nulliparity e. Younger than 18 at first intercourse

ANS: A, B, C, E Smoking, multiple sexual partners, poor diet, and age less than 18 for first intercourse are all risk factors for cervical cancer. Nulliparity is a risk factor for endometrial cancer.

A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the client's shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care.

ANS: A, B, D Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the client's shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care.

A client has mucositis. What actions by the nurse will improve the client's nutrition? (Select all that apply.) a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. c. Give the client hot liquids to hold in the mouth. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal.

ANS: A, B, D, E Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Hot liquids would be painful for the client.

1. The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old client with benign prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.) a.Assessing for blood pressure changes when lying, sitting, and arising from the bed b.Immediately reporting any change in the alanine aminotransferase laboratory test c.Teaching the client about the possibility of increased libido with these medications d.Taking the clients pulse rate for a minute in anticipation of bradycardia e.Asking the client to report any weakness, light-headedness, or dizziness

ANS: A, B, E Both the 5-alpha-reductase inhibitor (5-ARI) and the alpha1-selective blocking agents can cause orthostatic (postural) hypotension and liver dysfunction. The 5-ARI agent (Proscar) can cause a decreased libido rather than an increased sexual drive. The alpha-blocking drug (Cardura) can cause tachycardia rather than bradycardia.

6. A postmenopausal client is experiencing low back and pelvic pain, fatigue, and bloody vaginal discharge. What laboratory tests would the nurse expect to see ordered for this client if endometrial cancer is suspected? (Select all that apply.) a. Cancer antigen-125 (CA-125) b. White blood cell (WBC) count c. Hemoglobin and hematocrit (H&H) d. International normalized ratio (INR) e. Prothrombin time (PT)

ANS: A, C Serum tumor markers such as CA-125 assess for metastasis, especially if elevated. H&H would evaluate the possibility of anemia, a common finding with postmenopausal bleeding with endometrial cancer. WBC count is not indicated since there are no signs of infection. The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form. They are used to evaluate the extrinsic pathway of coagulation in clients receiving oral warfarin.

A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply moisturizers to dry skin. b. Apply steroid creams to the skin. c. Bathe the client using mild soap. d. Help the client with a hot water bath. e. Teach the client to avoid sunlight.

ANS: A, C The nurse can delegate applying unscented moisturizer and using mild soap for bathing. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function.

A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess all mucous membranes every 4 to 8 hours. b. Do not allow the client to eat meat or poultry. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours.

ANS: A, C, D, E Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device, and recording vital signs. Eating meat and poultry is allowed.

1. A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Reduce the pain by low-level heat. b. Discuss the high risk of infertility with this diagnosis. c. Relieve anxiety by relaxation techniques and education. d. Discuss in detail the side effects of laparoscopic surgery. e. Suggest resources such as the Endometriosis Association.

ANS: A, C, E With endometriosis, pain is the predominant symptom, with anxiety occurring because of the diagnosis. Interventions should be directed to pain and anxiety relief, such as low-level heat, relaxation techniques, and education about the pathophysiology and possible treatment of endometriosis. The nurse could suggest resources to give more information about the diagnosis. Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety.

2. A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.) a. Family history of prostate cancer b. Smoking c. Obesity d. Advanced age e. Eating too much red meat f. Race

ANS: A, D, E, F Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors.

8. The nurse is administering sulfamethoxazole-trimethoprim (Bactrim) to a client diagnosed with bacterial prostatitis. Which finding causes the nurse to question this medication for this client? a. Urinary tract infection b. Allergy to sulfa medications c. Hematuria d. Elevated serum white blood cells

ANS: B Before administering sulfamethoxazole-trimethoprim, the nurse must assess if the client is allergic to sulfa drugs. Urinary tract infection, hematuria, and elevated serum white blood cells are common problems associated with bacterial prostatitis that require long-term antibiotic therapy.

5. A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Which action by the nurse is a priority if bright red urinary drainage and clots are noted 5 hours after the surgery? a. Review the hemoglobin and hematocrit as ordered. b. Take vital signs and notify the surgeon immediately. c. Release the traction on the three-way catheter. d. Remind the client not to pull on the catheter.

ANS: B Bright red urinary drainage with clots may indicate arterial bleeding. Vital signs should be taken and the surgeon notified. The traction on the three-way catheter should not be released since it places pressure at the surgical site to avoid bleeding. The nurses review of hemoglobin and hematocrit and reminding the client not to pull on the catheter are good choices, but not the priority at this time.

10. A client has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation. What response by the nurse is correct about the staging of the cancer? a. The cancer has spread to the mucosa of the bowel and bladder. b. It has reached the vagina or lymph nodes. c. The cancer now involves the cervix. d. It is contained in the endometrium of the cervix.

ANS: B Stage III of endometrial cancer reaches the vagina or lymph nodes. Stage I is confined to the endometrium. Stage II involves the cervix, and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.

12. A 70-year-old client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The nurse reviews his laboratory results as follows: Sodium 128 mEq/L Hemoglobin 14 g/dL Hematocrit 42% Red blood cell count 4.5 What action by the nurse is the most appropriate? a. Consider starting a blood transfusion. b. Slow down the bladder irrigation if the urine is pink. c. Report the findings to the surgeon immediately. d. Take the vital signs every 15 minutes.

ANS: B The serum sodium is decreased due to large-volume bladder irrigation (normal is 136 to 145 mEq/L). By slowing the irrigation, there will be less fluid overload and sodium dilution. The hemoglobin and hematocrit values are a low normal, with a slight decrease in the red blood cell count. Therefore, a blood transfusion or frequent vital signs should not be necessary. Immediate report to the surgeon is not necessary.

A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facility's standing policy. d. Place the client on protective isolation precautions.

ANS: B A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.

14. A 20-year-old client is interested in protection from the human papilloma virus (HPV) since she may become sexually active. Which response from the nurse is the most accurate? a. You are too old to receive an HPV vaccine. b. Either Gardasil or Cervarix can provide protection. c. You will need to have three injections over a span of 1 year. d. The most common side effect of the vaccine is itching at the injection site.

ANS: B Current HPV vaccines are Gardasil and Cervarix, which should be given before the first sexual contact to protect against the highest risk HPV types associated with cervical cancer. The client is not too old since it is recommended that young women up to 26 years should receive an HPV vaccine. The entire series consists of three injections over 6 months, not 1 year. Local pain and redness surrounding the injection site are very common, but this does not include itching.

A client with cancer has anorexia and mucositis, and is losing weight. The client's family members continually bring favorite foods to the client and are distressed when the client won't eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isn't able to eat now no matter what they bring.

ANS: B Families often become distressed when their loved ones won't eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.

After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today

ANS: B Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward.

A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats.

ANS: B Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the client's risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug.

9. The nurse is doing preoperative teaching for a client who is scheduled for removal of cervical polyps in the office. Which statement by the client indicates a correct understanding of the procedure? a. I hope that I do not have cancer of the cervix. b. There should be little or no discomfort during the procedure. c. There may be a lot of bleeding after the polyp is removed. d. This may prevent me from having any more children.

ANS: B Polyp removal is a simple office procedure with the client feeling no pain. The other responses are incorrect. Cervical polyps are the most common benign growth of the cervix. Cautery is used to stop any bleeding, and there is no evidence that cervical polyps have a relationship to childbearing.

A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. "Are you getting adequate rest and sleep each day?" b. "It is normal to be fatigued even for years afterward." c. "This is not normal and I'll let the provider know." d. "Try adding more vitamins B and C to your diet."

ANS: B Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

ANS: D All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury.

A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. "Avoid getting salt water on the radiation site." b. "Do not expose the radiation area to direct sunlight." c. "Have a wonderful time and enjoy your vacation!" d. "Remember you should not drink alcohol for a year."

ANS: B The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.

3. A client is admitted to the emergency department with toxic shock syndrome. Which action by the nurse is the most important? a. Administer IV fluids to maintain fluid and electrolyte balance. b. Remove the tampon as the source of infection. c. Collect a blood specimen for culture and sensitivity. d. Transfuse the client to manage low blood count.

ANS: B The source of infection should be removed first. All of the other answers are possible interventions depending on the clients symptoms and vital signs, but removing the tampon is the priority.

A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the client's abdomen beforehand b. Ensuring that informed consent is on the chart c. Marking the client's bilateral pedal pulses d. Reviewing client teaching done previously

ANS: B This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority.

4. A client is scheduled to start external beam radiation therapy (EBRT) for her endometrial cancer. Which teaching by the nurse is accurate? (Select all that apply.) a. You will need to be hospitalized during this therapy. b. Your skin needs to be inspected daily for any breakdown. c. It is not wise to stay out in the sun for long periods of time. d. The perineal area may become damaged with the radiation. e. The technician applies new site markings before each treatment.

ANS: B, C, D EBRT is usually performed in ambulatory care and does not require hospitalization. The client needs to know to evaluate the skin, especially in the perineal area, for any breakdown, and avoid sunbathing. The technician does not apply new site markings, so the client needs to avoid washing off the markings that indicate the treatment site.

The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

ANS: B, C, D, E The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).

9. A 55-year-old male client is admitted to the emergency department with symptoms of a myocardial infarction. Which question by the nurse is the most appropriate before administering nitroglycerin? a. On a scale from 0 to 10, what is the rating of your chest pain? b. Are you allergic to any food or medications? c. Have you taken any drugs like Viagra recently? d. Are you light-headed or dizzy right now?

ANS: C Phosphodiesterase-5 inhibitors such as sildenafil (Viagra) relax smooth muscles to increase blood flow to the penis for treatment of erectile dysfunction. In combination with nitroglycerin, there can be extreme hypotension with reduction of blood flow to vital organs. The other questions are appropriate but not the highest priority before administering nitroglycerin.

11. A 25-year-old client has recently been diagnosed with testicular cancer and is scheduled for radiation therapy. Which intervention by the nurse is best? a. Ask the client about his support system of friends and relatives. b. Encourage the client to verbalize his fears about sexual performance. c. Explore with the client the possibility of sperm collection. d. Provide privacy to allow time for reflection about the treatment.

ANS: C Sperm collection is a viable option for a client diagnosed with testicular cancer and should be completed before radiation therapy, chemotherapy, or radical lymph node dissection. The other options would promote psychosocial support but are not the priority intervention.

3. A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended? a. Complete blood count b. Culture and sensitivity c. Prostate-specific antigen d. Cystoscopy

ANS: C The prostate-specific antigen test should be discussed as an option for prostate cancer screening. A complete blood count and culture and sensitivity laboratory test will be ordered if infection is suspected. A cystoscopy would be performed to assess the effect of a bladder neck obstruction.

8. A client has a recurrent Bartholin cyst. What is the nurses priority action? a. Apply an ice pack to the area. b. Administer a prophylactic antibiotic. c. Obtain a fluid sample for laboratory analysis. d. Suggest moist heat such as a sitz bath.

ANS: C A major cause of an obstructed duct forming a cyst is infection. The laboratory specimen is a priority since a culture is needed in order to prescribe sensitive antibiotics. Comfort measures can then be used, such as ice packs and moist heat.

4. A 55-year-old post-menopausal woman is assessed by the nurse with a history of dyspareunia, backache, pelvis pressure, urinary tract infections, and a frequent urinary urgency. Which condition does the nurse suspect? a. Ovarian cyst b. Rectocele c. Cystocele d. Fibroid

ANS: C Dyspareunia, backache, pelvis pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocelea protrusion of the bladder through the vaginal wall. Ovarian cysts are rare after menopause. A rectocele is associated with constipation, hemorrhoids, and fecal impaction. Fibroids are associated with heavy bleeding.

A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. "It causes rapid lysis of the cancer cell membranes." b. "It destroys the enzymes needed to create cancer cells." c. "It prevents the start of cell division in the cancer cells." d. "It sensitizes certain cancer cells to chemotherapy."

ANS: C Rituxan prevents the initiation of cancer cell division. The other statements are not accurate.

A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the client's serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery.

ANS: C Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

ANS: C TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.

5. The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her health care provider. Which signs and symptoms would be included in this teaching? (Select all that apply.) a. Constipation for 3 days b. Temperature of 99 F c. Abdominal pain d. Visible blood in the urine e. Heavy vaginal bleeding

ANS: C, D, E Health teaching for a client having brachytherapy should emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea (not constipation), urethral burning, extreme fatigue, and a fever over 100 F should also be reported.

2. A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the clients behavior, which statement by the nurse would be the most appropriate? a. The urine incontinence should not prevent you from socializing. b. You seem depressed and should seek more pleasant things to do. c. It is common for men at your age to have changes in mood. d. Nocturia could cause interruption of your sleep and cause changes in mood.

ANS: D Frequent visits to the bathroom during the night could cause sleep interruptions and affect the clients mood and mental status. Incontinence could cause the client to feel embarrassment and cause him to limit his activities outside the home. The social isolation could lead to clinical depression and should be treated professionally. The nurse should not give advice before exploring the clients response to his change in behavior. The statement about age has no validity.

6. A nurse and an unlicensed assistive personnel (UAP) are caring for a client with an open radical prostatectomy. Which comfort measure could the nurse delegate to the UAP? a. Administering an antispasmodic for bladder spasms b. Managing pain through patient-controlled analgesia c. Applying ice to a swollen scrotum and penis d. Helping the client transfer from the bed to the chair

ANS: D The UAP could aid the client in transferring from the bed to the chair and with ambulation. The nurse would be responsible for medication administration, assessment of swelling, and the application of ice if needed.

A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf

ANS: D All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.

The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. "I should take my temperature daily and when I don't feel well." b. "I will wash my toothbrush in the dishwasher once a week." c. "I won't let anyone share any of my personal items or dishes." d. "It's alright for me to keep my pets and change the litter box."

ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management.

11. The client is emotionally upset about the recent diagnosis of stage IV endometrial cancer. Which action by the nurse is best? a. Let the client alone for a long period of reflection time. b. Ask friends and relatives to limit their visits. c. Tell the client that an emotional response is unacceptable. d. Create an atmosphere of acceptance and discussion.

ANS: D Discussion of a clients concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears. Coping behaviors are encouraged with the support of friends and relatives. An emotional response should be accepted.

A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client's oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications.

ANS: D During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed.

13. A client has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess heart, lung, and bowel sounds. b. Check the hemoglobin and hematocrit levels. c. Evaluate the dressing for drainage. d. Empty the urine from the urinary catheter bag.

ANS: D The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.

5. The nurse is caring for a postoperative client following an anterior colporrhaphy. What action can be delegated to the unlicensed assistive personnel (UAP)? a. Reviewing the hematocrit and hemoglobin results b. Teaching the client to avoid lifting her 4-year-old grandson c. Assessing the level of pain and any drainage d. Drawing a shallow hot bath for comfort measures

ANS: D The UAP is able to provide comfort through a bath. The registered nurse should review any laboratory results, complete any teaching, and assess pain and discharge.

A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? a. Ensure the client is placed in protective isolation. b. Hand off a pregnant client to another nurse. c. No special action is necessary to care for this client. d. Read the policy on handling radioactive excreta.

ANS: D This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled directly. The nurse should read the facility's policy for handling and disposing of this type of waste. The other actions are not warranted.

1. Which action would the nurse teach to help the client prevent vulvovaginitis? a. Wipe back to front after urination. b. Cleanse the inner labial mucosa with soap and water. c. Use feminine hygiene sprays to avoid odor. d. Wear loose cotton underwear.

ANS: D To prevent vulvovaginitis, the client should wear cotton underwear. The client should wipe front to back after urination, not back to front. The client should cleanse the inner labial mucosa with water only, and avoid using feminine hygiene sprays.

7. A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is concerned about a loss of libido. What intervention by the nurse would be best? a. Suggest increasing vitamins and supplements daily. b. Discuss the value of a balanced diet and exercise. c. Reinforce that weight gain may be inevitable. d. Teach that estrogen cream inserted vaginally may help.

ANS: D Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy. Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? A.) Veins of the legs B.) Lung C.) Heart D.) Abdominal cavity

Abdominal cavity Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? A.) Alopecia B.) Allergy C.) Fever D.) Chills

Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab). Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

When caring for the client with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order? A.) Recombinant erythropoietin (Procrit) B.) Allopurinol (Zyloprim) C.) Potassium chloride D.) Radioactive iodine-131 (131I)

Allopurinol (Zyloprim) TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; allopurinol decreases uric acid production and is indicated in TLS. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

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. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion? (Select all that apply.) A.) Heavy menses B.) Smooth facial skin C.) Hyperkalemia D.) Breast tenderness Correct E.) Weight loss F.) Deep vein thrombosis Correct

Breast tenderness Deep vein thrombosis Breast tenderness and shrinking breast tissue may occur with antiestrogen therapy. Venous thromboembolism may also occur. Irregular menses or no menstrual period is the typical side effect of antiestrogen therapy. Acne may also develop. Hypercalcemia, not hyperkalemia, is typical. Fluid retention with weight gain may also occur.

When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) A.) Bruises B.) Fever C.) Petechiae D.) Epistaxis E.) Pallor

Bruises Petechiae Epistaxis Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count. Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A.) Increasing shortness of breath B.) Diminished bilateral breath sounds C.) Change in mental status D.) Weight gain of 4 pounds in 1 day

Change in mental status A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which is not related to thrombocytopenia. A large weight gain in a short period may be related to kidney or heart failure; bleeding is the major complication of thrombocytopenia.

Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)? A.) Recent radical mastectomy client requiring chemotherapy administration B.) Modified radical mastectomy client needing discharge teaching C.) Stage III breast cancer client requesting information about radiation and chemotherapy D.) Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy

Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains. The recent radical mastectomy client requires chemotherapy, so it is more appropriate to assign her to nurses who are familiar with teaching, monitoring, and providing chemotherapy for clients with breast cancer. The modified radical mastectomy client who requires discharge teaching, and the stage III breast cancer client requiring information about radiation and chemotherapy are more appropriate to assign to nurses who are familiar with breast cancer.

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A.) Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B.) Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C.) Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D.) Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client with chemotherapy-induced neutropenia first. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? A.) Bathe in cold water. B.) Wear cotton gloves when cooking. C.) Consume a diet high in fiber. D.) Make sure shoes are snug.

Consume a diet high in fiber. A high-fiber diet will assist with constipation due to neuropathy. The client should bathe in warm water, not hotter than 96° F. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A.) New onset of fatigue B.) Edema of arms and hands C.) Dry cough D.) Weight gain

Edema of arms and hands Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly, but because it is an early manifestation, this is not the priority. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone; although this should be addressed, it is an early sign so it is not the priority.

Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? (Select all that apply.) A.) Fatigue B.) Changes in color of hair C.) Change in taste D.) Changes in skin of the neck E.) Difficulty swallowing

Fatigue Change in taste Changes in skin of the neck Difficulty swallowing Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific; the larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair; this does not normally occur with radiation therapy.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? A.) Hemoglobin of 7.4 and hematocrit of 21.8 B.) Potassium level of 2.9 mEq/L and diarrhea C.) 250,000 platelets/mm3 D.) 5000 white blood cells/mm3

Hemoglobin of 7.4 and hematocrit of 21.8 Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 and hematocrit of 21.8 has anemia demonstrated by low hemoglobin and hematocrit. The client with diarrhea and a potassium level of 2.9 mEq/L has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 and the client with 5000 white blood cells/mm3 demonstrate normal values.

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 The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction .

Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy? A.) Assess anxiety level about the surgery. B.) Monitor vital signs after surgery. C.) Obtain data about breast cancer risk factors. D.) Teach about postoperative routine care.

Monitor vital signs after surgery. Vital sign assessment is included in UAP education and usually is part of the job description for UAP working in a hospital setting. Nursing assessment, obtaining data, and client teaching are not within the scope of practice for UAP and should be done by licensed nursing staff.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A.) Monitor weight B.) Trend red blood cells and hemoglobin and hematocrit C.) Monitor platelets D.) Observe for motor deficits

Monitor weight Cachexia results in extreme body wasting and malnutrition; severe weight loss is expected. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? A.) Morphine B.) Ondansetron (Zofran) C.) Naloxone (Narcan) D.) Diazepam (Valium)

Ondansetron (Zofran) Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Morphine is a narcotic analgesic or opiate; it may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only; lorazepam, another benzodiazepine, may be used for nausea.

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A.) Potential for lack of understanding related to side effects of chemotherapy B.) Potential for injury related to sensory and motor deficits C.) Potential for ineffective coping strategies related to loss of motor control D.) Altered sexual function related to erectile dysfunction

Potential for injury related to sensory and motor deficits The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? A.) Administering a biological response modifier B.) Encouraging oral care with commercial mouthwash C.) Providing oral care with a disposable mouth swab D.) Maintaining NPO until the lesions have resolved

Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition is important during cancer treatment; a local anesthetic may be prescribed for comfort.

An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A.) Storing drugs in dark locations at room temperature B.) Wearing soft clothing C.) Wearing a hat and sunglasses when going outside D.) Reducing all direct and indirect sources of light

Reducing all direct and indirect sources of light Lighting of all types must be kept to a minimum with clients receiving photodynamic therapy; it can lead to burns of the skin and damage to the eyes because these clients' eyes are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties; drugs should be stored according to the recommendations, but this is not the primary concern for this client. Clothing must cover the skin to prevent burns from direct or indirect light; texture is not a concern for the client receiving this treatment. The client will be homebound for 1 to 3 months after the treatment and should not go outside.

A client who has just been discharged from the hospital after a modified radical mastectomy is referred to a home health agency. Which nursing action is most appropriate to delegate to an experienced home health aide? A.) Assessing the safety of the home environment B.) Developing a plan to decrease lymphedema risk C.) Monitoring pain level and analgesic effectiveness D.) Reinforcing the guidelines for hand and arm care

Reinforcing the guidelines for hand and arm care Reinforcement of previously taught information about hand and arm care should be done by all caregivers. Assessment, developing a care plan, and monitoring pain level and analgesic effectiveness are not within the scope of practice of a home health aide and should be done by licensed nursing staff.

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery? A.) Cure of the cancer B.) Relief of symptoms or improved quality of life C.) Allowing other therapies to be more effective D.) Prolonging the client's survival time

Relief of symptoms or improved quality of life The focus of palliative surgery is to improve quality of life during the survival time. Curative surgery removes all cancer cells, visible and microscopic. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. Many therapies, such as surgery, chemotherapy, and biotherapy, increase the client's chance of cure and survival, but palliation improves quality of life.

A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, "I just don't know how this could have happened to me." Which response by the nurse is best? a) "Tell me what you mean when you say you don't know how this could have happened to you." b) "Do you have a family history that might make you more likely to develop breast cancer?" c) "Would you like me to help you find more information about how breast cancer develops?" d) "Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it." (Chp. 70, elsevier resources)

The client's statement that he or she does not know how this could have happened may indicate shock and denial or a request for more information. To provide appropriate care, further assessment is needed about the client's psychosocial status. The first action by the nurse in this situation is to obtain more data by asking open-ended questions. The nurse needs to further assess the client's emotional status before asking about family history of cancer or obtaining information for the client. (Chp. 70, elsevier resources)

The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A.) The student scrubs the hub of IV tubing before administering an antibiotic. B.) The nurse overhears the student explaining to the client the importance of handwashing. C.) The student teaches the client that symptoms of neutropenia include fatigue and weakness. D.) The nurse observes the student providing oral hygiene and perineal care.

The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia. Hygiene and perineal care help prevent infection and sepsis.

The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)? A.) Monitoring platelets B.) Administering packed red blood cells C.) Using strict aseptic technique to prevent infection D.) Administering low-dose heparin therapy for clients on bedrest

Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

a patient asks why it is essential that HAART meds be taken everyday at the same time. what is the nurses best response? a. missing or delaying doses of these drugs decreases blood conenctrations needed to inhibit viral replication b. missing or delayed doses of these drugs decreases the risk of developing infections c. missing or delaying doses of these drugs decreases the effectiveness missing or delaying doses can decrease the risk of developing HIV resistant mutations

a

a patient with PJP usually presents with which symptom? A. dyspnea, tachypnea, persistent dry cough, fever b. cough with copious thick sputum, fever, and dyspnea c. chest pain and difficulty swallowing D. fever, persistant cough and vomiting

a

an IV drug user who regularly shares needles is in the ER. what information does the nurse provide to decrease he patients risk of HIV through shared needles after each use? A. fill and flush syringe with clear water, fill with bleach and shake for 30-60 seconds and rinse with clear water B. fill and flush with water then soap and hot water, shake for 2 minutes and flush with cold water C. rinse needles with bleach and water solution and allow to air dry D. rinse needles after each use with rubbing alcohol and water, then rinse with water

a

which point are you sure to include when teaching a new RN to prevent HIV transmission from patients? A. wear gloves when in contact with patients mucous membrane or non-intact skin B. be sure to wear protective gear when providing any care to HIV positive patients C. always war a mask D. use PEP whether a patient is positive or not

a

The nurse is teaching post-mastectomy exercises to a client. Which statement made by the client indicates that teaching has been effective? a) "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." b) "In rope turning, I'll hold the rope with my arms flexed." c) "In rope turning, I'll start by making large circles." d) "With hand wall climbing, I'll walk my hands up the wall and back down until they are at waist level." (Chp. 70, elsevier resources)

a) "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." To perform the pulley exercise properly, the client should drape a 6-foot-long rope over a sturdy structure. In rope turning, the client holds the end of the rope and steps back from the door until the arm is almost straight out in front. The client starts with small circles and gradually increases to larger circles as the client becomes more flexible. With hand wall climbing, the client walks the hands up the wall and then back down until they are at shoulder level. (Chp. 70, elsevier resources)

A client has undergone transurethral resection of the prostate (TURP). Which interventions does the nurse incorporate in this client's postoperative care? (Select all that apply.) a) Administer antispasmodic medications. b) Encourage the client to urinate around the catheter if pressure is felt. c) Perform intermittent urinary catheterization every 4 to 6 hours. d) Place the client in a supine position with his knees flexed. e) Assist the client to mobilize as soon as permitted. (Chp 72, elsevier resources)

a) Administer antispasmodic medications. e) Assist the client to mobilize as soon as permitted. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur due to catheter use. Assisting the client to a chair as soon as permitted postoperatively will help to decrease the risk of complications from immobility. An indwelling catheter and continuous bladder irrigation are in place for about 24 hours after TURP. The client should not try to void around the catheter, which causes the bladder muscles to contract and may result in painful spasms. Intermittent urinary catheterization is not necessary. Typically, the catheter is taped to the client's thigh, so he should keep his leg straight. (Chp 72, elsevier resources)

which practices are recommended to prevent transmission of HIV? (Select all that apply) A. latex condoms for genital and anal intercourse B. natural membrane condoms for genital and anal intercourse C. topical contraceptives D. antiviral meds E. latex barrier for genital and anal intercourse

a, e

The RN working in the hospital emergency department is assigned to care for these four clients. Which client does the nurse attend to first? a) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain b) Young adult with a swollen, painful scrotum who has a recent history of mumps infection c) Middle-aged adult discharged 2 days ago after a transurethral resection of the prostate who has increased hematuria d) Older adult with a history of benign prostatic hyperplasia and palpable bladder distention (Chp 72, elsevier resources)

a) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain The client who has had an erection for "10 or 11 hours" has symptoms of priapism, which is considered a urologic emergency because the circulation to the penis may be compromised and the client may not be able to void with an erect penis. The client with a swollen, painful scrotum; the client with hematuria; and the client with a history of benign prostatic hyperplasia do not require the nurse's immediate attention since these are not medical emergencies. (Chp 72, elsevier resources)

A client with prostate cancer asks the nurse for more information and counseling. Which resources does the nurse suggest? (Select all that apply.) a) American Cancer Society's Man to Man program b) Us TOO International c) American Prostate Cancer Society d) National Prostate Cancer Coalition e) Client's church, synagogue, or place of worship (Chp 72, elsevier resources)

a) American Cancer Society's Man to Man program b) Us TOO International d) National Prostate Cancer Coalition e) Client's church, synagogue, or place of worship The American Cancer Society's Man to Man program helps the client and partner cope with prostate cancer by providing one-on-one education, personal visits, education presentations, and the opportunity to engage in open and candid discussions. Us TOO International is a prostate cancer support group that is sponsored by the Prostate Cancer Education and Support Network. The National Prostate Cancer Coalition provides prostate cancer information. The client's church, synagogue, or place of worship is a community support service that may be important for many clients. There is no such organization as the American Prostate Cancer Society. (Chp 72, elsevier resources)

After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate after the surgeon sees the client? (Select all that apply.) a) Antispasmodic drugs b) Emergency surgery c) Forced fluids d) Increased intermittent irrigation e) Monitoring for anemia (Chp 72, elsevier resources)

a) Antispasmodic drugs e) Monitoring for anemia Although not a common occurrence, bleeding may occur in the postoperative period. Venous bleeding is more common than arterial bleeding. The surgeon may apply traction on the catheter for a few hours to control the venous bleeding. Traction on the catheter is uncomfortable and increases the risk for bladder spasms, so analgesics or antispasmodics are usually prescribed. Hemoglobin and hematocrit should be monitored and trended for indications of anemia. Emergency surgery and increased intermittent irrigation would be indicated for an arterial bleed, which would be a brighter red color. Forced fluids are indicated after the catheter is removed. (Chp 72, elsevier resources)

A client with benign prostatic hyperplasia is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? (Select all that apply.) a) Avoid drugs used to treat erection problems. b) Be careful when changing positions. c) Keep all appointments for follow-up laboratory testing. d) Hearing tests will need to be conducted periodically. e) Take the medication in the afternoon. (Chp 72, elsevier resources)

a) Avoid drugs used to treat erection problems. b) Be careful when changing positions. c) Keep all appointments for follow-up laboratory testing. Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension and can cause liver damage, so it is important to keep appointments for follow-up laboratory testing. These drugs do not affect hearing. Alpha-adrenergic blockers should be taken in the evening to decrease the risk of problems related to hypotension. (Chp 72, elsevier resources)

A client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client is maladaptive? a) Avoiding eye contact with staff b) Saying, "I feel like less of a woman" c) Requesting a temporary prosthesis immediately d) Saying, "This is the ugliest scar ever" (Chp. 70, elsevier resources)

a) Avoiding eye contact with staff Avoiding eye contact may be an indication of decreased self-image. The client stating that she feels like less of a woman or that her scar is ugly illustrates an expected emotional state; by verbalizing her frustration, the client suggests a willingness to discuss and express feelings. Requesting a prosthesis can be a sign of healing and working through body image changes. (Chp. 70, elsevier resources)

When is the best time for the nurse to begin discharge planning and a community-based plan of care for a client with prostate cancer? a) Before surgery b) After surgery c) 2 days before being discharged d) The day of discharge (Chp 72, elsevier resources)

a) Before surgery Planning should begin as early as possible, on admission and before surgery. After surgery is not the correct time to begin planning. Planning should begin earlier than 2 days before discharge. (Chp 72, elsevier resources)

A young adult with testicular cancer is admitted for unilateral orchiectomy and retroperitoneal lymph node dissection. Which nursing action is best for the nurse to delegate to unlicensed assistive personnel (UAP)? a) Encourage the client to cough and deep-breathe after surgery. b) Discuss reproductive options with the client and significant other. c) Teach about the availability of a gel-filled silicone testicular prosthesis. d) Evaluate the client's understanding of chemotherapy and radiation treatment. (Chp 72, elsevier resources)

a) Encourage the client to cough and deep-breathe after surgery. Although teaching about routine postoperative client actions such as coughing and deep-breathing should be done by licensed nurses, reminding clients to perform these activities can be delegated to UAP. Client education and evaluation are more complex skills that should be done by licensed nurses. (Chp 72, elsevier resources)

A client is receiving chemotherapy treatment for breast cancer and asks for additional support for managing the associated nausea and vomiting. Which complementary therapy does the nurse suggest? a) Ginger b) Journaling c) Meditation d) Yoga (Chp. 70, elsevier resources)

a) Ginger It has long been believed that ginger helps alleviate nausea and vomiting. Current studies are being done on the effect of ginger on chemotherapy-induced nausea. Journaling is good for reducing anxiety, stress, and fear. Meditation helps reduce stress, improve mood, improve quality of sleep, and reduce fatigue. Yoga has been shown to improve physical functioning, reduce fatigue, improve sleep, and improve one's overall quality of life. (Chp. 70, elsevier resources)

Which statement about breast reconstruction surgery is correct? a) Many women want breast reconstruction using their own tissue immediately after mastectomy. b) Placement of saline- or gel-filled prostheses is not recommended because of the nature of the surgery. c) Reconstruction of the nipple-areola complex is the first stage in the reconstruction of the breast. d) The surgeon should offer the option of breast reconstruction surgery once healing has occurred after a mastectomy. (Chp. 70, elsevier resources)

a) Many women want breast reconstruction using their own tissue immediately after mastectomy. Many women want autogenous reconstruction after mastectomy. Saline- or gel-filled prostheses are recommended as breast expanders in breast augmentation surgery, not for reconstructive surgery. Reconstruction of the nipple-areola complex is the last stage in breast reconstruction surgery. Breast reconstruction surgery should be discussed before mastectomy takes place. (Chp. 70, elsevier resources)

Which client has the highest risk for breast cancer? a) Older adult woman with high breast density b) Nullipara older adult woman c) Obese older adult male with gynecomastia d) Middle-aged woman with high breast density (Chp. 70, elsevier resources)

a) Older adult woman with high breast density People at high increased risk for breast cancer include women age 65 years and older with high breast density. Nullipara women are at low increased risk for breast cancer. Men are not at high increased risk for breast cancer, but obesity can cause gynecomastia. Being middle-aged does not indicate a high increased risk for breast cancer. (Chp. 70, elsevier resources)

The nurse is caring for a client with erectile dysfunction who has not had success with other treatment modalities. The nurse anticipates that the health care provider will recommend which treatment for this client? a) Penile implants b) Penile injections c) Transurethral suppository d) Vacuum constriction device (Chp 72, elsevier resources)

a) Penile implants Penile implants (prostheses), which require surgery, are used when other modalities fail. Devices include semi-rigid, flexible, or hydraulic inflatable and multi-component or one-piece instruments. Penile injections are tried before using the option of last resort. Transurethral suppository is tried before using the option of last resort. A vacuum constriction device is easy to use, and is often the first option that is tried. (Chp 72, elsevier resources)

which conditions cause severe pain in HIV and AIDS (Select all that apply) a. enlarged organs b. peripheral neuropathy c. tumors d. high fever e. dry skin

a, b, c

an HIV positive women who is pregnant asks if her baby is at risk for HIV. which points must the nurse be sure to include when teaching? (Select all that apply) A. HIV can cross the placenta B. infant can contract HIV with exposure to blood and vaginal secretions during birth C. once your baby is born, you should be able to breastfeed D. there is a risk for perinatal transmission of HIV from you to your child. because you are on drug therapy, that risk is about 8% E. consider oral contraceptives o protect yourself from other STDs

a, b, d

what methods or agents are used to treat kaposi's sarcoma (Select all that apply) a. radiotherapy b. chemo c. antibiotics d. cryotherapy e. surgery

a, b, d

which actions are useful in helping orient a patient (Select all that apply) a. repeating person, place, time b. using clocks and calendars c. using MMSE screening test d. having familiar items present e. providing uninterrupted time

a, b, d

which descriptions are characteristic of a non progressor? (Select all that apply) A. has been infected for 10 years B. is asymptomatic C. has no CD4+ or t-lymphocytes D. is immunocompetent E. are functional antibodies

a, b, d

the nurse assesses a patient diagnosed with advanced AIDS for malnutirition. which findings does the nurse most likely assess (Select all that apply) a. pain b. anorexia c. urinary incontinence d. diarrhea e. vomiting

a, b, d, e

which methods or items are means of transmitting HIV (Select all that apply) a. sex b. household utensils c. breast milk d. toilet facilities e. mosquitoes

a, c

corticosteroids perform which actions (Select all that apply) a. block movement of neutrophils and monoctyes through cell membrane b. increase cell production in the bone marrow c. reduce number of circulating t cells, resulting in suppressed cell mediated immunity d. decrease ICP e. contrict blood vessels

a, c, d

where in the body can cytomegalovirus present with symptoms? (Select all that apply) a. eyes, causing visual impairment b. kidneys as glomerulonephritis c. respiratory tract causing pneumonia d. GI tract, causing diarrhea e. heart as cardiomyopathy

a, c, d

which actions can the nurse delegate to the UAP who will be giving mouth care to a patient with HIV/AIDS (Select all that apply) a. offer mouth rinses with sodium bicarb and sterile water several times a day b. assess mouth for increased presence of lesions c. encourage the patient to drink plenty of fluids d. provide a soft bristled toothbrush e. administer oral analgesic gel

a, c, d

which conditions may be the first signs of HIV in women? (Select all that apply) A. vaginal candidiasis B. bladder infections C. cervical caner D. PID E. mononucleosis

a, c, d

which lab resluts will the nurse expect to decrease (Select all that apply) a. cd4+ b. cd8+ c. WBC d. lymphocytes e. HIV antibodies

a, c, d

a patient presenting with toxicoplasmosis may have with s/s? (Select all that apply) A. speech difficulty B. Shortness of breath C. visual changes D. impaired gait E. mental status changes

a, c, d, e

which opportunistic infections can be observed in AIDS (Select all that apply) A. toxicoplasmosis B. gastroenteritis C. TB D. candidiasis E. cytomegalovirus

a, c, d, e

HAART causes what effects? A. reversal of a patients antibody status B. decrease of the viral load C. increase of the viral load D. moe delectable HIV

b

What type of precautions should the nurse take for a patient suspected of having TB as a result of HIV? A. universal b. airborne c. enteric d. protective isolation

b

the nurse is teaching a patient about preventing infection through sex. which statement indicates effective teaching? a. latex condom with spermicide proves the best protection b. mutually monogamous sex with a non infected partner will best prevent HIV c. contraceptive methods like implants and injections are recommended to prevent HIV transmission d. if my partner and i are both HIV positive, unprotected sex is permitted

b

the patient with HIV/AIDS appears emaciated and has diarrhea, anorexia, mouth lesions, and peristent weight loss. what condition does the nurse suspect this patient is developing? a. AIDS dementia B. AIDS wasting syndrome C. AIDS GI opportunistic infection D. AIDS candidiasis opportunistic infection

b

what is the most important means of preventing HIV spread? A. engineering B. education C. isolation D. counseling

b

which definition of immunodeficiency is accurate? A. disease/deficiency acquired as a result of viral infection, contact with toxin, or medical therapy B. deficient immune response as a result of imapired or missing immune components C. chronic infection wih immunodeficiency virus D. disease/deficiency pesent since birth

b

which statements about HIV are accurate? (Select all that apply) A. may be acquired or congenital B. it is retrovirus C. it always progresses to AIDS D. it is a virus that attacks the immune system E. it is a parasite that forces cells to make copies of itself

b, d, e

which immune function abnormalities are a result of HIV infection? (Select all that apply) A. lymphocytosis B. CD4+ depletion C. increased CD8+ activity D. long macrophage life span E. lymphocytopenia

b, e

A client with prostate cancer asks why he must have surgery instead of radiation, even if his cancer is the least-invasive type. What is the nurse's best response? a) "It is because your cancer growth is large." b) "Surgery is the most common intervention to cure the disease." c) "Surgery slows the spread of cancer." d) "The surgery is to promote urination." (Chp 72, elsevier resources)

b) "Surgery is the most common intervention to cure the disease." Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure. The size of the tumor is not likely to be why the client is having surgery. A bilateral orchiectomy (removal of both testicles) is palliative surgery that slows the spread of cancer by removing the main source of testosterone. A transurethral resection of the prostate is done to promote urination for clients with advanced disease; it is not used as a curative treatment. (Chp 72, elsevier resources)

The nurse is instructing a client on how to perform breast self-examination (BSE). Which techniques does the nurse include in teaching the client about BSE? (Select all that apply.) a) Instruct the client to keep her arm by her side while performing the examination. b) Ensure that the setting in which BSE is demonstrated is private and comfortable. c) Ask the client to remove her shirt. The bra may be left in place. d) Ask the client to demonstrate her own method of BSE. e) Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts. (Chp. 70, elsevier resources)

b) Ensure that the setting in which BSE is demonstrated is private and comfortable. d) Ask the client to demonstrate her own method of BSE. The setting should be private and comfortable to promote an environment conducive to learning and to prevent potential client embarrassment. Before teaching breast palpation, ask the client to demonstrate her own method, so that the nurse can assess the client's understanding of BSE. For better visualization, the arm should be placed over the head. The client should undress completely from the waist up. The finger pads, which are more sensitive than the fingertips, are used when palpating the breasts. (Chp. 70, elsevier resources)

A client is having a radical prostatectomy. Which preoperative teaching specific to this surgery does the nurse emphasize? a) Incentive spirometry b) Kegel exercises c) Pain control d) Penile implants (Chp 72, elsevier resources)

b) Kegel exercises Kegel perineal exercises may reduce the severity of urinary incontinence after radical prostatectomy. The client is taught to contract and relax the perineal and gluteal muscles in several ways. Incentive spirometry and pain control are important for everyone who undergoes surgery; neither is specific to radical prostatectomy. Penile implants are not important to discuss during preoperative teaching; however, they may be necessary to discuss later. (Chp 72, elsevier resources)

Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy? a) Assess anxiety level about the surgery. b) Monitor vital signs after surgery. c) Obtain data about breast cancer risk factors. d) Teach about postoperative routine care. (Chp. 70, elsevier resources)

b) Monitor vital signs after surgery. Vital sign assessment is included in UAP education and usually is part of the job description for UAP working in a hospital setting. Nursing assessment, obtaining data, and client teaching are not within the scope of practice for UAP and should be done by licensed nursing staff. (Chp. 70, elsevier resources)

Why is prostate cancer screening often emphasized to the African-American population in the United States? a) Metastasis of prostate cancer is higher. b) Prostate cancer occurs at an earlier age. c) Prostate-specific antigen (PSA) is not sensitive to prostate disease. d) Clinical presentation is different. (Chp 72, elsevier resources)

b) Prostate cancer occurs at an earlier age. In the United States, prostate cancer affects African-American men the most and at an earlier age. There is no difference in prostate cancer metastasis, PSA sensitivity, or clinical presentation of prostate cancer in the African-American population as compared to other populations. (Chp 72, elsevier resources)

A client had an orchiectomy and laparoscopic radical retroperitoneal lymph node dissection this morning. What is the nurse's priority for care? a) assess the client's pain level and provide pain management b) ensure that the client's urinary catheter is draining clear yellow urine c) observe the client's incision for redness, swelling, and drainage d) apply oxygen therapy via nasal cannula at 2 L/min (Ignatavicius & Workman, p. 1515)

b) ensure that the client's urinary catheter is draining clear yellow urine (Ignatavicius & Workman, p. 1515)

A client had a transurethral resection of the prostate (TURP) with continuous bladder irrigation yesterday. The staff nurse notes that the urinary drainage is bright red and thick. What is the nurse's best action? a) notify the charge nurse as soon as possible b) increase the rate of bladder irrigation c) document the assessment in the medical record d) prepare the patient for a blood transfusion (Ignatavicius & Workman, p. 1506)

b) increase the rate of bladder irrigation (Ignatavicius & Workman, p. 1506)

which statement about the transmission of HIV is true? (Select all that apply) A. can only be transmitted during end stage B. those with recent HIV infection and high viral load are very infectious C. those with end stage HIV and no drug therapy are very infectious D. HIV is only transmitted with sexual contact E. all people infected with HIV will quickly progress to AIDS

b, c

how does HSV manifest itself in patients with HIV/AIDS (Select all that apply) a. maculopapular lesions that can spread b. chronic ulceration after vesicles rupture c. vesicles ocated in the perirectal, oral, and genital area d. numbness and tingling before vesicle forms e. itching localized to perianal area

b, c, d

where can candidiasis occur in the body (Select all that apply) a. nose b. esophagus c. vagina d. mouth e. ears

b, c, d

HIV is most commonly transmitted by which routes? (Select all that apply) A. oral B. sexual C. parenteral D. airborne E. perinatal

b, c, e

which statements are true about immunodeficiency? (Select all that apply) A. it causes a decrease in the patients risk for infection B. it may be acquired or congential C. it occurs when a persons body cannot recognize antigens D. it is the same as autoimmunity E. it may cause varied reactions from mild, localized health problems to total immune system failure

b, c, e

shingles results from VZV leaving the body by which route? a. mucous membrane b. pulmonary space c. body fluids and other tissues d. bone marrow

c

The HIV positive patient tells the nurse that his HIV negative partner will be using preexposure drugs (Truvada). which statement indicates the need for additional teaching? A. my partner will need to be tested q3m B. this drug will decrease the chances of my partner becoming positive C. once we start using Truvada I will no longer need a condom D. my partner will need to be monitored for any side effects on this drug

c

the HCP prescribes an integrase inhibitor for an HIV patient. the patient asks the nurse how this drug works. what is the nurses best response? A. it reduces how well HIV genetic material can be converted into human genetic material B. it reinforces the immune systems ability to fight off an infection C. it prevents viral DNA from integrating into hosts DNA D. prevent HIV infection from progressing to AIDS

c

the patient with HIV/AIDS tells the nurse that food tastes funny and is difficult to swallow. what is the nurses priority action at this time? a. Check the patients gag reflex b. ask about blood cultures c. examine the patient's mouth and throat d. collaborate with the dietitian to provide a soft diet

c

The nurse is assigned care for a client who has undergone a modified radical left mastectomy for breast cancer. When delegating care, which statement by the nursing assistant would require further teaching by the nurse? a) "I will report urine intake and output to you." b) "If the client appears to be in pain, I will tell you right away." c) "It is important for me to take blood pressure on the client's left arm." d) "When ambulating, I will assist the client to stand straight with arms hanging at the side." (Ignatavicius & Workman, p. 1474)

c) "It is important for me to take blood pressure on the client's left arm." (Ignatavicius & Workman, p. 1474)

With which male client does the nurse conduct prostate screening and education? a) Young adult with a history of urinary tract infections b) Client who has sustained an injury to the external genitalia c) Adult who is older than 50 years d) Sexually active client (Chp 72, elsevier resources)

c) Adult who is older than 50 years A man who is 50 years or older is at higher risk for prostate cancer. A history of urinary tract infections, injury to the external genitalia, and sexual activity are not risk factors for prostate cancer. (Chp 72, elsevier resources)

The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about the side effects of doxorubicin (Adriamycin). Which side effect does the nurse instruct the client to report to the health care provider? a) Diaphoresis b) Dysphagia c) Edema d) Hearing loss (Chp. 70, elsevier resources)

c) Edema Doxorubicin is an anthracycline, and clients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue. Diaphoresis (profuse sweating), dysphagia (difficulty swallowing), and hearing loss are not associated side effects of doxorubicin. (Chp. 70, elsevier resources)

A premenopausal client diagnosed with breast cancer will be receiving hormonal therapy. The nurse anticipates that the health care provider will request which medication for this client? a) Anastrozole (Arimdex) b) Fulvestrant (Faslodex) c) Leuprolide (Lupron) d) Trastuzumab (Herceptin) (Chp. 70, elsevier resources)

c) Leuprolide (Lupron) Leuprolide is used in premenopausal women whose main estrogen source is the ovaries and who may benefit from luteinizing hormone-releasing hormone agonists that inhibit estrogen synthesis. Anastrozole is an aromatase inhibitor that is used in postmenopausal women whose main source of estrogen is not the ovaries, but rather body fat. Fulvestrant is a second-line hormonal therapy for postmenopausal women with advanced breast cancer. Trastuzumab is not a hormone and is used for targeted therapy for breast cancer. (Chp. 70, elsevier resources)

Which option for prevention and early detection of breast cancer is the option of choice for a client with a high genetic risk? a) Breast self-examination (BSE) beginning at 20 years of age b) Hormone replacement therapy (HRT) combining estrogen and progesterone c) Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 d) Prophylactic mastectomy (Chp. 70, elsevier resources)

c) Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 The American Cancer Society recommends that high-risk women (>20% lifetime risk) have an MRI and mammogram every year beginning at age 30. BSE is an option for everyone, not just those at high genetic risk for breast cancer. Use of HRT containing both estrogen and progestin increases risk; risk diminishes after 5 years of discontinuation. With a prophylactic mastectomy, there is a small risk that breast cancer will develop in residual breast glandular tissue because no mastectomy reliably removes all mammary tissue. (Chp. 70, elsevier resources)

Which assessment finding causes the nurse to suspect that a client may have testicular cancer? a) Hematuria b) Penile discharge c) Painless testicular lump d) Sudden increase in libido (Chp 72, elsevier resources)

c) Painless testicular lump A painless lump or swelling in the testicles is the most common manifestation of testicular cancer. Hematuria is not a symptom of testicular cancer, but could be indicative of other conditions such as bladder cancer. Penile discharge is not a symptom of testicular cancer, but could be indicative of another condition. A sudden increase in libido is not a symptom of testicular cancer. (Chp 72, elsevier resources)

The potential problem of grief is most relevant to a client after which procedure? a) Cystoscopy b) Transurethral microwave therapy c) Radical prostatectomy d) Sperm banking (Chp 72, elsevier resources)

c) Radical prostatectomy A radical prostatectomy may lead to erectile dysfunction, which could present a potential problem of grief at loss of function. Cystoscopy, a test to view the interior of the bladder, the bladder neck, and the urethra, does not affect sexuality. Transurethral microwave therapy is a minimally invasive procedure involving high temperatures that heat and destroy excess prostate tissue, and does not affect sexuality. The process of sperm banking would not result in a diagnosis of altered self-image; however, the diagnosis leading to the necessity of sperm banking might cause this. (Chp 72, elsevier resources)

Which method is a common complementary and alternative therapy for benign prostatic hyperplasia (BPH)? a) Acupuncture b) Calcium supplements c) Serenoa repens d) Yoga (Chp 72, elsevier resources)

c) Serenoa repens Serenoa repens (saw palmetto), a plant extract, is often used by men with early to moderate BPH. They believe that this agent relieves their symptoms and prefer this treatment over prescription drugs or surgery. (It should be noted, however, that studies on the effectiveness of Serenoa repens have not shown that it is effective.) Acupuncture, calcium, and yoga are not common alternative therapies for BPH. (Chp 72, elsevier resources)

A client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client's concerns? a) Allow the client to bring up the topic first. b) Remind the client to avoid sexual intercourse for 2 months after the surgery. c) Suggest that the client wear a bra or camisole during intercourse. d) Teach the client that birth control is a priority. (Chp. 70, elsevier resources)

c) Suggest that the client wear a bra or camisole during intercourse. Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to prevent contact with the surgical site during intercourse. The client may be embarrassed to discuss the topic of sexuality, so the nurse must be sensitive to possible concerns and approach the subject first. Sexual intercourse can be resumed after surgery whenever the client is comfortable. Sexually active clients receiving chemotherapy or radiotherapy must use birth control because of the therapy's teratogenic effects, but this is not necessary for clients who have had surgery only. (Chp. 70, elsevier resources)

a patient with HIV is receiving meds to reduce viral load and improve cd4+ counts. which term accurately describes this HIV drug regimen a. interferon treatment b. antiviremia c. ELISA administration d. HAART

d

cryptosporidiosis is a form of intestinal infection in which diarrhea can amount to a loss of how many liters of fluid per day? A. 1-2 B. 3-5 c. 5-8 d. 15-20

d

which is the most common route for HCP to contract HIV: A. blood B. bodily fluids C. mucous membranes D. needle sticks

d

which malignancy is most common in patients with HIV/AIDS a. non-hodgkins B cell lymphoma b. anal cancer c. primary brain cancer d. kaposi's sarcoma

d

which statements regarding HIV/AIDS among older adults are true? A. the risk for HIV infection after exposure is minimal for older adults B. older men are more susceptible to HIV C. it is not necessary to assess an older adult for history of drug use D. older adults who participate in high-risk behaviors are susceptible to HIV

d

which treatments are intended to boost the immune system? a. protease inhibitors b. hematopoietic growth factors c. lymphocyte transfusion d. interleukin-2 infusion

d

The nurse is educating a group of young men about testicular self-examination (TSE). Which statement by a member of the group indicates teaching has been effective? a) "I will examine my testicles right before taking a shower." b) "I should squeeze each testicle in my hand to feel any lumps." c) "I should only report any large lumps to my health care provider." d) "I will look and feel for any lumps or changes to my testes." (Chp 72, elsevier resources)

d) "I will look and feel for any lumps or changes to my testes." With early detection by monthly TSE and treatment, testicular cancer can be successfully cured. In TSE, the client should look and feel for any lumps or changes to the testes. Any lumps that are detected should be immediately reported. A TSE should be performed immediately following a shower. The client should gently roll each testicle between the thumb and forefinger. All lumps should be reported to the provider, no matter the size. (Chp 72, elsevier resources)

The nurse is teaching a client about taking sildenafil (Viagra) for erectile dysfunction. Which statement by the client indicates a need for further teaching? a) "I should have sex within an hour after taking the drug." b) "I should avoid alcohol when on the drug or it might not work well." c) "I can expect to maybe get a stuffy nose or headache when I take the drug." d) "If I have chest pain during sex, I should take a nitroglycerin tablet." (Ignatavicius & Workman, p. 1513)

d) "If I have chest pain during sex, I should take a nitroglycerin tablet." (Ignatavicius & Workman, p. 1513)

A client receiving external beam radiation therapy calls the nurse to report rectal urgency, cramping, and passing of mucus and blood. What is the nurse's best response? a) "This is an emergency. Go directly to the emergency department." b) "This is normal and will resolve as soon as the treatment stops." c) "Avoid caffeine and continue drinking plenty of water and other fluids." d) "Limit spicy or fatty foods, caffeine, and dairy products." (Chp 72, elsevier resources)

d) "Limit spicy or fatty foods, caffeine, and dairy products." The client's symptoms indicate that he is experiencing radiation proctitis, a common complication of external beam radiation therapy. The nurse's instructions to limit spicy or fatty foods, caffeine, and dairy products describe what the client should do to alleviate these symptoms. The client's symptoms do not indicate an emergency, but they should be reported to the health care provider. The client's symptoms should resolve 4 to 6 weeks after the treatment stops. Avoiding caffeine and drinking water and other fluids describe what the client should do if he is experiencing radiation cystitis, which he is not. (Chp 72, elsevier resources)

The nurse is discussing treatment options with a client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching? a) "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of it." b) "I might have chemotherapy before surgery." c) "If I get radiation, I am not radioactive to others." d) "Radiation will remove the cancer, so I might not need surgery." (Chp. 70, elsevier resources)

d) "Radiation will remove the cancer, so I might not need surgery." Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation therapy plays a critical role in the therapeutic regimen and is an effective treatment for almost all sites where breast cancer can metastasize. The purpose of radiation therapy is to reduce the risk for local recurrence of breast cancer. The purpose of hormonal therapy is to reduce the estrogen available to breast tumors to stop or prevent their growth. Chemotherapy drugs destroy breast cancer cells that may be present anywhere in the body; they are typically administered after surgery for breast cancer, although neoadjuvant chemotherapy may be given to reduce the size of a tumor before surgery. The client receiving radiation therapy is radioactive only if the radiation source is dwelling inside the breast tissue. (Chp. 70, elsevier resources)

The nurse is caring for four clients. Which client does the nurse recognize as having the highest risk for development of breast cancer? a) 45-year-old male with gynecomastia b) 40-year-old female whose father had colon cancer c) 50-year-old male whose mother had ovarian cancer d) 65-year-old female with history of a prior episode of breast cancer (Ignatavicius & Workman, p. 1467)

d) 65-year-old female with history of a prior episode of breast cancer (Ignatavicius & Workman, p. 1467)

Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)? a) Recent radical mastectomy client requiring chemotherapy administration b) Modified radical mastectomy client needing discharge teaching c) Stage III breast cancer client requesting information about radiation and chemotherapy d) Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy (Chp. 70, elsevier resources)

d) Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains. The recent radical mastectomy client requires chemotherapy, so it is more appropriate to assign her to nurses who are familiar with teaching, monitoring, and providing chemotherapy for clients with breast cancer. The modified radical mastectomy client who requires discharge teaching, and the stage III breast cancer client requiring information about radiation and chemotherapy are more appropriate to assign to nurses who are familiar with breast cancer. (Chp. 70, elsevier resources)

Which assessment finding indicates to the nurse that a client is at high risk for a malignant breast lesion? a) A 1-cm freely mobile rubbery mass discovered by the client b) Ill-defined painful rubbery lump in the outer breast quadrant c) Backache and breast fungal infection d) Nipple discharge and dimpling (Chp. 70, elsevier resources)

d) Nipple discharge and dimpling Nipple discharge and dimpling are high-risk assessment findings for a malignant breast lesion. On clinical examination, fibroadenomas are oval, freely mobile, rubbery masses usually discovered by the woman herself; their size varies from smaller than 1 cm in diameter to as large as 15 cm in diameter. Although the immediate fear is breast cancer, the risk of its occurring within a fibroadenoma is very small. Breast pain and tender lumps or areas of thickening in the breasts are typical symptoms of a fibrocystic breast condition; the lumps are rubbery, ill-defined, and commonly found in the upper outer quadrant of the breast. Many large-breasted women develop fungal infection under the breasts, especially in hot weather, because it is difficult to keep this area dry and exposed to air. Backaches from the added weight are also common. (Chp. 70, elsevier resources)

A large-breasted client reports discomfort, backaches, and fungal infections because of her excessive breast size. The nurse provides information to the client about which breast treatment option? a) Augmentation b) Compression c) Reconstruction d) Reduction mammoplasty (Chp. 70, elsevier resources)

d) Reduction mammoplasty Breast reduction mammoplasty surgery removes excess breast tissue and repositions the nipple and remaining skin flaps to produce the best cosmetic effect. Breast augmentation surgery enhances the size, shape, or symmetry of breasts. Breast compression is not a treatment. Breast reconstruction surgery is typically performed for women after a mastectomy. (Chp. 70, elsevier resources)

A client who has just been discharged from the hospital after a modified radical mastectomy is referred to a home health agency. Which nursing action is most appropriate to delegate to an experienced home health aide? a) Assessing the safety of the home environment b) Developing a plan to decrease lymphedema risk c) Monitoring pain level and analgesic effectiveness d) Reinforcing the guidelines for hand and arm care (Chp. 70, elsevier resources)

d) Reinforcing the guidelines for hand and arm care Reinforcement of previously taught information about hand and arm care should be done by all caregivers. Assessment, developing a care plan, and monitoring pain level and analgesic effectiveness are not within the scope of practice of a home health aide and should be done by licensed nursing staff. (Chp. 70, elsevier resources)

The issue that is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse is the alteration of which factor? a) Comfort because of surgical pain b) Mobility after treatment c) Nutrition because of radiation side effects d) Sexual function after treatment (Chp 72, elsevier resources)

d) Sexual function after treatment Altered sexual function is one of the biggest concerns of men after cancer treatment. Comfort, mobility, and nutrition are important, but are typically not the foremost concern in the minds of men with prostate cancer. (Chp 72, elsevier resources)

A client with testicular cancer is worried about sterility and the ability to conceive children later. Which resource does the nurse refer the client to before surgery takes place? a) American Cancer Society b) American Fertility Society c) RESOLVE: The National Infertility Association d) Sperm bank (Chp 72, elsevier resources)

d) Sperm bank After radiation therapy or chemotherapy has been started, the client is at increased risk for producing mutagenic sperm, which may not be viable or may result in fetal abnormalities. If the client is interested in having children, he should be encouraged to arrange for semen storage as soon as possible after diagnosis. Sperm collection should be completed before radiation therapy or chemotherapy is started. The client is referred to the American Cancer Society for more generalized information on testicular cancer. The American Fertility Society and RESOLVE: The National Infertility Association are appropriate referrals if permanent sterility occurs and sperm storage has not been feasible. (Chp 72, elsevier resources)

Hormone treatment for prostate cancer works by which action? a) Decreases blood flow to the tumor b) Destroys the tumor c) Shrinks the tumor d) Suppresses growth of the tumor (Chp 72, elsevier resources)

d) Suppresses growth of the tumor Hormone therapy, particularly antiandrogen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Antiandrogens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation). Hormone treatment for prostate cancer does not decrease blood flow to the tumor, destroy the tumor, or shrink the tumor. (Chp 72, elsevier resources)

Which statement about the early detection of breast masses is correct? a) Clinical breast examinations should be done yearly starting at age 20. b) Detection of breast cancer before or after axillary node invasion yields the same survival rate. c) Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age. d) The goal of screening for breast cancer is early detection. (Chp. 70, elsevier resources)

d) The goal of screening for breast cancer is early detection. The purpose of screening is early detection of cancer before it spreads. It is recommended that the clinical breast examination be part of a periodic health assessment at least every 3 years for women in their 20s and 30s, and every year for asymptomatic women who are at least 40 years of age. Detection of breast cancer before axillary node invasion increases the chance of survival. The American Cancer Society recommends screening with mammography annually beginning at age 40. (Chp. 70, elsevier resources)

which groups are experiencing increased numbers of HIV infection? (Select all that apply) A. men having sex with other men B. IV drug users C. women having sex with men D. african americans E. hispanics

d, e