chapter 7, 12, 13

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?

B. Smoking cessation

A client who is recovering from a stroke expresses frustration about their care to the nurse, stating, "It seems like everyone sees me as just a problem that needs fixing." This client's statement is suggestive of what model of disability?

C. Rehabilitation model

The nurse on a bone marrow transplant unit is caring for a client with cancer who has just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing diagnosis for this client?

C. Risk for infection related to altered immunologic response

The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse's priority assessment should include examination for the signs and symptoms of which complication?

A. Tumor lysis syndrome (TLS)

12. The nurse is assessing a client with end-stage liver failure for the presence of hope. What should the nurse identify as a hope-fostering category?

A. Uplifting memories

33. A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client's plan of nursing care, what should the nurse prioritize?

C. Providing realistic emotional preparation for death

15. The nurse is caring for a client who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the client's death is imminent?

A. Mottling of the lower limbs

You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patient asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time?

"Do you need more time to think about this?"

A patient has just been told that her illness is terminal. The patient tearfully states, "I can't believe I am going to die. Why me?" What is your best response?

"This must be very difficult for you."

Research has corroborated an experienced nurse's observation that the incidence and prevalence of chronic conditions is increasing in the United States. What health promotion initiative most directly addresses the factor that has been shown to contribute to this increase?

A community-based weight-loss program

An adult client with leukemia will soon begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy?

A. Administer an antiemetic.

16. A client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life?

A. Poor communication between the family and the care team

18. A nurse on a medical unit in the hospital often provides palliative care to clients with a variety of diagnoses. Which activities describe the primary palliative care functions of this nurse? Select all that apply. A. Provides assessment of symptoms B. Manages basic nursing problems C. Handles difficult conversations with clients D. Uses therapeutic communication skills with clients E. Identifies multifactorial symptoms

A. Provides assessment of symptoms B. Manages basic nursing problems D. Uses therapeutic communication skills with clients

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The child's mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority?

Allowing the patient to express her feelings without judging her

An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRFs). The nurse should know that these achieve a therapeutic effect by what means?

Altering the immunologic relationship between the tumor and the patient

You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?

Ask if he would like you to sit with him while he collects his thoughts.

An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patient's plan of nursing care should prioritize which of the following?

Assess the patient's wound for dehiscence every 4 hours.

As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died?

At a staff meeting

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

C. Secondary prevention

The nurse is caring for a young mother who has a longstanding diagnosis of multiple sclerosis (MS). The parent was admitted with a postpartum infection 3 days ago, and the plan is to discharge the client home when the client has finished 5 days of IV antibiotic therapy. What information would be most useful for the nurse to provide at discharge?

C. The same information you would provide to a client without a chronic condition

11. The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have the client's eldest child make all of the health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important that it occurs. How should the nurse best handle this situation?

C. Work with the team to negotiate informed consent.

A new client has been admitted with a diagnosis of stage IV breast cancer. The client has a comorbidity of myasthenia gravis. During the initial assessment, the client states that they felt the lump in the breast about 9 months ago. The nurse asks the client why they did not see the health care provider when first finding the lump in breast. What would be a factor that is known to influence the client in seeking health care services?

D. Unfavorable interactions with health care providers

After contributing to the care of several patients who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

Families' needs for information and support often go unmet.

A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients?

Provide skin care to maintain skin integrity.

A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patient's nutritional needs?

TPN administered via a peripherally inserted central catheter

Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention?

Teaching patients to wear sunscreen

The nurse is part of the health care team at an oncology center. A patient has been diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the bad news best be conveyed to the patient?

The prognosis should be delivered with the patient at eye level.

The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response?

"Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer."

The staff development nurse is presenting a class on the importance of incorporating "people-first" language into daily practice as well as documentation. What is an example of the use of "people-first" language when giving a verbal report?

"The patient with schizophrenia"

You are presenting patient teaching to a 48-year-old man who was just diagnosed withtype 2 diabetes. The patient has a BMI of 35 and leads a sedentary lifestyle. You give the patient information on the risk factors for his diagnosis and begin talking with him about changing behaviors around diet and exercise. You know that further patient teaching is necessary when your patient tells you what?

"There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented

A nurse is caring for an 87-year-old Mexican-American female patient who is in end- stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?

A barrier to hospice care for this patient

A case manager is responsible for ensuring that patients meet the criteria for diagnoses of chronic conditions in order to ensure their eligibility for federal programs. Which of these definitions may not apply for legal purposes?

A person who is temporarily disabled but later return to full functioning.

You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform?Select all that apply. A)Use a lip lubricant. B)Scrub the tongue with a firm-bristled toothbrush. C)Use dental floss every 24 hours. D) Rinse the mouth with normal saline. E) Eat spicy food to aid in eradicating the yeast.

A)Use a lip lubricant. C)Use dental floss every 24 hours. D) Rinse the mouth with normal saline.

35. The nursing director of a hospice program has observed increasing levels of emotional exhaustion and poor work performance in the nursing staff and believes the staff are suffering from burnout. Which actions can the nursing director take to reduce burnout in the nursing staff? Select all that apply. A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. D. Mandate personal leave days after a client dies. E. Develop programs to increase nurse resilience.

A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. E. Develop programs to increase nurse resilience.

An international nurse has noted that a trend in emerging countries is a decrease in mortality from some acute conditions. What has contributed to this decrease in mortality from some acute conditions?

A. Improved nutrition

40. The nurse is admitting a client to palliative care and notices that the client has health care provider orders for life-sustaining treatment (POLST). Which concepts regarding POLST will the nurse use to develop a plan of care for this client? Select all that apply. A. It can be used in any health care setting. B. It names the durable power of health care attorney. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR). E. It specifies the client's preferences for funeral arrangements.

A. It can be used in any health care setting. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR).

39. The family of a client receiving palliative care for end-stage congestive heart failure is upset that the client is not eating. Which intervention should the nurse recommend to the family?

A. Remove unpleasant odors and sights during meals.

An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?

Avoid rubbing or scratching the affected area

An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do?

Avoid using soap on the treatment area.

38. The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make?

B. "Tell me what's most important to you now."

32. A client with a terminal diagnosis has asked the nurse about "helping me end my suffering." What is the nurse's responsibility in the domain of assisted suicide?

B. Discussing concerns and fears with the client

30. A client experienced the death of a spouse from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the client will be going through the process of mourning for an extended period of time. What process(es) of mourning will allow the client to accommodate the loss in a healthy way? Select all that apply. A. Reiterating the client's anger at the spouse's care team B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time E. Renewing lifelong commitments to the spouse

B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time

29. A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what phase?

B. Uncomplicated grief and mourning

36. A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

C. Emotional exhaustion

An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?

Invading healthy host tissues

A nurse provides care on a bone marrow transplant unit and is preparing a client for a hematopoietic stem cell transplantation (HSCT) the following day. Which information should the nurse emphasize to the client's family and friends?

D. "Do not visit if you've had a recent infection."

34. A pediatric nurse is emotionally distraught by the death of a 9-year-old client who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief?

D. Attend the client's memorial service.

31. A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group?

D. Normalization of feelings and experiences

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if they will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo?

D. Sentinel node biopsy

A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which area of health promotion education is known to be neglected among adults with disabilities?

D. Sexual health

28. The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care?

D. Supporting the client's and family's values and choices

37. The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify?

D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

8. A client with cancer, who has just learned that the cancer has spread to distant organs, tells the nurse, "I am not sure how many more treatments I can put up with." The nurse responds by saying, "You have been through so many treatments for your cancer." Using the NURSE framework for responding to emotions, which empathic response did the nurse use?

D. UNDERSTAND the emotion

A patient's daughter has asked the nurse about "helping him end his terrible suffering." The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?

Identifying patient and family concerns and fears

A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patient's care in this setting be based?

Meaningful living during terminal illness is best supported in the home.

A patient with end-stage lung cancer has been admitted to hospice care. The hospice team is meeting with the patient and her family to establish goals for care. What is likely to be a first priority in goal setting for the patient?

Pain control

The nurse is caring for a patient diagnosed with cancer of the liver who has chosen to remain in his home as long as he is able. The nurse reviews the care plan for the patient and notes that it focuses on palliative measures. The nurse also notes that over the last 3 weeks, the patient's condition has continued to deteriorate. What is the nurse's best response to this clinical information?

Recognize that the patient is in the downward phase of chronic illness and should be reassessed.

A patient who undergoes hemodialysis three times weekly is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355-mL (12 ounce) soft drink afterthe patient has already reached the maximum intake of fluid for the day. What action should the nurse take?

Reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid

A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy to her spine. At the completion of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this?

The patient has not achieved the desired learning outcomes.

The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patient's strategy?

The patient may be trying to protect loved ones from the emotional effects of the illness.

A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patient's level of consciousness has declined and she is now unresponsive. How should the patient's pain control regimen be affected?

The patient's pain control regimen should be continued.

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite?

B. Malignant cells contain proteins called tumor-associated antigens.

A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?

B. Nausea and vomiting

A 55-year-old woman with multiple sclerosis is deficient in completing health screening and health promotion tests. Based on the information provided, and statistical data, what is the most likely test that the client missed?

B. Pelvic examination

A client who is legally blind is being admitted to the hospital. The client informs the nurse that they need to have their guide dog present during hospitalization. What is the nurse's best response to the client?

A. "Arrangements can be made for your guide dog to be at the hospital with you during your stay."

19. The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family?

A. "Hospice is the application of palliative care at the end of life."

While on spring break, a 22-year-old client was taken to the hospital for heat stroke and alcohol poisoning. The client is worried and states that a biopsy was taken and showed "some kind of benign condition." Which response by the nurse would be best?

A. "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results."

2. A client tells the nurse that the doctor just told the client that a new diagnosis of rheumatoid arthritis is considered to be a "chronic condition." The client asks the nurse what "chronic condition" means. What would be the nurse's best response?

A. "It is a health problem that require managements of several months or longer."

The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client?

A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and (x-ray)test results."

A client uses a wheelchair. The client wants to attend a church-sponsored support group for parents of children diagnosed with autism spectrum disorder. The client arrives at the church and realizes there are no ramps or elevators to the basement. What type of barrier did this client encounter?

A. A structural barrier

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide?

A. Administering a lethal dose of medication to a client whose death is imminent

The community nurse is caring for a client who has paraplegia following a farm accident when they were an adolescent. This client is now 64 years old and has just been diagnosed with congestive heart failure. The client states, "I'm so afraid about what is going to happen to me." What would be the best nursing intervention for this client?

A. Assist the client in making suitable plans for care.

The hospice nurse has just admitted a new client to the program. What principle guides hospice care?

A. Care addresses the needs of the client as well as the needs of the family.

17. The nurse is assessing a 73-year-old client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the client is most likely in what stage of death and dying?

A. Depression

24. A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis

A. Financial pressures on health care providers B. Client reluctance to accept this type of care D. Advances in "curative" treatment in late-stage illness

A nurse is presenting at a health fair and is promoting the benefits of maintaining a healthy body weight. The nurse should refer to reductions in the risks of what diseases? Select all that apply. A. Heart disease B. Stroke C. Neurologic cancers D. Diabetes E. Hypertension

A. Heart disease B. Stroke D. Diabetes E. Hypertension

The nurse is caring for a client who is to begin receiving external radiation for a malignant tumor of the neck. While providing client education, what potential adverse effects should the nurse discuss with the client?

A. Impaired nutritional status

25. A client with end-stage kidney disease who immigrated to the United States several years ago is receiving care from family at home. When discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. Which factors are potential barriers to care for this client and family? Select all that apply. A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system D. Wanting to care for the client at home E. Uncertainty about how long the client will live

A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system

A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care?

A. Limit the time that visitors spend at the client's bedside.

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

A. Liver function tests (LFTs)

A 45-year-old client was diagnosed with schizophrenia at the age of 20. The client is having trouble finding community-based services to help increase their quality of life. Which program would most benefit the client?

A. Medicaid

The nurse is caring for a client who has just been told that the client's stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?

A. Palliative

The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A. Rate of growth B. Ability to cause death C. Cell size D. Cell location E. Ability to spread

A. Rate of growth B. Ability to cause death E. Ability to spread

A home care nurse is making an initial visit to a 68-year-old client. The nurse finds the client tearful and emotionally withdrawn. Even though the client lives alone and has no family, the client has been managing well at home until now. What would be the most appropriate action for the nurse to take?

A. Reassess the client's psychosocial status and make the necessary referrals.

The nurse is assessing a client whose spouse died 16 months ago. The client tells the nurse about joining a hiking group, volunteering as a college mentor, and thinking about dating again. The nurse determines that the client is in which stage of Rando's processes of mourning?

A. Reinvestment

13. A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

A. Request the health care provider to prescribe analgesics by an alternative route.

A 16-year-old female client has post-chemotherapy alopecia. This prompts the nursing diagnoses of Disturbed Body Image and Situational Low Self-Esteem. Which response by the client would best indicate improved coping related to these diagnoses?

A. Requests that her family bring her makeup and a wig

The nurse is caring for a male client with a history of chronic angina. The client states that after breakfast he usually takes a shower and shaves. It is at this time, the client says, that he tends to experience chest pain. What should the nurse counsel the client to do to decrease the likelihood of angina in the morning?

A. Shower in the evening and shave before breakfast.

While a client is receiving intravenous (IV) doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize which action?

A. Stopping the administration of the drug immediately

An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

A. The client and family should be viewed as a single unit of care.

A client with a spinal cord injury is being assessed by the nurse prior to being discharged from the rehabilitation facility. The nurse is planning care through the lens of the interface model of disability. Within this model, the nurse will plan care based on what belief?

A. The client has the potential to function effectively despite the disability.

6. After caring for several clients who died in the hospital, the nurse has identified some lapses in the care that many of these clients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

A. The perception that palliative care constitutes "giving up."

A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care?

A. To improve the client's and family's quality of life

A 43-year-old female client with epilepsy is admitted to the hospital. The client has been on seizure medications most of their adult life. What would be an appropriate care plan for this client?

B. Increased fall risk related to medication regimen

20. The nurse is admitting a client with a diagnosis of ovarian cancer. The client has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment of the client?

B. "Do you have a sense of peace of mind and a purpose to your life?"

21. A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread?

B. Lymphatic circulation

20. During the care conference for a client who has multiple chronic conditions, the case manager has alluded to the principles of the interface model of disability. What statement is most characteristic of this model?

B. "This client can be empowered and doesn't have to be dependent."

The nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client?

B. "What is your understanding of your condition?"

A 19-year-old client with a diagnosis of Down syndrome is being admitted to the unit for the treatment of community-acquired pneumonia. When planning this client's care, the nurse recognizes that this client's disability is categorized as what type?

B. A developmental disability

A nurse knows that clients with "invisible" disabilities like chronic pain often feel that their chronic conditions are more challenging to deal with than more visible disabilities. Why would they feel this way?

B. Despite appearances, invisible disabilities can be as disabling as visible disabilities.

When discussing with a client factors that distinguish malignant cells from benign cells of the same tissue type, which characteristic should the nurse mention?

B. Different proteins in the cell membrane

The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?

B. Impaired wound healing

A client is hospitalized because a large abdominal tumor was seen on the computed tomography scan. A biopsy is ordered, and the client wants to know if "this will cause a big scar." Which type of biopsy will this client likely experience?

B. Incisional

A nurse is planning the care of a client who has been diagnosed with asthma, which the nurse recognizes as being a chronic condition. Which of the following descriptors apply to chronic conditions? Select all that apply. A. Resolve slowly B. Rarely are completely cured C. Have a short, unpredictable course D. Do not resolve spontaneously E. Have a prolonged course

B. Rarely are completely cured D. Do not resolve spontaneously E. Have a prolonged course

A client was diagnosed with cancer several weeks ago and family members describe the client as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action?

B. Refer the client to the appropriate mental health provider.

A medical-surgical nurse is teaching a client about the health implications of the client's recently diagnosed type 2 diabetes. The nurse should teach the client to be proactive with glycemic control to reduce the risk of what health problem?

B. Renal failure

23. As the American population ages, nurses expect to see more clients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care?

B. Restorative measures

26. Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?

B. Rules concerning completion of all cure-focused medical treatment

A nurse is taking an Advanced Cardiovascular Life Support class. The nurse has dyslexia and is given an extra hour to complete the exam. What type of disability best defines the nurse's condition?

B. Sensory disability

The nurse is caring for a client with an advanced stage of breast cancer and the client has recently learned that the cancer has metastasized. The nurse enters the room and finds the client struggling to breathe, and the nurse's rapid assessment reveals that the client's jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

B. Superior vena cava syndrome (SVCS)

A 39-year-old client with paraplegia has been admitted to the hospital for the treatment of a sacral pressure injury. The nurse is aware that the client normally lives alone in an apartment and manages their ADLs independently. Before creating the client's plan of care, how should the nurse best identify the level of assistance that the client will require in the hospital?

B. Talk with the client about the type and level of assistance that the client desires.

An initiative has been launched in a large hospital to promote the use of "people-first" language in formal and informal communication. What is the significance to the client when the nurse uses "people-first" language?

B. The client is of more importance to the nurse than the disability.

21. A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim?

B. To prevent and relieve suffering

The nurse is performing an initial assessment of a 75-year-old client who has just relocated to the long-term care facility. During the nurse's interview with the client, the client admits drinking around 600 mL (20 oz) of vodka every evening. What types of cancer does this put the client at risk for? Select all that apply. A. Malignant melanoma B. Brain cancer C. Breast cancer D. Esophageal cancer E. Liver cancer

C. Breast cancer D. Esophageal cancer E. Liver cancer

The nurse is reviewing the importance of preventive health care with a client who has a disability. The client describes intense financial pressures associated with being disabled. What is the nurse's best response?

C. "I'll look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions."

10. A client with cancer has just been told that the disease is now terminal. The client tearfully states, "I can't believe I am going to die. Why me?" What is the nurse's best response to elicit more information from the client?

C. "Tell me more about how you feel about this news."

A couple who are in their early 80s have provided constant care for their 44-year-old child who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have concerns around what question?

C. "Who will care for our child once we're unable?"

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic?

C. "You are anxious about the surgery. Do you see smoking as helping?"

A client who uses a wheelchair was unable to enter a health care clinic because the pavement was too high. The client filed a formal complaint stating that reasonable accommodations were not met. What is an example of a reasonable accommodation under the 1990 American Disabilities Act (ADA)?

C. Accessible facilities and equipment

A client who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with the chronic condition. The client's ability to meet this goal will primarily depend on the client's ability to do which of the following?

C. Adapt a lifestyle to accommodate the client's symptoms.

The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer?

C. Baked apricot chicken and steamed broccoli

Which intervention should the nurse teach a client who is at risk for hypercalcemia?

C. Consume 2 to 4 L of fluid daily.

A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia?

C. Epistaxis

As a case manager, the nurse oversees the multidisciplinary care of several clients living with chronic conditions. Two of the nurse's clients are living with spina bifida. The center of care for these two clients will typically exist where?

C. In the home

22. The organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice?

C. It is based on communication and cooperation between disciplines.

During a routine mammogram, a client asks the nurse whether breast cancer causes the most deaths. Which type of cancer is the leading cause of death in the United States?

C. Lung

4. Which nursing action best demonstrates primary cancer prevention?

C. Promoting and providing vaccines

A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery?

C. Prophylactic surgery

27. One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply. A. Describe their personal experiences in dealing with end-of-life issues. B. Encourage the client and family to "keep fighting" as a cure may come. C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

14. A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate?

D. Administer bronchodilators and corticosteroids, as prescribed.

The nurse is caring for a 25-year-old client with a traumatic brain injury and severe disabilities caused by a motor vehicle accident. The client asks the nurse for education about sex in regards to their condition. How should the nurse respond?

D. "Do you have specific questions first? I can bring additional resources into the discussion as needed."

Which issue has most often presented challenging ethical issues, especially in the context of palliative care?

D. Ability of technology to prolong life beyond meaningful quality of life

A major cause of health-related problems is the increase in the incidence of chronic conditions. Which factor has contributed to the increased incidence of chronic diseases in developing countries?

D. Adoption of a more sedentary lifestyle, which is increasing obesity

In recent decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?

D. Demographic changes in the population

A client with terminal small-cell lung cancer has been given a six-month prognosis and wants to die at home. The health care team believes the condition warrants inpatient care. The nurse might suggest which compromise?

D. Discuss a referral for hospice care.

The nurse manager is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, which action should the nurse manager emphasize?

D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.

A 37-year-old client with multiple sclerosis is married and has three children. The nurse has worked extensively with the client and family to plan appropriate care. What is the nurse's most important role with this client?

D. Help the client develop strategies to implement treatment regimens.

The nurse is caring for a 25-year-old client who has Down syndrome and who has just been diagnosed with type 2 diabetes. What consideration should the nurse prioritize when planning this client's nursing care?

D. How the developmental disability influences the client's health management

A client has recently been diagnosed with type 2 diabetes. The client is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the client increase their activity level?

D. Identify barriers with the client that inhibit lifestyle changes.

A nurse is aware that the number of people in the United States who are living with disabilities is expected to continue increasing. What is considered to be one of the factors contributing to this increase?

D. Increased survival rates among people who experience trauma

The interface model of disability is being used to plan the care of a client who is living with the effects of a stroke. Why should the nurse prioritize this model?

D. It promotes the idea that clients are capable and responsible.

Many individuals with disabilities are employed. What has research shown about this employed population?

D. People with disabilities earn less money than people without disabilities.