Collaborative Quiz 1 Chapter 2

17) For a patient who is receiving chemotherapy, which laboratory result is of particular importance? 1. White blood cell count 2. Prothrombin time 3. Electrolyte levels 4. Blood urea nitrogen level

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19) When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs? 1. Administration of chemotherapy requires precautions to protect self and others. 2. Many chemotherapeutic drugs are vesicants. 3. Chemotherapeutic drugs are frequently given through central venous access devices. 4. Oral and venous routes of administration are the most common.

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2) A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain? 1. "An Illustrated Guide to the Analgesic Ladder" 2. "Common Questions About Radiation Therapy" 3. "How to Make Preparations for Your Cancer Surgery" 4. "How Nerve Blocks Can Help to Manage Cancer Pain"

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21) The nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation? 1. "Last night my back really hurt, and I had trouble sleeping." 2. "My leg has been giving out when I try to stand." 3. "My bowels are just not moving like they usually do." 4. "When I try to pass urine, I have difficulty starting the stream."

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32) The nurse is providing end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops, and the patient appears anxious and fright- ened. What should the nurse do first? 1. Administer an as needed (PRN) dose of morphine elixir. 2. Alert the Rapid Response Team and call the health care provider. 3. Deliver breaths at 20 breaths/min with a bag-valve mask and prepare for intubation. 4. Sit quietly with the patient and offer emotional sup- port and comfort.

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39) The nurse is interviewing a patient who was treated several months ago for breast cancer. The patient reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain. Which patient comment is cause for greatest concern? 1. "The NSAIDs are really not relieving the back pain." 2. "The NSAID tablets are too large, and they are hard to swallow." 3. "I gained weight because I eat a lot before taking NSAIDs." 4. "The NSAIDs are upsetting my stomach in the morning."

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40) The nurse is talking to a group of older women about breast cancer. Based on the most recent guidelines from the American Cancer Society and the American Society of Clinical Oncology, what will the nurse tell the group about the current recommendations for breast cancer screening? 1. For older women in good general health and a life expectancy of 10 or more years, biennial or annual mammography screening is recommended. 2. For women older than the age of 55 years with aver- age risk for breast cancer, mammography screening is recommended every 3 to 5 years. 3. For women older than the age of 70 with average risk for breast cancer, annual screening mammography is not recommended. 4. Starting at age 40 years, all women with average risk for breast cancer should have annual clinical breast examination and mammography screening.

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6) The nurse is caring for a patient with esophageal cancer. Which task could be delegated to unlicensed assistive personnel (UAP)? 1. Assisting the patient with oral hygiene 2. Observing the patient's response to feedings 3. Facilitating expression of grief or anxiety 4. Initiating daily weights

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8) Which patient is at greatest risk for pancreatic cancer? 1. An older African-American man who smokes 2. A young white obese woman with gallbladder disease 3. AyoungAfrican-Americanmanwithtype1diabetes 4. An elderly white woman who has pancreatitis

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30) In the care of a patient with neutropenia, what tasks should the nurse instruct unlicensed assistive personnel (UAP) to perform? Select all that apply. 1. Taking vital signs every 4 hours 2. Reporting temperature of more than 100.4°F (38°C) 3. Assessing for sore throat, cough, or burning with urination 4. Gathering the supplies to prepare the room for protective isolation 5. Reporting superinfections, such as candidiasis 6. Practicing good hand-washing technique

1, 2, 4, 6

20) The oncoming day shift nurse has just received hand over report from the night shift nurse. List the order of priority for assessing and caring for the following patients, with 1 being first and 4 being last. 1. A patient who developed tumor lysis syndrome around 5:00 AM 2. A patient who is currently pain free but had breakthrough pain during the night 3. A patient scheduled for exploratory laparotomy this morning 4. A patient with anticipatory nausea and vomiting for the past 24 hours

1, 3, 2, 4

28) People at risk are the target populations for cancer screening programs. According to the latest screening recommendations from the American Cancer Society, which of these asymptomatic patients need extra encouragement to participate in cancer screening? Select all that apply. 1. A 21-year-old white American woman who is sexually inactive, for a Pap test 2. A 30-year-old Asian-American woman, for an annual mammogram 3. A 45-year-old African-American man, to talk with health care provider about prostate cancer 4. A 50-year-old white American man, for a fecal occult blood test 5. A 50-year-old white American woman, for a colonoscopy 6. A 70-year-old Asian-American woman who had a total hysterectomy 15 years ago (not for cancer reasons), for a Pap test

1, 3, 4, 5

10) When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN? 1. A patient with severe anemia secondary to GI bleeding 2. A patient who needs enemas and antibiotics to control GI bacteria 3. A patient who needs preoperative teaching for bowel resection surgery 4. A patient who needs central line insertion for chemotherapy

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24) For a patient with osteogenic sarcoma, which laboratory value causes the most concern? 1. Sodium level of 135 mEq/L (135 mmol/L) 2. Calcium level of 13 mg/dL (3.25 mmol/L) 3. Potassium level of 4.9 mEq/L (4.9 mmol/L) 4. Hematocrit of 40%

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27) After chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory result requires particular attention? 1. Platelet counts 2. Electrolyte levels 3. Hemoglobin levels 4. Hematocrit levels

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29) A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the health care provider, the nurse would anticipate which initial treatment for this patient? 1. A fluid bolus 2. Fluid restrictions 3. Urinalysis 4. Sodium-restricted diet

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3) Which nurse is demonstrating the first step in managing cancer pain by using the ABCDE (ask, believe, choose, deliver, and empower) clinical approach to pain management as recommended by the Agency for Healthcare Research and Quality? 1. Nurse J asks if the time of the prescribed dose of medication can be changed. 2. Nurse K asks the patient to describe pain and uses a numerical pain scale. 3. Nurse L asks the patient to participate and to con- tribute in pain management. 4. Nurse M asks about pain management options that are appropriate for the patient.

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31) A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to assign to an LPN/LVN? 1. Develop a "quit plan" 2. Explain how to apply a nicotine patch 3. Discuss strategies to avoid relapse 4. Suggest ways to deal with urges for tobacco

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34) The nurse is caring for a patient with uterine cancer who is being treated with intracavitary radiation therapy. Unlicensed assistive personnel (UAP) reports that the patient insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the priority action? 1. Assess the UAP's knowledge; explain the rationale for strict bed rest. 2. Assess for dislodgment; use forceps to retrieve and a lead container to store as needed. 3. Assess the patient's knowledge of the treatment plan and her willingness to participate. 4. Notify the health care provider about dislodgment of the radiation implant.

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36) Which assessment finding strongly suggests that the patient with cancer is having incident pain? 1. Frequently reports pain about 30 to 35 minutes before next scheduled dose 2. Demonstrates protectiveness of right arm whenever moving or standing up 3. Reports a continuous burning and tingling sensation in left lower leg 4. Appears quiet, withdrawn and depressed when family leaves after visiting

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38) The nurse hears in hand-off report that the patient with cancer received an as needed (PRN) oral dose of lorazepam. Which question is the oncoming nurse most likely to ask the off-going nurse in relation to the medication? 1. "What did the patient say about the location and level of the pain?" 2. "Were you able to determine what was making the patient so anxious?" 3. "When is the patient allowed to have another dose of lorazepam?" 4. "Did the patient have a normal bowel movement after the medication?

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4) The nurse assesses the patient and determines that the patient is having frequent breakthrough cancer pain. Which member of the health care team is the nurse most likely to contact first? 1. Physical therapist to reevaluate physical therapy routines 2. Health care provider to review medication, dosage, and frequency 3. Unlicensed assistive personnel to provide more assistance with activities of daily living 4. Psychiatric clinical nurse specialist to evaluate psychogenic pain

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9) Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? Select all that apply. 1. Provide mouthwash with alcohol for oral rinsing. 2. Use paper tape on fragile skin. 3. Provide a soft toothbrush or oral sponge. 4. Gently insert rectal suppositories. 5. Avoid aspirin or aspirin-containing products. 6. Avoid overinflation of blood pressure cuffs.

2, 3, 5, 6

25) Which cancer patients could be placed together as roommates? Select all that apply. 1. A patient who has a very low neutrophil count 2. A patient who underwent debulking of a tumor to relieve pressure 3. A patient who just underwent a bone marrow transplantation 4. A patient who had a laminectomy for spinal cord compression 5. A patient who is undergoing brachytherapy for prostate cancer 6. A patient with terminal cancer who is receiving end-of-life care

2, 4

22) The nurse is caring for an older woman with hepatic cancer. Unlicensed assistive personnel informs the nurse that the patient's level of consciousness is diminished compared with earlier in the shift. Prioritize the steps of assessment and intervention related to this patient's change of mental status. 1. Take vital signs, including pulse, respirations, blood pressure, and temperature. 2. Check responsiveness and level of consciousness. 3. Obtain a blood glucose reading; give glucose per protocol. 4. Check electrolyte values. 5. Check ammonia level. 6. Check pulse oximeter readings and administer oxygen as needed.

2, 6, 1, 3, 4, 5

11) A community health center is preparing a presentation on the prevention and detection of cancer. Which task would be best to assign to the LPN/LVN? 1. Explain screening examinations and diagnostic testing for common cancers. 2. Discuss how to plan a balanced diet and reduce fats and preservatives. 3. Prepare a poster on the seven warning signs of cancer. 4. Describe strategies for reducing risk factors such as smoking and obesity.

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12) The health care provider (HCP) tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement is cause for greatest concern? 1. "My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer." 2. "My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family." 3. "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death." 4. "Initially, I may have to take some time off work for my treatments; I can probably work full time in the future."

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13) For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to unlicensed assistive personnel (UAP)? 1. Helping the patient to identify patterns of fatigue 2. Recommending participation in a walking program 3. Reporting the amount and type of food consumed from the tray 4. Checking the skin for redness and irritation after the treatment

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15) For a patient receiving the chemotherapeutic drug vincristine, which side effect should be reported to the health care provider (HCP)? 1. Fatigue 2. Nausea 3. Paresthesia 4. Anorexia

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16) An experienced nurse is precepting a newly hired nurse who has 2 years of medical-surgical experience but limited experience with patients who have cancer. The new hire seems to be consistently under medicating the patients' pain. What should the preceptor do first? 1. Reassess all of the patients and administer additional pain medication as needed. 2. Write an incident report and inform the nurse manager about the nurse's performance. 3. Determine the new nurse's understanding and beliefs about cancer pain and treatments. 4. Ask the new nurse about past experience in administering pain medications.

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18) For care of a patient who has oral cancer, which task would be appropriate to assign to an LPN/LVN? 1. Assisting the patient to perform oral hygiene 2. Explaining when brushing and flossing are contraindicated 3. Giving antacids and sucralfate suspension as ordered 4. Recommending saliva substitutes

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26) An athletic young man was recently diagnosed with Ewing sarcoma. He has pain, low-grade fever, and anemia. The surgeon recommends amputation of the right lower leg for an operable tumor. The patient tells the nurse that he is leaving the hospital to go on a long hiking trip. What is the priority nursing concept to consider at this time? 1. Pain 2. Cellular regulation 3. Coping 4. Adherence

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33) The nurse is asked to float to a different nursing unit. During report, the nurse is told that the patient is receiving IV administration of vincristine that should be completed within the next 15 minutes. The IV site is intact, and the patient is not having any problems with the infusion. The nurse is not certified in chemo- therapy administration. What is the priority action? 1. Ask the off-going nurse to stay until the vincristine infusion is finished. 2. Ask the off-going nurse about problems to expect with vincristine infusions. 3. Contact the charge nurse and discuss the lack of chemotherapy certification. 4. Look up drug side effects and monitor because the infusion is almost complete.

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35) The charge nurse discovers that two nurses have switched patients because Nurse A does "not like to take care of patients with prostate cancer." Which action should the charge nurse take first? 1. Insist that they switch back to the original patient assignments and talk to each of them at the end of the shift. 2. Allow them this flexibility; as long as the patients are well cared for, it doesn't matter if the assignments are changed. 3. Ask Nurse A to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues. 4. Explain to Nurse A and B that all patients deserve kindness and care regardless of their condition or the nurses' personal feelings.

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5) The night shift nurse tells the oncoming dayshift nurse that the cancer patient is on around-the-clock dosing of morphine but that the patient might be having end-of-dose pain. Which question is the most important to ask the night shift nurse? 1. "How many times did you have to give a bolus dose of morphine?" 2. "Did the patient tell you that the pain was greater than a 5/10?" 3. "Did you notify the health care provider (HCP), and were changes prescribed?" 4. "Did you try any nonpharmaceutical therapies or adjuvant medications?

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1) The patient describes a burning sensation in the leg. The health care provider tells the nurse that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse is most likely to question the prescription of which drug? 1. Imipramine 2. Carbamazepine 3. Gabapentin 4. Morphine

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14) An older patient needs treatment and relief for severe localized pain related to postherpetic neuralgia that developed during chemotherapy. The nurse is most likely to question the prescription of which type of medication? 1. Lidocaine patch 2. Gabapentinoid 3. Capsaicin patch 4. Tricyclic antidepressant

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37) The home health nurse is reviewing the cancer patient's medication list and sees that a bisphosphonate medication has been prescribed. Which question is the nurse most likely to ask to evaluate the efficacy of the medication? 1. "Has the medication helped relieve the discomfort in your mouth?" 2. "Have you noticed any increase or changes in your energy level?" 3. "Has the medication helped to stop the nausea and vomiting?" 4. "Has the medication relieved the bone pain that you were having?"

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7) A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While the nurse is trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority nursing concept to consider in responding to this patient? 1. Elimination 2. Patient education 3. Cellular regulation 4. Anxiety

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23) The day shift nurse is assessing the patient who has breast cancer and notices edema of the face, periorbital edema, and tightness around the neck of the gown. The nurse immediately notifies the health care provider for early signs and symptoms of superior vena cava syndrome. On the figure below identify the superior vena cava.

Blue Y