Comfort and cellular regulation
Which risk factor associated with fibromyalgia should the nurse inquire about while taking a client's health history? a. Family history b. History of osteoarthritis c. Age 60-75 years d. Male gender
answer: a A family history of fibromyalgia is a risk factor for developing fibromyalgia. Female, not male, gender is a risk factor for developing fibromyalgia. Being diagnosed with another rheumatic disorder such as rheumatoid arthritis (not osteoarthritis) or systemic lupus erythematosus are risk factors associated with developing fibromyalgia. A risk factor for developing fibromyalgia is an age between 20 and 50 years old, not between 60 and 75 years old.
A client has a mass that has been identified by mammogram. Which test may be ordered to further differentiate the mammogram results? a. MRI b. Chest x-ray c. Breast cancer genetic screening d. PET scan
answer: a An MRI is used to further assess the tumor identified in the mammogram. A PET scan would not be used to further confirm the diagnosis of breast cancer. Rather, this test is used to assess for metastasis. A chest x-ray will not further differentiate mammogram results. The breast cancer genetic screening test is used to identify a predisposition to breast cancer; it cannot be used to further differentiate mammogram results.
The nurse administers an opioid analgesic to a client experiencing acute pain. Which assessment finding requires priority intervention from the nurse? a. respiratory depression b. tachycardia c. constipation d. pupil dilation
answer: a Any client experiencing respiratory depression after the administration of opioid analgesics requires priority intervention. Tachycardia, constipation, and pupil dilation can occur with opioid analgesics, but these findings do not require priority intervention.
The nurse is educating a client on the pathophysiology of paraneoplastic syndromes. Which statement by the client would indicate an understanding of the teaching? a. They are symptoms that come from the action of tumor cell products on other body systems. b. They do not occur for clients with lung cancer. c. They are problems that come from the pressure of the tumor on surrounding structures. d. They only occur within the central nervous system.
answer: a Clients with lung tumors are at risk for paraneoplastic syndromes. These are manifested in multiple body systems and result from the action of tumor cell products on other body systems.
The nurse is conducting an assessment of a client diagnosed with melanoma. Which item will the nurse include in the client's health history? a. Family history of skin cancer b. Palpation of skin texture c. Measurement of skin lesions d. Inspection of skin color
answer: a During the health history portion of the nursing assessment, the nurse would assess for a family history of skin cancer. Inspection of skin color, palpation of the texture, and measurement of lesions would be completed during the physical examination of the nursing assessment.
A student nurse is asking questions about fibromyalgia. The nurse educates the student that this disorder closely resembles what other disorder? a. chronic fatigue syndrome b. osteoarthritis c. muscular dystrophy d. sjogren syndrome
answer: a Fibromyalgia closely resembles chronic fatigue syndrome, with the exception of the musculoskeletal pain typically associated with fibromyalgia. Fibromyalgia does not closely resemble Sjögren syndrome, muscular dystrophy, or osteoarthritis.
A nurse is caring for a client with breast cancer with metastasis to the bones. Which therapy may be used to prevent fractures in this client? a. Radiation b. Chemotherapy c. Hormone therapy d. Calcium supplementation
answer: a Radiation may be used to help prevent fractures for clients with breast cancer and bone metastasis. The other options do not help prevent fractures in those with cancer in the bones.
A client with leukemia is scheduled to receive an autologous bone marrow transplant. When providing education, the nurse informs the family that the client will need to remain hospitalized in a private room for how long a period of time? a. 6 to 8 weeks b. 3 to 5 weeks c. 1 to 3 weeks d. 9 to 11 weeks
answer: a The nurse needs to educate the client and family that a client who is receiving an autologous bone marrow transplant will be required to remain hospitalized in a private room for 6 to 8 weeks, not 1 to 3 weeks, 3 to 5 weeks, nor 9 to 11 weeks.
A client is admitted with squamous cell lung cancer. Which type of medication should the nurse administer to reduce airway obstruction? a. Bronchodilators b. Cholingergic c. Chemotherapy d. Analgesics
answer: a The nurse should administer a bronchodilator to reduce airway obstruction. Chemotherapy attacks tumor cells but does not directly reduce airway obstruction. Cholinergic medications do not reduce airway obstruction. Analgesic medications assist in controlling pain but do not reduce airway obstruction.
A client is admitted with a breast mass that is newly diagnosed as breast cancer. Which clinical manifestations of this disease does the nurse expect during the assessment? (Select all that apply.) a. A burning sensation in the breast b. Low-grade fever c. Nipple discharge d. Flaking around the nipple e. Skin rash around the nipple
answer: a, c, d, e A persistent rash near the nipple area; flaking or eruption around the nipple; a burning, stinging, or pricking sensation in the breast; and discharge from the nipple are manifestations of breast cancer. A low-grade fever is not a common manifestation of breast cancer.
A client is newly diagnosed with acute lymphocytic leukemia. The nurse would anticipate that the client will be started on what chemotherapy medication? a. Prednisone with asparaginase (Elspar) b. Fludarabine (Fludara) c. Imatinib mesylate (Gleevec) d. All-trans retinoic acid (ATRA)
answer: a The nurse would anticipate that the client will be started on prednisone with asparaginase (Elspar) because this is a chemotherapy medication of choice for acute lymphocytic leukemia. Fludarabine (Fludara) is the chemotherapy medication of choice when treating chronic lymphocytic leukemia, not acute lymphocytic leukemia. ATRA is the chemotherapy medication of choice when treating acute myeloid leukemia, not acute lymphocytic leukemia. Imatinib mesylate (Gleevec) is the chemotherapy medication of choice when treating chronic myeloid leukemia, not acute lymphocytic leukemia.
The nurse educator asks the nursing student to explain the primary cause of anemia related to sickle cell disease (SCD). Which response by the nursing student is most accurate? a. Early destruction of RBCs b. Sickling of RBCs c. Deoxygenation of affected RBCs d. Deformity of RBCs
answer: a The primary cause of anemia related to sickle cell disease (SCD) is early destruction of RBCs. Effects of SCD include deoxygenation of RBCs, which causes a characteristic sickling deformity of the affected RBCs.
The client with sickle cell disease (SCD) asks the nurse to explain vaso-occlusive crisis. Which information is most appropriate for the nurse to include in the explanation? (Select all that apply.) a. Infection increases the risk for developing vaso-occlusive crisis. b. Vaso-occlusive crisis consists of pain resulting from ischemia caused by vascular occlusion. c. Conditions that impair oxygen transport to tissues may lead to vaso-occlusive crisis. d. Overhydration increases the risk for developing vaso-occlusive crisis. e. Prolonged vaso-occlusive crisis may progress to a more severe condition called sickle cell crisis.
answer: a, b, c Individuals with SCD are at risk for vaso-occlusive crisis, which is also described as sickle cell crisis. Vaso-occlusive crisis consists of painful periods resulting from ischemia due to vascular occlusion. Risk factors that predispose an individual with SCD to development of sickle cell crisis include dehydration, which increases blood viscosity, and any condition that increases the body's oxygen needs or impairs oxygen transport to the tissues, such as infection or trauma.
Mrs. Sorkilmo is a 62-year-old woman who has been diagnosed with a pigmented basal-cell carcinoma following a skin biopsy. Mrs. Sorkilmo has already had an excision of the lesion. Which additional therapies could also be expected to be recommended by the physician? (Select all that apply.) a. Radiation therapy b. Immunotherapy c. Chemotherapy d. Topical creams or gels e. Laser surgery
answer: a, b, c Immunotherapy, radiation therapy, and chemotherapy are additional therapies that may be recommended by the physician for a nonmelanoma type of skin cancer. Laser surgery and topical creams would be appropriate for actinic keratosis.
The nurse is caring for a client newly admitted with suspected leukemia. The nurse anticipates which tests will be ordered to confirm the diagnosis? (Select all that apply.) a. Bone marrow aspiration b. Red blood cell count c. White blood cell count d. Platelet count e. Sedimentation rate
answer: a, b, c, d A complete blood count and differential, which include red and white blood cell counts, are helpful in diagnosing leukemia because they provide information on the size, number, and morphology of blood cells. Platelet counts are also helpful in finding thrombocytopenia secondary to leukemia. Bone marrow aspiration provides information about bone marrow cells and any abnormal blood cell formation. Sedimentation rate is not useful in diagnosing leukemia.
A client seen in the dermatology clinic was diagnosed with actinic keratosis by the healthcare provider and sent for specialty follow-up. Which treatment option is for actinic keratosis? (Select all that apply.) a. Cryotherapy b. Chemical peeling c. Topical creams d. Curettage e. Phototherapy
answer: a, b, c, d Cryotherapy is the most common treatment for actinic keratosis. Curettage is also used to scrape off damaged cells; it may be followed by electrosurgery, in which a pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. Topical medications used to treat actinic keratosis include creams that destroy cells by blocking essential cellular functions. Chemical peeling involves applying a chemical solution that causes the skin to blister and peel, allowing new skin to form. Phototherapy treatment is used for the treatment of psoriasis, not for the treatment of actinic keratosis.
The client with sickle cell disorder (SCD) is preparing to be discharged to home. Which topics are most appropriate for the nurse to include when providing home care teaching for the client with SCD? (Select all that apply.) a. Recognizing manifestations of splenic sequestration b. Balancing rest with activity c. Keeping current with vaccinations d. Restricting oral fluid intake e. Maintaining adequate nutritional intake
answer: a, b, c, e Home care planning for the client with sickle cell disease (SCD) includes teaching the client about avoiding triggers for sickling of RBCs, such as dehydration. Rather than teaching the client to restrict oral fluid intake, the client with SCD should be taught to maintain adequate hydration. Appropriate home care teaching topics for the client with SCD include keeping current with vaccinations, balancing rest with activity, maintaining adequate nutritional intake, and recognizing manifestations of splenic sequestration.
A client with a life-threatening illness has been treated with repeated doses of opioids over a period of several weeks. Which symptoms obtained in the assessment indicate the client is experiencing side effects related to medication administration? Select all that apply. a. sedation b. constipation c. prutitus d. sweating e. vomiting
answer: a, b, c, e Opioid side effects include constipation, sedation, pruritus, and vomiting. Sweating can occur with opioid withdrawal but is not a side effect related to opioid administration.
A client is returning to the oncology clinic after a skin biopsy on an arm lesion that revealed melanoma. Which additional diagnostic tests would be done to evaluate this client for metastasis? (Select all that apply.) a. Bone scan b. Radiation therapy c. Liver function tests d. CT scan of the liver e. Chest x-ray
answer: a, c, d, e The client with a positive biopsy for melanoma would need further diagnostic tests to rule out metastasis and to perform staging of the malignancy. These would include a CT of the brain and liver, liver function tests, an initial chest x-ray, and a bone scan. Radiation therapy would be used in the treatment of inoperable lesions because of location or for clients who are a poor surgical risk; it is not used to evaluate for metastasis or lesion staging.
The nurse is providing education about ongoing care for a client with fibromyalgia. Which information should the nurse include? (Select all that apply.) a. Follow-up care b. Strategies for stress reduction c. Information on contacting support organizations d. The use of cold therapy e. Use of prescription medications
answer: a, b, c, e The nurse should educate the client about available support organizations such as the Fibromyalgia Network and the American College of Rheumatology.The nurse should educate the client about reducing stress to assist in managing symptoms of fibromyalgia.The nurse should educate the client about the importance of keeping follow-up appointments with healthcare providers.The nurse should educate the client about taking medications as prescribed. Cold therapy does not improve fibromyalgia symptoms.
The nurse is presenting information about leukemia at a health fair. Which risk factors that increase the incidence of leukemia will the nurse discuss? (Select all that apply.) a. Smoking b. Exposure to benzene c. Genetics d. Presence of the HIV e. Previous treatment for cancer
answer: a, b, c, e Smoking, genetics, exposure to benzene, and previous treatment for cancer are all risk factors for leukemia. Presence of HIV does not increase the incidence of leukemia.
A nurse is providing education about fibromyalgia to a group of new nurses. When discussing the pathophysiology of this disorder, which systems of the body that are involved with fibromyalgia does the nurse need to address? (Select all that apply.) a. The autonomic nervous system b. The endocrine system c. The cardiac system d. The somatic peripheral nervous system e. The renal system
answer: a, b, d The pathophysiology of fibromyalgia involves the autonomic nervous system, somatic peripheral nervous system, and endocrine system. The pathophysiology of fibromyalgia does not involve the renal or cardiac systems.
The nurse is providing home care instructions to a client with chronic pain. Which items are appropriate for the nurse to include in the teaching session. Select all that apply. a. eating a balanced diet b. using assistive devices c. having resuscitation equipment ready for use, if necessary d. administering pain medications by the IM route e. maintaining adequate hydration
answer: a, b, e Appropriate home care instructions for the nurse to provide a client with chronic pain include maintaining adequate hydration, eating a balanced diet, and appropriate use of assistive devices. The nurse would not provide instruction on administering intramuscular pain medications or having resuscitative equipment ready for use for a client being discharged home.
The nurse is teaching the client about the potential effects of sickle cell disease (SCD). When explaining the potential effects of sickling, which examples are most appropriate for the nurse to include in the teaching? (Select all that apply.) a. Tissue damage b. Organ damage c. Malformation of WBCs d. Prolonged life span of RBCs e. Occlusion of small blood vessels
answer: a, b, e Because of the characteristic crescent or sickle shape of the malformed RBCs associated with sickle cell disease (SCD), this process is called sickling. Chronic sickling of RBCs shortens the life span of these cells. Sickled RBCs can occlude small blood vessels, especially capillaries. Recurrent or prolonged ischemia due to sickle cell-induced occlusions causes tissue and organ damage. WBC malformation is not characteristic of SCD.
The nurse educator asks a nursing student to identify the pathophysiological processes behind the development of breast cancer. Which statements by the student indicate to the educator that the student understands the pathophysiology behind the development of breast cancer? (Select all that apply.) a. "The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue." b. "Breast cancer begins as a single cell mutation." c. "The BRCA4 gene is one of the genes believed to cause breast cancer." d. "Abnormal cells grow without the influence of hormonal regulation." e. "Breast cancer creates an alteration in the regulation of cell growth."
answer: a, b, e Mutations to a single cell can lead to tumor growth and the development of breast cancer. The BRCA1 and BRCA2 genes are involved in tumor suppression. Mutations in these genes put a client at much greater risk for the development of breast cancer. Breast tumor growth is usually hormone dependent. Breast cancer occurs with an alteration in the regulation of cell growth. The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue.
The nurse is planning care for a client with fibromyalgia. Which potential problems are priorities for the nurse to address? (Select all that apply.) a. Activity intolerance b. Fatigue c. Risk for injury d. Decreased cardiac output e. Pain
answer: a, b, e Pain is a priority potential problem for the nurse to address because of the pain associated with fibromyalgia. Activity intolerance and fatigue are priority potential problems for the nurse to address because of the exacerbation of pain and fatigue associated with exercise or increased activity. Risk for injury and decreased cardiac output are not priority potential problems for a client with fibromyalgia.
The nurse is caring for a client admitted to the oncology floor with malignant melanoma. What are the types of malignant melanomas? (Select all that apply.) a. Congenital nevi b. Solar keratosis c. Dysplastic nevi d. Lentigo maligna e. Hyperkeratosis
answer: a, c, d Congenital nevi are a type of malignant melanoma that is present at birth. Their size can range from small to very large, and they are typically brown or black. Congenital nevi are slightly raised with an irregular surface but regular borders. Dysplastic nevi are not present at birth. These appear typically in childhood and become dysplastic after puberty. A person can have more than 100 nevi, but one must be > 6 mm. These most often appear on the face, trunk, arms, scalp, breast, groin, and buttocks. The pigment is irregular and is a mixture of brown, tan, black, red, and pink with irregular borders. Lentigo maligna is a tan or black patch on the skin that appears to be a freckle. The lesions are slow-growing and become mottled, dark, thick, and nodular. These are usually located on the side of the face in older clients who have had large amounts of sun exposure. Solar keratosis is also known as actinic keratosis. This is a noncancerous skin lesion directly related to chronic sun exposure and photodamage. This is not a type of malignant melanoma. Hyperkeratosis is seen in psoriasis. The stratum corneum is typically sloughed in 14 days. In hyperkeratosis, the stratum corneum is sloughed in 4 to 7 days. This is not a type of malignant melanoma.
The nurse is providing education to a client with chronic myeloid leukemia about ongoing needs. Which interventions would the nurse include when educating this client? (Select all that apply.) a. Avoid alcohol-based mouthwash b. Encourage participation in strenuous exercise c. Drink 5 to 8 glasses of water a day d. Refrain from eating overly spicy foods e. Complete oral hygiene frequently
answer: a, c, d, e The nurse would educate the client to complete oral hygiene frequently to prevent infections. The nurse would educate the client to drink 5 to 8 glasses of water a day to prevent dehydration. The nurse would educate the client to refrain from using alcohol-based mouthwashes and eating overly spicy foods to prevent injury to the oral mucosa. The nurse would educate the client to avoid contact sports and strenuous exercise to prevent injury, not encourage participation in them.
The nurse is caring for a client admitted to an inpatient unit with fever and leukocytosis. During the initial examination, the nurse finds a suspicious-looking skin lesion possibly indicating malignancy. Which skin lesion is a form of skin cancer? (Select all that apply.) a. Malignant melanoma b. Actinic keratosis c. Basal-cell carcinoma d. Psoriasis e. Squamous-cell carcinoma
answer: a, c, e Basal-cell carcinoma is an epithelial cancerous tumor originating from the basal layer of the epidermis or from cells in the surrounding dermal structures. Squamous-cell carcinoma is a malignant tumor of the squamous epithelium of the skin or mucous membranes. Malignant melanoma is a cancerous skin lesion that arises from the melanocytes, or the cells located at or near the basal layer of the skin. Actinic keratosis is an epidermal noncancerous skin lesion directly related to chronic sun exposure and photodamage. Psoriasis is a chronic immune noncancerous skin disorder.
The nurse is caring for an older client on a medical-surgical unit who had abdominal surgery for mass removal one day ago. Which clinical manifestations of pain are typical for an older adult client? Select all that apply. a. decreased energy b. changes in sleep patterns c. guards abdomen d. loss of appetite e. cries inconsolably
answer: a, d The older adult client will often exhibit decreased energy and a loss of appetite when experiencing pain. Changes in sleep patterns occur in the adolescent client. Guarding the area of pain is seen in the toddler and preschool client. Crying inconsolably occurs in infants experiencing pain.
The nurse is assessing a client with rheumatoid arthritis. Which assessment data is typical for clients experiencing continuous, chronic pain? Select all that apply. a. heart rate of 80 bpm b. dilated pupils c. temperature of 97 F d. respiratory rate of 20 e. BP 120/80 mmHg
answer: a, d, e Clients with chronic pain often have normal heart and respiratory rates, and normal blood pressure. Temperature remains normal in the presence of chronic pain. Dilated pupils often occur with acute pain, not chronic pain.
The nurse is planning care for a client admitted for end-stage lung cancer. Which potential problem will assist in addressing the client's psychological needs? a. Activity intolerance b. Anticipatory grieving c. Pain d. Breathing pattern
answer: b Anticipatory grieving is the potential problem that will address the client's psychological needs associated with end-stage lung cancer. Pain, breathing pattern, and activity intolerance are potential problems that address the client's physical needs, not psychological needs.
The nurse is caring for a client with suspected fibromyalgia. Which diagnosis tool does the nurse anticipate will be used to properly diagnose this client? a. blood tests for neurotransmitter levels b. a widespread pain index c. failure of a cardiac stress test d. abnormalities on a thyroid panel
answer: b Fibromyalgia is a diagnosis of exclusion and based largely on client feedback, such as responding to questions on a screening tool like the widespread pain index. There is no laboratory or diagnostic study that establishes the diagnosis.
The client with sickle cell disease (SCD) is ordered to receive hydroxyurea. To correctly explain the rationale for administering hydroxyurea to the client, which statement is most appropriate for the nurse to include in the teaching? a. "Hydroxyurea will help decrease your nausea and vomiting." b. "Hydroxyurea decreases the production of abnormal blood cells." c. "Hydroxyurea may cause you to have more pain." d. "Hydroxyurea decreases the body's production of fetal hemoglobin."
answer: b For the client with sickle cell disease (SCD), hydroxyurea is used for cytotoxic effects. This medication decreases the production of abnormal blood cells, which leads to decreased pain. Hydroxyurea also increases fetal hemoglobin production and RBC mean corpuscle volume (MCV). Side effects of hydroxyurea include bone marrow suppression, headaches, dizziness, nausea, and vomiting.
The nurse is assessing the client with sickle cell disease (SCD) for manifestations of shock. Which assessment finding is most reflective of a classic manifestation of shock? a. Increased urine output b. Pallor c. Hypertension d. Persistent abdominal pain
answer: b Manifestations of shock include hypotension, changes in level of consciousness, pallor, dizziness or lightheadedness, decreased urine output, and increased capillary refill time. Clients with sickle cell disease (SCD) may experience pain in a variety of locations, including the abdomen, but pain is not a classic manifestation of shock.
When planning care for a client affected by fibromyalgia, the nurse addresses the potential problem of activity intolerance. What will the nurse recommend to the client in order to most effectively address this problem? a. daily meditation and guided imagery b. a program of regular, mild to moderate exercise c. referral to physical therapy for an assistive device d. NSAID medication taken on a regular schedule
answer: b Meditation and guided imagery can reduce anxiety. NSAIDs address the problem of pain. Assistive devices do not increase conditioning or activity tolerance in the absence of injury or neurologic deficits. Regular, mild to moderate exercise improves conditioning and activity tolerance.
A client with chromic myeloid leukemia (CML) is admitted to a clinic. The nurse understands the client is least likely to be part of which demographic group? a. Male b. Older than 65 years c. Younger than 20 years d. Female
answer: c CML makes up about 15% of all adult leukemias, with the average age of diagnosis at 65 years. While CML affects women more than men, it is least likely to affect children.
When planning care for a client with acute lymphocytic leukemia (ALL), the nurse addresses the problem of insufficient calorie intake. What nursing intervention will assist in addressing this problem? a. Weigh the client weekly b. Provide mouth care before meals c. Medicate for pain 90 minutes before meals d. Provide high-fat meals throughout the day
answer: b Providing mouth care before meals will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Weighing the client daily, not weekly, will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Medicating for pain 30 minutes, not 90 minutes, before meals will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL. Providing low-fat meals, not high-fat meals, will assist in addressing the problem of insufficient calorie intake when caring for a client with ALL.
A client who is scheduled for a mastectomy asks the nurse, "Why do I need to have radiation before surgery if the doctor is just going to cut out the tumor?" Which response by the nurse is the most appropriate? a. "Radiation will help to prevent infection after surgery." b. "Radiation can be used before surgery to shrink large tumors." c. "If the radiation works, you may not need to have the surgery." d. "Radiation will decrease the amount of pain that you will have after your surgery."
answer: b Radiation may be used before mastectomy surgery to shrink the size of large breast tumors, thus minimizing the amount of tissue that has to be removed. By saying that if the radiation works, the client may not need surgery, the nurse is providing false reassurance. Radiation and surgery are often used together. Radiation before mastectomy will not decrease postsurgical pain. Radiation will actually increase the client's susceptibility to infection after surgery.
The nurse is planning care for a client experiencing acute pain. What will the nurse include in the health history portion of the nursing assessment? a. assessing facial expressions b. using a developmentally appropriate tool c. inspecting injuries d. monitoring VS
answer: b The nurse will use a developmentally appropriate pain assessment tool during the health history portion of the nursing assessment. Monitoring vital signs, assessing facial expressions, and inspecting injuries occur during the physical examination portion of the nursing assessment.
A client with leukemia is prescribed a therapy that modifies the body's response to cancer cells. The nurse plans to educate the client about what therapy? a. Stem cell transplant b. Biologic c. Complementary d. Radiation
answer: b The nurse would plan to educate the client about biologic therapy because this therapy modifies the body's response to cancer cells. This therapy uses biologic agents such as interferon and interleukin to treat leukemia. Radiation does not modify the body's response to cancer cells, but it is used to kill abnormal white blood cells. Complementary therapy does not modify the body's response to cancer cells, but it does reduce symptoms of leukemia and side effects of treatment. A stem cell transplant does not modify the body's response to cancer cells. This treatment is used to completely replace the client's blood cells, leading to complete and sustained eradication of the disease.
A client presents to the urgent care clinic with an itchy, bulky. shiny tumor on his scalp that is pink in color and ulcerated in the center. The tumor started out appearing like a pimple about 6 months ago but has since doubled in size. Based on the client's history and the appearance of the tumor, which malignant skin lesion would the nurse suspect this client might have? a. Squamous-cell cancer b. Nodular basal-cell carcinoma c. Actinic keratosis d. Malignant melanoma
answer: b The nurse would suspect a nodular basal-cell cancer given that the lesion is bulky, shiny, pink, and started out as a papular (pimple-like) lesion which has grown rapidly in the past 6 months. Malignant melanomas present with color variegation rather than a pink or flesh-colored appearance. Squamous-cell cancer begins as a small firm red nodule. Crusted areas develop over the tumor, with ulceration, bleeding, and pain appearing as the tumor grows. Actinic keratosis is associated with chronic sun exposure and photodamage. The lesions are rough macules that are often shiny and a few millimeters in diameter. They occur in multiple patches, primarily on the face, dorsa of the hands, forearms, and occasionally on the trunk.
The nurse is caring for a client with malignant melanoma on her leg who was recently admitted to the oncology floor for biopsy. The client says that she has heard about certain skin lesions that are precursors to melanomas, and she asks the nurse to tell her about how they typically look so that she can make sure other family members know to check themselves for moles. The nurse would tell her about which of the following skin lesions that are precursors to melanoma? (Select all that apply.) a. Actinic keratosis b. Congenital nevi c. Lentigo maligna d. Dysplastic nevi e. Solar keratosis
answer: b, c, d Congenital nevi are present at birth. Their size ranges from small to very large, and they are typically brown or black in color. They have an irregular surface and fairly regular border. Dysplastic nevi are precursors to melanoma and typically appear normal in childhood but become dysplastic after puberty. Their pigmentation is irregular, with mixtures of tan, brown, black, red, and pink. Lentigo maligna is a tan or black patch on the skin that looks like a freckle, grows slowly, and over time becomes mottled, dark, thick, and nodular; it is usually found on one side of the face in elderly people. Solar keratosis is also known as actinic keratosis, a noncancerous skin lesion directly related to chronic sun exposure and photodamage. Actinic keratosis, also called solar keratosis, is not a melanoma precursor but can progress to squamous-cell cancer, a malignant tumor of the squamous epithelium of the skin or mucous membranes.
The charge nurse is reviewing the plan of care for a client newly diagnosed with leukemia with a decreased neutrophil count. Which interventions indicate that the focus of care is to prevent infection? (Select all that apply.) a. Monitor hydration status b. Implement protective isolation precautions c. Maintain strict hand hygiene measures d. Monitor white blood cell values e. Avoid invasive procedures
answer: b, c, d The nurse would implement protective isolation precautions, monitor white blood cell values, and maintain strict hand hygiene measures when the focus of care is to prevent infection in a client with neutropenia (low neutrophil count). Monitoring hydration status helps manage adverse medication effects, while avoiding invasive procedures addresses the risk for bleeding.
The nurse is caring for a client who was diagnosed with actinic keratosis. Which topic will the nurse include in the discharge teaching for this client? (Select all that apply.) a. Avoiding indomethacin, lithium, and beta-adrenergic blocking agents b. Seeking medical attention for any shiny or scaly skin lesions c. Wearing long sleeves if outdoors during peak sun hours d. Avoiding sun exposure e. Using sunscreen with at least 15 SPF
answer: b, c, d, e Actinic keratosis is directly related to chronic sun exposure and photodamage, and to psoriasis. The UV radiation exposure induces cellular DNA mutation in the skin. The absence of further UV light exposure may result in resolution through repair mechanisms. Additional UV light exposure may induce further DNA mutations, resulting in squamous-cell cancer. The client should be taught to wear long sleeves, long pants, and a wide-brimmed hat if outdoors during sunlight hours. Using sunscreen with an SPF of at least 15 reduces the rate of the disorder. Shiny or scaly skin lesions are a manifestation of squamous-cell cancer lesions. Indomethacin, lithium, and beta-adrenergic blocking agents are medications that can precipitate exacerbations of psoriasis and should be avoided if the client has a history of psoriasis. These medications do not cause an exacerbation of actinic keratosis.
A client is admitted with a diagnosis of breast cancer with metastasis. The client asks the nurse where the cancer has spread. Which common sites for metastasis from breast cancer will the nurse include in the response? (Select all that apply.) a. Kidney b. Bone c. Lungs d. Liver e. Brain
answer: b, c, d, e Common sites for metastasis from breast cancer include the brain, liver, bone, and lungs. The kidney is not considered a common site for metastasis from breast cancer.
The nurse is teaching a client prevention methods for pain. Which items will the nurse include in the teaching session? Select all that apply. a. ignoring symptoms b. taking medications as prescribed c. avoiding risky behaviors d. eating a balanced diet e. exercising daily
answer: b, c, d, e Pain prevention methods that the nurse will include in the teaching include the importance of exercise, eating a balanced diet, and avoiding risky behaviors. Ignoring symptoms is not a prevention strategy. Taking medications as prescribed is a treatment method and not a prevention method.
The nurse is caring for a client recovering from the excision of an 8-mm malignant melanoma on the face. Which nursing diagnoses are most appropriate, considering the client's condition? (Select all that apply.) a. Decreased anxiety b. Increased risk of skin infection c. Alterations in skin integrity d. Improved self-acceptance e. Potential for increased postoperative pain
answer: b, c, e The postoperative client may be at risk of increased pain, increased risk of infection, and impaired skin integrity following the excision of a malignant melanoma. The client's anxiety is potentially increased during this time of diagnosis and unknown prognosis. The client may be at an increased risk of diminished self- acceptance following surgery on the face, with its potential for scarring.
The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, cannot concentrate, and am so forgetful." Which statements made by the nurse in response to the client are true? (Select all that apply.) a. "This may occur with chemotherapy, however, it is rare." b. "This may last up to 2 years after completion of chemotherapy." c. "This is an abnormal side effect of chemotherapy and is very concerning." d. "This is also called chemo-brain." e. "You might want to make notes if needed as a memory aid."
answer: b, d, e The client is experiencing a normal side effect to chemotherapy, also called chemo-brain. The nurse should suggest that the client make notes or other memory aids as needed. These side effects may last up to 2 years after completion of chemotherapy.
The nurse is caring for a client with a history of chronic unrelieved pain related to leukemia. Which intervention of last resort might be considered for this client? a. muscle-relaxation techniques b. guided imagery c. nerve block d. oral analgesics
answer: c A client with chronic unrelieved pain that can occur with cancer would be a candidate for a nerve block. Oral analgesics are not reserved as a last resort therapy. Guided imagery and muscle-relaxation techniques are complementary and alternative therapies for pain that may be used at any stage and are not considered last resort interventions.
A client is newly diagnosed with acute lymphocytic leukemia. The nurse understands that the client will display which pathophysiology? a. Proliferation of small, abnormal, mature lymphocytes, usually B lymphocytes b. Uncontrolled proliferation of myeloblasts c. Transformation of B lymphocyte cells into cells that resemble immature lymphocytes but do not mature d. Abnormal proliferation of all bone marrow elements
answer: c Acute lymphocytic leukemia is characterized by transformation of B lymphocytes. Proliferation of small, abnormal mature lymphocytes is characteristic of chronic lymphocytic leukemia. Uncontrolled proliferation of myeloblasts is characteristic of acute myeloid leukemia, while abnormal proliferation of all bone marrow elements is characteristic of chronic myeloid leukemia.
Nurses taking care of clients experiencing pain should understand that the acute pain stimulates the adrenergic nervous system, which will result in which physiologic change? a. hypotension b. pupil constriction c. increased perspiration d. bradycardia
answer: c Acute pain stimulates the adrenergic nervous system and results in physiologic changes, including tachycardia, tachypnea, hypertension, pupil dilation, pallor, increased perspiration, and increased secretion of catecholamine and adrenocorticoid hormones.
A client is informed that she needs to have a mastectomy for breast cancer and states, "I will no longer be a woman." Which response by the nurse is the most appropriate? a. "You don't want your cancer to spread, do you?" b. "Do you want to talk with the priest?" c. "That is a very overwhelming thing to think about." d. "They are doing wonderful things with plastic surgery these days."
answer: c An open-ended statement or question allows the client to express her feelings. The nurse should try to reflect back the client's feelings. The nurse should focus on the client's current concerns. Focusing on plastic surgery could minimize the client's concerns. The nurse should not ask judgmental questions because doing so will minimize the client's feelings. The nurse should not ask yes/no questions because they do not allow for the expression of feelings. The client has not asked for spiritual assistance, and the priest may not be the most appropriate individual to attend to the client's concerns.
The nurse is analyzing and synthesizing assessment data, related to the care of the client with sickle cell disease (SCD), to formulate client-specific nursing diagnoses. Which client problem represents the highest priority when planning nursing care of the client with SCD? a. Activity intolerance b. Altered comfort c. Impaired oxygenation d. Imbalanced nutrition
answer: c During the diagnosis phase of the nursing process, the nurse analyzes and synthesizes assessment data to formulate client-specific nursing diagnoses. The nurse also identifies emergent and urgent problems that require immediate attention, and provides prompt client care as indicated. Nursing diagnoses that are reflective of safety risks or infectious disease transmission should be addressed immediately. While altered comfort, imbalanced nutrition, and activity intolerance should be addressed, impaired oxygenation represents the highest priority client problem.
A client tells the nurse, "The skin on my right breast is puckered up and looks like an orange peel." Which response by the nurse is most appropriate? a. "Do you have a history of skin problems?" b. "When was your last mammogram?" c. "Have you discussed these findings with your healthcare provider?" d. "Have you used a new lotion recently?"
answer: c Edema with dimpling of the skin that results in an orange-peel look is often present with inflammatory carcinoma, the most malignant form of breast cancer. The client needs to see a healthcare provider as soon as possible. The skin changes the client is describing are more likely related to inflammatory breast cancer than a reaction to lotion. The client's symptoms are most likely not related to skin problems. The client needs to address the current situation. The date of the last mammogram is irrelevant with respect to the client's situation.
The nurse educator is giving an in-service about the assessment and care of children who are diagnosed with sickle cell disease (SCD). Which information should the educator include in the in-service? a. Newborn screening for sickle cell disease is recommended and optional for children who are born in the United States. b. Beginning at 5 years of age, children with sickle cell disease should undergo routine ultrasound head scanning. c. Newborn blood testing for sickle cell disease usually involves obtaining a blood sample by way of a heel stick. d. Initial diagnosis of sickle cell disease is most often made by amniocentesis testing in the prenatal period.
answer: c Newborn screening for sickle cell disease (SCD) is mandatory in the United States. Although amniocentesis may be used to diagnose SCD in the prenatal period, the initial diagnosis is most often made by testing a few drops of the newborn's blood. In most cases, for newborns, the blood sample is obtained by way of a heel stick. Starting at 2 years of age, children with SCD should undergo routine ultrasound scanning of the head to evaluate cerebral blood flow.
The nurse is educating a client newly diagnosed with fibromyalgia about prescribed medications. Which medication will the nurse include in the teaching session that will assist in treating neuropathic pain and may reduce pain associated with fibromyalgia? a. Tramadol b. Fluoxetine c. Pregabalin d. Milnacipran
answer: c Pregabalin (Lyrica) is prescribed to a client with fibromyalgia to assist in treating neuropathic pain and to help in reducing pain associated with fibromyalgia. Tramadol (Ultram) is prescribed to a client with fibromyalgia to assist with pain relief, but it does not assist in treating neuropathic pain. Fluoxetine (Prozac) is prescribed to a client with fibromyalgia, but it does not assist in treating neuropathic pain or reduce pain associated with fibromyalgia. This medication promotes better sleep and helps in relieving other manifestations of fibromyalgia.Milnacipran (Savella) is prescribed to a client with fibromyalgia, but it does not assist in treating neuropathic pain or reduce pain associated with fibromyalgia. This medication mixes with reuptake inhibitors to increase serotonin and norepinephrine levels.
The nurse is caring for a client who is experiencing acute pain. Which independent nursing intervention is appropriate for this client? a. administering a nonopioid analgesic b. asking the client what methods enhance comfort c. repositioning for comfort d. placing a transdermal patch
answer: c Repositioning the client for comfort is an independent intervention that the nurse can implement for this client. Administering a nonopioid analgesic and placing a transdermal patch both require a health care provider prescription. Asking the client what methods enhance comfort is a nursing assessment not intervention.
The nurse is planning a smoking cessation teaching session for a group of clients scheduled for discharge soon. What should the nurse include in the session regarding the importance of smoking cessation and lung cancer? a. Genetic factors play a larger role in the development of lung cancer than tobacco use. b. There is little benefit to quitting smoking after the age of 50. c. Those who quit smoking before age 40 reduce their risk for developing lung cancer by 90% compared with those who continue smoking. d. Former smokers are at the same risk for developing lung cancer as the general population.
answer: c Smoking is the most influential factor in the development of lung cancer. Former smokers are at greater risk than those who have never smoked but quitting is beneficial at any age. Genetic factors do not play a larger role in developing lung cancer than tobacco use.
The nurse is caring for several clients who are receiving pharmalogical treatments for pain. Which type of treatments is the client who can self-administer a present dose of IV opioids receiving. a. epidural injection b. transdermal patch c. PCA d. IM opioid injection
answer: c The PCA is a patient-controlled analgesic pump that allows the client to self-administer a preset dose of intravenous opioids. An IM injection is administered intramuscularly by the nurse. A transdermal patch is administered by the nurse and is considered a topical preparation. An epidural injection is administered in the epidural space by a qualified healthcare provider.
The nurse is caring for a client who is due to undergo a biopsy of a suspicious mass in her breast. The client is crying and is tachycardic and tachypneic. Based on this assessment data, which problem is a priority? a. Body image disturbance b. Impairment of gas exchange c. Anxiety d. Risk for infection
answer: c The client is exhibiting signs and symptoms of anxiety, which is a common nursing problem in clients with a breast disorder. The data provided do not support the nursing problems of risk for infection, body image disturbance, or impaired gas exchange.
The nurse is reviewing discharge instructions with a client who just had a mastectomy for breast cancer. Which statement by the client indicates that teaching has been successful? a. "To improve my stamina, I will plan on trying not to sit down too much during the day." b. "I will be certain to not lift my arms over my head." c. "I am going to see when the support group meetings are so I can attend them." d. "I should avoid using the arm on the surgical side if at all possible for a while."
answer: c The client should be encouraged to participate in a breast cancer support group as a source of education and support. Postmastectomy exercises include over-the-head activities such as wall climbing and using an overhead pulley. The affected side should be used for activities of daily living, such as eating, combing the hair, and face washing to maintain function and strength. The client should be taught the importance of adequate rest periods.
The nurse is caring for a client with a history of malignant melanoma. While performing the admission assessment, the nurse reviews ongoing self-care with the client. Which assessment parameter is a priority during the initial physical examination? a. Dental examination b. Detailed foot examination c. Detailed skin assessment d. Mental health examination
answer: c The client with a history of malignant melanoma should perform regular self-assessment of the skin and report any suspicious lesions or findings. Regular skin examinations by a healthcare provider should also be encouraged according to the suggested follow-up schedule to evaluate for recurrence. The nurse should complete a detailed skin assessment to assess for suspicious lesions or findings. Clients should have a brief mental health assessment, foot assessment, and dentition assessment, but these are not related to a history of melanoma.
The healthcare provider is scheduled to perform a diagnostic test that will visualize and obtain a tissue sample of a client's lung tumor. What diagnostic test would the nurse anticipate the healthcare provider performing? a. CT scan b. Chest x-ray c. Bronchoscopy d. Pneumonectomy
answer: c The nurse should anticipate the healthcare provider performing a bronchoscopy. A bronchoscopy is performed to visualize the tumor and to obtain a tissue specimen for diagnosis of the tumor type. A CT scan is a diagnostic test that assists in determining the location of the tumor. A chest x-ray is a diagnostic test that provides the first evidence of lung cancer with evidence of changes on the film. Pneumonectomy is a surgical procedure, not a diagnostic test, that removes the entire lung.
The nurse is completing discharge teaching for a client with lung cancer. Which information should the nurse include when providing this education? a. Increased risks with asbestos exposure b. Avoiding alcohol consumption c. Limiting secondhand smoke exposure d. Physical activity
answer: c The nurse should include education about how the exposure to asbestos increases the client's risk for lung cancer. The nurse needs to educate the client about avoiding, not limiting, secondhand smoke. Alcohol intake is not linked to lung cancer. Physical activity does not affect the risk for lung cancer.
The nurse is completing a physical assessment on a client with possible fibromyalgia. To support the diagnosis of fibromyalgia, the nurse must assess and document pain upon palpation on how many standard tender points? a. 9 b. 5 c. 7 d. 11
answer: c To assist with the diagnosis of fibromyalgia, the client must have pain upon palpation at 11 or more of the 18 standard tender points, not nine, seven, or five of the standard tender points.
The nurse is assessing the coping skills of a client undergoing treatment for leukemia. What is the best time for the nurse to assess the client's management of issues such as nutrition, rest/sleep, medication administration, and psychosocial needs? a. When the client is at home b. When the client is receiving radiation therapy in the clinic c. When the client is receiving IV medication in the clinic d. When the client is at work
answer: c When the client is receiving IV medication in the clinic is the best time to assess the client's coping skills. Clients are isolated during radiation therapy, so this is not an ideal time to assess a client. It is more difficult to assess the client at home or work than during a scheduled IV treatment session in the clinic.
The nurse is teaching the client with sickle cell disease (SCD) about hemosiderosis, which is a complication associated with frequent blood transfusions. Which statement is most appropriate for the nurse to include in the client teaching? a. "Hemosiderosis occurs when your immune system reacts to antigens." b. "Vitamin C can increase your risk for developing hemosiderosis." c. "Hemosiderosis is storage of iron in tissues and organs." d. "In most cases, hemosiderosis is caused by iron-chelating medications."
answer: c Hemosiderosis, which is a complication associated with frequent blood transfusions, is storage of iron in the tissues and organs. To help prevent hemosiderosis, an iron-chelating drug (such as deferoxamine) may be given with vitamin C to promote iron excretion. Alloimmunization happens when the child's immune system reacts to antigens on the donated tissues (e.g., blood and stem cells).
Which components of a focused health history will the nurse include during the assessment of a client with lung cancer? a. Nausea, dry mouth, and joint pain b. Sudden unexplained weight gain c. Recent weight loss, fatigue, anorexia, and bone pain d. Restlessness, anxiety, and insomnia
answer: c Weight loss, fatigue, and anorexia are systemic manifestations of lung cancer. Bone pain indicates possible metastasis.
The nurse is preparing to teach a client who is diagnosed with fibromyalgia regarding nonpharmacologic therapies for treating the disorder. Which goals of therapy should the nurse include in the teaching session? (Select all that apply.) a. Curing the disorder b. Helping the client to understand they are imagining their symptoms c. Enhancing self-efficacy and positive outlook d. Improving activity tolerance e. Relieving pain
answer: c, d, e Clients with fibromyalgia experience real pain and fatigue that are disruptive to their daily lives. Suggesting they are imagining these things will increase frustration and is not therapeutic. There is no known cure. Clients gain great benefit form activities that increase conditioning and activity tolerance, enhance feelings of self-efficacy, and assist with pain control.
A client recently diagnosed with fibromyalgia is receiving education from the nurse. Which reasons should the nurse provide to the client regarding pain perception occurring at lower levels of stimulation with this disorder? (Select all that apply.) a. Fat and connective tissue replace muscle fibers b. Autoantibodies attacking host tissues c. Autonomic nervous system differences d. Decreased neurotransmitter levels e. Abnormal hypothalamic response
answer: c, e A client with fibromyalgia perceives pain at a lower level of stimulation because of increased neurotransmitter levels and an abnormal hypothalamic response. A client with fibromyalgia perceives pain at a lower level of stimulation because of increased, not decreased, neurotransmitter levels. A client with fibromyalgia does not perceive pain at a lower level of stimulation because of fat and connective tissue replacing muscle fibers or because of antibodies becoming autoantibodies and attacking host tissues.
A healthcare provider prescribes duloxetine (Cymbalta) for a client diagnosed with fibromyalgia. The client asks the nurse why this medication is being prescribed. The nurse will base the response on which rationale? a. To relax the client and promote sleep b. To decrease joint pain and swelling c. To increase levels of dopamine and serotonin d. This is the correct answer. To reduce neuropathic pain
answer: d Duloxetine (Cymbalta) is prescribed to a client with fibromyalgia to increase serotonin and norepinephrine levels. This medication is not prescribed to reduce neuropathic pain, decrease swelling to joints, or relax the client to promote sleep. Pregabalin (Lyrica) is prescribed to reduce neuropathic pain. Nonsteroidal anti-inflammatory drugs are prescribed to decrease swelling to joints. Fluoxetine (Prozac) and paroxetine (Paxil) are medications prescribed to promote sleep.
The nurse is educating a client with lung cancer about systemic manifestations. What manifestation associated with the gastrointestinal (GI) system should the nurse include in the teaching session? a. Fatigue b. Bone pain c. Hemoptysis d. Dysphagia
answer: d Fatigue and bone pain are systemic manifestations that are not associated with the GI system. Hemoptysis is a respiratory manifestation. Dysphagia, or difficulty swallowing, is associated with the GI system.
The nurse is assessing the client with sickle cell disease (SCD) for signs and symptoms of acute chest syndrome. Which assessment finding is most reflective of a manifestation of acute chest syndrome? a. Oxygen saturation of > 90% b. Absence of adventitious breath sounds c. Urine output > 0.5 mL/kg/hr d. Increased white blood cell count
answer: d Manifestations of acute chest syndrome include chest pain, adventitious breath sounds, pulmonary infiltrates, and increased white blood cell (WBC) count. Absence of adventitious lung sounds, oxygen saturation of > 90%, and urine output of > 0.5 mL/kg/hr are normal findings and do not reflect manifestations of acute chest syndrome.
The nurse is planning care for a client admitted for lung cancer. Which nursing intervention assists in addressing the potential problem of activity intolerance? a. Administer analgesics b. Place the client in a supine position c. Provide chest physiotherapy d. Plan rest periods
answer: d Planning rest periods is an appropriate nursing intervention to address the potential problem of activity intolerance. Placing the client in a supine position will not address the potential problem of activity intolerance. Providing chest physiotherapy is a nursing intervention that addresses the potential problem of breathing pattern, not activity intolerance. Administering analgesic addresses the problem of pain.
The nurse is caring for a client receiving analgesics for pain. Which medication is considered a coanalgesic? a. acetaminophen b. aspirin c. morphine d. prednisone
answer: d Prednisone is a corticosteroid that is considered a coanalgesic, a medication that may enhance pain relief when used in conjunction with an analgesic. Aspirin and acetaminophen are nonopioid analgesics. Morphine is an opioid analgesic.
A client and her husband both carry the genetic trait for sickle cell disease (SCD). The client asks the nurse practitioner, "What is the risk that we will have a child with sickle cell disease?" Which response by the nurse practitioner is most accurate? a. "All of your children will have some form of SCD, though severity will vary." b. "All of your children will have the SCD trait, but none will have SCD." c. "There is a 50 percent chance that any of your children will have SCD." d. "There is a 25 percent chance that any of your children will have SCD."
answer: d SCD is caused by an autosomal recessive defect of the genes that are involved in producing hemoglobin. If both parents have the genetic trait for SCD, then with each pregnancy, there is a 25% risk of having a child with the disease.
The nurse is educating a student about the different types of lung cancer. The nurse asks the student which type of lung carcinoma grows rapidly and spreads early. Which response by the student indicates understanding of the teaching? a. Large-cell carcinoma b. Squamous cell carcinoma c. Adenocarcinoma d. Small-cell carcinoma
answer: d Small-cell lung carcinoma grows rapidly and spreads early. Adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma do not grow rapidly and spread early.
The nurse is caring for a client admitted for malignant melanoma on his trunk. What is the treatment of choice for malignant melanoma? a. Curettage b. Cryosurgery c. Immunotherapy d. Surgical excision
answer: d Surgical excision of the lesion is the treatment of choice for clients with malignant melanoma. These require wide excisions that include the full thickness of the skin and the subcutaneous tissue. Often, regional lymph node dissection is done as well. Immunotherapy is an experimental treatment of malignant melanoma but it is not the treatment of choice. Curettage is one of the treatments used to treat basal-cell and squamous-cell cancers that are less than 2 cm in diameter, that are superficial, or that recur; it is not used as a treatment for malignant melanoma. Cryosurgery is a treatment that uses the application of liquid nitrogen to the tumor to freeze and kill abnormal cells. This is used to treat basal-cell and squamous-cell cancers; it is not used for the treatment of malignant melanoma.
A client with adenocarcinoma lung cancer is scheduled for a procedure to remove peripheral lung tissue. Which procedure should the nurse educate the client about? a. Lobectomy b. Laser bronchoscopy c. Mediastinoscopy d. Wedge resection
answer: d The nurse needs to educate the client about a wedge resection; this procedure will remove a small section of the peripheral lung tissue. A laser bronchoscopy is used to resect tumors in the main bronchus. A mediastinoscopy is used to visualize the mediastinum and to remove mediastinal tumors and lymph nodes. A lobectomy removes a single lung lobe, not just the peripheral lung tissue.
The nurse is educating a client, newly diagnosed with small-cell cancer, about treatment options. What is the treatment of choice for this type of cancer? a. Lobectomy b. Laser bronchoscopy c. Brachytherapy d. Chemotherapy
answer: d The nurse needs to provide education on chemotherapy because this is the treatment of choice for small cell cancer. Brachytherapy is not the treatment of choice for small cell cancer. A lobectomy and laser bronchoscopy are the treatments of choice for nondashsmall-cell cancer, not small-cell lung cancer.
A client is diagnosed with a leukemia that is caused by uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow and the spleen. The nurse recognizes that this pathophysiology is present in which type of leukemia? a. Acute lymphocytic leukemia b. Chronic lymphocytic leukemia c. Chronic myeloid leukemia d. Acute myeloid leukemia
answer: d The nurse recognizes that the client likely has acute myeloid leukemia because this leukemia is caused by uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow and the spleen. Chronic myeloid leukemia is caused by the abnormal proliferation of all bone marrow elements and is usually associated with the Philadelphia chromosome, which is a translocation of chromosome 22 to chromosome 9. Acute lymphocytic leukemia is caused from a malignant transformation of B cells. Chronic lymphocytic leukemia is caused by a proliferation of abnormal B lymphocytes.
The nursing student is creating a presentation about pharmacologic treatments used in the care of clients with sickle cell disease (SCD). Which information is most appropriate for the student to include in the presentation? (Select all that apply.) a. Vaccinations are contraindicated for clients with sickle cell disease. b. Analgesics should be administered to clients with sickle cell disease only on a prn (as needed) basis. c. Analgesics are administered to clients with sickle cell disease to help reduce blood viscosity. d. Patient-controlled analgesia (PCA) machines may be ordered for clients with sickle cell disease. e. Prophylactic antibiotic therapy may be ordered for clients with sickle cell disease.
answer: d, e Analgesics are administered for pain control. For the client with sickle cell disease (SCD), analgesics should be administered at scheduled intervals as opposed to prn (as needed). A patient-controlled analgesia (PCA) machine may be ordered for analgesic administration. Because infection poses severe risks for clients with SCD, prophylactic antibiotic therapy also may be ordered. Vaccinations are recommended for clients of all ages who have SCD. Oral and IV fluid replacement helps to reduce blood viscosity.
The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instructions are appropriate for the nurse to include in the teaching session? (Select all that apply.) a. "You will be able to resume playing golf with your friends." b. "You should apply hot compresses to the right arm if it is aching." c. "Sleep with the right arm elevated on a pillow." d. "Do not allow anyone to take your blood pressure in the right arm." e. "It is okay to carry your purse on your right arm as long as it is not heavy."
answer: d, e Elevation of the affected extremity after lymph node removal will allow drainage of fluid, prevents swelling, and promotes circulation. Compression of the arm on the surgical side may increase the risk of developing lymphedema. The client should avoid carrying a purse or a briefcase on the affected arm. The client should avoid hot water contact on the affected extremity. Heat promotes vasodilation and fluid accumulation. Sports such as golf should be avoided in a client with a radical mastectomy.