Exam 1 Practice

The nurse is volunteering at a community center to teach women regarding breast cancer. The nurse would include which of the following when discussing risk factors (select all that apply)? A. Nulliparity B. Age 30 or over C. Early menarche D. Late menopause E. Personal history of colon cancer

A. Nulliparit (never given birth) C. Early menarche D. Late menopause E. Personal history of colon cancer Women are at an increased risk for development of breast cancer if they are over the age of 50; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 or are nulliparous.

A child with newly diagnosed leukemia has been admitted for the initial round of chemotherapy. What common signs and symptoms of leukemia related to bone marrow involvement would the nurse expect to find either in the child's history or during the assessment? A. Petechiae, infection, and fatigue B. Headache, papilledema, and irritability C. Muscle wasting, weight loss, and fatigue D. Decreased intracranial pressure, psychosis, and confusion

A. Petechiae, infection, and fatigue These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

The mother of a child receiving chemotherapy asks about the term, "nadir." Which explanation by the nurse is best? A. The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest. B. The nadir occurs when the blood counts have returned to their pre-chemotherapy values. C. The nadir occurs 2 to 3 days after chemotherapy administration when the blood counts begin to drop. D. The nadir describes the first few hours after chemotherapy administration has finished.

A. The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest.

A child is being placed on long-term prednisone therapy as part of the treatment for her leukemia and will be going home on the regimen. What teaching about the steroid treatment should the nurse provide to the parents?Select all that apply. A. Weight gain happens because of increased appetite. B. Frequent urination because of fluid loss. C. Her blood pressure should be monitored. D. Sleep disturbances, such as dreaming, can occur. E. Calm behavioral patterns should be present. F. Facial fullness usually disappears when the prednisone therapy has stopped.

A. Weight gain happens because of increased appetite., C. Her blood pressure should be monitored D. Sleep disturbances, such as dreaming, can occur. F. Facial fullness usually disappears when the prednisone therapy has stopped. Weight gain occurs because of increased appetite and salt/fluid retention. Her blood pressure should be monitored because of fluid retention. Sleep disturbances, such as dreaming, can occur. It is true that the facial fullness usually disappears when the prednisone therapy has stopped. It will take a while to resolve, just as it took a while to appear. Fluid retention is common, not fluid loss. Emotional lability (mood changes) is characteristic of this medication. The child can be happy one minute and angry several minutes later without a trigger for the anger.

A syndrome that leads to the deposition of platelets and fibrinogen plugs in the vasculature and the simultaneous depletion of platelets and clotting factor proteins is commonly known as DIC or _____________________.

ANS: disseminated intravascular coagulation The pathophysiology of DIC is complicated and not easily understood because both extreme bleeding and clotting occur at the same time.

A preschooler with vomiting and diarrhea lost 0.5 kg of weight since being weighed in the pediatrician's office prior to admission to the hospital. How much fluid would the nurse calculate that this child has lost? A. 250 mL B. 500 mL C. 750 mL D. 1000 mL

B. 500 mL One milliliter of body fluid is approximately equal to 1 g of body weight, so a weight loss or gain of 1 kg represents 1 liter or 1000 mL. A half-kilogram loss would be 500 mL.

A patient has a tumor that secretes excessive antidiuretic hormone (ADH). He is confused and lethargic. His partner wants to know how a change in blood sodium can cause these symptoms. What should the nurse teach the patient's partner? A. Decreased sodium in the blood causes the blood volume to decrease so that not enough oxygen reaches the brain. B. Decreased sodium in the blood causes brain cells to swell so that they do not work as effectively. C. Increased sodium in the blood causes the blood volume to increase so that too much oxygen reaches the brain. D. Increased sodium in the blood causes brain cells to shrivel so that they do not work as effectively.

B. Decreased sodium in the blood causes brain cells to swell so that they do not work as effectively.

A toddler is hospitalized with severe dehydration. The nurse should assess the child for which possible complication? A. Hypertension B. Hypokalemia C. A rapid, bounding pulse D. Decreased specific gravity

B. Hypokalemia Hypokalemia is a concern in severe dehydration.

Which of the following female patients should report her results from breast self-examination? A. Denser breast tissue B. Left nipple deviation C. Palpable rib margins D. Different size breasts

B. Left nipple deviation Unilateral deviation of a nipple and nipple retraction are clinical indicators of breast cancer and should be reported promplty to the HCP. The breasts of most women are slightly different sizes

A 22 year old female patient has come to the clinic for oral contraceptives. The nurse uses the opportunity for patient teaching about BSE. What should the nurse include in patient teaching? A. Women at high risk for breast cancer begin BSE at 30 years old B. Perform BSE monthly on the day of the first pill in each package C. Older women use BSE annually as breast tissue density declines D. Healthy women need to have annual mammograms beginning at age 50

B. Perform BSE monthly on the day of the first pill in each package The nurse instructs the pt to use the packaging for the oral contraceptives as a convenient reminder to perform BSE monthly to increase adherence

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. Which of the following interventions would the nurse use to decrease the lymphedema? A. Keep affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure on unaffected arm only. D. Restrict exercise of the affected arm for 1 week.

C. Assess blood pressure on unaffected arm only. Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended to reduce fluid volume in the arm.

A toddler with mucosal ulceration related to chemotherapy is not eating because of pain. The nurse would expect to administer which solution to ease the child's discomfort? A. Lemon glycerin swabs for cleansing B. Mouthwashes with hydrogen peroxide C. Mouthwashes with normal saline solution D. Local anesthetic such as viscous lidocaine before meals

C. Mouthwashes with normal saline solution Normal saline solution mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without risking adverse effects on the mucosa or adverse effects caused by the child swallowing the rinse. Viscous lidocaine is not recommended for toddlers because it depresses the gag reflex. Lemon glycerin swabs can irritate eroded tissue and cause tooth decay. Hydrogen peroxide delays healing by breaking down protein.

Why are infants at greater risk for fluid and electrolyte imbalances than older children? A. Their metabolic rate is lower. B. They have a decreased surface area. C. Their kidney functioning is immature. D. Their daily exchange of extracellular fluid is decreased.

C. Their kidney functioning is immature. The infant's kidneys are unable to concentrate or dilute urine, conserve or excrete sodium, and acidify urine.

DIC is a disorder in which: A. the coagulation pathway is generally altered, leading to thrombus formation in all major blood vessels B. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts C. a disease process stimulates coagulation process with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage D. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature

C. a disease process stimulates coagulation process with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage

A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. What would be the most appropriate response from the nurse? A. "Radiation therapy may be necessary." B. "A kidney transplant will be planned." C. "No additional treatments are usually necessary." D. "Chemotherapy with or without radiation therapy is indicated."

D. "Chemotherapy with or without radiation therapy is indicated." This determination will be made on the basis of the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Radiation therapy may be necessary, but chemotherapy is first. Most children with Wilms tumor do not require renal transplants. Additional therapy is indicated after the tumor is removed.

A nurse is evaluating an infant brought to the clinic with severe diarrhea. What signs and symptoms indicate that the infant has severe dehydration? A. Tachycardia, decreased tears, 5% weight loss B. Normal pulse and blood pressure, intense thirst C. Irritability, moderate thirst, normal eyes and fontanel D. Tachycardia, capillary refill greater than 3 seconds, sunken eyes and fontanel

D. Tachycardia, capillary refill greater than 3 seconds, and sunken eyes and fontanel are the symptoms of severe dehydration.

The nurse is evaluating lab results to determine if her patient is experiencing a diagnosis of DIC. The nurse should anticipate the following results: increased red blood cell count, low platelet counts, and an increased fibrinogen level. Is this statement true or false?

False The results indicate a decreased red blood cell count, low platelets, red blood cell fragments, prolonged prothrombin time, and a decreased fibrinogen level with an increased D-dimer.

What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea? a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours." b. "The pediatrician should be contacted if the infant has two loose stools in an8-hour period." c. "Call the doctor immediately if the infant has a temperature greater than 100° F." d. "Notify the pediatrician if the infant naps more than 2 hours."

a. "Call your pediatrician if the infant has not had a wet diaper for 6 hours."

A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed? a. "Have you had sexual intercourse?" b. "Do you use any illegal substances?" c. "Do you have cramping with your periods?" d. "At what age did your menstrual periods start?"

a. "Have you had sexual intercourse?" The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21 years. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test.

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."

a. "Tell me what you think is important to know about the surgery." This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

Which information will the nurse include in patient teaching for a 36-yr-old patient who is scheduled for stereotactic core biopsy of the breast? a. A local anesthetic will be given before the biopsy specimen is obtained. b. You will need to lie flat on your back and lie very still during the biopsy. c. A thin needle will be inserted into the lump and aspirated to remove tissue. d. You should not have anything to eat or drink for 6 hours before the procedure.

a. A local anesthetic will be given before the biopsy specimen is obtained. A local anesthetic is given before stereotactic biopsy. NPO status is not needed because nosedative drugs are given. The patient is placed in the prone position. A biopsy gun is used toobtain the specimens.

Patients may reduce the risk of developing cancer using health promotion strategies. Identify strategies which can reduce the risk of developing cancer (select all that apply.). a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

a. Control weigh b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.

A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. The nurse should alert the health care provider immediately that the patient is on which medication? a. Digoxin (Lanoxin) 0.25 mg/day b. Metoprolol (Lopressor) 12.5 mg/day c. Ibuprofen (Motrin) 400 mg every 6 hours d. Lantus insulin 24 U subcutaneously every evening

a. Digoxin (Lanoxin) 0.25 mg/day Hypokalemia increases the risk for digoxin toxicity, which can cause serious dysrhythmias. The nurse will also need to do more assessment regarding the other medications, but they are not of as much concern with the potassium level.

A 51-yr-old patient with a small immobile breast lump is considering having a fine-needleaspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. b. only a small incision is needed, resulting in minimal breast pain and scarring. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days FNA is done in outpatient settings, and results are available in 24 to 48 hours. No incision isneeded. FNA may be guided by ultrasound but not by mammogram. Because the immobilityof the breast lump suggests cancer, further testing will be done if the FNA results arenegative.

A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome (HUS) is classified as a. Intrarenal b. Prerenal c. Postrenal d. Chronic

a. Intrarenal A) Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are HUS, glomerulonephritis, and pyelonephritis. B) Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension. C) Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature. D) Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? a. Maintain a high intake of fluid and fiber in the diet. b. Discontinue intake of medications causing constipation. c. Eat several small meals per day to maintain bowel motility. d. Sit upright during meals to increase bowel motility by gravity

a. Maintain a high intake of fluid and fiber in the diet. Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)? a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed.

a. Maintain hope. b. Exhibit a caring attitude . e. Be available to listen to fears and concerns. Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk? (Select all that apply.) a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

a. Pap testing c. Sunscreen use d. Mammography e. Colorectal screening The patient's age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy.

Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete? a. Presence of the Chvostek's sign b. Abnormal serum potassium level c. Decreased thyroid hormone level d. Bleeding on the patient's dressing

a. Presence of the Chvostek's sign The patient's symptoms indicate possible hypocalcemia, which can occur secondary to parathyroid injury or removal during thyroidectomy. There is no indication of a need to check the potassium level, the thyroid hormone level, or for bleeding.

The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children? a. The respiratory, renal, and chemical-buffering systems b. The kidneys balance acid; the lungs balance base c. The cardiovascular and integumentary systems d. The skin, kidney, and endocrine systems

a. The respiratory, renal, and chemical-buffering systems

A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. The nurse will anticipate teaching the patient about a. endometrial biopsy. b. endometrial ablation. c. uterine balloon therapy. d. dilation and curettage (D&C).

a. endometrial biopsy. A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse's first action should be to a. palpate the breasts for the presence of any discrete lumps. b. explain that this is a temporary condition caused by hormonal changes. c. refer the patient for mammography and biopsy of the breast tissue. d. teach the patient about dietary changes to reduce the breast size.

a. palpate the breasts for the presence of any discrete lumps. Rationale: If discrete, circumscribed lumps are present, the patient should be referred for further testing to determine whether breast cancer is present. Gynecomastia is usually a temporary change, but it can be caused by breast cancer. Mammography and biopsy will not be needed unless lumps are present in the breast tissue. Dietary changes will not affect the condition.

When admitting a patient with acute glomerulonephritis, it is most important that the nurse ask the patient about a. recent sore throat and fever. b. history of high blood pressure. c. frequency of bladder infections. d. family history of kidney stones.

a. recent sore throat and fever. Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by hypertension, urinary tract infection (UTI), or kidney stones.

The nurse will anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS) about a. tamoxifen. b. lumpectomy. c. lymphatic mapping. d. MammaPrint testing.

a. tamoxifen. Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that a. the tumor is not likely to be responsive to hormone therapy. b. HER-2 receptor testing was repeated for a total of three samples. c. treatment with chemotherapy is not likely to be recommended. d. estrogen receptor testing identified the three hormones causing the cancer.

a. the tumor is not likely to be responsive to hormone therapy. A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

b. "I rarely have the energy to get out of bed." Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flu-like symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

The nurse provides discharge teaching for a 61-yr-old patient who has had a left modifiedradical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."

b. "I will avoid reaching over the stove with my left hand." The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."

b. "I will call if I have any eye problems." Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

Which statement by the patient indicates that she understands breast self-examination? a. "I will examine both breasts in two different positions." b. "I will perform breast self-examination 1 week after my menstrual period starts." c. "I will examine the outer upper area of the breast only." d. "I will use the palm of the hand to perform the examination."

b. "I will perform breast self-examination 1 week after my menstrual period starts." The woman should examine her breasts when hormonal influences are at a low level, typically the week after her menses. Women who don't menstruate should pick a date and perform SBE on that date every month. She should use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. She should use the sensitive pads of the middle three fingers.

A 58-yr-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make a decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."

b. "Tell me what you understand about the surgical options that are available." Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurses opinions or showing an unwillingness to discuss the topic could cut off communication.

A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress slowly."

b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information.

A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

b. "Would you like to talk about options for the care of your children?" This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's friends will raise the children, more assessment information is needed before making plans.

The nurse identifies that which patient is at highest risk for developing colon cancer? a. A 28-yr-old man who has a body mass index of 27 kg/m2 b. A 32-yr-old woman with a 12-year history of ulcerative colitis c. A 52-yr-old man who has followed a vegetarian diet for 24 years d. A 58-yr-old woman taking prescribed estrogen replacement therapy

b. A 32-yr-old woman with a 12-year history of ulcerative colitis Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ?5= 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome; eating red meat (?5=7 servings/week); cigarette use; and drinking alcohol (?5=4 drinks/week).

Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency

b. A breast nodule that is 1 cm in size, nontender, and fixed Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.DIF: Cognitive Level: Apply (application) REF: 1212TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? a. There is yellow discharge from the patient's right nipple. b. An area on the breast is hot, pink, and tender to the touch. c. Firm, moveable lumps are in the upper outer breast quadrants. d. The lumps get more painful before the patient's menstrual period.

b. An area on the breast is hot, pink, and tender to the touch. An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well-delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump is usually observed to increase in size and perhaps in tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which patient problem should the nurse identify? a. Denial b. Anxiety c. Acute confusion d. Ineffective adherence to treatment

b. Anxiety The patient who has a new cancer diagnosis is likely to have high anxiety, which may affect learning and require that the nurse repeat and reinforce information about health maintenance. There is no evidence to support confusion. The patient asks for the information to be repeated, indicating that denial is not present. The patient has recently been diagnosed, so adherence has not yet been required.

Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Assist with the application of a compression sleeve. c. Keep the right arm at or below the level of the heart. d. Check blood pressure (BP) on both right and left arms.

b. Assist with the application of a compression sleeve. Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's left-arm. The arm should not be placed in a dependent position.

A patient with multiple draining wounds is admitted for hypovolemia. Which assessment would be the most accurate way for the nurse to evaluate fluid balance? a. Skin turgor b. Daily weight c. Urine output d. Edema presence

b. Daily weight Daily weight is the most easily obtained and accurate means of assessing volume status. Skin turgor varies considerably with age. Considerable excess fluid volume may be present before fluid moves into the interstitial space and causes edema. Urine outputs do not take account of fluid intake or of fluid loss through insensible loss, sweating, or loss from the gastrointestinal tract or wounds.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem? a. Suggest that the patient limit social contacts until hair regrowth occurs. b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss d. Inform the patient that hair usually grows back once chemotherapy is complete

b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicles and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is notimmediately helpful in maintaining the patient's self-esteem.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? a. Osteoarthritis b. History of colorectal polyps c. History of lactose intolerance d. Use of herbs as dietary supplements

b. History of colorectal polyps A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d Hypophosphatemia

b. Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. What should the nurse explain as the reason for the test? a. Identify any metastasis of the cancer. b. Monitor the tumor status after surgery c. Confirm the diagnosis of a specific type of cancer. d. Determine the need for postoperative chemotherapy

b. Monitor the tumor status after surgery CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made based on the biopsy. Chemotherapy use is based on factors other than CEA.

During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Schedule a sigmoidoscopy to provide baseline data. b. Obtain more information about the patient's relatives. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood

b. Obtain more information about the patient's relatives. The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning

A healthy 28-year-old who has been vaccinated against human papillomavirus (HPV) has a normal Pap test. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a. You can wait until age 30 before having another Pap test. b. Pap testing is recommended every 3 years for women your age. c. No further Pap testing is needed until you decide to become pregnant. d. Yearly Pap testing is suggested for women with multiple sexual partners.

b. Pap testing is recommended every 3 years for women your age. The current national guidelines suggest Pap testing every 3 years for patients between ages 21 to 65. Although HPV immunization does protect against cervical cancer, the recommendations are unchanged for individuals who have received the HPV vaccination

A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide? a. The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy. b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity .c. The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients. d. The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.

b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity Rationale: The impact on breast function and appearance is less with lumpectomy and radiation, but there is some effect on breast sensitivity. The rate of cancer recurrence is the same for the two procedures. Chemotherapy may be used after either lumpectomy or mastectomy, but it is not always needed. The treatment period is shorter after mastectomy, but breast reconstruction does not provide a normal-appearing breast.

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

b. The patient swims several days each week. The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

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

b. The patient's visitors bring in fresh peaches. Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection.

What is the most important factor in determining the rate of fluid replacement in the dehydrated child? a. The child's weight b. The type of dehydration c. Urine output d. Serum potassium level

b. The type of dehydration A The child's weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. B Isonamtremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level. C Urine output is not a consideration for determining the rate of administration of replacement fluids. D Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer. b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes. d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.

b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. Rationale: Family history is a risk factor for breast cancer, and the nurse should discuss testing for BRCA genes with the patient. Although the BRCA gene is associated with increased risk for breast and ovarian cancer, the patient may be at risk if her mother had either one. About 5% to 10% of patients with breast cancer may have a genetic abnormality that contributes to breast cancer development. Risk factors are cumulative, but a family history alone will increase breast cancer risk.

The nurse will plan to teach a 34-yr-old patient diagnosed with stage 0 cervical cancer about a. radiation. b. conization. c. chemotherapy. d. radical hysterectomy.

b. conization. Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is a. fibrocystic complex. b. fibroadenoma. c. breast abscess. d. adenocarcinoma.

b. fibroadenoma. Rationale: Fibroadenoma is the most frequent cause of breast lumps in women under 25 years of age. Fibrocystic changes occur most frequently in women ages 35 to 50. Breast abscess is associated with pain and other systemic symptoms. Breast cancer is uncommon in women younger than 25.

During a well-woman physical examination, a 43-yr-old patient asks about her risk for breastcancer. Which question is most pertinent for the nurse to ask? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"

c. "At what age did you start having menstrual periods?" Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse's best response to the patient is, a. "If your mammogram was painful, it is especially important that you have it done annually." b. "An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram." c. "Because of your age, it is even more important for you to have annual mammograms." d. "Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60."

c. "Because of your age, it is even more important for you to have annual mammograms." Rationale: Annual mammograms are recommended for women over age 40 as long as they are in good health. The incidence of breast cancer increases in women over 60. Pain with a mammogram does not indicate any greater risk for breast cancer. Ultrasound may be used in some situations to differentiate cystic breast problems from cancer but is not a substitute for annual mammograms.

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

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

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

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

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

c. "I will need follow-up examinations for many years after treatment before I can be considered cured." The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

c. "Malignant tumors may spread to other tissues or organs." The major difference between benign and malignant tumors is that malignant tumors invadeadjacent tissues and spread to distant tissues and benign tumors do not metastasize. The otherstatements are inaccurate. Both types of tumors may cause damage to adjacent tissues.Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do notusually recur.

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."

c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy? a. A 55-yr-old patient who has 3 to 4 alcoholic drinks each day b. A 35-yr-old patient who has used oral contraceptives for 15 years c. A 25-yr-old patient who has a family history of hereditary nonpolyposis colorectal cancer d. A 45-yr-old patient who has had six previous full-term pregnancies and two spontaneous abortions

c. A 25-yr-old patient who has a family history of hereditary nonpolyposis colorectal cancer Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? a. A nursing assistant on the unit who also has hospice experience b. A licensed practical nurse that has worked on the unit for 10 years c. A registered nurse with 6 months of experience on the surgical unit d. A registered nurse who has floated to the surgical unit from pediatrics

c. A registered nurse with 6 months of experience on the surgical unit The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.

c. Administer prescribed antiemetics 1 hour before the treatments. Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma.

c. Assess the perineal drainage and incision. Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. Thepatient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Core needle biopsy d. MRI

c. Core needle biopsy When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or one of the other types of biopsies. A mammogram screens for breast cancer. An ultrasound may be used with or before biopsy. An MRI might be used in select cases.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband tells the nurse that he does not know what to say to his wife. Which problem is appropriate for the nurse to address in the plan of care? a. Anxiety b. Death anxiety c. Difficulty coping d. Lack of knowledge

c. Difficulty coping The data indicate that difficulty coping with the situation may be present reflected by the poor communication among the family members. The data given does not suggest death anxiety, anxiety, or lack of knowledge as an etiology.

49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT. b. Increased incidence of colon cancer in women taking HT requires more frequent colonoscopy. c. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

c. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT

Which assessment is most relevant to the care of an infant with dehydration? a. Temperature, heart rate, and blood pressure .b. Respiratory rate, oxygen saturation, and lung sounds. c. Heart rate, sensorium, and skin color. d. Diet tolerance, bowel function, and abdominal girth.

c. Heart rate, sensorium, and skin color. A. Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color. B. Respiratory assessments will not provide data about impending hypovolemic shock. C. Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child. D. Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

What is a priority intervention in planning care for the child with disseminated intravascular coagulation (DIC)? a. Hospitalization at the first sign of bleeding b. Teaching the child relaxation techniques for pain control c. Management in the intensive care unit d. Provision of adequate hydration to prevent complications

c. Management in the intensive care unit A DIC typically develops in a child who is already hospitalized. B Relaxation techniques and pain control are not high priorities for the child with DIC. C The child with DIC is seriously ill and needs to be monitored in an intensive care unit. D Hydration is not the major concern for the child with DIC.

Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? a. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.

c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the left arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeksafter surgery.

Which action should the nurse take when a 35-year-old patient has a result of minor cellular changes on her Pap test? a. Teach the patient about colposcopy. b. Teach the patient about punch biopsy. c. Schedule another Pap test in 4 months. d. Administer the human papillomavirus (HPV) vaccine.

c. Schedule another Pap test in 4 months. Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26.

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy(HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history ofBRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. Because HT has been linked to increased risk for breast cancer, the patient and health care provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for bothnon-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/μL.

c. The patient's apical pulse is irregular. Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count areexpected effects of chemotherapy.

A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been diagnosed with stage III ovarian cancer is a. sexual dysfunction related to loss of vaginal sensation. b. risk for infection related to impaired immune function. c. anxiety related to cancer diagnosis and need for treatment decisions. d. situational low self-esteem related to guilt about delaying medical care.

c. anxiety related to cancer diagnosis and need for treatment decisions. The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. Rationale: Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate? a. "A frequent cause of spotting is endometrial cancer." b. "How long has it been since your last menstrual period?" c. "Breakthrough bleeding is not unusual in women your age." d. "Are you using prescription hormone replacement therapy?"

d. "Are you using prescription hormone replacement therapy?" In postmenopausal women, a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent? a. "Do you currently smoke cigarettes?" b. "Have you ever had any breast injuries?" c. "Is there any family history of fibrocystic breast changes?" d. "At what age did you start having menstrual periods?"

d. "At what age did you start having menstrual periods?" Rationale: Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

The nurse provides discharge teaching for a patient who has had a left modified radical mastectomy and axillary lymph node dissection. The nurse determines that teaching has been successful when the patient says, a. "I should keep my left arm supported in a sling when I am up until my incision is healed." b. "I may expose my left arm to the sun for several hours each day to increase circulation and promote healing." c. "I can do whatever exercises and activities I want as long as I do not elevate my left hand above my head." d. "I will continue to exercise my left arm with finger-walking up the wall or combing my hair."

d. "I will continue to exercise my left arm with finger-walking up the wall or combing my hair." Rationale: The patient should continue with arm exercises to regain strength and range of motion. The left arm should be elevated to the level of the heart when the patient is up. Sun exposure is avoided because of the risk of sunburn. The left hand should be elevated at or above heart level to reduce swelling and lymphedema.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c. A 40-yr-old patient who still has left side chest and arm pain 2 months after a left modified radical mastectomy d. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue

d. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count

d. Absolute neutrophil count Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? a. Maintain the patient on bed rest. b. Auscultate lung sounds every 4 hours. c. Monitor for Trousseau's and Chvostek's signs. d. Encourage fluid intake up to 4000 mL every day.

d. Encourage fluid intake up to 4000 mL every day To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with hypercalcemia. Trousseau's and Chvostek's signs are monitored when there is a possibility of hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although these would be assessed every shift.

Which statement best describes why infants are at greater risk for dehydration than older children? a. Infants have an increased ability to concentrate urine. b. Infants have a greater volume of intracellular fluid. c. Infants have a smaller body surface area. d. Infants have an increased extracellular fluid volume.

d. Infants have an increased extracellular fluid volume.

What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration? a. Estimating insensible fluid loss b. Collecting urine for culture and sensitivity c. Palpating the posterior fontanel d. Measuring the infant's weight

d. Measuring the infant's weight

A patient who is taking a potassium-wasting diuretic for treatment of hypertension complains of generalized weakness. Which action is appropriate for the nurse to take? a. Assess for facial muscle spasms. b. Ask the patient about loose stools. c. Recommend the patient avoid drinking orange juice with meals. d. Suggest that the health care provider order a basic metabolic panel.

d. Suggest that the health care provider order a basic metabolic panel. Generalized weakness is a manifestation of hypokalemia. After the health care provider orders the metabolic panel, the nurse should check the potassium level. Facial muscle spasms might occur with hypocalcemia. Orange juice is high in potassium and would be advisable to drink if the patient is hypokalemic. Loose stools are associated with hyperkalemia.

When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-yr-old patient about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. c. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. d. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI).

d. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI). MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A woman should have a clinical breast examination about every 3 years for women in their 20s and 30s and every year for women aged 40 years and older. Annual mammograms are recommended for women older than 40 years of age.

The nurse who is teaching a group of women about breast cancer should tell the women that a. risk factors identify almost all women who will develop breast cancer. b. African-American women have a higher rate of breast cancer. c. 1 in 10 women in the United States will develop breast cancer in her lifetime. d. the exact cause of breast cancer is unknown.

d. The exact cause of breast cancer in unknown. Risk factors help identify women who may get breast cancer and for whom increased surveillance is recommended; however, breast cancer can occur without risk factors. Caucasian women have a higher incidence of breast cancer; however, African-American women have a higher rate of dying of breast cancer after they are diagnosed. One in eight women in the United States will develop breast cancer in her lifetime.

Adjuvant treatment with tamoxifen may be recommended for patients with breast cancer if the tumor is a. smaller than 5 cm. b. located in the upper outer quadrant only. c. contained only in the breast. d. estrogen receptive.

d. estrogen receptive. Tamoxifen is antiestrogen therapy for tumors stimulated by estrogen. Tamoxifen is used depending on age, stage, and hormone receptor status, not size. Location of the cancer does not determine the usefulness of tamoxifen. Stage of the cancer is a consideration, but more important is its sensitivity to estrogen.

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE after the menstrual period is more comfortable.

d. performing BSE after the menstrual period is more comfortable. Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.

The nurse will teach a patient with metastatic breast cancer who has a new prescription fortrastuzumab (Herceptin) that a. hot flashes may occur with the medication .b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling.

d. the patient should call if she notices ankle swelling. Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor forsymptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes orchanges in visual acuity may occur with tamoxifen, but not with trastuzumab.