Exam 4: Lewis Test Book 322
Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis?
Loss of height
A client is to have a below-the-knee amputation. Prior to the surgery, what should the circulating nurse in the operating room do?
Initiate a time-out
What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?
assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation
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?
"Can you tell me what has been helpful when coping with past stressful events?"
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?
"Would you like to talk about options for the care of your children?"
Normal platelet count
150,000-400,000
The nurse examines the lymph nodes of a patient during a physical assessment. Which finding would be of most concern to the nurse?
A 2-cm nontender supraclavicular node
The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?
A 24-yr-old patient who received neck radiation and has blood oozing from the neck
Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?
Avoid intramuscular (IM) injections
Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis?
C-reactive protein
A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient?
Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.
Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider?
Calf swelling and pain
Which action will the admitting nurse include in the care plan for a patient who has neutropenia?
Check temperature every 4 hours.
External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?
Clean the perianal area carefully after every bowel movement
A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nursetoreporttothehealthcare provider?
Crackles are auscultated in the lung bases
Which finding should the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?
Discomfort with joint movement
Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia?
Infection
A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
Notify the health care provider.
Which menu choice indicates that the patient understands the nurse's recommendations about dietary choices for iron-deficiency anemia?
Omelet and whole wheat toast
What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease?
Pain intensity
A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?
Patient who has not voided 8 hours after a laminectomy
Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?
Review the patient's serum creatinine results.
After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take?
Review the preoperative assessment data in the health record.
A client is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) to manage the pain of rheumatoid arthritis. What information should the nurse give to the client about taking these medications?
Take NSAIDs with food.
A patient with hypertension and gout has a red, painful right great toe. Which action should the nurse include in the plan of care for this patient?
Use a footboard to hold bedding away from the toe.
A nurse reviews the laboratory data for an older adult. The nurse would be most concerned about which finding?
White blood cell count of 2800/µL
The client asks the nurse to explain what it means that Hodgkin's disease is diagnosed at stage 1A. What should the nurse explain about the involvement of the disease?
involvement of a single lymph node
A client asks the nurse what PSA is. The nurse should reply that it stands for
prostate-specific antigen, which is used to screen for prostate cancer.
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to
sit upright, leaning slightly forward.
The nurse is making a room assignment for a client whose laboratory test result indicate pancytopenia. Which client should the nurse put into the same room with the client with pancytopenia?
a client with digoxin toxicity
A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include:
heavy smoking, sedentary lifestyle, and high intake of carbonated drinks
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
intrinsic factor
A nurse is caring for a client who recently underwent a total hip replacement. The nurse should:
limit hip flexion of the client's hip when he sits.
The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?
maintaining the joints in a flexed position
A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of
organ meats
A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
polyps
A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used
to provide long-term access to central veins.
The nurse should determine additional instruction is needed when a patient diagnosed with scleroderma makes which statement?
"I should lie down for an hour after each meal."
A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance?
"I think my left foot is starting to droop down."
A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective?
"I will begin doing exercises to strengthen and support my back."
After teaching a 28-yr-old with fibromyalgia about the disease, which patient statement does the nurse determines indicates a go d understandingofeffective self-management?
"I will need to stop drinking so much coffee and soda."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
"I will receive parenteral vitamin B12 therapy for the rest of my life."
The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. Which patient statement indicates to the nurse a need for additional teaching?
"I will take 1 gram of acetaminophen (Tylenol) every 4 hours."
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?
dyspnea, tachycardia, and pallor
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
initiating weight-bearing exercise routines
A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?
injury related to the decreased platelet count
A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to
provide oral and I.V. fluids.
When reviewing the health record for a new patient with rheumatoid arthritis, the nurse reads that the patient has swan neck deformities. Which deformity should the nurse expect to observe when assessing the patient?
swan neck deformity
A client with rheumatoid arthritis tells the nurse that she feels "quite alone" in adjusting to changes in her lifestyle. Which response by the nurse will be most effective?
telling the client about her community's arthritis support group.
Which nursing intervention is important when providing care for a patient with sickle cell crisis?
. Evaluating the effectiveness of opioid analgesics
Normal RBC values
4.5-5.5
Normal WBC count
5,000-10,000
Which statement by a patient with discomfort from a bunion indicates to the nurse that more teaching is needed?
"I can only wear sandals, no closed-toe shoes."
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
A client with osteoarthritis tells the nurse they are concerned that the disease will prevent them from doing their chores. Which suggestion should the nurse offer?
"Pace yourself and rest frequently, especially after activities."
A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?
"Stand close to the object you're lifting."
A client with rheumatoid arthritis tells the nurse, "I know it's important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate?
"Take a warm tub bath or shower before exercising. This may help with your discomfort."
A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make?
"Tell me more about the situations that are causing you stress."
A client has a 10-year history of rheumatoid arthritis and is concerned now that the client's child is experiencing some morning stiffness and pain. What would be the most appropriate response by the nurse?
"There is some evidence that a genetic basis for the disease may exist, so you might want to have your child evaluated."
A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse?
"We'll need more genetic counseling in the future."
Which patient should the nurseassignastheroommatefora patient who has aplastic anemia?
A patient with chronic heart failure
How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day?
A warm bath followed by a short rest
The nurse is collaborating with the healthcare provider to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan would be most appropriate for managing the client's pain?
Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain.
The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order should the nurse question?
Administer varicella vaccine
A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus?
Anti-Smith antibody (Anti-Sm)
Which information should the nurse include when preparing teaching materials for a patient who has an exacerbation of rheumatoid arthritis?
Applying cold packs before exercise may decrease joint pain
Which action should the nurse take first when a patient is seen in the outpatient clinic with neck pain?
Ask about numbness or tingling of the hands and arms.
The nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the clinic reporting chills and muscle aches. Which action should the nurse take to follow up on that finding?
Ask the patient about recent outdoor activities
A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should the nurse take?
Assess the nodules for skin breakdown or infection.
What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis?
Assist the patient to sit up at the bedside.
A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care?
Assist the patient with ambulation.
What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?
Avoid activities requiring repetitive use of the same muscles and joints
The nurse should suggest which food choice for a patient scheduled to receive external-beam radiation for abdominal cancer?
Baked chicken
The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check?
Bilirubin level
A young adult who has von Willebrand disease is admitted to the hospital for minor knee surgery. Which laboratory value should the nurse monitor?
Bleeding time
A patient with gout has a new prescription for losartan (Cozaar). What should the nurse plan to monitor?
Blood pressure
The nurse teaches a patient with liver cancer about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?
Blueberry yogurt
The nurse should anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?
Capsaicin cream (Zostrix)
A patient in the emergency department reports back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. What should the nurse's first action be?
Disconnect the transfusion and infuse normal saline
A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?
Discontinue the heparin infusion.
The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer?
Discuss risks associated with cigarettes during each patient encounter
Which information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about managing the condition?
Do daily deep-breathing exercises
Which action for the care of a patient who has scleroderma can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?
Document the patient's oral intake
Which result for a patient with systemic lupus erythematosus (SLE) should the nurse identify as most important to communicate to the health care provider?
Elevated blood urea nitrogen (BUN)
Which action should the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?
Encourage the patient to take a nap in the afternoon.
A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care?
Establish time to take a short walk almost every day
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. Which nutrient supplement should the nurse plan to explain to the patient?
Folic acid
Anakinra (Kineret) is prescribedfora patient withrheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug?
Giving subcutaneous injections.
A patient with pancytopenia will have a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
Have the patient lie on the left side for 1 hour.
Which action should the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?
Have the patient sleep on their back with a flat pillow
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
Hematuria
An adult male with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. Which laboratory data would the nurse identify as consistent with these symptoms?
Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?
Hemoglobin level
The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level is 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?
Heparin
Normal CBC values
Hgb 13-18 M 12-16F Hct 40-52M 35-47F
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). Which information should the nurse include in the patient's teaching plan?
Hospitalization is required for several weeks after the stem cell transplant
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?
Rinse the mouth before and after each meal and at bedtime with a saline solution.
A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching?
How to monitor and care for a long-term IV catheter
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?
IL-2 enhances the body's immunologic response to tumor cells
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?
IgE
A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should the nurse include in the initial plan of care?
Immobilization of the left leg
A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action should the nurse include in the plan of care?
Keep the environment warm and draft free.
What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms?
Keep the head elevated slightly and flex the knees when resting in bed
The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information should the nurse discuss with the health care provider for an urgent change in the treatment plan?
Laboratory results indicate blood urea nitrogen (BUN) is elevated
A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?
Lip swelling
Which action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?
Log roll the patient from side to side every 2 hours
Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy?
Place a pillow between the patient's legs and turn the entire body as a unit
During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?
Providing a solution of viscous lidocaine for use as a mouth rinse
What finding should indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout?
Reduced joint pain
A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. What safety priority should the nurse identify for this patient?
Risk for aspiration
When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?
Schedule immunization with the pneumococal vaccine
Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?
Serum calcium level is 15 mg/dL.
Which information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?
Serum iron level
Which information from a patient's health history should the nurse identify as a risk factor for septic arthritis?
Sexually active with several partners
Which assessment information should indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?
The patient's blood glucose is 165 mg/dL
A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, "Inever leave my housebecause I hate the way I look." Which patient problem should the nurse plan to address?
Social isolation
A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?
Stop the transfusion, infuse normal saline solution, and call the physician.
A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take?
Suggest the patient use over-the-counter (OTC) artificial tears
Which action should the nurse take when caring for a patient with osteomalacia?
Teach about the use of vitamin D supplements
A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider?
Temperature 101.4° F (38.6° C)
A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding should the nurse report immediately to the health care provider?
The blood pressure is 86/50 mm Hg
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse indicates a need for further teaching?
The patient's visitors bring in fresh peaches
The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication?
The patient has dark-colored stools.
A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding should the nurse reportimediatelytothehealthcare provider?
The patient has painful hematuria.
A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider?
The patient is trying to get pregnant before her disease becomes more severe.
The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed?
The patient sleeps with two pillows under the head.
A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine should the nurse understand indicates a need for teaching regarding gout management?
The patient takes one aspirin a day to prevent angina
A patient is taking methotrexate totreatrheumatoidarthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider?
The white blood cell count is 1500/µL.
A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?
Use the smallest needle possible for injections.
A client received treatment with cytotoxic medications 24 hours ago. Which precautions are necessary when caring for the client?
Wear personal protective equipment when handling blood, body fluids, and feces.
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." What is the most appropriate response by the nurse?
"It is important to start methotrexate early to decrease the extent of joint damage."
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?
"It will get better and worse again."
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? (Select all that apply.)
a. Cook food thoroughly before eating. . c. Avoid public transportation such as buses. . e. Talk to the oncologist before having any dental work.
A client with aplastic anemia is instructed to eat foods rich in iron. The nurse should instruct the client to include which food in the diet to increase iron intake?
dark green leafy vegetables
Which patient seen by the nurse in the outpatient clinic is most likely to need teaching about ways to reduce the risk for osteoarthritis (OA)?
A 56-yr-old woman who works on an automotive assembly line
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?
Absolute neutrophil count
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?
Anxiety
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
Logroll the client from side to side.
The nurse is developing a care plan for a client who has leukemia. What instructions should the nurse include in the plan? Select all that apply.
Monitor temperature and report elevation. Recognize signs and symptoms of infection. Avoid crowds. Maintain integrity of skin and mucous membranes
Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching?
Need for follow-up appointments to screen for malignancy
The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider?
Neutropenia:WBC 1500/µL
Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?
Oatmeal with skim milk and fruit yogurt
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis should the nurse identify as a likely adverse effect of the medication?
Blurred vision
A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient?
Bone marrow biopsy
The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional teaching is needed?
"I did not have this bone cancer until my leg broke a week ago."
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse's teaching about the condition?
"I will use sunscreen when I am outside."
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide concerning cast care?
"Keep your right leg elevated above heart level."
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 accurate?
"Malignant tumors may spread to other tissues or organs."
The nurse is preparing to administer 500 mL of whole blood to a client. The blood is to be infused over 4 hours. The infusion tubing delivers 10 gtt/mL. How many drops of blood per minute must the nurse infuse to complete the infusion in 4 hours? Record your answer using a whole number.
21
Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
A 23-yr-old with no previous health problems who has a nontender axillary lump
A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be most effective in improving oral intake?
Apply prescribed anesthetic gel to oral lesions before meals.
Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (Select all that apply.)
a. Monitor serum calcium. c. Explain the use of sustained-release opioids. d. Support the left leg when repositioning the patient. e. Assist family and patient as they discuss the prognosis.
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 c. Sunscreen use d. Mammography e. Colorectal screening
During assessment of the patient with fibromyalgia, the nurse should expect the patient to report which of the following? (Select all that apply.)
a. Sleep disturbances b. Multiple tender points e. Widespread bilateral, burning musculoskeletal pain
A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include
administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.
A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose?
hydrochlorothiazide.
Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.)
c. Expect symptoms of acute low back pain to improve in a few weeks. d. Avoid activities that require twisting of the back or prolonged sitting. e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.
A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply
decreased white blood cells decreased platelets decreased RBCs
A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. What long-term therapy should the nurse plan to explain to the patient?
doxycycline (Vibramycin)
A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as
fluid retention and weight gain
The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family?
focuses on supportive care for the client and family.
A male client comes to the clinic with complaints of pain in his great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has
gouty arthritis.
A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women
have a mammogram annually.
After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?
A 33-yr-old with a fever of 100.8° F (38.2° C)
Which information should the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?
A gradual increase in daily exercise may help decrease fatigue
Which patient statement to the nurse indicates that the patient understands self-care for pernicious anemia?
"I could choose nasal spray rather than injections of vitamin B12."
Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/VN)?
Administering subcutaneous filgrastim (Neupogen) injection
The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take to prepare the patient for this procedure?
Assist the patient to a flat position
Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?
Avoid exposure to crowds when possible
A patient with cancer is eating very little due to altered taste sensation. Which nursing action would address the cause of the patient problem?
Avoid giving the patient foods that are strongly disliked.
The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?
Avoid intramuscular injections
What action is expected by the nurse caring for a patient who has an acute exacerbation of polycythemia vera?
Monitor fluid intake and output
Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma?
Monitor fluid intake and output.
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement by the patient indicates that teaching was effective?
"The biopsy will help decide the treatment for my enlarged prostate."
A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate?
"The cancer involves only the cervix."
A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
"Do you have any history of lung disease?"
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
"Do you take medication containing salicylates?"
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?
"The side effects of chemotherapy are difficult, but AML often goes into remission with chemotherapy."
The nurse is planning to administer atransfusion ofpackedred blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?
. Obtain the patient's temperature and blood pressure before the transfusion
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?
Obtain more information about the patient's relatives
A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate?
Administer prescribed antiemetics 1 hour before the treatments.
A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?
Elevated reticulocyte count
The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding should the nurse expect?
Elevated temperature
Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia?
Encourage alternating rest and activity
A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem?
Encourage the patient to purchase a wig or hat to wear when hair loss begins.
The nurse is caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee. Which action should the nurse take?
Immobilize the knee joint
An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?
Patient has crackles up to the midline posterior chest
After change-of-shift report on the oncology unit, which patient should the nurse assess first?
Patient who is neutropenic and has a temperature of 100.5° F (38.1° C).
A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?
Platelet count is 42,000/uL
Which information shown in the table below about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care provider?
Platelet count: • Platelets 19,500/µL
Which action should the nurse take when caring for a patient who is receiving chemotherapy and reports problems with concentration?
Suggest use of a daily planner and encourage adequate sleep
Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the health careprovider?
Tarry stools
A patient receiving outpatient chemotherapy for myelogenous leukemia develops an absolute neutrophil count of 850/µL. Which collaborative action should the outpatient clinic nurse anticipate??
Teach the patient to administer filgrastim (Neupogen) injections
The nurse assesses a patient with pernicious anemia. Which finding would the nurse expect?
Tender, bleeding gums
Which patient requires the most rapid assessment and care by the emergency department nurse?
The patient with neutropenia who has a temperature of 101.8° F.
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?
"I will need follow-up examinations for many years after treatment before I can be considered cured."
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?
Difficulty coping
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider?
Increased carcinoembryonic antigen (CEA)
A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature of 102° F (38.9° C), and severe back pain. Which prescribed action will the nurse implement first?
Infuse normal saline 500 mL over 30 minutes
A patient who has acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). What is the best approach for the nurse to assist the patient with this treatment decision?
Inquire whether there are questions or concerns about HSCT
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?
"I can buy some aloe vera gel to use on my skin."
Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?
"I should notify my health care provider if my stools turn black."
Which statement by a patient indicates good understanding of the nurse's teaching about preventing sickle cell crisis?
"Risk for a crisis is decreased by having an annual influenza vaccination."
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider?
Crackles at the lung bases
Which action will the nurse include intheplan ofcare for apatient who has thalassemia major?
Administer chelation therapy as needed.
A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?
Administer PRN acetaminophen (Tylenol).
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?
"I rarely have the energy to get out of bed."
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?
Serum sodium of 126 mEq/L
The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?
Shortness of breath
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?
Stop the infusion if swelling is observed at thesite.
Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?
Activated partial thromboplastin time
A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?
Assess for sensation and strength in the legs.
A patient with pancytopenia of unknown origin is scheduled for diagnostic tests. The nurse will ensure a consent form was signed before which test?
Bone marrow biopsy
Which nursing intervention is appropriate for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy?
Test all stools for occult blood.
A patient with a large stomachtumor attachedto the liver is scheduled for a debulking procedure. What should the nurse teach the patient about the outcome of this procedure?
Decreasing the tumor size will improve the effects of other therapy
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?
The UAP assists the patient to use dental floss after eating
The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?
The UAP stands by the patient's bed for 30 minutes talking with the patient
Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?
The patient is difficult to arouse
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?
The patient swims several days each week
A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective?
The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
A patient who has a history of a transfusion-relatedacutelung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient?
Transfuse leukocyte-reduced PRBCs
A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?
Wash hands and avoid persons who are ill.
The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?
White blood cell count 15,500/µL
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?
White blood cells (WBC) 2700/µL
