Exam 4: Powerpoint & Reading Questions

D (2L minimum)

A patient with non-Hodgkin's lymphoma is prescribed cyclophosphamide. What will the RN teach the patient? A. To observe for hepatotoxicity B. That alopecia is a rare side effect of this med C. To take the med on an empty stomach to reduce nausea D. To increase fluid intake to prevent kidney damage

A, C, D (The most serious adverse effect of vincristine is nervous system toxicity. Numbness of the feet or hands, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity. Options 2 and 5 are incorrect. Cardiac and pulmonary toxicities are not associated with vincristine.)

A 2-year-old patient is receiving vincristine (Oncovin) for Wilms' tumor. Which of the following findings will the nurse monitor to prevent or limit the main adverse effect for this patient? (Select all that apply.) A. Numbness of the hands or feet B. Angina or dysrhythmias C. Constipation D. Diminished reflexes E. Dyspnea and pleuritis

D (Medroxyprogesterone (Depo-Provera) carries a black box warning about the risk of decreased bone density that may occur over time. Joint or bone pain, or pain on ambulation, should be assessed as a sign of this potential adverse effect. Options 1, 2, and 3 are incorrect. Medroxyprogesterone may cause spotting between menstrual periods but is usually not an adverse effect of concern unless it increases. Insomnia or dryness of the eyes, mouth, or vagina are not effects associated with medroxyprogesterone.)

A 43-year-old patient is receiving medroxyprogesterone (Depo-Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, which condition may indicate a potential adverse effect? A. Breakthrough bleeding between periods B. Insomnia or difficulty falling asleep C. Eye, mouth, or vaginal dryness D. Joint pain or pain on ambulation

B, C, D (Bisphosphonates such as alendronate require the patient to take the drug on an empty stomach and remain upright for 30 minutes to 1 hour. Adequate serum calcium levels should be confirmed before starting bisphosphonates, and adequate calcium and vitamin D intake should be encouraged while on drug therapy. Any narrowing of the esophagus may place the patient at risk of increased adverse esophageal effects from the drug. Options 1 and 5 are incorrect. Adequate calcium intake is advised while on bisphosphonates to maintain normal serum calcium levels. The use of green tea is not a contraindication to the use of bisphosphonates.)

A 62-year-old female has received a prescription for alendronate (Fosamax) for treatment of osteoporosis. The nurse would be concerned about this order if the patient reported which condition? (Select all that apply.) A. She enjoys milk, yogurt, and other dairy products and tries to consume some with each meal. B. She is unable to sit upright for prolonged periods because of severe back pain. C. She is lactose intolerant and rarely consumes dairy products. D. She has had trouble swallowing and has been told she has "problems with her esophagus." E. She has a cup of green tea every night before bed.

C

A client asks the nurse why his colorectal cancer is being tested for genetic mutations even though no one else in the family has ever had cancer. What is the nurse's best response? A. "Colorectal cancer is rare and most cases are caused by a genetic mutation." B. "The results of this testing will indicate what caused your cancer so you can avoid further exposure." C. "Many tumors have one or more genetic differences that can help determine the most effective treatment options." D. "Genetic testing of tumor cells can help determine the stage of your cancer and whether it has spread to other organs."

B, C, F

A client receiving radiation for head and neck cancer reports that the skin in the radiation field is itching and painful. What teaching will the nurse provide? Select all that apply. A. "This is likely from medication, not the radiation treatment." B. "Cover the area with soft clothing." C. "Be sure to wash your hands well before touching the area." D. "Sunlight to the radiated area can help the skin heal." E. "Use a washcloth to thoroughly clean the area with soap and water." F. "Do not remove the ink markings on the skin."

B

A client with chemotherapy-induced neutropenia is prescribed filgrastim. The client states, "The bones in my legs are aching so bad." What is the appropriate nursing response? A. "The pain in your legs is likely from the cancer." B. "Bone pain is a side effect of filgrastim that improves with time." C. "Increasing activity will help with the bone pain." D. "Have you had any fever or nausea?"

C

A client with increased intraocular pressure has a new prescription for timolol eye drops. Which of the following describes this class of medication by MOA? A. Prostaglandin analog B. Carbonic anhydrase inhibitor C. Beta adrenergic blocker D. Alpha adrenergic agonist

A

A client with prostate cancer is receiving external beam radiation for treatment. What teaching will the nurse provide following the radiation treatment? A. "After the treatment, there is no radiation hazard to others." B. "Do not share a bathroom with your spouse for 2 days." C. "Visitors should be limited to 30 minutes to avoid prolonged radiation exposure." D. "Report a temperature of 99.1°F to the primary health care provider."

B (Decreases vascular pressure and prevents aspiration)

A client with thrombocytopenia, secondary to leukemia, develops epistaxis (nose bleeding). The nurse should instruct the client to: A. lie supine with his neck extended. B. sit upright, leaning slightly forward. C. blow his nose and then put lateral pressure on his nose. D. hold his nose while bending forward at the waist.

C

A client's cancer is staged as T1, N2, M1 according to the TNM classification system. How does the nurse interpret this report? A. The client has two tumors that are nonresponsive to treatment. B. The client has leukemia confined to the bone marrow. C. The client has a 2-cm tumor with one regional lymph node involved and no distant metastasis. D. The client has a small primary tumor extension into two lymph nodes and one site of distant metastasis.

B (A nagging cough with hoarseness is one of the seven warning signs of cancer. Given the genetic predisposition combined with the assessment data, there is cause for concern so the nurse must intervene here first. Other findings can be subsequently addressed.)

A nurse is assessing a client with a genetic history of cancer. Which assessment finding requires immediate nursing intervention? A. Blood pressure 140/90 B. Nagging cough with hoarseness C. Nasal congestion for several days D. Muscle tension in the cervical spine

A

A nurse is caring for a client who has bilateral hearing loss. The nurse expects to find which of the following on assessment? A. Better hearing with low pitched than high pitched tones B. Large amounts of moist cerumen C. Increased amounts of thickened epithelial tissue in the ear canal D. Tear in the tympanic membrane

A, C

A nurse is caring for an elderly client who has blindness as a result of glaucoma. The nurse knows to implement which of the following interventions when caring for this client? SATA A. Announce entry and exit from the room B. Instruct the client to use a cane with the non-dominant hand C. Orient the client to the placement of items on the meal tray by using a clock face description D. Stand close to the client and speak loudly to ensure comprehension E. As the client's spouse about the client's preferred arrangement of hygiene items

B

A nurse is providing discharge for a client who has loss of hearing and uses hearing aids. Which action is most appropriate when communicating with this client? A. Stand at the front of the room and use a visual aid for teaching B. Speak slowly and clearly and avoid shouting C. Use hand gestures and miming when information is not understood D. Try using a tone of voice with a higher pitch

D

A nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukemia is the presence of a large number of immature: A. monocytes. B. thrombocytes. C. basophils. D. leukocytes.

A (Infertility may result from physical obstruction, pelvic infections, or endocrine-related reasons resulting in lack of ovulation. If a fertility workup suggests that infrequent or lack of ovulation is a primary cause, clomiphene may be tried to increase ovulation and is approximately 80% effective for patients with ovulatory-related infertility. Options 2, 3, and 4 are incorrect. Clomiphene will not be therapeutic if the causes of infertility are other than lack of ovulation. The risk of multiple births is higher with ovulatory stimulants with approximately 5% resulting in twins. Contraceptives do not continue to suppress ovulation after they have been discontinued.)

A patient has started taking clomiphene (Clomid, Serophene) after an infertility workup and asks the nurse why she is not having in-vitro fertilization. Which statement would be most helpful in explaining the use of clomiphene to the patient? A. The patient's diagnostic workup suggested that infrequent ovulation may be the cause for her infertility, and clomiphene increases ovulation. B. In-vitro fertilization is expensive and because clomiphene is less expensive, it is always tried first. C. There is less risk of multiple births with clomiphene. D. The patient's past history of oral contraceptive use has prevented her from ovulating. Clomiphene is given to stimulate ovulation again in these conditions.

A, C, D (Enlarged prostatic tissue will decrease over a period of 3 to 6 months. The drug is teratogenic and should not be handled by pregnant women. Blood donation should not occur while taking finasteride because the blood may be given to a woman. Options 2 and 5 are incorrect. Finasteride in lower doses is given under the trade name "Propecia" for treatment of male pattern baldness. There is a concern for edema and weight gain when alpha-adrenergic antagonists are used to treat BPH, but finasteride (Proscar) is a 5-alpha reductase inhibitor, not an alpha-adrenergic antagonist, and edema and weight gain are not associated with its use.)

A patient is given a prescription for finasteride (Proscar) for treatment of benign prostatic hyperplasia. Essential teaching for this patient includes which of the following? (Select all that apply.) A. Full therapeutic effects may take 3 to 6 months. B. Hair loss or male-pattern baldness may be an adverse effect. C. The drug should not be handled by pregnant women, especially if it is crushed. D. Blood donation should not occur while taking this drug. E. Report any weight gain of over 2 kg (5 lb) in 1 week.

B (Seasonique is taken for 84 consecutive days, followed by 7 days of a lower dose that is contained in the same pill pack. Options 1, 3, and 4 are incorrect. None of these explanations are correct for Seasonique.)

A patient is interested in taking levonorgestrel and estradiol (Seasonique) and asks how it is taken. Which explanation by the nurse is correct? A. "Seasonique is taken year-round without a break and without a period." B. "Seasonique is taken for 84 days and then followed by 7 days of a lower dose contained in the same package." C. "Seasonique is a vaginal ring that is inserted monthly." D. "Seasonique is taken for 2 months then off for 1 month using regular oral contraceptives."

A, B, C, D, E

A patient taking oral cyclophosphamide needs to be taught which of the following? (SELECT ALL THAT APPLY.) A. Swallow medicine whole without chewing or crushing. B. Wash hands thoroughly after touching drug. C. Caregivers should not handle med, or if they do where latex gloves. D. If you vomit or miss a dose, take next dose at regular time. E. The drug may be present in saliva, urine semen, or vaginal secretions.

B (Effectiveness of chemotherapy is increased by use of multiple drugs from different classes that attack cancer cells at different points in the cell cycle. Thus, lower doses of each individual medication can be used to reduce side effects. A third benefit of combination chemotherapy is reduced incidence of drug resistance. Options 1, 3, and 4 are incorrect. A combination of drugs is given for most cancers regardless of how advanced the cancer is. The multidrug is not given to find the right drug because many may exert therapeutic effects. The drugs do not "cancel out" each other but work together.)

A patient who is undergoing cancer chemotherapy asks the nurse why she is taking three different chemotherapy drugs. What is the nurse's best response? A. "Your cancer was very advanced and therefore requires more medications." B. "Each drug attacks the cancer cells in a different way, increasing the effectiveness of the therapy." C. "Several drugs are prescribed to find the right drug for your cancer." D. "One drug will cancel out the side effects of the other."

D (Finasteride promotes shrinking of enlarged prostates and helps restore urinary function with full therapeutic effects obtained within 6 to 12 months. Because this patient reports a sudden increase in urinary symptoms after taking the drug for 9 months, he should be evaluated by the healthcare provider for prostate cancer screening. Options 1, 2, and 3 are incorrect. Continuing to take the dose, or a low-dose diuretic, with the onset of new symptoms would not be appropriate. Decreasing bladder irritants, such as coffee, tea, and alcohol, may help overall but does not explain the sudden increase in symptoms.)

A patient with a history of benign prostatic hyperplasia is complaining of feeling like he "cannot empty his bladder." He has been taking finasteride (Proscar) for the past 9 months. What should the nurse advise this patient to do? A. Continue to take the drug to achieve full therapeutic effects. B. Discuss the use of a low-dose diuretic with the healthcare provider. C. Decrease the intake of coffee, tea, and alcohol. D. Return to the healthcare provider for laboratory studies and a prostate exam.

C (Closed-angle glaucoma is an acute type of glaucoma that is caused by stress, impact injury, or medications. Pressure inside the anterior chamber increases suddenly because the iris is pushed over the area where the aqueous fluid normally drains. Signs and symptoms include intense headaches, difficulty concentrating, bloodshot eyes, blurred vision, and a bulging iris. Closed-angle glaucoma constitutes an emergency. Options 1, 2, and 4 are incorrect. All other options are inappropriate in this emergency and only delay appropriate and prompt treatment.)

A patient with a history of glaucoma who has been taking latanoprost (Xalatan) eyedrops complains of severe pain in the eye, severe headache, and blurred vision. What should be the nurse's first response? A. Document the occurrence; this symptom is expected. B. Medicate the patient with a narcotic analgesic. C. Notify the healthcare provider immediately. D. Place the patient in a quiet, darkened environment.

B

A patient with glaucoma is being discharged from the hospital. When teaching the patient and family ways to improve home safety, the nurse tells the family to: A. Use throw rugs to prevent tripping B. Install extra incandescent lighting C. Install handrails painted the same color as the walls D. All of the above

A, C, D (DMARDs modify immune and inflammatory responses but may increase the risk of infections and malignancies, and may reactivate latent TB. Injection site reactions such as pain, swelling, and bruising are common adverse effects. Options 2 and 5 are incorrect. Adalimumab has not been associated with an increased risk of osteoporosis and is given subcutaneously, every other week.)

A patient with rheumatoid arthritis will begin treatment with adalimumab (Humira). Which statement related to this therapy is correct? Select all that apply. Adlimumab: A. May lower immune response and increase the risk of infections and malignancies. B. Is associated with osteoporosis and baseline and periodic DXA scans should be conducted. C. May reactivate latent TB. D. May cause local injection-site irritations such as pain and bruising. E. Must be taken daily for up to 6 months.

D

A patient with this condition is unable to see an object when he or she looks directly at it, due to deterioration in the central field of vision. A. Glaucoma B. Cataracts C. Diabetic Retinopathy D. Macular Degeneration

B (Raloxifene carries a black box warning that the drug increases the risk of venous thromboembolism and death from strokes, especially in women with coronary artery disease. With a previous history, the drug may not be given, or the healthcare provider will evaluate risk-versus-benefit before beginning this drug. Options 1, 3, and 4 are incorrect. Raloxifene may cause depression in some patients, but it is an adverse effect, not a contraindication. A history of osteoarthritis is not a contraindication for this drug. Black cohosh may interfere with the effectiveness of raloxifene if taken concurrently, but a history of using the herbal product does not present a contraindication now.)

A postmenopausal woman is started on raloxifene (Evista) for prevention of osteoporosis. Because of the black box warning, what condition, noted in the patient's history, may indicate that this drug should not be given, or given with extreme caution? A. A history of depression B. A history of coronary artery disease or thrombophlebitis C. A history of osteoarthritis D. A history of using black cohosh to treat menopausal symptoms

C (Plan B (levonorgestrel) is administered by taking one pill, followed by another pill 12 hours later. Options 1, 2, and 4 are incorrect. Plan B should be taken within 120 hours after unprotected intercourse. After 7 days it is ineffective in preventing pregnancy. It is available OTC to women older than 17 after age verification by a pharmacist, and a prescription is not required.)

A woman consults the nurse about Plan B (levonorgestrel) after unprotected intercourse that occurred 2 days earlier. Which instruction will the nurse give to this patient? A. "You must wait 7 days before taking the pills for Plan B to be effective." B. "Plan B is effective only within 24 hours of unprotected intercourse." C. "You will take one pill of Plan B at first, followed by another pill 12 hours later." D. "You will need to obtain a prescription for Plan B."

A, D, E, F

An older client reports all of the following changes since his last checkup. Which changes alert the nurse to the possibility of prostate cancer? Select all that apply. A. Bloody urine B. Constipation intermittent with diarrhea C. Erectile dysfunction D. Night sweats and fever E. Persistent pain in the lower back and legs F. Reduced urine stream

D (Contact lenses should be removed before instilling eyedrops and remain out for a minimum of 15 minutes after instilling eyedrops. Options 1, 2, and 3 are incorrect. Administering eyedrops into the conjunctival sac, applying slight pressure to the lacrimal duct for 1 full minute, and avoiding direct contact with the dropper tip and the eye are all appropriate techniques to use when administering eyedrops.)

Appropriate administration is key for patients who are taking eyedrops for the treatment of glaucoma to optimize therapeutic effects and reduce adverse effects. The nurse would be concerned if the patient reports administering the drops in which manner? A. Into the conjunctival sac B. Holding slight pressure on the tear duct (lacrimal duct) for 1 minute after instilling the eyedrops C. Avoiding direct contact with the eye dropper tip and the eye D. Leaving contact lenses in to be sure the eyedrop is maintained in the eye

C (Monoclonal antibodies used in cancer therapy are highly targeted to specific cell types. They target specific types of cancer with fewer effects on normal cells. Options 1, 2, and 4 are incorrect. Because they are highly specific, they treat selective types of cancer. The period of administration is drug-specific and different drugs require different administration periods. Monoclonal antibodies may cause adverse effects, similar to other drug groups.)

How are monoclonal antibodies such as bevacizumab (Avastin) different from other antineoplastic drugs? A. They treat many different types of cancer, both blood and solid tumors. B. They only need to be administered for a short period of time. C. They are highly specific to certain cell types and target specific cancers. D. They have fewer adverse effects than traditional antineoplastic drugs.

B, C, G

How does a mutation in a suppressor gene, such as BRCA1, increase the risk for cancer development? A. Converting a proto-oncogene into an oncogene B. Removing the control over proto-oncogene expression C. Reducing the amount of cyclins produced by the oncogenes D. Inhibiting the recognition of abnormal cells through immunosurveillance

B

Identify most important nursing action to prevent nausea & vomiting in JJ, a client who is prescribed to receive the first round of IV chemotherapy? A. Keep client NPO during time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6- hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B

JJ, newly diagnosed with acute leukemia, asks why he is at such extreme risk for infection when his WBC count is so high. What is the nurse's best response? A."These WBCs are cancerous and live longer than normal WBCs, so they are too old to fight infection." B."Even though you have many WBCs, they are too immature to fight infection." C."For now, your risk is low; however, when chemo-therapy begins, your risk for infection will be high." D."It is not WBCs that provide protection; it is red blood cells, which are very low in your blood right now."

C

Multiple drugs are used in combination to treat leukemia and lymphoma because A. the chance that one of the drugs will be effective is increased. B. drug resistance is likely to be increased with combination therapy. C. the drugs will interrupt cell growth and division at multiple points in the cell cycle. D. patients are likely to develop drug toxicity to some of the drugs.

C, D, E

Neulasta is a granulocyte stimulating factor, which means it will stimulate the growth of... (SELECT ALL THAT APPLY) A. Red Blood Cells B. Platelets C. Eosinophil D. Basophil E. Neutrophil

C

Staging of Hodgkin's or Non-Hodgkin's Lymphoma includes identification of "B Symptoms." B symptoms include: A. hepatomegaly, fever, thrombocytopenia. B. weight loss, anemia, fatigue C. fever, night sweats, weight loss. D. night sweats, fatigue, painless lymph node involvement

C, D, E

The nurse is assessing a client who has advanced bone cancer. Which client assessment finding causes the nurse to suspect spinal cord compression? Select all that apply. A. Reports of a headache for the past 7 hours B. Decreased breath sounds in the left lung C. Worsening mid-thoracic back pain D. Tingling in the right lower extremity E. Unsteady gait when ambulating to the bathroom F. Reports of difficulty sleeping

D (Sustained contractions increase the risk of uterine rupture and adverse effects to the fetus. They should be reported immediately and prompt and appropriate intervention started, including stopping the oxytocin drip and starting oxygen therapy for the patient. Options 1, 2, and 3 are incorrect. The absence of vaginal bleeding during labor, appropriate pain management, and fetal heart rate continuing at baseline parameters are appropriate findings during oxytocin administration.)

The nurse completes an assessment of a patient in labor who is receiving an intravenous infusion of oxytocin. Which assessment indicates the need for prompt intervention? A. There is no vaginal bleeding noted. B. The patient is managing her pain through breathing techniques. C. Fetal heart rate remains at baseline parameters. D. Contractions are sustained for 2 minutes in duration.

D (Patients with glaucoma must be especially careful with anticholinergic mydriatics because these drugs can worsen glaucoma by impairing aqueous humor outflow and thereby increasing intraocular pressure. Options 1, 2, and 3 are incorrect. Antibiotic drops, cycloplegic drops, and anti-inflammatory drugs may be used with caution in the patient with glaucoma.)

The nurse emphasizes to the patient with glaucoma the importance of notifying the healthcare provider performing an eye examination of a glaucoma diagnosis because of potential adverse reactions to which drugs? A. Antibiotic drops B. Cycloplegic drops C. Anti-inflammatory drops D. Anticholinergic mydriatic drops

A

The nurse is caring for a client who reports beginning to transition from male to female. Which nursing action is appropriate regarding pronoun use? A. Ask the patient which pronouns are preferred and use those. B. Implement use of "he/him" pronouns as the client's natal sex is male. C. Use "Miss" or" Mrs.," since the client has begun the transition to female. D. Document that male or female pronouns are appropriate to use at this time.

D

The nurse is caring for a client with a sealed radiation implant for the treatment of cancer. Which nursing intervention is appropriate? Select all that apply. A. Place a caution sign on the door of the client's room. B. Wear a dosimeter badge for protection when providing care. C. Allow the client's spouse to stay with the client at least 6 feet away for 4 hours. D. Do not allow children to visit the client for any length of time. E. Keep the door to the client's room closed.

B

The nurse is observing the assistive personnel (AP) provide care to a client who is neutropenic. Which action by the AP requires the nurse to intervene? A. Performing a bed bath because the client is too tired to get in the shower B. Using the unit mobile blood pressure machine to assess the client's vitals C. Using alcohol-based hand foam before touching the client D. Cleaning the client's bathroom with disinfectant

A (Latanoprost (Xalatan) may cause darkening and thickening of the eyelashes and upper lid and darkening of the color of the iris. Options 2, 3, and 4 are incorrect. It will not cause mydriasis (dilation of the pupils), loss of eyelashes, or a bluish tint to the sclera.)

The nurse is planning health teaching for a patient who has been prescribed latanoprost (Xalatan) drops for open-angle glaucoma. The nurse should include which of the following in the teaching plan? A. The drops may cause darkening and thickening of the eyelashes and upper lid and darkening of the iris color. B. The drops may cause a temporary loss of eyelashes that will regrow once the drug is stopped. C. The drops will cause dilation of pupils, and darkened glasses should be worn in bright light. D. The drops will cause a permanent bluish tint to the conjunctiva that is harmless.

C, D

The nurse is teaching a client who has been prescribed an oral chemotherapy agent. What teaching will the nurse include? A. "Oral chemotherapy drugs are not as toxic as IV chemotherapy." B. "Do not crush, split, break, or chew the oral chemotherapy drug." C. "You may dispose of unused oral chemotherapy drugs in the trash." D. "Oral chemotherapy drugs are not absorbed through the skin."

C (Tadalafil (Cialis) and other similar drugs are not effective if the ED is psychologic in nature. Options 1, 2, and 4 are incorrect. Tadalafil will not heighten sexual response in women. It does not cause decreased sensations over time and it enhances, rather than causes, an erection.)

The nurse is teaching a patient about the use of tadalafil (Cialis). What will the nurse teach him about the effects of tadalafil? A. It should always result in a penile erection within 10 minutes. B. It may heighten female sexual response. C. It is not effective if sexual dysfunction is caused by psychologic conditions. D. It will result in less intense sensation with prolonged use.

A (Women and children should avoid contact with the gel or areas of the skin where gel has been applied to avoid drug absorption. Options 2, 3, and 4 are incorrect. Whereas weight gain of 2 kg (5 lb) in 1 week should be reported, the same gain over 1 month may not be significant. The gel should be applied to the chest or upper torso, not to the scrotal or perineal areas. Showering or swimming should be avoided for several hours after gel application to allow for adequate absorption, but there is no need to wait a full 12 hours before these activities.)

The nurse is teaching a patient who has a new prescription for testosterone gel. Which instruction should the nurse give to this patient? A. "Avoid exposing women to the gel or to areas of skin where the gel has been applied." B. "Report any weight gain over 2 kg (5 lb) in 1 month." C. "Avoid showering or swimming for at least 12 hours after applying the gel." D. "Apply the gel to the scrotal and perineal areas daily."

B

The nurse is teaching about infection prevention to a client with cancer who is neutropenic. Which client statement indicates a need for additional teaching? A. "I will call the primary health care provider if I get a temperature of 100.4 or greater. B. "I will wash my hands after attending church." C. "I will wear a condom when having intercourse." D. "I will not drink anything that has been at room temperature for more than an hour."

B (The nadir is the point of greatest bone marrow suppression, as measured by the lowest neutrophil count. Options 1, 3, and 4 are incorrect. The nadir does not refer to chemotherapy dose, level, or client symptoms.)

The nurse notes that the patient has reached his nadir. What does this finding signify? A. The patient is receiving the highest dose possible of the chemotherapy. B. The patient is experiencing bone marrow suppression and his blood counts are at their lowest point. C. The patient has peaked on his chemotherapy level and should be going home in a few days. D. The patient is experiencing extreme depression and will be having a psychiatric consult.

C

The nurse prepares to remove impacted cerumen. Which of the following is the correct technique: A. Use a cotton-tipped applicator B. Remove by suctioning C. Irrigate with water D. All of the above

D

The nurse provides health teaching for a transgender woman receiving estrogen therapy. Which statement by the client indicates a need for further teaching? A. "I'll call my doctor if I have any redness or swelling in my legs." B. "I'll have less hair on my body after taking this drug." C. "I know that the drug will make my breasts bigger." D. "I think I will have more sex drive when taking this drug."

D

The nurse reviewing a hematology report recognizes the distinctive indicator of pancytopenia. The report shows A. platelets that are immature. B. white cells that are undifferentiated. C. red cells that have become polymorphic. D. cellular components of the blood are reduced.

A, B, D (The nurse needs to notify the healthcare provider if the patient has a history of heart block, bradycardia, cardiac failure, heart failure, or COPD because timolol may be contraindicated for clients with these conditions. If the drug is absorbed systemically, it will worsen these conditions. Proper administration lessens the danger that the drug will be absorbed systemically. Options 3 and 5 are incorrect. The renal and hepatic systems are not affected by timolol.)

The patient is prescribed timolol (Timoptic) for treatment of glaucoma. During the history and physical, the nurse assesses for which of the following medical disorders that may be a contraindication to the use of this drug? (Select all that apply.) A. Heart block B. Heart failure C. Liver disease D. Chronic obstructive pulmonary disease E. Renal disease

C (Gout is a metabolic disorder characterized by the accumulation of uric acid in the bloodstream or joint cavities. Alcohol increases uric acid levels. Options 1, 2, and 4 are incorrect. Alcohol does not cause a significant increase in drug levels of allopurinol, does not affect the absorption of anti-gout medications, and increases urine acidity.)

The patient who is receiving allopurinol (Lopurin) for treatment of gout asks why he should avoid the consumption of alcohol. The nurse's response is based on the knowledge that the use of alcohol along with allopurinol may result in which of the following? A. It significantly increases the drug levels of allopurinol. B. It interferes with the absorption of anti-gout medications. C. It raises uric acid levels. D. It causes the urine to become more alkaline.

A (Life-threatening hypotension is an adverse effect in patients who are taking sildenafil (Viagra) along with organic nitrates for angina. Options 2, 3, and 4 are incorrect. Diabetes, allergies to dairy, or migraines are not contraindications for sildenafil.)

The patient with erectile dysfunction is being evaluated for the use of sildenafil (Viagra). Which question should the nurse ask before initiating therapy with sildenafil? A. "Are you currently taking medications for angina?" B. "Do you have a history of diabetes?" C. "Have you ever had an allergic reaction to dairy products?" D. "Have you ever been treated for migraines?"

C (Beta-adrenergic drugs such as timolol (Timoptic) may reduce resting heart rate and blood pressure. The patient should hold slight pressure on the inner canthus of the eye to prevent the drug from entering the lacrimal duct with possible systemic absorption. Options 1, 2, and 4 are incorrect. Timolol (Timoptic) should not affect urine output or respiratory rate, increase the risk of respiratory infections, or affect glucose levels.)

Timolol (Timoptic) drops have been ordered to treat glaucoma. Because of the possibility of systemic adverse effects, what essential instruction should the patient receive? A. Monitor urine output and daily weight. Promptly report any edema. B. Monitor blood glucose and alert the healthcare provider to any significant changes. C. Hold slight pressure on the inner canthus of the eye for 1 minute after instilling the drop. D. Monitor respiratory rate and for signs and symptoms of upper respiratory infection.

C (Chemotherapy-induced hair loss is usually temporary, and regrowth usually begins 1 month after chemotherapy is finished. New hair growth may differ from the original hair in color, texture, and thickness. No known treatment completely prevents alopecia.)

What does the nurse teach a client undergoing chemotherapy about the expected outcome related to hair loss? A. Hair loss may be permanent. B. Viable treatments exist for the prevention of alopecia. C. Hair regrowth usually begins about 1 month after completion of chemotherapy. D. New hair growth is usually identical to previous hair growth in color and texture.

C

What finding does the nurse anticipate when assessing a client with a new diagnosis of glaucoma? A. Seeing "shooting stars" B. Decrease in central vision C. Gradual loss of visual fields D. Abrupt onset of excruciating pain

D

What is the appropriate nursing response when a 66-year-old healthy client asks how often a visit to the eye care provider is recommended? A. "Annually." B. "Every 6 months." C. "Only if you have vision problems." D. "Every 1-2 years if you have no eye problems."

C

What is the effect of administered tamoxifen to an emaciated patient? A. Decreased effectiveness of drug B. Increased effectiveness of drug C. Increased risk of toxicity D. Decreased risk of toxicity

C (For maximum effect, patients should be given an antiemetic prior to the start of treatment. Options 1, 2, and 4 are incorrect. Waiting to give an antiemetic until after the chemotherapy has started may result in a delay in treatment of the nausea and vomiting. IM injections are usually avoided during chemotherapy because of an increased risk of infection. Fluids are encouraged throughout chemotherapy but will not prevent or treat the nausea and vomiting that may occur.)

What is the most effective treatment method for the nausea and vomiting that accompany many forms of chemotherapy? A. Administer an oral antiemetic when the patient complains of nausea and vomiting. B. Administer an antiemetic by intramuscular injection when the patient complains of nausea and vomiting. C. Administer an antiemetic prior to the antineoplastic medication. D. Encourage additional fluids prior to administering the antineoplastic medication.

C, E

What teaching will the nurse provide to a client who continues to experience more frequent episodes associated with Ménière disease? Select all that apply. A. Reducing activity can reduce frequency of episodes. B. Episodes will eventually decrease in severity and number. C. Reducing sodium, caffeine, and alcohol intake can be beneficial. D. The only treatment that is effective is to undergo labyrinthectomy. E. When moving from sitting to standing, be cautious and take your time.

D

What teaching will the nurse provide to a client who has just been fitted for new hearing aids? A. Turn off the hearing aid when not using it. B. Immerse the ear mold in alcohol to fully clean it. C. Store the hearing aid in a warm, humid bathroom when not in use. D. Avoid using hair spray, makeup, and personal care products around the device.

B

When caring for a patient with multiple myeloma, the nurse should take appropriate precautions to A. alleviate respiratory difficulty. B. prevent fractures. C. prevent seizures. D. alleviate diarrhea.

D

When caring for four clients, which client does the nurse report to the health care provider who should not receive an otoscopic examination? A. 25-year-old with throat and ear pain B. 39-year-old experiencing dizziness C. 46-year-old who has type 2 diabetes D. 60-year-old experiencing delirium

D (Tumor lysis syndrome can occur when a large number of tumor cells are rapidly destroyed. This is usually seen in patients with high-grade cancers or those with bulky tumor burden, and occurs after receiving radiation and chemotherapy.)

When does the nurse determine that a client with Non-Hodgkin's Lymphoma is at greatest risk of developing tumor lysis syndrome? A. After the first cycle of chemotherapy B. During the second cycle of chemotherapy C. Anytime during the client's treatment course D. While undergoing radiation and chemotherapy

C, E

When teaching a community group of older adults, what information will the nurse include regarding normal hearing changes associated with aging? Select all that apply. A. Hair in the ear thins and falls out B. Hearing acuity changes in all older adults C. Cerumen dries and becomes impacted more easily D. The ability to hear low-frequency pitches diminishes first E. Sounds such as f, s, sh, and pa may be more difficult to discern

A, C, D, E

Which assessment data do the nurse anticipate when a client presents to the emergency department reporting the sensation of a foreign body in the eye? Select all that apply. A. Pain B. Fever C. Tearing D. Photophobia E. Blurred vision

C (Toxicity from calcitriol (Calcijex, Rocaltrol) includes symptoms of hypercalcemia and bone pain, anorexia, nausea and vomiting, increased urination, hallucinations, and dysrhythmias. Options 1, 2, and 4 are incorrect. Muscle aches, fever, and dry mouth are not related to calcitriol toxicity, and other causes, including infection, should be investigated. Tremor, abdominal cramping, hyperactive bowel sounds, muscle twitching, numbness, and tingling of the extremities are signs of hypocalcemia. Calcitriol may cause symptoms of hypercalcemia.)

Which assessment findings in a patient who is receiving calcitriol (Calcijex, Rocaltrol) should the nurse immediately report to the healthcare provider? A. Muscle aches, fever, dry mouth B. Tremor, abdominal cramping, hyperactive bowel sounds C. Bone pain, lethargy, anorexia D. Muscle twitching, numbness, and tingling of the extremities

B, C, D, E

Which client statement affirms that nurse teaching about instillation of multiple different eyedrops has been effective? Select all that apply. A. "It will be very easy for me to instill all of the drops at one time." B. "A schedule will help me remember when to instill the eyedrops." C. "If I have trouble instilling the drops, there are devices that can be helpful." D. "I can label the eye-drops by color to help me easily distinguish which one is which." E. "I will not touch the droppers to my eyes as this can cause contamination and infection."

A, C, D

Which client statement regarding a new diagnosis of tinnitus requires nursing teaching? Select all that apply. A. "I am so glad this condition will go away permanently." B. "It is important that I do not drive when I have tinnitus." C. "Watching my diet will make a difference in my condition." D. "Surgery is the only treatment that is available for tinnitus." E. "I have found a couple of support groups that I like to attend."

A

Which communication method is appropriate when the nurse is interacting with a client who is deaf? A. Use pictures and writing B. Speak with enunciated words C. Ask client to read the nurse's lips D. Dialogue with the client's caregivers

C, E, F

Which nursing action decreases the risk for health care disparities for transgender clients? Select all that apply. A. Refer to the client's identification card for name. B. Determine gender identity based on clothing worn. C. Seek to understand the experience of the transgender client. D. Apologize several times if the wrong name is used for the client. E. On meeting the client, ask what name and which pronouns are desired. F. Explain how the health history and assessment are affected by gender identity.

A, C, E

Which of the following is true about open angle glaucoma? (SATA) A. No initial manifestations B. Abrupt onset of eye pain C. Mild increase in IOP D. Rapid increase in IOP E. Occurs unilaterally F. Treated with trabeculectomy

B, C (A side effect of testosterone therapy is fluid retention. Testosterone is also used to increase muscle mass and strength. Options 1, 4, and 5 are incorrect. The hematocrit may increase with the use of testosterone because it promotes the synthesis of erythropoietin. Muscle wasting should not occur, and blood dyscrasias are not common with the use of testosterone.)

Which of the following nursing assessments would be appropriate for the patient who is receiving testosterone? (Select all that apply.) A. Monitor for a decrease in hematocrit. B. Assess for signs of fluid retention. C. Assess for increased muscle mass and strength. D. Check for blood dyscrasias. Assess for muscle wasting.

D, E (Patients and family members should avoid receiving live virus vaccinations or exposure to chickenpox. The patient could have an exacerbation or a more pronounced episode of the disease. The patient should not care for the granddaughter if vaccination with live viruses is planned. The patient should also avoid crowds, especially in enclosed spaces when possible, to minimize exposure risk. The nurse should discuss measures to minimize the risk of infections if the patient desires to go shopping. Options 1, 2, and 3 are incorrect. Attending a support group, maintaining normal activities when possible, and eating small, frequent meals with sufficient protein are routine care measures during chemotherapy.)

Which of the following statements by a patient who is undergoing antineoplastic therapy would be of concern to the nurse? (Select all that apply.) A. "I have attended a meeting of a cancer support group." B. "My husband and I are planning a short trip next week." C. "I am eating six small meals plus two protein shakes a day." D. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week."

C

Which patient does the nurse identify at highest risk for development of dry age-related macular degeneration (AMD)? A. 55-year-old client who recently began wearing glasses B. 59-year-old client who has controlled hypertension C. 62-year-old client with hypothyroidism D. 65-year-old client with diabetes

A, D (A previous history of depression is a relative contraindication because OCs may worsen depression in some women. The use of OCs should be evaluated by the healthcare provider in this situation. Women who smoke have a greater risk of adverse cardiovascular effects and the FDA has issued a black box warning about these effects. Options 2, 3, and 5 are incorrect. OCs are sometimes prescribed as an off-label treatment for acne. Obesity alone is not a contraindication for OCs, nor is age. A 41-year-old who has delivered two healthy children is not at risk.)

Which patients would have a higher risk for adverse effects from estradiol and norethindrone (Ortho-Novum)? (Select all that apply.) A. An 18-year-old with a history of depression B. A 16-year-old with chronic acne C. A 33-year-old with obesity per her body mass index (BMI) D. A 24-year-old who smokes one pack of cigarettes per day E. A 41-year-old who has delivered two healthy children

C, D, G

Which specific cancer types have a higher rate of occurrence among the Hispanic/Latino population of the United States compared with the non-Hispanic white population? Select all that apply. A. Breast B. Colorectal C. Gall-bladder D. Liver E. Lung F. Prostate G. Stomach

B

Which statements made by a 62-year-old client alert the nurse to the possibility that he may be at increased genetic risk for cancer development? Select all that apply. A. An older aunt died from a brain tumor while she had breast cancer. B. He had two benign colon polyps removed during his most recent routine colonoscopy. C. His sister died from cancer of the appendix. D. His brother is being treated for breast cancer. E. His 32-year-old daughter has been recently diagnosed with cervical cancer. F. One person in each of the previous three generations of his family died from lung cancer.

A

Which supplement will the nurse recommend to a client who wants to enhance eye health? A. Lutein B. Vitamin D C. Magnesium D. Saw palmetto

A, B, C

Which symptom will the nurse teach the client who just had surgery to correct a retinal detachment to immediately report to the eye care provider? Select all that apply. A. Pain in the affected eye B. Pus in the affected eye C. Decreased visual acuity D. Temperature of 99.0°F E. Pupil that constricts in response to light

A (Alendronate (Fosamax) should be taken on an empty stomach with a full glass of water, and the patient should remain upright for a minimum of 30 minutes to prevent esophageal irritation. Options 2, 3, and 4 are incorrect. The drug should not be taken with food and should be taken early in the day.)

Which teaching point will the nurse provide to a patient with a new prescription for alendronate (Fosamax)? A. Take the medication with a full glass of water 30 minutes before breakfast. B. Take the medication with a small snack or meal containing dairy. C. Take the medication immediately before bed. D. Take the medication with a calcium supplement.