Medsurg 2: Exam 1 Questions

A nurse is caring for a client whose surgeon informed him postoperative that he has metastasizing malignant neoplasm in the colon. Which of the following statements by the client should the nurse identify as an indication that the client understands this information? A. "I have cancer of the colon that has begun to spread." B. "I have growths in my bowel that the doctor can treat easily." C. "As long as my tumor doesn't get any bigger, i'll be okay." D. "There is not much point in having more treatments."

A neoplasm is a continued growth of nonessential cells, and the term "malignant" means that these cells are cancerous. These cells are also metastasizing, or spreading, to adjacent tissues; therefore, the client's statement is accurate.

A nurse is caring for a postmenopausal client who is concerned that she might have an elevated risk of breast cancer. After conducting a risk assessment, the nurse should identify which of the following factors as increasing the client's breast cancer risk? Select all that apply. A. Increased bone density B. BMI of 32 C. Having given birth to 5 children D. Undergoing hormonal replacement therapy for 10 years. E. Having 1-2 alcoholic drinks per week

A, B, D Women who have dense breast tissue are at an increased risk for developing breast cancer because they have more connective and glandular breast tissue. Postmenopausal obesity increases the risk of developing breast cancer. Hormone related risks for developing breast cancer include the long term use of oral contraceptives or hormone replacement therapy, early menarche, late menopause, and first pregnancy after 30 years of age.

A nurse is planning an educational program for a group of young adults about reducing the risk of cervical cancer. Which of the following interventions should the nurse include? A. Get the human papillomavirus (HPV) immunization. B. Avoid the use of tampons on a routine basis. C. Avoid drinking alcohol D. Get a papanicolaou test every year starting at age 30

A. HPV is the leading cause of cervical cancer in women. A preventive recommendation is to receive the HPV immunization between 9-26 years of age.

A nurse is providing discharge teaching to a client who has AIDS about preventing infection while at home. Which of the following instructions should the nurse include in the teaching? A. Wash your genitalia using an antimicrobial soap. B. Rinse your dishes with cold water C. Clean your toothbrush once per month D. Incorporate raw fruits and vegetables into your diet.

A. The nurse should instruct the client to bathe daily using an antimicrobial soap to prevent the spread of infection. If bathing is not possible, washing the genitalia using antimicrobial soap is recommended.

A nurse is providing teaching to a client with cancer who is receiving external radiation therapy. Which of the following statements by the client indicates an understanding of the teaching? A. "I need to protect the area from sunlight" B. "I'm going to apply a heating pad to the area after each treatment." C "I'll massage the area once per day." D. "I'll wash off the markings after each therapy treatment."

A. To prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight that receive radiation

A nurse is providing teaching to a client who has a new prescription for alprazolam. Which of the following items is a priority for teaching? A. "This medication can affect your ability to drive or handle mechanical equipment." B. "You should avoid drinking beverages that contain caffeine with this medication." C. "You should avoid taking antacids within 2 hours of this medication." D. "This medication should be taken with or shortly after meals"

A. Handling mechanical equipment or driving creates a safety risk for the client who takes alprazolam

A nurse is providing teaching to a client who has cervical cancer and is scheduled to receive brachytherapy in an ambulatory care clinic. Which of the following statements by the client indicates an understanding of the teaching? A. I need to lie still in bed during my brachytherapy treatment. B. I will have an implant placed once a month during my brachytherapy treatment. C. I must stay at least 3 feet away from others between brachytherapy treatments. D. I should expect some blood in my urine after each brachytherapy treatment.

A. The nurse should confirm that the client understands the need to remain on bed rest with limited movement while the radioactive implant is in place to prevent dislodgment.

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer? A. The client is a hairdresser B. The client uses tobacco C. The client is over 60 years of age D. The client has frequent UTIs

B.

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide. A. "The risk of renal toxicity is lessened when a combination of chemotherapy medications is used." B. "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." C. "The use of more chemotherapy medications will shorten the time you have to be in treatment." D. "The combinations of chemotherapy medications will eliminate the potential for bone marrow suppression."

B. Different chemo agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply.

A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy? A. Thinning of the scalp hair B. Tingling of the hands and feet C. Reduced ability to concentrate D. Sores in mucous membranes

B. Severe chemotherapeutic agents might cause peripheral neuropathy. One major manifestation of this is numbness and tingling of an extremity.

A nurse is teaching a client who has HIV about how the virus is transmitted. Which of the following statements should the nurse include in the teaching? A. HIV can be transmitted as soon as a person develops manifestations. B. HIV can be transmitted to anyone who has had contact with infected blood. C. HIV is transmitted through the respiratory route via droplets D. HIV is transmitted only during the active phase of the virus

B. The concentration of the virus is highest in blood but also has been isolated in other body fluids including sputum, saliva, cerebrospinal fluid, urine, and semen. Clients who have HIV are cautioned to practice safe sex, avoid donating blood, and abstain from sharing needles with others.

A nurse is providing postop discharge teaching to a client following a panhysterectomy for uterine cancer. Which of the following pieces of information should the nurse include in the teaching? A. You will need to continue to use some form of birth control for 6 months. B. You might experience manifestations of menopause. C. Do not lift anything heavier than 15 lbs D. Pain or burning with urination is an expected outcome of this surgery

B. The nurse should inform the client that a panhysterectomy includes the removal of the uterus and the ovaries, which might cause manifestations of menopause (hot flashes, night sweats, and vaginal dryness)

The nurse is providing teaching to a client who has somatitis due to chemotherapy and radiation therapy. Which of the following statements by the client indicates a need for further teaching? A. I will use a soft toothbrush or foam swab for oral care B. I will use lemon and glycerin swabs after meals C. I will remove my dentures except while eating D. I will rinse my mouth frequently with hydrogen peroxide solution

B. The nurse should instruct the client who has stomatitis to aoid the use of lemon-glycerin swabs because they cause drying and irritation to the mucous membranes

A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? A. Monitor visitors for manifestations of infection. B. Remind the client to use an electric razor. C. Encourage frequent rest periods D. Instruct the client to rinse mouth daily with normal saline

B. Thrombocytopenia is a decrease in the client's blood platelet count, which places the client at an increased risk of bleeding due to the blood's inability to clot. Therefore, the nurse should institute bleeding precautions, including the use of an electric razor.

A nurse is planning a presentation at a community center about risk factors for cancer. Which of the following types of cancer should the nurse include when discussing familial clustering of specific types of cancer? A. Skin B. Prostate C. Bone D. Bladder

B. Types of cancer that typically demonstrate a familial tendency include breast, colorectal, ovarian and prostate.

A nurse is performing an admission assessment for a client who has colorectal cancer. Which of the following manifestations should the nurse expect to find? A. Hematuria B. Abdominal cramps C. Weight gain D. Polycythemia

B. Clients who have colorectal cancer are likely to have changes in bowel habits, occult blood in the stool, weight loss, fatigue, and "gas pains" or abdominal cramping

A nurse is providing teaching to a client who is receiving chemotherapy and has developed neutropenia. Which of the following statements indicates that the client needs further instructions? A. I'll keep an antibacterial hand gel in my purse. B. My partner will have to take care of the cat's litter boxes for a while. C. I'm planning a large gathering of friends and family for the holidays. D. I will eat canned fruits and veggies

C. A client who has neutropenia should avoid exposure to infection, so this statement warrants more teaching. A client who has neutropenia should avoid large crowds of people because a large gathering increases the client's risk for exposure to infection.

A nurse is caring for a client who is receiving brachytherapy. Which of the following measures should the nurse include in the client's plan of care? A. Plan to spend extra time with the client to provide emotional support. B. Ensure that chemotherapy medications do not extravasate into the client's tissues. C. Keep the door to the client's room closed. D. Encourage family members and friends to visit for at least 1hr per day.

C. Brachytherapy is a type of radiation therapy during which the radiation source is in direct contact with the client's tumor. During the therapy, the client emits radiation and is potentially hazardous to others. The clients should be in a private room with a private bathroom, and the nurse should keep the door to the client's room closed.

A nurse is caring for a client who is recieveing chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy? A. Gingival hyperplasia B. Hirsutism C. Pancytopenia D. Weight gain

C. Pancytopenia (deficiency of WBCs, RBCs, and platelet count) is an expected adverse effect of chemotherapy.

A nurse is providing preop teaching for a client with colorectal cancer who is scheduled to undergo colostomy placement with a peritoneal wound. Which of the following statements by the client indicates an understanding of the teaching? A. Not having any more rectal pain will be a relief B. I will need to sit on a rubber donut when I am in a chair C. I can only have liquids for 2 days before the surgery D. The colostomy will start working about 7 days after the surgery

C. The client should consume a full or clear liquid diet for 24-48 hours before the surgery to decrease bulk. The client should consume a low residual diet for several days prior to surgery to decrease peristalsis.

A nurse is planning care for a client who is postoperative following a radical mastectomy. Which of the following interventions should the nurse include in the plan? A. Rest the arm on the affected side on the bed when the client is sleeping. B. Instruct the client to keep the affected arm flexed when ambulating C. Begin exercises with the client 1 day after the procedure. D. Maintain the client on bed rest for 2 days after the procedure

C. The nurse should plan to begin exercises that do not stress the incision on the first postoperative day to promote lymphatic return and mobility

A nurse is caring for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care? A. Empty the collection pouch when it is at 2/3 full B. Expect urine outflow into pouch to begin 1-2 days after surgery C. Change the collection pouch in the early morning D. Place an aspirin in the collection pouch to control odor.

C. The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced.

A nurse is teaching a client how to perform a breast self examination (BSE). The nurse should identify which of the following findings as an indication for breast cancer? A. Lumps that are mobile and tender on palpation prior to a menstral period. B. Multiple round masses that are tender and found on both breasts. C. Bilateral darkened areolas D. A nontender, hard lump that is palpated in a breast.

D Cancerous tumors are typically hard, fixed, irregular in shape, and nontender to palpation.

A nurse is collecting a client's health history. Which of the following findings is the highest risk factor for the client developing skin cancer? A. Age over 60 B. Genetic predispoition C. Light skinned race D. Overexposure to sunlight

D.

A nurse is planning a presentation for a group of older adults at a community center about risk factors for cancer. Which of the following factors increases the risk of developing cancer after age 60? A. High protein diet B. Insufficient calcium intake C. Declining muscle mass D. Weakened immune responses

D. After age 60, clients have a higher risk of cancer due to hormonal changes, altered immune responses, and accumulation of free radicals. Age is a significant factor because the longer people are exposed to external carcinogenic factors (e.g. tobacco and alcohol use, environmental pollutants, radiation), the greater their risk of developing cancer becomes.

A nurse is caring for a client who will receive brachytherapy to treat uterine cancer. The nurse should unsure the client understands that she will receive which of the following interventions? A. Chemotherapy via a central venous access device. B. Radiation to the tumor from an external source C. Precise delivery of high dose radiation after tumor imaging. D. Radioactive infusions or insertions into or near the tumor.

D. Brachytherapy is a type of radiation therapy during which the radiation source, either an implant or via infusion, is in direct contact with the client's tumor continuously for a specific duration.

A nurse is admitting a client who has multiple lyeloma and a WBC of 2,200. Which of the following foods should the nurse prohibit the family members from bringing the client? A. Fried chicken from a fast food resturant. B. A case of canned nutritional supplements C. A factory sealed box of chocolates D. A fresh fruit basket

D. Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin of these food items might harbor bacteria that can cause an infection.

A nurse is planning care for a client who has AIDS and has developed stomatitis. Which of the following interventions should the nurse include in the plan of care? A. Rinse the mouth with chlorhexidine solution every 2hr B. Limit fluid intake with meals C. Provide oral hygiene with a firm-bristled toothbrush after each meal. D. Avoid salty foods

D. Stomatitis is an inflammation of the mucosa of the mouth, usually with ulcerations. Foods that are spicy, acidic, or salty should be avoided to prevent further irritation and damage to the oral mucous.

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following indicates the client is developing superior vena cava syndrome. A. Irregular cardiac rhythm B. Numbness in the hands C. Muscle cramps D. Facial edema

D. Superior vena cava syndrome is a medical emergncy resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest (ie advanced lung and breast cancers and lymphoma). The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected.

A nurse is assessing a 66 year old client during a routine physical examination. This is the client's first clinic visit, and she does not have her medical records. When the nurse asks if she has recieved the pneumococcal immunization, the client replies "I'm not sure, but it's been at least 5 years since I've had any immunizations." Which of the following responses should the nurse provide? A. "In case you had the immunization before, we can't give you another one" B. "You'll need a series of 3 injections" C. "This immunization is unsafe for people over the age of 65 years old" D. "Let's go ahead and give you this immunization"

D. The CDC recommends this immunization for people who are 65+ and older. If the client did receive this immunization more than 5years ago, the nurse should administer another because the client is over 65.

A nurse is caring for a client who is receiving radiation therapy for mouth cancer and reports a dry mouth. Which of the following dietary recommendations should the nurse provide? A. Offer graham crackers as a snack B. Avoid foods containing citrus C. Rinse the mouth with an alcohol-based mouth wash before eating D. Use gravies or sauces to soften food

D. The nurse should instruct the client to use gravies or sauces to soften foods and make them easier to eat.

A home health nurse is planning care for a client who is receiving chemotherapy and has neutropenia. Which of the following foods should the nurse include in the client's plan of care? A. Soft boiled eggs B. Brie cheese made of unpasturized milk C. Cold deli meat sandwiches D. Baked chicken

D. Well cooked meats, including baked chicken, do not pose a threat to clients who have neutropenia and may be included in the cleint's dietary plan.

A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which of the following dietary recommendations should the nurse share with the client. A. Eat with metal utensils B. Limit coffee C. Avoid citrus foods D. Offer mints

D. The nurse should encourage the client to suck on mints, which can overcome the metallic taste the client is experiencing.

A nurse is preparing a plan of care for a client who is postoperative following a modified radical mastectomy. Which of the following invasive devices should the nurse expect the client to have? A. Chest tube B. Indwelling urinary catheter C. NG tube D. Jackson pratt drain

D. The nurse should expect this client to have 1-2 JP drains.

A hospice nurse is providing education about palliative care to the partner of a client who has end stage liver cancer. Which of the following statements by the partner indicates an understanding of the teaching? A. I will do my best to try to get him to eat something B. I will lay him flat if his breathing becomes shallow C. I will use an electric blanket to keep him warm D. I will continue to talk to him, even when he's sleeping

D. The nurse should reinforce to the partner that the client's hearing is thought to be the last sense to leave during the dying process. Therefore, continue to communicate softly with the client.

A nurse is providing teaching to a client who has cancer and is undergoing external radiation treatment. Which of the following statements by the client indicates an understanding of the teaching? A. I should use petroleum based lotions on the areas being radiated. B. I will dry the areas being radiated by rubbing in a circular pattern. C. I will apply sunscreen to the areas being radiated when spending time in the sun. D. I should use my hand, instead of a washcloth, to wash the areas being radiated.

D. Washing the areas being radiated with the hand is gentler than using a washcloth

A nurse is planning care for a client who is receiving chemotherapy and has a protein deficiency. Which of the following interventions should the nurse include in the plan of care? Select all that apply. A. Mix powdered skim milk into liquid milk B. Add a raw egg to fruit smoothies C. Add a slice of cheese to hot veggies. D. Add honey to hot tea E. Mix yogurt into fresh fruit

ACE Dairy products are good sources of protein.

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect? A. Bone and joint pain B. Enlarged lymph nodes C. Intermitten hematuria D. Productive cough

B.

A nurse is talking to a group of women at a community center about the current recommendations for early detection of breast cancer. The nurse should explain which of the following options? A. Begin monthly breast self examinations at age 40 B. Have a clinical breast examination each year after age 30 C. Begin annual mammograms at age 40. D. Have breast magnetic resonance imaging every 5 years after age 50

C. Women should begin performing monthly breast self examinations at 20 years of age. From 20 - 39 years of age, women should undergo a breast examination by a healthcare provider every 3 years. Women older than 40 years of age should have annual breast examinations by a healthcare provider and annual mammogram.

A charge nurse is observing a newly licensed nurse provide care for a client who is receiving internal radiation therapy for the treatment of cervical cancer. For which of the following actions by the newly licensed nurse should the charge nurse intervene? A. Leave soiled linens in a container in the client's room. B. Instructing visitors to remain 3ft away from the client. C. Borrowing a dosimeter film badge from another nurse before entering the client's room. D. Removing an extra IV pole from the client's room to be used by another client.

C. A nurse should never borrow a dosimeter film badge from another staff member. Nurses who are caring for the client should each have a personal badge and wear it while in the client's room. The badge measures the radiation exposure that the nurse is receiving, and each film badge will indicate the nurse's cumulative radiation exposure.

A nurse is obtaining a client's health history who has cancer of the cervix. Which of the following manifestations should the nurse expect? A. Weight gain B. Oliguria C. Vaginal bleeding D. Back pain

C. The most common manifestation of cancer of the cervix is painless vaginal bleeding

A nurse is teaching a client who has leukemia and has developed thrombocytopenia. Which of the following instructions should the nurse include in the teaching? A. Limit flossing your teeth to once a week B. Gently blow your nose if needed C. Use an electric razor when shaving D. Wear shoes that have a soft sole

C. The nurse should instruct the client to use an electric razor o prevent nicks and cuts caused by conventional razors that can increase the risk of bleeding.

A nurse is caring for a client who has human immunodeficiency virus (HIV). Which of the following types of isolation should the nurse implement to prevent the transmission of HIV? A. Protective isolation B. Droplet precautions C. Standard precautions D. Airborne precautions

C. Standard

A nurse is collecting a health history from a female client who is undergoing screening for breast cancer. Which of the following factors increases the client's risk of developing breast cancer? A. Obesity B. Oral contraceptive use C. Alcohol use D. Age over 50 years

D. A female client who is over 50 years of age has an increased risk of developing breast cancer.