Medsurg 3: 12, 30, 32, 34

34. During a code blue, a nurse sustained a needlestick injury from a client whose human immunodeficiency virus (HIV) status was unknown. The nursing supervisor is notified, an incident report is generated, and a post-HIV exposure prophylaxis checklist is started for this nurse. In which order would the checklist be implemented? A. Administer post-exposure prophylaxis (PEP) medication. B. Advise exposed health care providers to use precautions. C. Get counseling at the time of exposure. D. Undergo early reevaluation after exposure. E. Determine the HIV status of the client.

1: E 2: C 3: B 4: A 5: D

17. A nurse is working with a client with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the client is experiencing adverse effects of this drug? A. "I have this ringing in my ears that just won't go away." B. "I feel so foggy in the mornings and it takes me so long to wake up." C. "When I eat a meal that's high in fat, I get really nauseous." D. "I seem to have lost my appetite, which is unusual for me."

A. "I have this ringing in my ears that just won't go away."

14. While on spring break, a 22-year-old client was taken to the hospital for heat stroke and alcohol poisoning. The client is worried and states that a biopsy was taken and showed "some kind of benign condition." Which response by the nurse would be best? A. "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results." B. "You have every right to be upset; a benign condition means you may have cancerous cells. Let me call your health care provider to talk to you." C. "Are you sure a biopsy was done? Your admitting diagnosis would not prompt that kind of procedure." D. "Do not worry; if something was wrong, your primary health care provider would have told you and started treatment."

A. "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results."

10. A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A. "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B. "OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees." C. "OA originates with an infection. RA is a result of your body's cells attacking one another." D. "OA is associated with impaired immune function; RA is a consequence of physical damage."

A. "OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

16. The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client? A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." B. "These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer." C. "Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy." D. "Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying."

A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results."

27. Following an extensive diagnostic workup, a client has been diagnosed with myelodysplastic syndrome (MDS). Which assessment question most directly addresses the potential etiology of this client's health problem? A. "Were you ever exposed to toxic chemicals in any of the jobs that you held?" B. "When you were younger, did you tend to have recurrent infections of any kind?" C. "Have you ever smoked cigarettes or used other tobacco products?" D. "Would you say that you've had a lot of sun exposure in your lifetime?"

A. "Were you ever exposed to toxic chemicals in any of the jobs that you held?"

12. A client with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on a medical unit. The nurse observes that the client expresses anger and irritation when the call bell isn't answered immediately. Which response would be the most appropriate? A. "You seem like you're feeling angry. Is that something that we could talk about?" B. "Try to remember that stress can make your symptoms worse." C. "Would you like to talk about the problem with the nursing supervisor?" D. "I can see you're angry. I'll come back when you've calmed down."

A. "You seem like you're feeling angry. Is that something that we could talk about?"

22. A client is receiving treatment for a new diagnosis of chronic lymphocytic leukemia (CLL). Based on known risk factors, age, ethnicity, and accompanying clinical conditions, which client is most likely to have this disease? A. 82-year-old Vietnam War veteran with widely disseminated shingles B. 62-year-old client of Asian descent with a left fractured hip C. 69-year-old Gulf War veteran with deep vein thrombosis (DVT) D. 85-year-old client of Native American/First Nation descent with chest pain

A. 82-year-old Vietnam War veteran with widely disseminated shingles

18. An adult client with leukemia will soon begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A. Administer an antiemetic. B. Administer an antimetabolite. C. Administer a tumor antibiotic. D. Administer an anticoagulant.

A. Administer an antiemetic.

20. A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? A. Administer antidiarrheal medications on a scheduled basis, as prescribed. B. Encourage the client to eat three balanced meals and a snack at bedtime. C. Increase the client's oral fluid intake. D. Encourage the client to increase his or her activity level.

A. Administer antidiarrheal medications on a scheduled basis, as prescribed.

4. A nurse is implementing the care plan of diarrhea related to enteric pathogens of human immunodeficiency virus infections. Which interventions are needed to reach the goal of resuming usual bowel habits? Select all that apply. A. Administer antimicrobials. B. Restrict fluid to 1500 mL/50.7 fl oz daily. C. Implement a BRAT diet. D. Administer antitussives. E. Establish normal bowel pattern.

A. Administer antimicrobials. D. Administer antitussives. E. Establish normal bowel pattern.

8. A client has a diagnosis of rheumatoid arthritis, and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address which potential adverse effect? A. Bone marrow suppression B. Acute confusion C. Sedation D. Malignant hyperthermia

A. Bone marrow suppression

32. The hospice nurse has just admitted a new client to the program. What principle guides hospice care? A. Care addresses the needs of the client as well as the needs of the family. B. Care is focused on the client centrally and the family peripherally. C. The focus of all aspects of care is solely on the client. D. The care team prioritizes the client's physical needs and the family is responsible for the client's emotional needs.

A. Care addresses the needs of the client as well as the needs of the family.

9. A client with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the client? A. Chew with care to avoid inadvertently biting the tongue. B. Use the oral anesthetic 1 hour prior to mealtime. C. Brush teeth before and after eating. D. Swallow slowly and deliberately.

A. Chew with care to avoid inadvertently biting the tongue.

13. A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse should identify what main goal of care? A. Cure of the disease B. Enhancing quality of life C. Controlling symptoms D. Palliation

A. Cure of the disease

38. A nurse is performing the admission assessment of a client who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A. Current medication regimen B. Identification of client's support system C. Immune system function D. Genetic risk factors for HIV E. History of sexual practices

A. Current medication regimen B. Identification of client's support system C. Immune system function E. History of sexual practices

28. A female client who is HIV negative arrives for a gynecologist appointment and reports that her husband, who is HIV positive, no longer wants to wear a latex condom. Which alternative treatments would the nurse recommend to reduce the likelihood of HIV transmission? Select all that apply. A. Dental dam B. Polyurethane female condom C. Microbicidal vaginal suppository D. Non-latex male condoms E. Pre-exposure prophylaxis

A. Dental dam B. Polyurethane female condom D. Non-latex male condoms

34. A nurse is writing the care plan of a client who has been diagnosed with myelofibrosis. What nursing diagnoses should the nurse address? Select all that apply. A. Disturbed body image B. Impaired mobility C. Imbalanced nutrition: Less than body requirements D. Acute confusion E. Risk for infection

A. Disturbed body image B. Impaired mobility C. Imbalanced nutrition: Less than body requirements E. Risk for infection

24. On admission to a medical unit, a client with human immunodeficiency virus (HIV) tests positive for benzodiazepine. The client denies using this medication. Which medication is likely causing a false-positive result? A. Efavirenz B. Doravirine C. Nevirapine D. Etravirine

A. Efavirenz

9. A home health nurse is caring for a client who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? A. Encourage the client and family to be active partners in the management of the immunodeficiency. B. Encourage the client and family to manage the client's activity level and activities of daily living effectively. C. Make sure that the client and family understand the importance of monitoring fluid balance. D. Make sure that the client and family know how to adjust dosages of the medications used in treatment.

A. Encourage the client and family to be active partners in the management of the immunodeficiency.

11. A clinic nurse is caring for a client admitted with acquired immunodeficiency syndrome (AIDS). The nurse has assessed that the client is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of which complication? A. Human immunodeficiency virus (HIV) encephalopathy B. B-cell lymphoma C. Kaposi sarcoma D. Wasting syndrome

A. Human immunodeficiency virus (HIV) encephalopathy

3. An oncology nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse should anticipate which imbalance? A. Hypercalcemia B. Hyperproteinemia C. Elevated serum viscosity D. Elevated red blood count (RBC)

A. Hypercalcemia

6. The nurse is caring for a client who is to begin receiving external radiation for a malignant tumor of the neck. While providing client education, what potential adverse effects should the nurse discuss with the client? A. Impaired nutritional status B. Cognitive changes C. Diarrhea D. Alopecia

A. Impaired nutritional status

15. A nurse is planning the care of a client with acquired immunodeficiency syndrome (AIDS) who is admitted to the unit with Pneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this client? A. Ineffective airway clearance B. Impaired oral mucous membranes C. Imbalanced nutrition: Less than body requirements D. Activity intolerance

A. Ineffective airway clearance

2. A nurse is caring for a client who has a diagnosis of acute myelocytic leukemia (AML). Assessment of which factor most directly addresses the most common cause of death among clients with leukemia? A. Infection status B. Nutritional status C. Electrolyte levels D. Liver function

A. Infection status

33. A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care? A. Limit the time that visitors spend at the client's bedside. B. Teach the client to perform all aspects of basic care independently. C. Assign male nurses to the client's care whenever possible. D. Situate the client in a shared room with other clients receiving brachytherapy.

A. Limit the time that visitors spend at the client's bedside.

2. A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A. Liver function tests (LFTs) B. Complete blood count (CBC) C. Platelet count D. Blood urea nitrogen and creatinine

A. Liver function tests (LFTs)

10. Since the emergence of the human immunodeficiency virus (HIV), there have been significant changes in epidemiologic trends. At present, members of which group are most affected by new cases of HIV? A. Male-to-male sexual contact B. Heterosexual contact C. Male-to-male sexual contact with injection drug use D. People 25 to 29 years of age

A. Male-to-male sexual contact

25. An oncology nurse recognizes a client's risk for fluid imbalance while the client is undergoing treatment for leukemia. What related assessments should the nurse include in the client's plan of care? Select all that apply. A. Monitoring the client's electrolyte levels B. Monitoring the client's hepatic function C. Measuring the client's weight on a daily basis D. Measuring and recording the client's intake and output E. Auscultating the client's lungs frequently

A. Monitoring the client's electrolyte levels C. Measuring the client's weight on a daily basis D. Measuring and recording the client's intake and output E. Auscultating the client's lungs frequently

27. The nurse is caring for a client who has just been told that the client's stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A. Palliative B. Reconstructive C. Salvage D. Prophylactic

A. Palliative

22. A health care provider is taking post-exposure prophylaxis (PEP) medications for exposure to a client with human immunodeficiency virus (HIV). Which topics will the health care provider need to understand regarding PEP administration prior to beginning this regimen? Select all that apply. A. Potential drug toxicities B. Needed dietary changes C. Potential drug interactions D. Sleep pattern disturbances E. Adherence requirements

A. Potential drug toxicities C. Potential drug interactions E. Adherence requirements

2. A client with Wiskott-Aldrich syndrome (WAS) is admitted to the medical unit. The nurse caring for the client should prioritize which intervention? A. Protective isolation B. Fresh-frozen plasma (FFP) administration C. Chest physiotherapy D. Nutritional supplementation

A. Protective isolation

18. A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's care plan? A. Protective isolation and vigilant use of standard precautions B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene C. Including the family in planning the client's activities of daily living D. Monitoring and treating the client's pain

A. Protective isolation and vigilant use of standard precautions

22. The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A. Rate of growth B. Ability to cause death C. Cell size D. Cell location E. Ability to spread

A. Rate of growth B. Ability to cause death E. Ability to spread

17. A 16-year-old female client has post-chemotherapy alopecia. This prompts the nursing diagnoses of Disturbed Body Image and Situational Low Self-Esteem. Which response by the client would best indicate improved coping related to these diagnoses? A. Requests that her family bring her makeup and a wig B. Begins to discuss the future with her family C. Reports less disruption from pain and discomfort D. Cries openly when discussing her disease

A. Requests that her family bring her makeup and a wig

32. A nurse is planning the care of client who has been diagnosed with essential thrombocythemia (ET). Which nursing diagnosis should the nurse prioritize when choosing interventions? A. Risk for ineffective tissue perfusion B. Risk for imbalanced fluid volume C. Risk for ineffective breathing pattern D. Risk for ineffective thermoregulation

A. Risk for ineffective tissue perfusion

32. A nurse is completing the nutritional status of a client who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A. Serum albumin level B. Weight history C. White blood cell count D. Body mass index E. Blood urea nitrogen (BUN) level

A. Serum albumin level B. Weight history D. Body mass index E. Blood urea nitrogen (BUN) level

7. While a client is receiving intravenous (IV) doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize which action? A. Stopping the administration of the drug immediately B. Notifying the client's health care provider C. Continuing the infusion but decreasing the rate D. Applying a warm compress to the infusion site

A. Stopping the administration of the drug immediately

1. An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A. The different leukemias all involve unregulated proliferation of white blood cells. B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. C. The different leukemias all result in a decrease in the production of white blood cells. D. The different leukemias all involve the development of cancer in the lymphatic system.

A. The different leukemias all involve unregulated proliferation of white blood cells.

20. A 60-year-old client with chronic myeloid leukemia (CML) will be treated in the home setting, and the nurse is preparing appropriate health education. Which topic should the nurse emphasize? A. The importance of adhering to the prescribed drug regimen B. The need to ensure that vaccinations are up to date C. The importance of daily physical activity D. The need to avoid shellfish and raw foods

A. The importance of adhering to the prescribed drug regimen

30. The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse's priority assessment should include examination for the signs and symptoms of which complication? A. Tumor lysis syndrome (TLS) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Disseminated intravascular coagulation (DIC) D. Hypercalcemia

A. Tumor lysis syndrome (TLS)

5. The nurse is applying standard precautions in the care of a client who has an immunodeficiency. What are key elements of standard precautions? Select all that apply. A. Using appropriate personal protective equipment B. Placing clients in negative pressure isolation rooms C. Placing clients in positive pressure isolation rooms D. Using safe injection practices E. Performing hand hygiene

A. Using appropriate personal protective equipment D. Using safe injection practices E. Performing hand hygiene

This client will be considered to have AIDS when the CD4+ T-lymphocyte cell count drops below what threshold? A. 75 cells/mm3 of blood B. 200 cells/mm3 of blood C. 325 cells/mm3 of blood D. 450 cells/mm3 of blood

B. 200 cells/mm3 of blood

5. A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? A. Communicate to the health care provider the need to provide more information to the client and family. B. Assess how much information is desired from the client in terms of illness, treatment, and complications. C. Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death. D. Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life.

B. Assess how much information is desired from the client in terms of illness, treatment, and complications.

24. A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity? A. Teach the client about the risks of immobility and the benefits of exercise. B. Assist the client to a chair during awake times, as tolerated. C. Collaborate with the physical therapist to arrange for stair exercises. D. Teach the client to perform deep breathing and coughing exercises.

B. Assist the client to a chair during awake times, as tolerated.

19. A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action? A. Initiate measures to prevent venous thromboembolism (VTE). B. Check the client's most recent platelet level. C. Place the client on protective isolation. D. Ambulate the client to promote circulatory function.

B. Check the client's most recent platelet level.

38. A client has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. Which action should the nurse promote? A. Daily performance of weight-bearing exercise to prevent muscle atrophy B. Close monitoring of urine output and kidney function C. Daily administration of warfarin, as prescribed D. Safe use of supplementary oxygen in the home setting

B. Close monitoring of urine output and kidney function

18. A nurse is performing an admission assessment on a client with stage 3 human immunodeficiency virus (HIV). After assessing the client's gastrointestinal system and analyzing the data, which nursing diagnosis is most likely to be the priority? A. Acute abdominal pain B. Diarrhea C. Bowel incontinence D. Constipation

B. Diarrhea

23. When discussing with a client factors that distinguish malignant cells from benign cells of the same tissue type, which characteristic should the nurse mention? A. Slow rate of mitosis of cancer cells B. Different proteins in the cell membrane C. Differing size of the cells D. Different molecular structure in the cells

B. Different proteins in the cell membrane

29. A nurse is preparing health education for a client who has received a diagnosis of myelodysplastic syndrome (MDS). Which of the following topics should the nurse prioritize? A. Techniques for energy conservation and activity management B. Emergency management of bleeding episodes C. Technique for the administration of bronchodilators by metered-dose inhaler D. Techniques for self-palpation of the lymph nodes

B. Emergency management of bleeding episodes

3. A nurse is performing the initial assessment of a client who has a recent diagnosis of systemic lupus erythematosus (SLE). Which skin manifestation would the nurse expect to observe on inspection? A. Petechiae B. Erythematous rash C. Jaundice D. Skin sloughing

B. Erythematous rash

10. A client diagnosed with acute myeloid leukemia has just been admitted to the oncology unit. When writing this client's care plan, which potential complication should the nurse address? A. Pancreatitis B. Hemorrhage C. Arteritis D. Liver dysfunction

B. Hemorrhage

37. A client who has acquired immunodeficiency syndrome (AIDS) has been admitted for the treatment of Kaposi sarcoma. Which nursing diagnosis should the nurse associate with this complication of AIDS? A. Risk for disuse syndrome related to Kaposi sarcoma B. Impaired skin integrity related to Kaposi sarcoma C. Diarrhea related to Kaposi sarcoma D. Impaired swallowing related to Kaposi sarcoma

B. Impaired skin integrity related to Kaposi sarcoma

31. The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A. Cognitive deficits B. Impaired wound healing C. Cardiac tamponade D. Tumor lysis syndrome

B. Impaired wound healing

27. A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? A. Appropriate use of prophylactic antibiotics B. Importance of personal hygiene C. Signs and symptoms of wasting syndrome D. Strategies for adjusting antiretroviral dosages

B. Importance of personal hygiene

34. A client is hospitalized because a large abdominal tumor was seen on the computed tomography scan. A biopsy is ordered, and the client wants to know if "this will cause a big scar." Which type of biopsy will this client likely experience? A. Excisional B. Incisional C. Needle D. Fine needle

B. Incisional

21. A client is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). Which assessment finding is certain to be present if the client has CLL? A. Increased numbers of blast cells B. Increased lymphocyte levels C. Intractable bone pain D. Thrombocytopenia with no evidence of bleeding

B. Increased lymphocyte levels

1. A client with a documented history of allergies presents to the clinic. The client reports being frustrated by chronic nasal congestion, anosmia (inability to smell), and inability to concentrate. The nurse should identify which nursing diagnosis? A. Deficient knowledge of self-care practices related to allergies B. Ineffective individual coping with chronicity of condition C. Acute confusion related to cognitive effects of allergic rhinitis D. Disturbed body image related to sequelae of allergic rhinitis

B. Ineffective individual coping with chronicity of condition

16. A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care? A. There is a need for the client to be assessed for lymphoma. B. Infection is the most likely cause of the client's change in health status. C. The client is exhibiting signs and symptoms of leukemia. D. The client should undergo diagnostic testing for multiple myeloma.

B. Infection is the most likely cause of the client's change in health status.

21. A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread? A. Apoptosis B. Lymphatic circulation C. Invasion D. Angiogenesis

B. Lymphatic circulation

20. An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A. Malignant cells possess greater mobility than normal body cells. B. Malignant cells contain proteins called tumor-associated antigens. C. Chromosomes contained in cancer cells are more durable and stable than those of normal cells.

B. Malignant cells contain proteins called tumor-associated antigens.

37. A nurse is providing care for a client who has just been diagnosed with early-stage rheumatoid arthritis (RA). The nurse should anticipate the administration of which medication? A. Hydromorphone B. Methotrexate C. Allopurinol D. Prednisone

B. Methotrexate

8. A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A. Pruritis (itching) B. Nausea and vomiting C. Altered glucose metabolism D. Confusion

B. Nausea and vomiting

30. A client with human immunodeficiency virus (HIV) is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this client should expect the health care provider to prescribe which medication for the management of the client's diarrhea? A. Fluoxetine B. Octreotide acetate C. Levofloxacin D. Valganciclovir

B. Octreotide acetate

15. A 20-year-old client with no medical history arrives at a walk-in/urgent care clinic reporting swelling on the left side of the neck. On palpation, the lymph nodes on the neck are painless, firm but not hard. What is the next appropriate intervention for this client? A. Recommend immediate and urgent transfer to the nearest trauma center. B. Perform diagnostic studies to rule out any infectious origin at a hospital. C. Refer the client to a primary health care provider for a nonurgent appointment. D. Complete a computed tomography scan because the client has Hodgkin lymphoma.

B. Perform diagnostic studies to rule out any infectious origin at a hospital.

35. An adult client's abnormal complete blood count (FBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease? A. Schwann cells B. Reed-Sternberg cells C. Lewy bodies D. Loops of Henle

B. Reed-Sternberg cells

35. A client was diagnosed with cancer several weeks ago and family members describe the client as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action? A. Reassure the client and the family that these types of responses to cancer are common. B. Refer the client to the appropriate mental health provider. C. Educate the client about the mental health benefits of exercise. D. Reassure the family that the client is grieving and will eventually come to terms with the diagnosis.

B. Refer the client to the appropriate mental health provider.

6. A nurse is caring for a client with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this client, the nurse should assign the highest priority to which nursing diagnosis? A. Activity intolerance B. Risk for infection C. Acute confusion D. Risk for spiritual distress

B. Risk for infection

1. The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A. Monthly self-breast exams B. Smoking cessation C. Annual colonoscopies D. Monthly testicular exams

B. Smoking cessation

28. The nurse is caring for a client with an advanced stage of breast cancer and the client has recently learned that the cancer has metastasized. The nurse enters the room and finds the client struggling to breathe, and the nurse's rapid assessment reveals that the client's jugular veins are distended. The nurse should suspect the development of what oncologic emergency? A. Increased intracranial pressure B. Superior vena cava syndrome (SVCS) C. Spinal cord compression D. Metastatic tumor of the neck

B. Superior vena cava syndrome (SVCS)

34. A nurse is providing care for a client who has a rheumatic disorder. The nurse's focused assessment includes the client's mood, behavior, level of consciousness, and neurologic status. Which diagnosis is most likely for this client? A. Osteoarthritis (OA) B. Systemic lupus erythematosus (SLE) C. Rheumatoid arthritis (RA) D. Gout

B. Systemic lupus erythematosus (SLE)

12. A nurse is assessing a client with HIV who has been admitted with pneumonia. In assessing the client, which of the following observations takes immediate priority? A. Oral temperature of 37.2°C (99°F) B. Tachypnea and restlessness C. Frequent loose stools D. Weight loss of 0.45 kg (1 lb) since yesterday

B. Tachypnea and restlessness

25. A client is in the primary infection stage of human immunodeficiency virus (HIV). Which statement regarding this client's current health status is most accurate? A. The client's HIV antibodies are successfully, but temporarily, killing the virus. B. The client is infected with HIV but lacks HIV-specific antibodies. C. The client's risk for opportunistic infections is at its peak. D. The client may or may not develop long-standing HIV infection.

B. The client is infected with HIV but lacks HIV-specific antibodies.

16. A nurse is planning client education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect? A. Tinnitus B. Visual changes C. Stomatitis D. Hirsutism

B. Visual changes

21. A nurse is caring for a client hospitalized with AIDS. A friend comes to visit the client and privately asks the nurse about the risk of contracting HIV when visiting the client. What is the nurse's best response? A. "Do you think that you might already have HIV?" B. "Your immune system is likely very healthy." C. "AIDS isn't transmitted by casual contact." D. "You can't normally contract AIDS in a hospital setting."

C. "AIDS isn't transmitted by casual contact."

11. A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement? A. "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." B. "I'll try to be as physically active as possible between flare-ups." C. "I'll make sure to monitor my body temperature on a regular basis." D. "I'll stop taking my steroids when I get relief from my symptoms."

C. "I'll make sure to monitor my body temperature on a regular basis."

19. A client with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? A. "Complementary therapies generally have not been approved, so clients are usually discouraged from using them." B. "Researchers have not looked at the benefits of alternative therapy for clients with HIV, so we suggest that you stay away from these therapies until there is solid research data available." C. "Many clients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks." D. "You'll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach."

C. "Many clients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks."

19. A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic? A. "Smoking is the reason you are here." B. "The doctor left orders for you not to smoke." C. "You are anxious about the surgery. Do you see smoking as helping?" D. "Smoking is OK right now, but after your surgery it is contraindicated."

C. "You are anxious about the surgery. Do you see smoking as helping?"

2. A 68-year-old client with a history of rheumatic disease has persistent swelling, no stiffness, and full range of motion to his left knee after an injury sustained several months ago. X-rays reveal no fracture of the extremity. Which factor is the most likely cause of the client's continued swelling? A. Degradation of cartilage B. Aging C. An inflammation process D. Reinjury not seen on x-ray results

C. An inflammation process

28. A client with myelodysplastic syndrome (MDS) is being treated on a medical unit. Which priority finding should prompt the nurse to contact the client's primary care provider? A. Reports of a frontal lobe headache B. An episode of urinary incontinence C. An oral temperature of 37.5°C (99.5°F) D. An oxygen saturation (SpO2) of 91% on room air

C. An oral temperature of 37.5°C (99.5°F)

6. A client with a diagnosis of primary immunodeficiency disease informs the nurse that the client has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the client's vital signs are within reference ranges, what action should the nurse take? A. Administer a nebulized bronchodilator. B. Perform oral suctioning. C. Assess the client for signs and symptoms of infection. D. Teach the client deep breathing and coughing exercises.

C. Assess the client for signs and symptoms of infection.

26. After receiving a diagnosis of acute lymphocytic leukemia, a client is visibly distraught, stating, "I have no idea where to go from here." How should the nurse prepare to meet this client's psychosocial needs? A. Assess the client's previous experience with the health care system. B. Reassure the client that treatment will be challenging but successful. C. Assess the client's specific needs for education and support. D. Identify the client's plan of medical care.

C. Assess the client's specific needs for education and support.

37. The clinical nurse educator is presenting health promotion education to a client who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A. Avoiding direct sun exposure in excess of 15 minutes daily B. Avoiding grapefruit juice and fresh grapefruit C. Avoiding highly crowded public places D. Using an electric shaver rather than a razor

C. Avoiding highly crowded public places

3. The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer? A. Smoked salmon and green beans B. Pork chops and fried green tomatoes C. Baked apricot chicken and steamed broccoli D. Liver, onions, and steamed peas

C. Baked apricot chicken and steamed broccoli

24. The nurse is performing an initial assessment of a 75-year-old client who has just relocated to the long-term care facility. During the nurse's interview with the client, the client admits drinking around 600 mL (20 oz) of vodka every evening. What types of cancer does this put the client at risk for? Select all that apply. A. Malignant melanoma B. Brain cancer C. Breast cancer D. Esophageal cancer E. Liver cancer

C. Breast cancer D. Esophageal cancer E. Liver cancer

29. Which intervention should the nurse teach a client who is at risk for hypercalcemia? A. Avoid the use of stool softeners. B. Take laxatives daily. C. Consume 2 to 4 L of fluid daily. D. Restrict calcium intake.

C. Consume 2 to 4 L of fluid daily.

4. A nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor? A. Labyrinthitis B. Left ventricular hypertrophy C. Decreased bone density D. Hypercoagulation

C. Decreased bone density

7. A nurse is providing care to a client with multiple myeloma with reports of nausea, diarrhea, alopecia, and red urine. The client's recent interventions include electrocardiogram (ECG), multigated acquisition scan (MUGA), and a central line venous access placed on the right chest wall. Which medication is the client most likely receiving? A. Dexamethasone B. Lenalidomide C. Doxorubicin D. Etoposide

C. Doxorubicin

9. A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia? A. Interrupted sleep pattern B. Hot flashes C. Epistaxis D. Increased weight

C. Epistaxis

39. A client underwent an antibody test for human immunodeficiency virus (HIV) as part of a screening process and has just been told that the results were positive. Which anticipatory guidance regarding the next step should the nurse provide to the client? A. The client will be started on fluoxetine in 1 month. B. Antiretroviral therapy will begin within 3 months. C. Follow-up testing will be promptly performed to confirm the result. D. The client will be monitored for signs and symptoms of HIV to determine the need for treatment.

C. Follow-up testing will be promptly performed to confirm the result.

33. A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of which medication? A. Dalteparin B. Allopurinol C. Hydroxyurea D. Hydrochlorothiazide

C. Hydroxyurea

7. A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A. Cool joints with decreased range of motion B. Signs of systemic infection C. Joint stiffness lasting longer than 1 hour, especially in the morning D. Visible atrophy of the knee and shoulder joints

C. Joint stiffness lasting longer than 1 hour, especially in the morning

20. A nurse is educating a client with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A. Ensuring adequate rest B. Limiting exposure to sunlight C. Limiting intake of alcohol D. Smoking cessation

C. Limiting intake of alcohol

12. During a routine mammogram, a client asks the nurse whether breast cancer causes the most deaths. Which type of cancer is the leading cause of death in the United States? A. Colorectal B. Prostate C. Lung D. Breast

C. Lung

31. A client with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in clients with AIDS by increasing body fat stores? A. Psyllium B. Momordica charantia C. Megestrol D. Ranitidine

C. Megestrol

26. A client with systemic lupus erythematosus (SLE) asks the nurse why the client has to come to the office so often for "check-ups." Which rationale for frequent office visits would be best for the nurse to mention? A. Seeing the client face to face B. Ensuring that the client is taking medications as prescribed C. Monitoring the disease process and how well the prescribed treatment is working D. Drawing blood work every month

C. Monitoring the disease process and how well the prescribed treatment is working

11. An emergency department nurse is triaging a 77-year-old client who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for which health problem? A. Hodgkin disease B. Non-Hodgkin lymphoma C. Multiple myeloma D. Acute thrombocythemia

C. Multiple myeloma

4. Which nursing action best demonstrates primary cancer prevention? A. Encouraging yearly Pap tests B. Teaching testicular self-examination C. Promoting and providing vaccines D. Facilitating screening mammograms

C. Promoting and providing vaccines

5. A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery? A. Salvage surgery B. Palliative surgery C. Prophylactic surgery D. Reconstructive surgery

C. Prophylactic surgery

23. A nurse is caring for a client who is being treated for leukemia in the hospital. The client was able to maintain nutritional status for the first few weeks following the diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention? A. Arrange for total parenteral nutrition (TPN). B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube. C. Provide the client with several small, soft-textured meals each day. D. Assign responsibility for the client's nutrition to the client's friends and family.

C. Provide the client with several small, soft-textured meals each day.

13. The nurse on a bone marrow transplant unit is caring for a client with cancer who has just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing diagnosis for this client? A. Fatigue related to altered metabolic processes B. Altered nutrition: less than body requirements related to anorexia C. Risk for infection related to altered immunologic response D. Body image disturbance related to weight loss and anorexia

C. Risk for infection related to altered immunologic response

36. A client has received the news that the client's treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the client receives regular health assessments in the future due to the risk of which complication? A. Iron-deficiency anemia B. Hemophilia C. Secondary malignancy D. Lymphedema

C. Secondary malignancy

25. A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A. Disease prophylaxis B. Risk reduction C. Secondary prevention D. Tertiary prevention

C. Secondary prevention

7. A nurse caring for a client who has an immunosuppressive disorder knows that continual monitoring of the client is critical. What is the primary rationale behind the need for continual monitoring? A. So that the client's functional needs can be met immediately B. So that medications can be given as prescribed and signs of adverse reactions noted C. So that early signs of impending infection can be detected and treated D. So that the nurse's documentation can be thorough and accurate

C. So that early signs of impending infection can be detected and treated

11. A nurse provides care on a bone marrow transplant unit and is preparing a client for a hematopoietic stem cell transplantation (HSCT) the following day. Which information should the nurse emphasize to the client's family and friends? A. "Your family should likely gather at the bedside in case there is a negative outcome." B. "Make sure the client doesn't eat any food in the 24 hours before the procedure." C. "Wear a hospital gown when you go into the client's room." D. "Do not visit if you've had a recent infection."

D. "Do not visit if you've had a recent infection."

14. A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. Which response by the nurse would be best? A. "Avoiding these factors can reduce the risk of Reed-Sternberg cells developing." B. "These behaviors can reduce the effectiveness of your chemotherapy." C. "Engaging in these activities increases your risk of hemorrhage." D. "It's important to reduce other factors that increase the risk of second cancers."

D. "It's important to reduce other factors that increase the risk of second cancers."

23. An 18-year-old client who is pregnant has tested positive for human immunodeficiency virus (HIV) and asks the nurse if her baby is going to be born with HIV. Which response by the nurse is the best? A. "Your baby has a one in four chance of being born with HIV." B. "Your health care provider is likely the best one to answer that question." C. "If the baby is HIV-positive, we can't do anything until after the birth, so try not to worry." D. "Your baby could contract HIV before, during, or after delivery."

D. "Your baby could contract HIV before, during, or after delivery."

8. A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. The client's blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects which diagnosis? A. Acute myeloid leukemia (AML) B. Chronic myeloid leukemia (CML) C. Myelodysplastic syndromes (MDS) D. Acute lymphocytic leukemia (ALL)

D. Acute lymphocytic leukemia (ALL)

13. A client has come into the free clinic asking to be tested for human immunodeficiency virus (HIV) infection. The client asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the acquired immunodeficiency syndrome (AIDS) virus are present in the blood, this indicates that the client has which of the following? A. Immunity to HIV B. An intact immune system C. An AIDS-related complication D. An HIV infection

D. An HIV infection

30. A client is being treated for polycythemia vera, and the nurse is providing health education. Which practice should the nurse recommend to prevent the complications of this health problem? A. Avoiding natural sources of vitamin K B. Avoiding altitudes of 1500 feet (457 meters) C. Performing active range of motion exercises daily D. Avoiding tight and restrictive clothing on the legs

D. Avoiding tight and restrictive clothing on the legs

15. A client with terminal small-cell lung cancer has been given a six-month prognosis and wants to die at home. The health care team believes the condition warrants inpatient care. The nurse might suggest which compromise? A. Discuss a referral for rehabilitation hospital. B. Panel the client for a personal care home. C. Discuss a referral for acute care. D. Discuss a referral for hospice care.

D. Discuss a referral for hospice care

10. The nurse manager is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, which action should the nurse manager emphasize? A. Adjust the dose to the client's present symptoms. B. Wash hands with an alcohol-based cleanser following administration. C. Use gloves and a lab coat when preparing the medication. D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.

D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.

9. A clinic nurse is caring for a client newly diagnosed with fibromyalgia. When developing a care plan for this client, which nursing diagnosis should the nurse prioritize? A. Impaired urinary elimination related to neuropathy B. Altered nutrition related to impaired absorption C. Disturbed sleep pattern related to central nervous system stimulation D. Fatigue related to pain

D. Fatigue related to pain

31. A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease? A. Document the color of the client's palms and face during each visit. B. Follow the client's erythrocyte sedimentation rate over time. C. Document the client's response to erythropoietin injections. D. Follow the trends of the client's hematocrit.

D. Follow the trends of the client's hematocrit.

24. A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On which aspect of the client's health should the nurse focus most closely during the visit? A. Understanding of rheumatoid arthritis B. Risk for cardiopulmonary complications C. Social support system D. Functional status

D. Functional status

12. A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain? A. Implementing distraction techniques B. Educating the client about the effective use of hot and cold packs C. Teaching the client to use NSAIDs effectively D. Helping the client manage the opioid analgesic regimen

D. Helping the client manage the opioid analgesic regimen

36. A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate? A. Position the client in the high Fowler position whenever possible. B. Temporarily eliminate animal protein from the client's diet. C. Make sure the client eats at least two servings of raw fruit each day. D. Obtain a stool culture to identify possible pathogens.

D. Obtain a stool culture to identify possible pathogens.

39. A nurse is caring for a client whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment? A. Stomatitis B. Nephropathy C. Cognitive changes D. Peripheral neuropathy

D. Peripheral neuropathy

32. A nurse's plan of care for a client with rheumatoid arthritis includes several exercise-based interventions. What goal should the nurse prioritize? A. Maximize range of motion while minimizing exertion. B. Increase joint size and strength. C. Limit energy output in order to preserve strength for healing. D. Preserve or increase range of motion while limiting joint stress.

D. Preserve or increase range of motion while limiting joint stress.

26. A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if they will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo? A. Lymphadenectomy B. Needle biopsy C. Open biopsy D. Sentinel node biopsy

D. Sentinel node biopsy

17. A client's current antiretroviral regimen includes enfuvirtide (T-20). What dietary counseling will the nurse provide based on the client's medication regimen? A. Avoid high-fat meals while taking this medication. B. Limit fluid intake to 2 L/day. C. Limit sodium intake to 2 g/day. D. Take this medication without regard to meals.

D. Take this medication without regard to meals.

8. A nurse is planning the care of a client who requires immunosuppression to ensure engraftment of depleted bone marrow during a transplantation procedure. What is the most important component of infection control in the care of this client? A. Administration of IVIG B. Antibiotic administration C. Appropriate use of gloves and goggles D. Thorough and consistent hand hygiene

D. Thorough and consistent hand hygiene

17. Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult client who is otherwise healthy. The client and the care team have collaborated and the client will soon begin induction therapy. The nurse should prepare the client for: A. daily treatment with targeted therapy medications. B. radiation therapy on a daily basis. C. hematopoietic stem cell transplantation. D. an aggressive course of chemotherapy.

D. an aggressive course of chemotherapy.