02 Cancer, Thyroid Storm, Acute Renal Failure

Which patient is most at risk for Thyroid Storm? a. A 60 year old female who reports not taking (levothyroxine) Synthroid regularly. b. A 45 year old male who has not been taking (methimazole) Tapazole as ordered and is experiencing diabetic ketoacidosis. c. A 6 year old with an allergy to iodine. d. A 25 year old female who is pregnant with her 4th child and is experiencing eczema.

Answer is b. A 45 year old male who has not been taking Tapazole as ordered and is experiencing diabetic ketoacidosis. The red flag in this option is "not been taking Tapazole" and is experiencing "DKA". This indicates the patient has hyperthyroidism (Tapazole is an antithyroid medication) and this already puts him at risk for thyroid storm. Then DKA is another added stress on the body that can send him into thyroid storm. All the other options are either incorrect or the patient is at risk for myxedema coma (a complication of HYPOTHYROIDISM).

A patient with breast cancer is about to begin radiation therapy, and asks the nurse, "How frequent are treatments and what can I expect?" An appropriate response by the nurse would be: a. "Don't worry about it. I'll walk you through everything as we go along." b. "Prior to the start of treatment, the treatment area will be specifically marked with a colored semipermanent ink by your doctor. He will then aim an external beam to the targeted mass to reduce it's size. Treatment is usually given 5-7 days per week for 15-30 minutes per day over 2-7 weeks." c. "It's a painful procedure, but we'll give you cold packs to reduce the swelling post-treatment." d. ""Prior to the start of treatment, the treatment area will be specifically marked with a colored semipermanent ink by your doctor. He will then aim an external beam to the targeted mass to reduce it's size. Treatment is usually given every 2-3 weeks."

"Prior to the start of treatments, the treatment area will be specifi- cally located by the radiation oncologist and marked with colored semipermanent ink or tatoos. Treatment is usually given 5 days per week for 15 to 30 minutes per day over 2 to 7 weeks."

What will an EKG reveal in a patient with hyperthyroidism who has excessive thyroid hormone in the heart?

- A-fib - Changes in P & T waves

The goals of cancer treatment are (3) ?

- Cure - Control - Palliation

What causes can cause thyroid storm?

- Untreated or undiagnosed HYPERthyroidism - Illness, stress, trauma (septic, DKA, surgery "thyroidectomy") - Graves Disease not being treated correctly - Not taking anti-thyroid meds as prescribed - Medications that increase thyroid hormone (Salicylates - Aspirin, Bayer) - Radioactive iodine (CT scan or Tx) thyroid LOVES iodine - Pregnant

What are the risk factors of thyroid storm?

- Women - 30-40 - Genetic (autoimmune) - Family hx (esp. Graves Disease) - Cigarette smoking - Not enough iodine - Stress (surgery, trauma, infection) - Not med compliant with anti-thyroid meds

Acute renal failure is generally identified by oliguria (urine output <_____ mL/day).

400 ml/day

Why don't we see a lot of goiters in the U.S., Great Britain, and Australia?

Because we have iodine in our salt. You see goiters more frequently in developing countries where they don't have the luxury of iodine in their salt.

What acronym is used to help nursing students remember the general s/s of cancer?

CAUTION: C: Change in bowel or bladder habits. A: A sore that does not heal. U: Unusual bleeding or discharge. T: Thickening or lump in the breast or elsewhere. I: Indigestion or difficulty in swallowing. O: Obvious change in a wart or mole. N: Nagging cough or hoarseness.

A patient with hyperthyroidism is scheduled to undergo a radioactive iodine uptake test, and asks the nurse, "What is this for and what does it entail?" The nurse should include which of the following in her patient teaching? SELECT ALL THAT APPLY: a. "This test clarifies the size and function of the thyroid gland." b. "This procedure is safe for pregnant women." c. "We will need to complete an assessment for allergy to iodine or shellfish before the test." d. "The uptake of radioactive iodine, administered 24 hours prior to the test, is measured." e. "A decreased uptake is indicative of hyperthyroidism."

CORRECT: a. "This test clarifies the size and function of the thyroid gland." c. "We will need to complete an assessment for allergy to iodine or shellfish before the test." d. "The uptake of radioactive iodine, administered 24 hours prior to the test, is measured." INCORRECT: b. "This procedure is safe for pregnant women." --> FALSE! NOT SAFE! e. "A decreased uptake is indicative of hyperthyroidism." --> FALSE! AN ELEVATED UPTAKE IS HYPERTHYROIDISM.

Which of the following patients are appropriate candidates for PTU? SELECT ALL THAT APPLY. a. 18 year old with Graves disease b. Pregnant mother in her 3rd trimester with hyperthyroid c. 25 year old woman who has underwent thyroid surgery two days ago d. Woman with a history of Graves disease who's vital signs include a temperature 96.8, pulse 58/minute and regular, BP 110/60. e. Patient with Graves disease who had an allergic reaction to methimazole.

CORRECT: a. 18 year old with Graves disease b. Pregnant mother in her 3rd trimester with hyperthyroid e. Patient with Graves disease who had an allergic reaction to methimazole. INCORRECT: c. 25 year old woman who has underwent thyroid surgery two days ago --> FALSE. - Need to achieve euthyorid state BEFORE surgery or radiation. d. Woman with a history of Graves disease who's vital signs include a temperature 96.8, pulse 58/minute and regular, BP 110/60. --> FALSE. These are s/s of HYPOthyroid. PTU is used to treat HYPERthyroid. Indications include: - Graves in YOUNG patients - Hyperthyroid during pregnancy --> PTU is used for patients in their 1ST TRIMESTER instead of methimazole. - Need to achieve euthyorid state BEFORE surgery or radiation. - Adverse reaction to methimazole

What nursing interventions are appropriate for patients experiencing thyroid storm? SELECT ALL THAT APPLY: a. Administer propranolol as prescribed b. Place in a cool, quiet room away from ill patients and noisy areas c. Use light bed coverings and change linen frequently d. Discourage exercises involving large muscle groups

CORRECT: a. Administer propranolol as prescribed b. Place in a cool, quiet room away from ill patients and noisy areas c. Use light bed coverings and change linen frequently INCORRECT: d. Discourage exercises involving large muscle groups--> though you want to avoid high energy exercises, a nurse should encourage and assist the patient with mild exercises involving the large muscle groups to release nervous tension and restlessness.

Which nursing actions should a nurse implement to prevent extravasation when administering vesicant chemotherapy medications such as doxorubican hydrochloride? SELECT ALL THAT APPLY: a. Administer vesicant infusions through a peripheral IV device if it is to be infused in less than 60 minutes and check latency every 5-10 minutes. b. Ask the client frequently about discomfort and peripheral IV site during infusion c. Check IV pump and alarm for indications of infiltration of the medication d. Check for blood return in the central venous catheter prior to administering the vesicant medication e. Flush the peripheral and central venous cat ethers with 5-10mL of normal saline between medications f. Use small-gauged syringes to flush all catheters

CORRECT: a. Administer vesicant infusions through a peripheral IV device if it is to be infused in less than 60 minutes and check latency every 5-10 minutes. b. Ask the client frequently about discomfort and peripheral IV site during infusion d. Check for blood return in the central venous catheter prior to administering the vesicant medication e. Flush the peripheral and central venous cat ethers with 5-10mL of normal saline between medications INCORRECT: c. Check IV pump and alarm for indications of infiltration of the medication --> FALSE! IV pumps and alarms cannot be relied upon toe detect extravasation bc infiltration usually does not cause sufficient pressure to trigger an alarm. f. Use small-gauged syringes to flush all catheters --> FALSE! Too much pressure in line!

In discussing bad news with a client about a diagnosis of cancer, which actions are most appropriate for a nurse to use at this time of emotional impact? SELECT ALL THAT APPLY: a. Advocate expressing feelings b. Avoid using the word "cancer" c. Give the client as much information as possible d. Maintain a professional detachment e. Promote a broad time frame by avoiding a definite time scale f. Provide for privacy and adequate time with family present

CORRECT: a. Advocate expressing feelings e. Promote a broad time frame by avoiding a definite time scale f. Provide for privacy and adequate time with family present INCORRECT: b. Avoid using the word "cancer" c. Give the client as much information as possible --> remember, DON'T BE A CHATTY KATHY! THIS MAY BE OVERWHELMING - LISTEN TO THE PATIENT'S CUES! d. Maintain a professional detachment

A patient is in the recovery room after a thyroidectomy. Postoperatively, the client should be carefully assessed for which of the following: SELECT ALL THAT APPLY: a. Edema and swelling of the airway b. Bleeding (check for bleeding behind the neck) c. Tetany, nervousness, and irritability d. CBCs

CORRECT: a. Edema and swelling of the airway b. Bleeding (check for bleeding behind the neck) c. Tetany, nervousness, and irritability --> s/s of hypocalcemia d/t parathyroid damage. INCORRECT: d. CBCs

A nurse doesn't verify x-ray placement of the CVAD tip before administering chemotherapy drugs via IV. Extravasation occurs and the patient is now experiencing the side effects of the nurse's mistake. What might these side effects include? Select all that apply: a. Sepsis b. Amputation c. Contractures d. Joint pain e. Nerve loss f. Loss of eye sight

CORRECT: a. Sepsis b. Amputation c. Contractures d. Joint pain e. Nerve loss INCORRECT: f. Loss of eye sight

A patient has just received her first radiation treatment. Which of the following instructions should the nurse include in her patient teaching? SELECT ALL THAT APPLY: a. Wash the skin that is marked as the radiation site only with plain water, no soap b. Do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period. c. Take care not to wash off the treatment marks. d. Do not rub, scratch, or scrub treated skin areas. If necessary, use only an electric razor to shave the treated area. e. Apply heat nor cold (e.g., heating pad or ice pack) to the treatment site to tamper down the swelling f. Inspect the skin for damage or serious changes, and report these to the radiologist or physician. g. Stay hydrated and eat a balanced diet h. Slather on aquaphor and cover with light dressing (old t-shirt squares) to prevent chafing i. Avoid tight-fitted clothing to prevent chafing. j. Monitor for s/s of infection (redness, fever, warm to touch, swollen, pain)

CORRECT: a. Wash the skin that is marked as the radiation site only with plain water, no soap b. Do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period. c. Take care not to wash off the treatment marks. d. Do not rub, scratch, or scrub treated skin areas. If necessary, use only an electric razor to shave the treated area. f. Inspect the skin for damage or serious changes, and report these to the radiologist or physician. g. Stay hydrated and eat a balanced diet h. Slather on aquaphor and cover with light dressing (old t-shirt squares) to prevent chafing i. Avoid tight-fitted clothing to prevent chafing. j. Monitor for s/s of infection (redness, fever, warm to touch, swollen, pain) INCORRECT: e. Apply heat or cold (e.g., heating pad or ice pack) to the treatment site to tamper down the swelling --> FALSE. DO NOT APPLY HEAT OR COLD TO THE RADIATED SITE.

Which of the following can cause a false elevation in serum thyroid levels in a patient undergoing a radioactive iodine uptake diagnostic test? SELECT ALL THAT APPLY: a. contrast media b. oral contraceptives c. severe illness (cancer, cirrhosis, etc.) d. malnutrition e. aspirin f. corticosteroids g. phenytoin sodium

CORRECT: a. contrast media b. oral contraceptives INCORRECT --> ALL OF THESE CAUSE A FALSE DECREASE IN SERUM THYROID HORMONE LEVELS: c. severe illness (cancer, cirrhosis, etc.) d. malnutrition e. aspirin f. corticosteroids g. phenytoin sodium

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which patient teaching would be appropriate to include in the plan of care? a. "Monitor for s/s of the flu (nausea, headache, chills) because these are life threatening symptoms of infection." b. "Get out of bed slowly, pausing between different elevations (sitting up, standing)." c. "Interferon is a radiation therapy used to suppress the proliferation of malignant cells." d. "You will be well enough to work at the Minnesota State Fair while on interferon."

CORRECT: b. "Get out of bed slowly, pausing between different elevations (sitting up, standing)." --> Patients may experience ORTHOSTATIC HYPOTENSION and are at a FALL RISK while on interferon. INCORRECT: a. "Monitor for s/s of the flu (nausea, headache, chills) because these are life threatening symptoms of infection." --> FALSE. If short term, flu like symptoms are a normal finding. c. "Interferon is a radiation therapy used to suppress the proliferation of malignant cells." --> FALSE. Interferon is an IMMUNE MODIFIER/BIOLOGIC therapy that suppresses proliferation of malignant cells by attacking cancer cells directly and manipulating the immune system to create an environment that cancer cells don't like. d. "You will be well enough to work at the Minnesota State Fair while on interferon." --> FALSE. You will be immunocompromised on this med and should stay away from large crowds.

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

CORRECT: b. "I rarely have the energy to get out of bed." --> REASON: Fatigue can be a dose-limiting toxicity for use of biologic therapies. INCORRECT: a. "I have frequent muscle aches and pains." AND d. "I experience chills after I inject the interferon." FALSE BEAUSE: Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use, BUT if they persist, notify the provider. c. "I take acetaminophen (Tylenol) every 4 hours." FALSE --> Patients are advised to use Tylenol every 4 hours. The meds you really have to avoid are salicylates like Aspirin.

A patient just received a large dose of iodine (Lugol's and SSKI) in preparation for his thyroidectomy. The CNA asks the nurse how iodine therapy works. The nurse's most appropriate response is: a. "Iodine solution damages and destroys the thyroid tissue to limit thyroid hormone secretion." b. "Iodine solution given in large quantities rapidly inhibits synthesis of T3 and T4, blocks the secretion of these hormones into circulation, and decreases the vascularity of thyroid gland, making surgery safer and easier." c. "Iodine solution are used for symptomatic relief of thyroid storm by blocking the effects of the SNS (tachycardia, nervousness, irritability, tremors)." d. "Iodine solution is indicated in patients with large goiters that press against the trachea or for patients who are unresponsive to RAI."

CORRECT: b. "Iodine solution given in large quantities rapidly: 1) INHIBITS SYNTHESIS of T3 and T4 2) BLOCKS the SECRETION of these hormones into circulation 3) DECREASES the VASCULARITY of THYROID GLAND, making surgery safer and easier."

A doctor has prescribed propranalol to a patient with thyroid storm. Propranalol is contraindicated in which patient populations? SELECT ALL THAT APPLY: a. IBS b. A-fib c. COPD d. RA e. asthma f. cor pulmonale

CORRECT: b. A-fib c. COPD e. asthma f. cor pulmonale INCORRECT: a. IBS d. RA Beta blockers are contraindicated in patients with asthma and heart disease. COPD is a combo of asthma + bronchitis + emphysema.

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? SELECT ALL THAT APPLY: a. anorexia b. heat intolerance c. constipation d. palpitations e. weight loss f. bradycardia

CORRECT: b. heat intolerance d. palpitations e. weight loss INCORRECT: a. anorexia --> FALSE. In anorexia, the patient is not eating. In hyperthyroid, the patient eats a ton, but loses weight. c. constipation --> FALSE. They experience diarrhea f. bradycardia --> FALSE> They experience tachycardia.

A nurse is assessing a patient who is 12 hours post-op following thyroidectomy. The nurse should identify which of the following findings as indicative of thyroid crisis? SELECT ALL THAT APPLY: a. bradycardia b. hypothermia c. dyspnea d. ab pain e. mental confusion

CORRECT: c. dyspnea d. ab pain e. mental confusion Remember, in a thyroidectomy, the doc is cutting into the thyroid and releasing tons of T3&T4 (potentially) into circulation...this can lead to thyroid storm, so c, d, and e are symptoms of hyperthyroidism/thyroid storm.

A nurse is performing a neurological assessing a patient with Graves Disease for thyroid storm. What method might the nurse use? a. Tapping the facial nerve in front of the ear to illicit a muscle spasm and tremor b. Inflate a BP cuff for a few minutes to illicit tremors in the hands c. Look at the GFR labs d. Have the patient hold our their hands to observe for tremors

CORRECT: d. Have the patient hold our their hands to observe for tremors INCORRECT: a. Tapping the facial nerve in front of the ear to illicit a muscle spasm and tremors --> FALSE tests hypocalcemia b. Inflate a BP cuff for a few minutes to illicit tremors in the hands --> FALSE tests hypocalcemia c. Look at the GFR labs --> FALSE tests kidney function

A 32-year-old woman meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesn't go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client's current needs? a. Call the physician to discuss allowing the client to return to work earlier. b. Suggest that the client learn relaxation techniques to help with her insomnia c. Perform a nutritional assessment to assess for anorexia d. Ask open-ended questions about sexuality issues related to her mastectomy

CORRECT: d. Ask open-ended questions about sexuality issues related to her mastectomy The content of the client's comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first address the psychosocial and sexual issues that are contributing to her sleeping difficulties. A nutritional assessment may be useful, but there is no indication that she has anorexia.

The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply a) instill isotonic eye drops as necessary b) provide several, small, well-balanced meals c) provide rest periods d) keep environment warm e) encourage frequent visitors and conversation f) weigh the client daily

CORRECT: a, b, c, and f (a) The client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea. (b and f) The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. (c) The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy. INCORRECT: d d) keep environment warm --> they already feel hot e) encourage frequent visitors and conversation --> they are already hyper stimulated

For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures

Correct answer is C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

Which of the following patients is at increased risk of breast cancer? a. A 65 year old African American woman who smokes 2 packs a day, with fibrocystic breasts b. a 22 year old caucasian woman who is overweight and has had 2 miscarriages. c. A 40 year old morbidly obese male drinks a case of beer a night, makes midnight secret runs to Taco Bell, smokes 2 cigars a week, and who's dad had breast cancer. d. A 75 year old hispanic woman who has a family history of breast cancer, and has had radiation treatment to her neck.

Correct answer: c. A 40 year old morbidly obese male drinks a case of beer a night, makes midnight secret runs to Taco Bell, smokes 2 cigars a week, and who's dad had breast cancer. Breast cancer risks: - Post menopause >55 - Fibrocystic breasts - Female - Family hx / hereditary - Lifestyle (smoking, diet, drinking) - Radiation of face/neck before age 30 - Caucasian - Overweight - No full term pregnancies or 1st child after 30 - Periods younger than 12 years old

A CNA asks a nurse, "What is the mechanism of action of radiation therapy?" The most appropriate response by the nurse is: a. "It works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects." b. "During treatment, your blood travels through tubes from your body into the dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which removes waste and extra fluid." c. "It works by damaging the genes (DNA) in cells. Genes control how cells grow and divide. When radiation damages the genes of cancer cells, they can't grow and divide any more. Over time, the cells die. This means radiation can be used to kill cancer cells and shrink tumors."

Correct: c. "It works by damaging the genes (DNA) in cells. Genes control how cells grow and divide. When radiation damages the genes of cancer cells, they can't grow and divide any more. Over time, the cells die. This means radiation can be used to kill cancer cells and shrink tumors." Incorrect: a. "It works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects." --> FALSE. This is chemotherapy b. "During treatment, your blood travels through tubes from your body into the dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which removes waste and extra fluid." --> FALSE. This is hemodialysis.

A nurse is providing a community teaching regarding cancer prevention. Which of the following should she include in her teaching? SELECT ALL THAT APPLY: a. Screenings - PAP, mammogram b. Regular physical exams c. Regular exercise d. Low saturated fat, high fiber diet e. Lose weight if needed f. Reduce stress g. Avoid HIV patients h. Wear sunscreen

Correct: c. Regular exercise d. Low saturated fat, high fiber diet e. Lose weight if needed f. Reduce stress h. Wear sunscreen Incorrect: a. Screenings - PAP, mammogram b. Regular physical exams g. Avoid HIV patients

The difference between benign and malignant neoplasms is: a. Malignant neoplasms are encapsulated, benign are not b. Malignant neoplasms are typically differentiated, while benign are not c. Malignant neoplasms don't metastasize, but benign do d. Recurrence rates of benign neoplasms is rare, but possible in malignant neoplasms e. Benign neoplasms have marked vascularity, while malignant neoplasms don't. f. The cells of benign cells are abnormal and become more unlike parent cells, but malignant cells are fairly normal and similar to parent

Correct: d. Recurrence rates of benign neoplasms is rare, but possible in malignant neoplasms

A patient receiving chemotherapy agents through their CVAD is experiencing pain, stinging and burning at their insertion site. What might the nurse suspect?

Extravasation - leaking chemo drugs into surrounding tissue --> tissue necrosis and amputation!

What is the first line of defense for hyperthyroidism vs. thyroid storm?

Hyperthyroidism --> antithyroid drugs PTU & methimazole Thyroid storm --> Cardiac meds like propranalol to get HR down (otherwise, they'll die!)

What is the pharm action of anti-thyroid drugs, PTU and methimazole?

INHIBITS SYNTHESIS of T3 & T4 (thyroid hormone)

What is the common med route of chemotherapy? Why?

IV (usually PICC lines) because the chemo meds are caustic on peripheral veins.

Which of the following are not a treatment for Thyroid Storm? a. Propylthiouracil (PTU) b. Levothyroxine (Synthroid) c. Propranalol (Inderal) d. Glucocorticoids

Levothyroxine (Synthroid) is a medication treatment for HYPOthyroidism. All the other options are for HYPERthyroidism.

Which of the following foods below should a patient experiencing a thyroid storm avoid? Select all that apply:* a. Shrimp b. Milk c. Hard boiled eggs d. Seaweed (Kelp) e. Broccoli f. Peas

The answer is A, B, C, D. Foods high in iodine are seafoods like shrimp, seaweed, and dairy/eggs.

A patient undergoing radiation treatment complains of their skin feeling hot, red, itchy and uncomfortable. What should the nurse tell the patient?

This often precedes drying and flaking of the skin, known as dry desquamation. The cumulative effect of further doses of radiotherapy can then cause the skin to break down, leading to moist desquamation.

What can cause extravasation?

What can cause this? - CVAD surgically placed in an area prone to movement; difficult to secure - inadequately secured needle in implanted port - inadequately secured catheter - inappropriate needle length for Implanted Intravenous - Access Port (IVAP) (ie too short to reach back of reservoir) development of fibrin sheath/thrombus at catheter tip - IVAP (port)/catheter separation, catheter fracture or catheter dislodgement - flushing with a small gauge syringe (pressure bursts line)

A patient with thyroid cancer will likely need _____.

a thyroidectomy Other candidates are: - Unresponsive to anti-thyroid therapy (PTI, methamizole, iodine) - Large goiter pressing against trachea - Not a candidate for RAI

After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? a) hoarseness of voice b) difficulty in swallowing c) tetany d) fever

a) hoarseness of voice Laryngeal nerve damage is manifested by severe hoarseness of voice of "whispery voice".

When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" b. "How long ago were you diagnosed with this cancer?" c. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d. "How do you feel about having a possibly terminal illness?"

a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.

A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? a. "Chemotherapy affects all rapidly dividing cells by decreasing the # of malignant cells." b. "Chemotherapy alters the DNA structure of malignant cells." c. "Chemotherapy makes cancer cells susceptible to drug toxins." d. "Chemotherapy encourages cancer cells to divide."

a. "Chemotherapy affects all rapidly dividing cells by decreasing the # of malignant cells."

A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is: a. "Why don't we talk about the options you have for the care of your children?" b. "Many patients with cancer live for a long time, so there is time to plan for your children." c. "For now you need to concentrate on getting well, not worry about your children." d. "Perhaps your ex-husband will take the children when you can't care for them."

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

A 56-year-old client has lost 34 pounds since the start of chemotherapy for colon cancer. Which of the following laboratory findings should be reported to the health care provider? a. Albumin of 2.4 g/dL b. White blood cell (WBC) count 3800/mm3 c. Urine specific gravity 1.020 d. Platelet count 90,000/mm3

a. Albumin of 2.4 g/dL Albumin levels less than 3.5 g/dL indicate catabolism and possible malnutrition.

A patient taking (methimazole) Tapazole reports feeling dizzy, intolerant to cold, and tired. On assessment, you note the patient's heart rate is 45 and blood pressure is 70/30. What is the most likely cause? a. Antithyroid toxicity b. Agranulocytosis c. Thyroid storm d. Bronchospasm

a. Antithyroid toxicity The patient may be experiencing antithyroid toxicity (too much of the antithyroid medication). This will causes signs and symptoms of hypothyroidism which can lead to a myxedema coma, if not treated immediately.

A patient with hyperthyroidism is experiencing pain and requests something PRN. Which medication should the nurse avoid? SELECT ALL THAT APPLY: a. Aspirin b. Tylenol c. Bayer d. Ibuprofen e. Advil f. Motrin

a. Aspirin c. Bayer Both of these are salicylates and can increase thyroid hormone production. Tylenol, Ibuprofen (Advil, Motrin) are not salicylates, and can be administered.

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the PRIORITY nursing assessment is which of the following? a. Assess LOC b. Assess skin turgor c. Assess bowel sounds d. Assess temperature

a. Assess LOC A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following? a. Hypocalcemia b. Hypercalcemia c. Hypokalemia d. Hyperkalemia

a. Hypocalcemia The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

Which instruction should a nurse include when teaching parents who have a child diagnosed with hypoparathyroidism? a. Monitor for muscle spasms, tingling around the mouth, and muscle cramps b. Monitor for side effects of excess medication therapy to include dry, scaly, coarse skin. c. Decrease intake of foods high in calcium and phosphorus. d. Increase environmental stimuli and encourage participation in high-energy activities.

a. Monitor for muscle spasms, tingling around the mouth, and muscle cramps The parathyroid RAISES (think PRAISES!) calcium levels. In hypoparathyroidism, not enough thyroid hormone is produced so calcium levels are low. Muscle spasms, tingling around the mouth, and muscle cramps are signs of hypocalcemia. Dry, scaly, coarse skin ARE signs of hypoparathyroidism, but they are NOT due to medication overdose. You want to keep the environment QUIET. TEST TIP: Focus on looking for key words in the options that are opposite of the expected finding and treatment for hypoparathyroidism and eliminate the options.

A nurse obtains the following assessment data for a client diagnosed with acute myeloid leukemia. For which finding should a nurse plan interventions FIRST? a. Pain from mucositis b. Weakness and fatigue c. T 99, P 100, R 20, BP 132/64 d. Ecchymosis and petechiae noted on arms

a. Pain from mucositis Pain control is priority. Elevated vitals could be d/t pain. Weakness and fatigue could be d/t anemia. Ecchymosis and petechiae are associated with low placement counts and the nurse should check the labs, BUT pain is the priority.

A client receiving chemotherapy has an infiltrated intravenous line and extravasation at the site. The nurse avoids doing which of the following in the management of this situation? a. applying direct manual pressure to the site b. stopping the administration of the medication c. administering an available antidote as prescribed d. leaving the needle in place and aspirating any residual medication

a. applying direct manual pressure to the site General recommendations for managing extravasation of a chemotherapeutic agent include stopping the infusion, leaving the needle in place and attempting to aspirate any residual medication from the site, administering an antidote if available, and assessing the site for complications. Direct pressure is not applied to the site because it could further injure tissues exposed to the chemotherapeutic agent.

A child is admitted with thyrotoxic crisis. Which manifestations should the nurse expect to observe during the day? SELECT ALL THAT APPLY: a. delirium b. hypothermia c. bradycardia d. nausea e. vomiting

a. delirium d. nausea e. vomiting

If T3 and T4 levels are down, we would expect the TSH levels to be _____. If T3 and T4 levels are up, we would expect the TSH levels to be _____. a. elevated, decreased b. decreased, elevated c. decreased, decreased d. elevated, elevated e. no change, elevated f. elevated, no change

a. elevated, decreased If T3 & T4 are down, TSH is up because it needs to signal the thyroid gland to secrete more T3&T4 If T3 & T4 are up, TSH is down because it does not need to signal the thyroid gland to make more T3&T4.

Which nursing diagnosis should have the highest priority for a client experiencing superior vena cava syndrome? a. ineffective breathing pattern b. ineffective tissue perfusion c. risk for infection d. impaired skin integrity

a. ineffective breathing pattern --> occurs because the superior vena cava is located next to the main stem bronchus and causes compression of the intrathoracic structures.

How do kidneys control Na+ levels and K+ levels? a. Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the levels of Na+ and K+ b. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+ c. The kidneys release renin which controls K+. d. The kidneys release angiotensin which causes Na+ realease.

b. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the levels of Na+ and K+

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. The nurse evaluates that the teaching is understood when the client states, "I should: a. "Lay supine at night." b. "Avoid using a sleeping mask at night." c. "Eliminate excessive blinking." d. "Not move my extraocular muscles."

b. "Avoid using a sleeping mask at night." I know Louise said to use a mask, but NCLEX EBP says don't because the mask may irritate or scratch the eyes if the mask moves during sleep. This is why they said to "tape the eyes shut" instead. "LEWIS" INTERVENTIONS: - Eye drops - Salt restriction to reduce periorbital edema - Elevate head of bed to promote fluid drainage from periorbital area - Dark glasses to reduce glare and prevent irritation from dust/dirt/airflow - Tape eyelids shut during sleep if cannot close

A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is: a. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." b. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." c. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." d. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return."

b. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." The impact on sperm count and erectile function depends on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

Which patient is more likely to cope BEST with the stress of chemotherapy and radiation treatment? a. A 78 year old immigrant from Japan who has stage 4 lung cancer, and cries alone in her room every night when no one is watching because she doesn't want to show weakness. b. A 32 year old Hispanic married woman and parent two toddlers who has a recurrent bout of breast cancer, and attends church religiously every Wednesday and Sunday, and views herself as a "fighter". c. A 19 year old teenage boy with terminal leukemia who draws to take his mind off his illness, despite feeling ugly and throwing up every day from his chemo treatments.

b. A 32 year old Hispanic married woman and parent two toddlers who has a recurrent bout of breast cancer, and attends church religiously every Wednesday and Sunday, and views herself as a "fighter". Factors that impact coping ability include: - Ability to cope with stressful events in the past. - Significant other available - Can express feelings/concerns - Age (younger may cope better) - Extent of disease - Disruption of body image - Presence of symptoms - Past experience with cancer - Attitude associated with cancer

Which of the following medication orders should a nurse question if ordered on a patient with thyroid storm?* a. Propylthiouracil "PTU" for a 25 year old who is 8 weeks pregnant: b. Aspirin as needed for a fever greater than 102.2 'F c. Propranalol (Inderal) for a patient who reports having insomnia d. Tapazole for a 30 year old having complaints of a headache

b. Aspirin as needed for a fever greater than 102.2 'F A patient who has hyperthyroidism or thyroid storm should NEVER take salicylate (ex: aspirin) because it canincrease thyroid hormones. All the other options are correct or insignificant for why the patient is taking the medication.

A female client undergoing chemotherapy for breast cancer is distressed about hair loss. The most effective intervention by the nurse would be to: a. Teach the client about daily scalp massaging and washing to stimulate hair growth b. Explain hair loss is temporary and will grow back to original appearance c. Provide resources of wig selection before hair loss begins d. Recommend limited social interaction until hair regrows

b. Explain hair loss is temporary and will grow back to original appearance Wig selection should be made before hair completely falls out, as hair may or may not grow back to original appearance. Scalp massage and frequent washing will promote hair loss. This client should be encouraged to socialize with others.

A physician orders a patient in thyroid storm to be started on propranalol (Inderal). What in the patient's health history causes the nurse to question the doctor's order?* a. History of mental illness b. History of asthma c. History of tachycardia d. History of cancer

b. History of asthma Patients with a history of asthma should not take propranalol (Inderal) (a beta blocker) because it can cause asthma exacerbation or bronchospasm. Therefore, the nurse should question this order.

A doctor has prescribed methimazole to a pregnant woman in her 1st trimester for her hyperthyroidism. The nurse should: a. Administer the medication on an empty stomach. b. Hold the medication and call the doctor. c. Administer the medication with milk to ease the GI side effects. d. Advise the patient not to drive until the effects of the medication are known - this drug can cause dizziness.

b. Hold the medication and call the doctor. Methimazole is contraindicated in pregnant women in their 1st trimester of pregnancy. This means, a woman in her 2nd and 3rd trimesters CAN be prescribed methimazole. Be careful how the questions are worded! PTU is used instead (think P-pregnant, P-PTU) in the 1st trimester of pregnancy.

A client presents to the emergency room with a history of Graves' disease. The client reports having symptoms for a few days, but has not previously sought or received any additional treatment. The client also reports having had a cold a few days back. Which of the following interventions would be appropriate to implement for this client, based on the history and current symptoms? Select all that apply. a. Administer aspirin b. Replace intravenous fluids c. Induce shivering d. Relieve respiratory distress e. Administer a cooling blanket

b. Replace intravenous fluids c. Induce shivering d. Relieve respiratory distress e. Administer a cooling blanket Rapid treatment of thyroid storm is essential to preserve life. Treatment includes cooling without aspirin (which increases free TH) or inducing shivering, replacing fluids, glucose, and electrolytes, relieving respiratory distress, stabilizing cardiovascular function, and reducing TH synthesis and secretion. #1 is incorrect because cooling happens without the use of aspirin. All of the other choices are correct.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? a. Diabetic ketoacidosis b. Thyroid crisis c. Hypoglycemia d. Tetany

b. Thyroid crisis Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

A client's absolute neutrophil count is less than 1000/mm3 during a course of chemotherapy. Which of the following interventions would be most appropriate for the nurse to implement? a. Wearing a gown and mask while caring for this client b. Washing hands before entering the room c. Limiting visitors d. Contacting the physician to obtain an order for erythropoietin (Epogen)

b. Washing hands before entering the room Remember! Single most important intervention for disease transmission!

A client with renal cancer is being treated preoperatively with radiation therapy. The nurse evaluates that the client has an understanding of proper care of the skin over the treatment field if the client states to: a. wash the ink marks off the skin b. avoid skin exposure to direct sunlight c. apply perfumed lotion to the affected skin d. wear tight clothing over the skin site to provide support

b. avoid skin exposure to direct sunlight

Anti-cancer medication administered to keep cancer dormant but NOT completely wipe it out fit into what cancer treatment goal? a. cure b. control c. palliative

b. control

A client diagnosed with Hodgkin's lymphoma develops radiation pneumonitis 3 months after radiation treatment. For which symptoms of radiation pneumonitis should the nurse observe in the client? a. tachypnea, hypotension, fever b. cough, fever, dyspnea c. bradypnea, cough, decreased urine output d. cough, tachycardia, altered mental status

b. cough, fever, dyspnea --> classic sign of radiation pneumonitis

A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify which of the following lab results is an expected finding? a. decreased thyrotropin receptor antibodies b. decreased thyroid-stimulating hormone (TSH) c. Decrease free thyroxine index d. Decreased triiodothyronine

b. decreased thyroid-stimulating hormone (TSH) Remember, TSH down, T3&T4 up in hyperthyroid!

The thyroid hormone _____ calcium levels, and the parathyroid hormone _____ calcium levels. a. increases, decreases b. decreases, increases c. increases, increases d. decreases, decreases

b. decreases, increases thyroid gland LOWERS blood calcium levels. parathyroid glands RAISES blood calcium levels.

A patient undergoing chemo treatment has a body temperature of 101, HR 95, and a RR 24. Which lab finding would alarm the nurse to take immediate action? a. platelet count of 90,000 b. neutrophil count of 1000 c. RBC count of 3.9 d. albumin 2.9

b. neutrophil count of 1000. Neutropenia is a serious risk factor for life-threatening infection and sepsis. Significant neutropenia will prompt treatment delay or modification.

Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? a. endometrial polyps b. ovarian cancer c. cervical dysplasia d. history of heart disease

b. ovarian cancer ovarian cancer and breast cancer are very closely linked.

Of what precautions should a client receiving radioactive iodine-131 be made aware? a.) Drink plenty of fluids, especially those high in calcium. b.) Avoid close contact with children or pregnant women for one week after administration of drug. c.) Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety. d.) Wear a mask if around children or pregnant women.

b.) Avoid close contact with children or pregnant women for one week after administration of drug. After receiving radioactive iodine-131, you should avoid prolonged, close contact with other people for several days, particularly pregnant women and small children. The majority of the radioactive iodine that has not been absorbed leaves the body during the first two days following the treatment, primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces.

The pharm action of propranalol is?

beta blocker that BLOCKS EFFECTS OF CNS

Upon auscultation of the thyroid area of a patient with an enlarged thyroid gland r/t hyperthyroidism, what might the nurse hear?

bruits (turbulent blood flow)

A nurse is providing teaching to a client beginning external beam radiation therapy to the right axilla. The nurse should emphasize: a. Use of a heating pad to promote circulation b. Use of cold compresses to relieve pain c. Applying deodorant only to the left axilla d. Immobilization of the right arm to prevent further tissue damage

c. Applying deodorant only to the left axilla Hot, cold, and chemical applications to the radiation site should be avoided. The arm should be used freely to avoid contractures or atrophy.

A nurse is caring for a patient who has just undergone a subtotal thyroidectomy. His/her priority intervention is: a. Monitor for electrolyte imbalances, especially calcium b. Control pain with medications c. Assess every 2 hours for 24 hours for s/s of hemorrhaging or tracheal compression and have a trach kit, O2, and suction ready. d. Monitor vital signs every 15 minutes x 4

c. Assess every 2 hours for 24 hours for s/s of hemorrhaging or tracheal compression and have a trach kit ready. Your PRIORITY intervention is keeping the airway patent (ABCs).

A nurse is providing a information to a patient who has just been diagnosed with hyperthyroidism. Which of the instructions below indicate a knowledge deficit? a. A high calorie diet of 4000-5000 cal/day may be ordered b. Expect to eat 6 full meals a day with high protein snacks, minerals, and vitamins c. Decrease carb and caffeine intake d. Avoid high-seasoned and high-fiber foods because they stimulate an already hyperactive GI

c. Decrease carb and caffeine intake Although you DO decrease caffeine intake, you should INCREASE your carb intake

In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions? a. Provide emotional support b. Provide nutritional support c. Provide pain control d. Prepare the client's will

c. Provide pain control The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort. Preparing the client and his family for the impending death and providing emotional support is also important but shouldn't be the primary focus until the pain is under control. Nutritional support may be provided, but as the terminal phase advances, the client's nutritional needs greatly decrease. Nursing care doesn't focus on helping the client prepare the will.

The nurse counsels the patient receiving radiation or chemo therapy that: a. Effective birth control methods should be used for the rest of the patient's life b. If nausea and vomiting occur during treatment, the treatment plan will be modified c. after successful treatment, the return of the patient's previous functional level can be expected d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity

c. after successful treatment, the return of the patient's previous functional level can be expected

The goal of palliation cancer treatment is to: a. eradicate cancer b. keep cancer dormant c. control symptoms and maintain satisfactory quality of life

c. control symptoms and maintain satisfactory quality of life

Lugol's solution helps block ________ of thyroid hormones in thyroid storm. Which of the following are a common side effect of this medication? a. synthesis; oral sores b. excretion; swollen lymph nodes c. secretion; taste changes d. movement; hypocalcemia

c. secretion; taste changes

A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a) relief of pain b) signs of renal toxicity c) signs and symptoms of hyperglycemia d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A doctor has prescribed methimazole to a 21 year old who has recently been diagnosed with Graves Disease. What is an appropriate question for the doctor to ask? a. "Are you on any anti-depressants, especially SSRIs?" b. "How many alcoholic beverages do you consume a day?" c. "Is there someone here who can drive you home. A common side effect of this medication is dizziness, so driving is not advised until we know how this medication is going to affect your body." d. "Are you, or is there a chance that you are, pregnant?"

d. "Are you, or is there a chance that you are, pregnant?" Methimazole is contraindicated in women in their 1st trimester of pregnancy. The patient is well within the fertile years (21 years old), and may not know she is pregnant.

A patient undergoing radiation therapy panics because her once dry, flaky red patch and is now weeping serous fluid and is shiny. She tells the nurse, "It's infected!" The nurse's best response is: a. "Don't worry, this is a normal finding. Your skin starts out dry and flaky, but with more radiation treatments, the rate of cell sloughing out-paces the rate of cell repair." b. "I'll call the doctor in right away to take a look at that." c. "I'll get a culture STAT to make sure it's not an infection." d. "In the later stages of radiation therapy, the rate of sloughing can out-pace the rate of cell repair, leading your skin to appear shiny because it's leaking serous fluid. This is considered a normal finding, but, I will inspect your skin to make sure it's not an infection."

d. "In the later stages of radiation therapy, the rate of sloughing can out-pace the rate of cell repair, leading your skin to appear shiny because it's leaking serous fluid. This is considered a normal finding, but I will inspect your skin to make sure it's not an infection."

A 78-year-old male is receiving chemotherapy and states his appetite has left. Which of the following meals would be the best for this client? a. Cereal with berries and milk b. Toast, gelatin, and cookies c. Steak and house fries d. Baked chicken, black beans, and cottage cheese

d. Baked chicken, black beans, and cottage cheese Optimal nutrition includes a balance of protein, carbohydrate, and a small amount of fat. Cereal, toast, gelatin, and cookies are high in carbohydrates, and are not balanced with enough protein. Steak provides adequate protein, but this meal is too high in fat and low in nutrients.

A patient that has just undergone a double mastectomy tells the nurse, "You just don't understand what I'm going through!" What nursing intervention would yield the most appropriate result for the patient? a. Active listening b. Therapeutic touch c. Suggest she see a therapist d. Connect her to a survivor's support group

d. Connect her to a survivor support group

A client informs the nurse that she is using herbal remedies in addition to her chemotherapy medications. The nurse should: a. Guide the client's decision-making process to select either Western traditional or alternative therapies b. Encourage alternative remedies that do not include ingesting unproven substances c. Recommend that the client stop using the alternative remedies immediately d. Determine what the client is using, and inform the rest of the health care team

d. Determine what the client is using, and inform the rest of the health care team The health care team should be made aware of what substances the client is using, so adverse reactions can be avoided. Traditional and alternative therapies are not mutually exclusive, and care should be taken not to violate client autonomy. Some alternative remedies may cause adverse reactions if stopped suddenly.

A patient is admitted with thyroid storm. Which sign and symptoms are NOT present with this condition-SELECT ALL THAT APPLY?* a. Temperature of 104.9'F b. Heart rate of 125 bpm c. Respirations of 42 d. Heart rate of 20 bpm e. Intolerance to cold f. Restless and tremors g. Labile

d. Heart rate of 20 bpm e. Intolerance to cold Bradycardia (heart rate of 20 bpm) and intolerance to cold are NOT signs and symptoms of thyroid storm. All the other options are very typical signs and symptoms of thyroid storm.

A novice nurse is caring for a patient who is day 1 post op and recovering from a subtotal thyroidectomy. Which of the following indicates a need for the expert nurse to step in and correct the novice nurse? a. Assesses the neck every 2 hours for 24 hours for s/s of hemorrhage and tracheal compression and has trach kit, suction, and O2 at the bedside b. Regularly monitors vital signs c. Administers pain medication via IV, and assesses the IV site for signs of infection d. Replaces wet, blood-stained dressing using aseptic technique. e. Monitors for tingling toes, fingers and around the mouth, muscle twitching, apprehension, dysphasia, and hoarseness f. Places the patient in a semi-fowler position, supporting head with pillows, and advises the patient to avoid flexion of neck and any tension in the suture lines. g. Gives the patient ice chips to suck on

d. Replaces wet, blood-stained dressing using aseptic technique. NEVER do this the day after surgery. Instead, outline the blood stain with a pen to monitor spread of blood, and put another dressing onto the old dressing.

The nurse is caring for a 59-year old woman who had surgery 1 day ago for the removal of a suspected malignant abdominal mass. The patient is awaiting a pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use the opportunity to: a. motivate change in an unhealthy lifestyle b. teach her about the 7 warning signs of cancer c. instruct her about healthy stress relief and coping practices d. allow her to express the meaning of this experience

d. allow her to express the meaning of this experience

The PRIMARY difference between benign and malignant neoplasms is: a. rate of cell proliferation b. site of malignant tumor c. requirements for cell nutrients d. characteristics of cell invasiveness

d. characteristics of cell invasiveness

One year after radiation therapy for his breast cancer, a patient is experiencing dyspnea. This may be a sign of: a. nephrotoxicity b. alopecia c. hyperuricemia d. pericarditis or myocardititis

d. pericarditis or myocarditis Etiology: - Inflammation secondary to radiation injury or a side effect of some chemo drugs - Complication occurs when the chest wall is irradiated - can occur up to 1 year after treatment Nurse interventions: - Monitor for s/s of pericarditis or myocarditits like dyspnea

What does breastfeeding do the your risk of getting breast cancer?

decreases risk of breast cancer

A doctor has prescribed a beta blocker to help relieve the symptoms of a patients who is experiencing thyroid storm. The patient's history reads: "congenital valve disorder". Which medication should the doctor prescribe? a. propranalol b. PTU c. methimazole d. levothyroxine e. atenolol

e. atenolol --> choice beta blocker for patients with asthma or CV conditions

This drug is used for symptomatic relief of thyroid storm: a. PTU b. methimazole c. iodine bolus d. thyroidectomy e. propranolol

e. propranalol This is a beta blocker that is used to decrease tachycardia, nervousness, irritability, and tremors

A patient is undergoing radioactive iodine therapy (RAI). Which teaching by the nurse indicates a knowledge deficit? a. RAI limits thyroid secretion by damaging or destroying thyroid tissue b. There is a HIGH incidence of post-treatment hypothyroidism, and you may need lifelong thyroid hormone therapy c. Watch for s/s of hypothyroidism: fatigue, lethargy, personality and mental changes, impaired memory, slowed speech, weight gain, decreased cardiac output, DIB on exertion). d. Take necessary precautions while receiving treatment, such as using plastic utensils, using a separate bathroom, and flushing 3x to minimize the effects of radiation to those around you. e. The effects of RAI are immediate

e. the effects of RAI are immediate. FALSE --> Max effects may not be seen for up to 3 months. Patients are treated with anti-thyroid drugs and propranolol before and for 3 months after RAI until the effects of radiation become apparent.

What is the advantage of thyroidectomy over RAI?

more rapid reduction of T3&T4 levels -->duh, we basically removed the thyroid gland!