300F Exam 4

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normal ESR

0-20

induration: -recent arrival from high prevalence country -IV drug user -comorbid conditions -children less than 4yo -high risk

10 +

normal sodium level

135 - 145

induration: -persons with no known risk factors for TB -low risk individuals

15 +

normal plt level

150 - 450

normal rbc

3.8 - 5.2

manifestations may not appear until late in infection -malaise, fever, anorexia, weight loss, flu like symptoms -lymphadenopathy for at least 3mo -leukopenia -diarrhea -night sweats -opportunistic infections -neoplasms -fungal or viral infections

AIDS

A nurse is reviewing the lab data of a client who has an acute exacerbation of Crohn's disease. Which of the following blood lab results should the nurse expect to be elevated (select all that apply) A. Hematocrit B. ESR C. WBC D. Folic acid E. Albumin

B, c

live, attenuated strain of mycobacterium bovis, that is given to infants in parts of the world with a high prevalence of TB -can give false positive TST

BCG vaccine

cell that is the target cell for HIV -type of lymphocyte -HIV binds to the cell through fusion

CD4

monitors progression of HIV decreases with disease progression, resulting in a decrease in immunity

CD4

retrovirus that causes immunosuppression making persons more susceptible to infections -commonly spread through sexual transmission

HIV

chronic progressive systemic inflammatory disease that can cause major organs and systems to fail no cure - cause unknown remission possible

SLE

interventions: -ABCs -HOB 30 degrees -strict I/O -monitor CO and tissue perfusion

SVC

manifestations: -anorexia, weight loss -malaise -abdominal tenderness and cramping -severe diarrhea that may contain blood and mucus -malnutrition, dehydration, electrolyte imbalance -anemia -vitamin K deficiency

a hospitalized pt with AIDS has wasting syndrome. which nursing action is appropriate to assign to LPN? a. adminsitering oxandrolone 5mg/day b. assessing pt for other nutritional risk factors c. developing POC to improve pts appetite d. providing instructions for high calorie high protein diet

a pt with a new ileostomy asks how much it will drain. how many cups of drainage per day should the nurse explain for the pt to expect? a. 2 b. 3 c. 4 d. 5

the oncoming day shift nurse has just received the handoff report from the night shift nurse. which would you see first based off priority? a. pt developed tumor lysis syndrome around 5am b. pt who is currently pain free but had breakthrough pain during the night c. pt scheduled for ex-lap this morning d. pt with anticipatory n/v for the past 24 hours

which of the following is not an exacerbation factor of SLE? a. exercise b. pregnancy c. infection d. sunlight

characteristics of RA include SATA a. chronic progressive systemic disease b. peak incidence age 30-50 c. men affected more than women d. results in joint destruction

a, b, d

The nurse is caring for a child diagnosed with tuberculosis infection. Which risk factor should the nurse identify that would greatly increase the risk for progression to disease? (Select all that apply.) A. Presence of HIV infection B. Genetic factors C. Age less than 2 years D. Virulence of the organism E. Magnitude of the infection

a, c

in a pt with RA, which interventions would the nurses plan to implement for promoting muscle strength and joint mobility? SATA a. ROM exercises b. high-intensity exercise c. apply heat d. offer cold showers in the evening e. frequent change of position

a, c, e

a primary nursing responsibility is the prevention of lung cancer by assisting pts in the cessation of smoking or other tobacco use. which task would be appropriate to assign to LPN? a. devleop a quit plan b. explain how to apply nicotine patch c. discuss strategies to avoid relapse d. suggest ways to deal with cravings

which nursing action will the nurse include in the POC for a pt admitted with an exacerbation of IBD? a. restrict oral fluid intake b. monitor stools for blood c. ambulate six times daily d. increase dietary fiber intake

what protein is found in multiple myeloma in the 24h UA?

bence jones

spontaneous bone fusion of the small joints of the hand

bony ankylosis

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

a nurse is teaching a client with SLE who has a new prescription for prednisone. the nurse should monitor for which of the following adverse effects of this med? a. hypoglycemia b. tendinitis c. infection d. weight loss

after change of shift report on the oncology unit, which pt would the nurse assess first? a. pt with pet 82000 after chemo b. pt who has xerstomia after receiving head/neck radiation c. pt who is neutropenic and temp of 100.5 d. pt wooded about getting prescribed long acting opioid on time

for a pt receiving the chemo drug vincristine, which side effect would be reported to the HCP? a. fatigue b. nausea c. parathesia d. anorexia

the nurse is monitoring a client for s/s related to superior vena cava syndrome. which is an early sign of this oncological emergency? a. cyanosis b. arm edema c. periorbital edema d. mental staus changes

remission where there is no evidence of the disease

complete

reduce inflammation and suppress the immune response

corticosteroid

manifestations: -fever -cramping after meals -diarrhea (semi-solid), that can contain mucus or pus -abdominal distention -anorexia, nausea, vomiting, weight loss -anemia -dehydration -f/e imbalance -malnutrition

crohns

which question is the HH nurse most likely to ask to evaluate the efficacy of a biphosphonate med that was prescribed for a pt with cancer? a. "has the med helped relieved discomfort in your mouth?" b. "have you noticed any increase or changes in energy level?" c. "has the med helped to stop n/v?" d. "has the med relieved the bone pain that you reported?"

TB drug: se: optic neuritis, rash, GI upset *check hepatic and renal labs and vision

ethambutol

fibrous connective tissue process which results in decreased ROM

fibrous ankylosis

interventions: -aggressive hydration to increase calcium excretion-loop diuretics -inhibit osteoclast activity in the bone -neuro assessment -encourage mobility and safety -prevent urinary calculi (strain urine) -encourage fluids

hypercalcemia

caused by tumors forcing bones to release calcium in levels the kidneys are not able to excrete all of

hypercalcemia (>12)

which drugs used in initial treatment for TB?

isoniazid, rifampin, pyrazinamide, ethambutol

originate form the bone marrow and lymph structures-proliferation of lymphocytes

lymphoma

a pt has weight loss, swollen lymph nodes, fatigue, and night sweats. what lymphoma do you expect?

non Hodgkins

a 57yo female presents to the ED with abdominal pain, constipation, frequent urination, and palpable ovaries. what cancer do you suspect?

ovarian

remission characterized by a lack of symptoms and normal peripheral blood smear, but still evidence of disease in bone marrow

partial

what is the goal of treatment for tumor lysis syndrome?

prevent renal failure and electrolyte imbalance

post primary TB that occurs greater than 2 years after infection - infectious

reactivation

3 consecutive sputum samples 8-24h intervals -stained sputum smears examined for AFB -definitive diagnosis is mycobacterial growth (can take 6w)

sputum culture

what meds are used for SVC syndrome?

steroid, loop diuretic

RA treatments: -cold in acute exacerbations -warm bath/shower/whirlpool -warm, moist compresses -paraffin drip

thermotherapy

autoimmune diseases are characterized by having an ___ inflammatory response

uncontrolled

___ testing measures the presence of HIV viral genetic material or another viral protein in the clients blood

viral load

the lower the ___ the less active the HIV

viral load

-can involve any segment of the GI tract -onset teens to mid 30s -abd cramping and pain -diarrhea common -fever common -malabsoprtion/nutritional deficiencies common -weight loss common, may be severe -affects entire thickness of bowel wall -skip lesions -complications: cancer, Cdiff, perianal abscess and fistula, strictures -microscopic leaks can allow bowel contents to enter peritoneal cavity due to inflammation going through entire wall -manifestations: diarrhea, abdominal cramping, weight loss, malabsorption

Crohns

-decreased WBC -lymphopenia -neutropenia -thrombocytopenia -anemia -altered liver function

HIV

interventions: -monitor disease progression, immune function and manage symptoms -initiate and monitor ART -prevent, detect, and/or treat opportunistic infections -prevent further transmission -decrease viral load -maintain/increase CD4

HIV

manifestations: -acute: mono like symptoms, fever, swollen lymph nodes, sore throat, headache, malaise, nausea, diffuse rash, joint pain, muscle/joint pain -2-4 weeks after infection and highly infectious -symptomatic: shingles, persistent vaginal candidate infections, oral or genital herpes, bacterial infections -advances to more active stages and s/s become worse-persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches, severe fatigue

HIV

a pt has painless and moveable lymph nodes in the cervical and axillary areas. what lymphoma do you expect?

Hodgkins

chronic inflammation of the GI tract characterized by periods of remission and exacerbation, characterized by clinical manifestations exact cause unknown-may result from overactive, inappropriate or sustained immune response to environmental and bacterial trigger; diet, smoking, stress, NSAIDs, antibiotics, oral contraceptives -complications include hemorrhage, strictures, perforation, abscesses, fistulas, toxic megacolon, increased risk for colorectal cancer and small intestinal cancer, systemic complicaitons

IBD

interventions: -exac: NPO, f/e IV, restrict activity to reduce intestinal activity -monitor bowel sounds and abdominal tenderness/cramping -monitor bm, color, consistency, presence of blood -low fiber diet as needed -instruct client to avoid trigger foods -avoid smoking -meds: salicylates, corticosteroids, immunosuppressants, antidiarrheals

IBD

resistant to two of the 1st line treatment drugs d/t incorrect prescribing, lack of public health case management, non adherence, or lack of funding for education and prevention sensitivity test determines drugs: -initial: 5 drugs for at least 6 mo (2 1st line, fluoroquinolone, inj antibiotic, and 1+ second line) -continuation: 4 drugs for 18-24mo

MDR TB

what is the gold standard diagnostic for SCC?

MRI

what is the gold standard for diagnosing SVC syndrome?

MRI

screening for TB where PPD is injected into ventral forearm -inspect site for induration within 48-73h -induration indicates development of antibodies following TV exposure

Mantoux

comprehensive strategy to reduce chances of acquiring HIV infection in persons at risk -currently involves daily ART regimen -used in conjunction with other proven prevention interventions **an undetectable viral load by taking ART daily as prescribed prevents sexual transmission of virus to others Truvada orally descovy orally apretude injectable

PrEP

chronic progressive systemic disease that causes inflammatory changes in diarthodial joints and related structures, resulting in joint destruction remission and exacerbations Rhematoid factor + ESR and CRP elevated Antinuclear antibody (ANA) + CPP test X-rays, MRI, doppler, joint fluid analysis

diagnostic criteria: 4 present for 6w -morning stiffness >1hr -swelling in 3+ joints -swelling in hand joints -symmetrical joint swelling -erosions/decalcifications on xray -rheumatoid nodules -Positive RF

manifestations: -bilateral diarthrodial joint changes -4 stages (synovitis, pannus formation, fibrous ankylosis, bony ankylosis) -joints have limited motion (morning and after activity) -crippling deformity pleuritis, intrapulmonary nodules, interstitial fibrosis, endo/pericarditis, Raynauds, scleritis, dryness

treatment: -relieve pain -inhibit inflammatory response -preserve joint function -prevent deformity

which autoimmune joint disease affects women (30-50) more often than men

intervention: -early recognition -thorough assessment -spine precautions -skin care -safety

SCC

malignant tumor or metastasis in epidural space that causes compression of the spinal cord **neurologic emergency MRI, CT radiation, corticosteroids, surgery

SCC

manifestations: depends on level of SC affected -new or worsening back pain -loss of sensation in affected limbs -numbness, tingling, coldness -autonomic dysfunction

SCC

connective tissue and fibrin deposits collect in blood vessels on collagen fibers and on organs deposits lead to necrosis and inflammation in blood vessels, lymph nodes, GI tract, and pleura

SLE

contributing factors -estrogen sensitivity -sun exposure -sunburns -UV exposure -infections/illness -certain meds

SLE

diagnostic criteria: 4+ -malar rash -discoid rash -photosensitivity -arthritis -serositis -renal disorder -neurological disorder-seizures, psychosis -anemia, leukopenia, lymphopenia, thrombocytopenia -immunologic disorder -antinuclear antibody

SLE

interventions: -monitor skin integrity -frequent oral care -avoid harsh products on skin -use creams/lotions for rash -administer supplements as needed -high vitamin/iron diet -measures to conserve energy -corticosteroids, salicylates, NSAIDs -monitor I/O and daily weight -avoid exposure to sunlight and UV light -monitor for bleeding, bruising, injury

SLE

manifestations: -butterfly rash -alopecia -joint pain -oral ulcers

SLE

manifestations: Butterfly rash, dry/scaly/raised skin on face/upper body, fever, weakness, fatigue, anorexia, weight loss, photosensitivity, joint pain, anemia, positive ANA, elevated ESR

SLE

precipitating factors: meds, stress, genetic factors, sunlight, UV light, pregnancy

SLE

which disorders will an ANA test most likely be positive

SLE, RA

manifestations: -tachypnea/dyspnea -trunk or upper extremity swelling -periorbital edema -distended neck and chest veins

SVC

compression or obstruction of the SVC d/t tumor or thrombosis -impedes venous drainage from head and thorax Xray, CT, MRI, lab values radiation, chemo, end-vascular shunts, anticoagulant, thrombolytic, corticosteroids

SVC syndrome

infectious disease with gram positive, aerobic, acid fast bacillus (AFB) airborne droplets, transmission requires close and frequent prolonged exposure aerophilic-has affinity for lungs but can spread via lymphatics and grow in other organs

interventions: -teach pt to prevent spread -pt wears mask if outside room -airborne isolation -2 consecutive negative cultures = noninfectious -teach pt to minimize exposure to others -teach symptoms of recurrence or factors that could reactivate -smoking cessation -proper hand hygiene

manifestations: -high fever -chills -flu like symptoms -pleuritic pain -productive cough -crackles and/or adventitious sounds

-limited to colon -onset teens to mid 30s -abd pain common, severe, constant -diarrhea common -fever during acute attacks -minimal nutritional deficiencies -rectal bleeding common -weight loss rare -usually starts in rectum and spreads in a continuous pattern up colon -only mucosa affected -pseudopolyps common -complications: cancer, Cdiff, perforation, strictures, toxic megacolon -fistulas and abscesses rare due to inflammation not extending throughout entire bowel -manifestations: bloody diarrhea, abdominal pain, increased stool output, fever, rapid weight loss, tachycardia, anemia, dehydration

IBD resulting in poor absorption of nutrients, commonly beginning in rectum and spreading upward colon becomes edematous and develops bleeding lesions and ulcers, possibly leading to perforation scar tissue develops, loss of elasticity, loss of ability to absorb nutrients chronic-muscular hypertrophy, fat deposits, fibrous tissue, bowel thickening, shortening, and narrowing

A client has a 6-mm area that is slightly red and soft to the touch at the site of a PPD (Mantoux) test. Which finding should the nurse document for this client? A. Negative response B. Positive response if the client had an abnormal chest x-ray C. Positive response D. Indeterminate response

A client with tuberculosis experiences shortness of breath, hypoxia, cyanosis, and subcutaneous emphysema. Which pathophysiologic change should the nurse suspect as causing this client's symptoms? A. Rupture of tuberculosis lesion B. Encapsulation of the bacilli C. Reactivation tuberculosis D. Miliary tuberculosis

A newly admitted patient is diagnosed with hyponatremia. When making room assignments, the charge nurse should take which action? a. Assign the patient to a room near the nurse's station. b. Place the patient in a room nearest to the water fountain. c. Place the patient on telemetry to monitor for peaked T waves. d. Assign the patient to a semi-private room and place an order for a low-salt diet.

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

As the nurse reviews the history of a client admitted in labor, the nurse notes that the client has inactive tuberculosis. Which should the nurse include in the plan of care for this client? A. The client will be allowed to breastfeed the infant. B. Once delivered, the infant will be placed on prophylactic treatment. C. Direct contact should be avoided until the client is noninfectious. D. Pharmacologic therapy for the client should be initiated immediately.

The nurse is caring for a patient with a massive burn injury and possible hypovolemia. Which assessment data will be of most concern to the nurse? a. Blood pressure is 90/40 mm Hg. b. Urine output is 30 mL over the last hour. c. Oral fluid intake is 100 mL for the last 8 hours. d. There is prolonged skin tenting over the sternum

The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammography every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A CT scan will be done every year after I turn 50.

The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse take next? a. Monitor ionized calcium level. b. Give oral calcium citrate tablets. c. Check parathyroid hormone level. d. Administer vitamin D supplements.

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review?a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

a nurse in a clinic is teaching a client who has UC. which of the following statements by the client indicates understanding of the teaching? a. "I plan to limit fiber in my diet." b. "I will restrict fluid intake during meals." c. "I will try to eat cold foods rather than warm when my stomach feels upset." d. "I will eat high sodium foods."

a nurse is admitting a client who has manifestations that suggest TB. which of the following actions is the nurses priority? a. initiate airborne precautions b. administer antimicrobial therapy c. tell client the infection will be communicable for 2-3 weeks from start of med therapy d. teach client about manifestations of TB

a nurse is monitoring a newly licensed nurse who is caring for a client. the client has active pulmonary TB, was placed on airborne precautions and is scheduled for a chest xray. the nurse should instruct the newly licensed nurse to take which of the following? a. have client wear surgical mask b. wear gown for protection from clients infection c. ask radiology staff to perform a portable chest xray in clients room d. have client wear N95

a nurse is planning care for a pt who has acute SLE and is scheduled to begin treatment for systemic manifestations. which of the following types of meds should the nurse plan to administer? a. corticosteorids b. antimalarials c. antidepressants d. opioids

a nurse is providing discharge teaching to a client who has a new diagnosis of SLE. which of the following statements by the client indicates an understanding of the teaching? a. I will need to take methotrexate, even if im in remission b. im thankful that this type of lupus only affects the skin c. each day I should apply a sunblock with a sun protection factor of 15 d. a mild fever is common with SLE and usually does not require medical intervention

a nurse is teachign a client with HIV about the early manifestations of AIDS. which of the following statements should the nurse include? a. you can expect persistent fever and swollen glands b. you can expected elevated WBC c. you can expect increased BP and edema d. you can expect weight gain

a nurse is teaching a client who has Raynaud's disease. which of the following pieces of information should the nurse include in the teaching? a. protect against cold by wearing layers of clothing b. begin exercise of 2 mile walks once per week c. increase vitamin A in diet d. elevate hands above heart level when resting

a patient who has cancer will need ongoing treatment for pain. which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain? a. an illustrated guide to analgesic ladder b. common questions about radiation therapy c. how to make preparations for your cancer surgery d. how nerve blocks can help to manage cancer pain

a person who is receiving chemo is approaching the nadir period. which instruction will the team leader gives to the LPN? a. monitor neutrophil count; be vigilant for s/s of infection b. expect n/v; give antiemetics as prescribed c. observe for breakthrough pain; report frequency of bolus doses of opioids d. monitor for anorexia; initiate daily weights prn

a pt with SLE is admitted to the hospital for acute joint inflammation. which information obtained in the lab testing will be of highest concern? a. elevated BUN b. increased C reactive protein c. positive antinuclear antibody test d. positive lupus erythematous cell preparation

a pt with crohns disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. which symptom is most important to communicate to the HCP? a. fever b. nausea c. joint pain d. headache

a pt with newly diagnosed AIDS has a 6mm induration at 48 hours after a skin test for TB. which action will the nurse anticipate next? a. arrange for chest xray to check for active TB b. tell pt the TB results are negative c. teach pt about multi-drug treatment for TB d. schedule TB skin testing again in 12 months

a pt with terminal liver cancer is receiving end of life care. the pt is weak and restless and her skin is mottled and cool. dyspnea develops and she appears anxious and frightened. what would the nurse do first? a. administer prn dose of morphine elixir b. alert RRT and call HCP c. deliver breaths at 20/min with bag valve mask and prepare for intubation d. sit quietly with pt and offer emotional support and comfort

a young woman with crohns disease develops a fever and symptoms of a UTI with tan, fecal smelling urine. what info will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this pt? a. fistulas can form between bowel and bladder b. bacteria in perianal area can enter the urethra c. drink adequate fluids to maintain normal hydration d. empty bladder before and after sexual intercourse

after having frequent diarrhea and a weight loss of 10lb over 2 months, a pt has a new diagnosis of crohns disease. what should the nurse plan to teach to the pt? a. med use b. fluid restriction c. enteral nutrition d. activity restrictions

an older pt is receiving standard multi drug therapy for TB. the nurse should notify the HCP if the pt exhibits which finding? a. yellow tinged skin b. orange colored sputum c. thickening of fingernails d. difficulty hearing high pitched voices

for a pt who is receiving chemo, which lab result is of particular importance? a. WBC 3000 b. serum potassium 3.4 c. pre albumin 14 d. BUN 9

nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. which pt statement is most likely to suggest an early manifestation? a. "last night my back really hurt, and I had trouble sleeping." b. "My leg has been giving out when I try to stand." c. "my bowels are just not moving like they usually do." d. "when I try to pass urine, I have difficulty starting the stream."

the HH care nurse is caring for a client with cancer who is complaining for acute pain. the most appropriate determination of the clients pain should include which assessment? a. clients pain rating b. nonverbal cues c. nurses impression of the clients pain d. pain relief after appropriate nursing intervention

the newly is providing discharge teaching for a client with. newly diagnosed crowns disease about dietary measures during exacerbation episodes. which statement made by the client indicates a need for further instruction? a. I should increase fiber in my diet b. I will need to avoid caffeinated beverages c. im going to learn some stress reduction techniques d. I can have exacerbations and remission with crohns

the nurse asses a pt with non-hodgkins lymphoma who is receiving an infusion of rituximab. which assessment finding would require the most rapid action by the nurse? a. SOB b. shivering and chills c. muscle aches and pains d. temp of 100.2

the nurse is caring for a pt with esophageal cancer. which task could be delegated to AP? a. assisting with oral hygiene b. observe response to feedings c. evaluate risk for aspiration d. initiating weight measurements prn

the nurse is creating a POC for a pt with multiple myeloma and includes which priority intervention in the plan? a. encourage fluids b. provide frequent oral care c. cough and deep breath d. monitor RBC

the nurse is evaluating a pt with HIV who is receiving TMP-SMX as a treatment for pneumocystis jiroveri pnemonia. which information is most important to communicate to HCP? a. blistering rash b. fluid intake 2L/day c. potassium 3.4 d. pt enjoys spending time outside in sun

the nurse is interviewing a pt who was treated several months ago for breast cancer. the pt reports taking NSAIDs for back pain. which pt comment is cause for greatest concern? a. "NSAIDs are really not relieving the back pain." b. "NSAID tabs are too large, and they are hard to swallow." c. "I gained weight because I eat a lot before taking NSAIDs" d. "the NSAIDs are upsetting my stomach in the morning"

the nurse is reviewing the lab results of a client with multiple myeloma. which would the nurse expect to note specifically in this disorder? a. increased calcium b. increased WBC c. decreased BUN d. decreased number of plasma cells I the bone marrow

the nurse manager in a public health department is implementing a plan to reduce the incidence of infection with HIV in the community. which nursing action will be delegated to the AP? a. supplying injection drug users with sterile injection equipment b. interviewing pts about behaviors that indicate a need for annual HIV testing c. teaching high risk community members about the use of condoms in preventing HIV infections d. assessing the community to determine which popuithn groups to target

the nurse provides home care instructions to a client with SLE and tells the client about methods to manage fatigue. which statement by the client indicates a need for further teaching? a. I should take hot baths because they are relaxing b. I should sit whenever possible to conserve my energy c. I should avoid long periods of rest because it causes joint stiffness d. I should do some exercises, such as walking, when I am not fatigued

when staff assignments are made for the care of pts who are receiving chemo, which consideration related to chemo drugs is most important? a. administration of chemo requires precautions to protect self and others b. many chemo drugs are vesicants c. chemo drugs are frequently given through CVADs d. PO/IV routes are the most common

which assessment finding is the most critical and needs to be addressed first? a. pt with small cell lung cancer has tracheal deviation after pulmonary resection b. pt with bladder cancer has decreased uriantion after IV chemo c. pt with non-Hodgkin lymphoma has cardiac dysrhythmias after chemo d. pt has severe abdominal pain after bowel resection for colon cancer

which pt is at greatest risk for pancreatic cancer? a. older AA man who smokes b. young obese Asian woman with gallbladder disease c. young AA man with type I diabetes d. elderly white woman with pancreatitis

which pt statement indicates that the teaching about sulfasalazine (Azulfidine) for UC has been effective? a. I should apply sunscreen before going outdoors b. the med will be tapered if I need surgery c. I will need to avoid contact with people who are sick d. the med presents the infections that cause diarrhea

The nurse is assessing a client with tuberculosis. Which should the nurse focus on during this assessment? (Select all that apply.) A. Presence of cough B. Difficulty breathing C. Skin color D. Carbon dioxide level E. Nasal congestion

a, b, c

a nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. the client reports having a cough along with night sweats and fatigue. the client reports having a cough along with nausea and diarrhea. their temp is 100.6 degrees orally. the client is concerned about the possibility of having HIV, which actions should the nurse take? SATA a. perform physical assessment b. determine when manifestations begin c. obtain a sexual history d. refer the client to a local support group

a, b, c

The nurse instructs a client with tuberculosis on prescribed medication. Which finding should the nurse instruct the client to report to the healthcare provider? (Select all that apply.) A. Yellow tint to sclera B. Sudden weight gain C. Hemoptysis D. Orange tint to sweat E. Chest pain

a, b, c, e

in the care of a pt with neutropenia, what tasks would the nurse delegate to the AP? select all that apply a. vitals every 4 hours b. reporting temp of greater than 100.4 c. assessing for sore throat, cough, or burning with urination d. gathering supplies to prepare room for protective isolation e. reporting superinfections f. practicing good hand hygiene

a, b, d, f

The nurse in a community clinic is asked to determine which clients require tuberculosis testing. Which individual should the nurse recommend for this screening? (Select all that apply.) A. An individual with close contacts who already have or are suspected to have tuberculosis B. An individual who is a resident or staff member of a long-term residential facility C. An individual who had the bacille Calmette-Guérin (BCG) vaccine D. An individual that has had PPD E. An individual infected with HIV or at high risk for HIV infection

a, b, e

a nurse is providing discharge teaching to a client who has HIV. which of the following instructions about infection prevention should the nurse include? SATA a. avoid large gatherings of people b. clean toothbrush by running through dishwasher c. change pet litter boxes with disposable gloves d. consume fresh fruits/veggies e. avoid digging in garden

a, b, e

the nurse is conducting a history and monitoring lab values on a client with multiple myeloma. what assessment findings should the nurse expect to note? SATA a. pathological fracture b. UA positive for pence jones protein c. Hob 15.5 d. calcium 8.6 e. creatinine 2.0

a, b, e

a client with carcinoma of the lung develops SIADH as a complication of the cancer. the nurse anticipates that the PCP will request which prescription? SATA a. radiation b. chemo c. increased fluid intake d. decreased oral sodium intake e. serum sodium level determination f. medication that is antagonistic to antidiuretic hormone

a, b, e, f

The nurse instructs a client with tuberculosis on the medication rifampin. Which client statement indicates teaching has been effective? (Select all that apply.) A. "I should take rifampin on an empty stomach." B. "I need to monitor my vision daily by reading a newspaper." C. "I should not take aspirin while I am taking rifampin." D. "I should not be frightened if my urine changes to an orange-red color; it is a normal side effect." E. "I need to take pyridoxine (vitamin B6) along with the rifampin."

a, c, d

a nurse is assessing a client with HIV. which of the following risk factors associated with the virus should the nurse identify? SATA a. perinatal exposure b. monogamous sex partner c. older adult woman d. occupational exposure

a, c, d

A nurse is providing information about TB to a group of clients at a local community center. which of the following manifestations should the nurse include? (select all that apply) a. persistent cough b. weight gain c. fatigue d. night sweats e. purulent sputum

a, c, d, e

The nurse is preparing teaching for a client newly diagnosed with tuberculosis. Which drug generally used in initial treatment should the nurse include in the session? (Select all that apply.) A. Isoniazid B. Amikacin C. Pyrazinamide D. Rifampin E. Ethambutol

a, c, d, e

a nurse is providing information about TB to a group of clients at a local community center. which of the following manifestations should the nurse include? SATA a. persistent cough b. weight gain c. fatigue d. night sweats e. purulent sputum

a, c, d, e

people at risk are the target population for cancer screening programs. according to the latest screening recommendations from the American cancer society which of these asymptomatic pts need extra encouragement to participate? select all that apply a. 25yo AA woman who is sexually inactive, for a pap test b. 30yo Asian woman for annual mammogram c. 45yo AA man to talk to HCP about prostate cancer d. 55yo white man who smokes to talk about lung cancer screening e. 50yo white woman for colon cancer screening f. 70yo Asian woman who had total hysterectomy (not cancer reasons) for a Pap

a, c, d, e

The nurse is providing care to a client who has been diagnosed with tuberculosis. Which diagnostic test should the nurse expect to be prescribed prior to initiating antibiotic treatment? (Select all that apply.) A. Polymerase chain reaction (PCR) B. Intradermal PPD (Mantoux) test C. Sputum culture D. Tine test E. Sputum smear

a, c, e

a nurse is reviewing the plan of care for a client who has SLE. the client reports fatigue, joint tenderness, swelling, and difficulty urinating. which of the following lab findings should the nurse anticipate? SATA a. positive ANA tier b. increased hemoglobin c. 2+ urine protein d. increased serum C3 and C4 e. elevated BUN

a, c, e

a nurse on an oncology unit is providing discharge teaching to an adolescent female client who received a bm transplant for leukemia. which pieces of info should the nurse include? SATA a. take your temp twice each day b. you may return to school if you feel strong enough c. it is important to always wear shoes d. clean your toothbrush weekly with isopropyl alcohol e. avoid using tampons

a, c, e

the nurse is caring for a client with lung cancer and bone metastases. what s/s would the nurse recognize as indications of a possible oncological emergency? SATA a. facial edema in morning b. weight loss of 20lb in 1 month c. serum calcium of 12 d. serum sodium of 136 e. serum potassium of 3.4 f. numbness and tingling of lower extremities

a, c, f

if left untreated, AIDS is typically diagnosed in 10 years after initial HIV infection

asymptomatic

immune response against self in which the immune system no longer differentiates self from nonself and immune cells that are usually unresponsive are activates autoantibodies and autosensitized T cells cause pathophysiologic tissue damage tend to cluster-may have more than one

autoimmunity

A nurse is teaching a client who has TB. which of the following statements should the nurse include? a. you will need to continue to take the multi-medication regimen for 4 months b. you will need to provide sputum samples every 4 weeks to monitor the effectiveness of the meds c. you will need to remain hospitalized for treatment d. you will need to wear a mask at all times

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

An older adult client experiencing a cough, hemoptysis, night sweats, anorexia, and weakness reports being told of having tuberculosis when younger. Which reason should the nurse suspect is responsible for the client's current symptoms? A. New-onset tuberculosis B. Reactivation tuberculosis C. Skeletal tuberculosis D. Dormant tuberculosis

Ms. Jones has breast cancer. She has been lethargic, complaining of abdominal pain and bloating. Labs were drawn: Creat=1.7, calcium= 12.1. What would the initial treatment be to correct this disorder? A. Alendronate B. 1 liter of NS C. Zoledronic acid D. Gallium Nitrate

Oncologic emergencies can happen at any time duringthe course of an Oncologic diagnosis As nurses, our overall goals is to: A.Prevent, reverse or minimize life-threatening complication B.Identify patients at risk and assess each interaction C.Educate patients and family members regarding risk and how/when to manage the complications D.Follow the physicians orders only

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

a 22yo female with an exacerbation of UC has been having 15-20 stools/day and has excoriated perianal skin. which pt behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. pt uses incontinence briefs to contain loose stool b. pt uses witch hazel compresses to soothe irritation c. pt asks for antidiarrheal med after each stool d. pt cleanse perianal area with soap after each stool

a 75yo male is experiencing changes in their mental status, n/v, ecg changes and lethargy. what do you suspect? a. tumor lysis b. hypercalcemia c. vena cava syndrome d. SIADH

a client is diagnosed with scleroderma. which intervention should the nurse anticipate be prescribed? a. maintain bed rest as much as possible b. administer corticosteroids as prescribed for inflammation c. advise the client to remain supine for 1-2 hours after meals d. keep room temp warm during day and cool at night

a nurse in an oncology unit is assessing a client who has early stage Hodgkin's lymphoma. which of the following findings should the nurse expect? a. bone and joint pain b. enlarged lymph nodes c. intermittent hematuria d. productive cough

a nurse is assessing a client who has systemic scleroderma. which of the following findings should the nurse expect? a. excessive salivation b. finger contractures c. periorbital edema d. alopecia

a nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. which of the following findings should the nurse anticipate? a. swelling of joints and fingers b. pallor of toes with cold exposure c. feet that become reddened with ambulation d. client report of intense feeling of heat in fingers

a nurse is caring for a client who is experiencing an acute exacerbation of RA. the nurse should anticipate that the clients affected joints will require which of the following treatments? a. assistive device when the client is ambulating b. heat paraffin therapy applied to clients joints c. gentle massage of clients hands d. active ROM on clients affected joints

a nurse is completing discharge teaching with a client who has crohns disease. which of the following instructions should the nurse include? a. decrease intake of calorie dense food b. drink canned protein supplements c. increase intake of high fiber foods d. eat high residue foods

a nurse is evaluating the injection site of a client who had a Mantoux skin test 48 hours ago. the nurse finds a 10mm of induration with slight redness. which of the following conclusions should the nurse make? a. client has active TB b. client had an exposure to TB c. nurse must re-evaluate the result in 24h d. test is negative for TB

a nurse is providing discharge teaching to the partner of a client who has AIDS. which of the following statements by the clients partner indicates a need for further teaching? a. I will dispose of soiled tissues in separate plastic bags b. ill clean up blood spills immediately with hot water c. I know that handwashing is important preventative measure d. I will wash soiled clothes in hot water

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

a patient had radiation 3 months ago and recently the hcp prescribed epoetin. which instruction will the HH nurse give to the HH aide related to the new therapy? a. encourage pt to eat smaller amounts until nausea subsides b. allow the pt to rest between care activities until energy improves c. help pt to send up slowly until ortho hypotension resolves d. frequently cleanse the mouth with clear water until mucositis abates

a patient with Hodgkins lymphoma who is undergoing external radiation tells the nurse, "I am so tired I can hardy get out of bed in the morning." which intervention should the nurse add to the POC? a. minimize activity until treatment complete b. establish time to take a short walk almost every day c. consult psychiatrist for treatment of depression d. arrange for delivery of hospital bed to pts home

a pt being admitted with an acute exacerbation of UC reports crampy abdominal pain and passing 15 bloody stools a day. what should the nurse include in the POC? a. administer IV Reglan b. discontinue pts oral food intake c. administer cobalamin (vit b12) inj d. teach pt about total colectomy surgery

a pt diagnosed with SLE is being seen in the clinic for a followup appointment. she is prescribed cyclosporine and indomethacin. which statement made by the pt should the nurse assess first? a. my feet are swollen b. I have a paper cut on my index finger and its red and painful c. it seems like I am always so tired d. im using vitamin C cream to minimize the rsh on my face

a pt newly diagnosed with lung cancer tells the nurse, I don't think im going to live to see my next birthday. which response by the nurse is best? a. "would you like to talk to the chaplain about your feelings?" b. "can you tell me what it is that makes you think you will die so soon." c. "are you afraid that the treatment for your cancer will not be effective?" d. "do you think that taking an antidepressant would be helpful?"

a pt who has HIV and is taking nucleoside reverse transcriptase inhibitors and a protease inhibitor is admitted to the psych unit with a panic attack. which information about the pt is most important to discuss with the HCP? a. pt exclaims "Im afraid im going to die right here." b. the prescribed pt meds include midazolam 2mg IV STAT c. pt is diaphoretic and tremulous and reports dizziness d. symptoms occurred suddenly while the pt was driving to work

a pt who is being treated for stage IV lung cancer tells the nurse about new onset back pain. which action should the nurse take first? a. give pt prescribed PRN opioid b. assess for sensation and strength in lungs c. notify HCP about symptoms d. teach pt how to use relaxation to decrease pain

a pt with lung cancer develops SIADH. which treatment does the nurse anticipate the HCP prescribe first? a. fluid bolus b. fluid restriction c. urinalysis d. sodium restricted diet

a pt with uterine cancer is being treated with intracavitary radiation. the AP reports that the pt instead on ambulating to the bathroom and now it feels like something is falling out. what is priority action? a. assess AP knowledge and explain rationale for strict bedrest b. assess for dislodgment and retrieve/store as needed c. assess pts knowledge of treatment plan and her willingness to participate d. notify HCP about dislodgment of the radiation implant

after 2 months of TB treatment with isoniazid, rifampin, pyrazaminide, and ethambutol, a pt continues to have positive sputum smears for AFB. which action should the nurse take next? a. tach about treatment for drug resistant TB treatment? b. ask pt whether meds have been taken as directed c. schedule for directly observed therapy three times weekly d. discuss with HCP the need for pt to use injectable antibiotic

after 2 months of TB treatment x4 drugs, a pt continues to have positive sputum smears for AFB. which action should the nurse take? a. teach about treatment for MDR TB b. ask pt whether meds have been taken as directed c. schedule pt for DOT three times/week d. discuss with HCP the need for pt to use inj antibiotic

after a total proctocolectomy and permanent ileostomy, the pt tells the nurse, "I cannot manage all this. I don't want to look at the stoma." what action should the nurse take? a. reassure the pt that the ileostomy care will become easier b. ask pt about the concerns with stoma management c. postpone nay teaching until the pt adjusts to the ileostomy d. develop a detailed written list of stony care tasks for the pt

after assessing the patients pain patterns, the nurse determines that frequent breakthrough cancer pain si occurring. which member of the health care team is the nurse most likely to contact first? a. PT to reevaluate PT routines b. HCP to review med dosage and frequency c. AP to increase help with ADLs d. psychiatric clinical nurse specialist to evaluate psychogenic pain

after chemo, a pt is being closely monitored or tumor lysis syndrome. which lab result requires particular attention? a. platelets b. electrolytes c. RBC d. WBC

an 18yo college student with an exacerbation of SLE has been receiving prednisone 20mg/day for 4 days. which action prescribed by the HCP is most important for use to question? a. discontinue prednisone after todays dose b. give catch up dose of varicella vaccine c. check patient c reactive protein level d. administer ibuprofen 800mg PO TID

for a pt with osteogenic sarcoma, which lab value causes the most concern? a. sodium 135 b. calcium 13 c. potassium 4.9 d. BUN 10

initiation of subq etanercept for a pt with RA is being considered. which pt information is most important for the nurse to communicate with the HCP? a. pt currently taking methotrexate b. pt has positive tuberculin skin test c. pt has had type 2 diabetes for 5 years d. pt is anxious about having to self inject

pt reports gas pains and abdominal distention 2 days after a small bowel resection. which nursing action. should the nurse take? a. administer morphine sulfate b. encourage pt to ambulate c. offer prescribed promethazine d. instill mineral oil retention enema

some __ lymphocytes lie dormant until a specific antigen enters the body, at which time they greatly increase in number and are available for defense

the nurse assesses a 24yo pt with RA who is considering using methotrexate for treatment. which pt information is most important to communicate to the HCP? a. pt has many concerns about safety of the drug b. pt has been trying to get pregnant c. pt takes daily multivitamin d. pt says she has taken methotrexate in the past

the nurse is assessing a client with lung cancer. which symptom does the nurse anticipate finding? a. early bruising b. dyspnea c. night sweats d. chest wound

the nurse is reviewing the history of a client with bladder cancer. the nurse expects to note documentation of which most common s/s of this type of cancer? a. dysuria b. hematuria c. urgency d. frequency

the nurse is supervising a student nurse who is caring for a pt with HIV. the pt has severe esophagitis caused by Candida albicans. which action by the student requires the most rapid intervention? a. putting on mask and gown before entering room b. giving pt glass of water before administering prescribed oral nystatin c. suggest the pt order chili con carne or chicken soup for next meal d. placing no visitors sign on the door

the nurse is working in a hospice facility for pts with AIDS. the facility is staffed with LPNs and APs. which action can be assigned to the LPN? a. assess nutritional needs and individualizing diet plans to improve nutrition b. collect data about pts responses to meds used for pain and anorexia c. develop AP training programs about how to lower the risk for spreading infections d. assisting pts with personal hygiene and other ADLS as needed

the nurse teaches a pt about the transmission of pulmonary TB. which statements, if made by the pt, indicates the teaching was effective? a. I will avoid being outdoors whenever possible b. my husband will be sleeping in the guest bedroom c. I will take the bus instead of driving to visit my friends d. I will keep the windows closed at home to contain the germs

the oncoming nurse hears in handoff report that the pt with cancer received a prn oral dose of lorazepam. which question is the oncoming nurse most likely to ask in relation to the med? a. "what did the pt say about the location and level of pain?" b. "were you able to determine what was making the pt anxious?" c. "when is the pt allowed to have another dose?" d. "did the pt have a normal bm after the med?"

when caring for a pt hospitalized with TB, the nurse observes a student nurse who is assigned to take care of a pt. which action, if performed by the student, would require intervention by the nurse? a. pt offered a tissue from box at bedside b. surgical face mask applied before visiting pt c. snack brought to pt from unit refrigerator d. hand washing performed before entering the pts room

when the occupational health nurse is teaching AP about bloodborne pathogen exposure and HIV risk, which information is most important to emphasize? a. occupational transmission of HIV from pts to HCP is relatively rare b. occupational exposure to HIV affected fluids should be reported immediately to supervisor c. treatment for occupational exposure to HIV may include use of ART d. post exposure treatment will include HIV testing at baseline and several intervals after

which assessment finding strongly suggests that the pt with cancer is having incident pain? a. frequently reports pain 30-35 minutes before next scheduled dose b. demonstrates protectiveness of right arm whenever moving or standing up c. reports continuous burning and tingling sensation in LLE d. appears quiet, withdrawn, and depressed when family leaves

which of the following is an electrolyte abnormality associated with TLS? a. hypokalemia b. hypercalcemia c. hyperuricemia d. hypophosphatemia

which of these pts cared for by the nurse in the clinic presents the highest risk for infection with HIV during sexual intercourse? a. uninfected man who reports performing oral sex with HIV infected woman b. uninfected man who is the receiver during anal intercourse with HIV infected man c. uninfected woman who has had vaginal intercourse with infected man d. uninfected woman who has performed oral intercourse with an HIV infected woman

which pt with a health problem related to GI cancer would be the most appropriate to assign to an LPN under the supervision of a team leader RN? a. pt who needs a blood transfusion secondary to GI bleed b. pt who needs enemas and antibiotics to control GI bacteria c. pt who needs preop teaching for bowel resection surgery d. pt who needs central line insertion for chemo

A HH nurse is teaching a client who has active TB and is following a med regimen that includes a combination of isoniazid, rifampin, pyrazinamide, and ethambutol. which of the following client statements indicate understanding? SATA a. I can substitute one med for another if I run out because they all fight infection b. I will wash my hands each time I cough c. I will wear a mash when I am in a public area d. I don't need to worry where I go once I start taking my meds

b, c

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)?a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

b, c

a HH nurse is teaching a client who has active TB and is following a medication regimen that includes a combination of Isoniazid, Rifampin, pyrazinamide, and ethambutol. which of the following client statements indicate understanding? (select all that apply) a. I can substitute one med for another if I run out because they all fight infection b. I will wash my hands every time I cough c. I will wear a mask when I am in a public area d. I am glad I don't have to have any more sputum specimens e. I don't need to worry where I go once I start taking my meds

b, c

The nurse suspects that a client is at risk for tuberculosis. Which risk factor should the nurse assess in this client? (Select all that apply.) A. Sharing clothes with an infected individual B. Living in a poorly ventilated environment C. Using injection drugs D. Being an immigrant to the United States E. Having a compromised immune system

b, c, d, e

The infection control nurse is teaching the staff at a long-term care facility after a recent outbreak of tuberculosis. Which element of infection control should the nurse include in the teaching? (Select all that apply.) A. Implementation of universal screening B. Use of airborne precautions C. Treatment of clients with suspected or confirmed disease D. Administration of the bacille Calmette-Guérin (BCG) vaccine to residents E. Identification of infected individuals

b, c, e

pts receiving chemo are at risk for thrombocytopenia related to the therapy or cancer disease process. which actions for bleeding precautions can be delegated to AP? select all that apply a. provide mouthwash with alcohol for oral rinsing b. use paper tape on fragile skin, if tape is needed c. use a soft toothbrush or oral sponge d. gently insert the rectal thermometer e. handle gently to reduce bruising f. avoid overinflation of BP cuffs

b, c, e, f

The public health nurse is training a nurse on tuberculin skin testing. Which information about the Mantoux test should the public health nurse include in the training? (Select all that apply.) A. "PPD (0.1 mL) is injected intradermally into the dorsal aspect of the forearm." B. "The test is read within 48 to 72 hours." C. "This test is less accurate than the T-SPOT test." D. "Ten tuberculin units are injected." E. "Diameter of induration is recorded in millimeters."

b, e

most people do not have the abnormal gene or a family history manifestations: lump or thickening (hard, irregularly shaped, poorly delineated, nonmotile, nontender), nipple discharge (unilateral, clear, bloody), nipple retraction, orange skin and dimpling, recurrence mammogram and biopsy, lymph node analysis management: surgery, radiation, palliative, brachytherapy, chemo, hormone therapy, prevention, education, screening, pain control, restoring arm function, lymphedema

breast

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)

A nurse is preparing to administer a new prescription for Isoniazid to a light-skinned client who has TB. the nurse should instruct the client to report which o the following findings as an adverse effect of the med? a. you might notice yellowing of your skin b. you might experience pain in your joints c. you might notice tingling of your hands d. you might experience a loss of appetite

A patient receiving treatment for lymphoma reports experiencing numbness and tingling in the feet, weakness when ambulating and dribbling of the urine. The nurse should suspect: A.Development of diabetes mellitus B.Peripheral neuropathy C.Development of spinal cord compression D.Production of ectopic hormone

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/uL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding? a. Reported weight gain b. Serum hematocrit of 42% c. Serum sodium level of 120 mg/dL d. Total urinary output of 280 mL during past 8 hours

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time

In planning care for a patient with crohns disease, the nurse recognizes that a major difference between UC and crohns is that crohns: a. often results in megacolon b. causes fewer nutritional deficiences than UC c. often recurs after surgery, while UC is curable with a colectomy d. manifested by rectal bleeding and anemia more often than UC

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit 32% b. Pain with deep inspiration c. Serum sodium 126 mEq/L d. Decreased breath sounds on left side

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. 35-year-old patient who has wet desquamation associated with abdominal radiation b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old patient who received neck radiation and has blood oozing from the neck d. 56-year-old patient who developed a new pericardial friction rub after chest radiation

The nurse visits the home of a client with tuberculosis. Which action should the nurse teach family members to take during the first 2 weeks of treatment to prevent the spread of the infection to other family members? A. Be compliant with the medication regimen. B. Ensure that housemates of the client are tested and receive prophylactic treatment if indicated. C. Use disposable tissues to contain respiratory secretions. D. Emphasize the importance of maintaining good general health through diet and exercise.

Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back.

a community health center is preparing a presentation on the prevention and detection of cancer. which task would be best to delegate to the LPN? a. explain screening exams and diagnostics for common cancers b. discuss how to plan a balanced diet and reduce fats/preservatives c. prepare a poster on the seven warning signs of cancer d. describe strategies for reducing risk factors such as smoking/obesity

a newly hired nurse, who has 2 years of medsurg experience but limited experience caring for pts with cancer, seems to be consistently under medicating the pts pain. what would the supervising nurse do first? a. reassess all pts and administer additional pain meds as needed b. write incident report and inform nurse manager c. assess new nurses understanding and beliefs about cancer pain and treatments d. ask the nurse about past experience in administering pain meds

a nurse in a providers office is teaching client with a recent diagnosis of RA who has a new prescription for naproxen tabs. which of the following statements by the client indicate the need for further teaching? a. "after taking this med for 4w, ill start to notice relief in my joints." b. "I can take an antacid with this med for indigestion." c. "I can take this med with aspirin." d. "The naproxen goes down easier when I crush it and put it in applesauce."

a nurse is caring for a client who has HIV. the client asks the nurse, "should I tell my partner that I am HIV positive?" which of the following responses should the nurse provide? a. that is your decision alone b. I would if I were you c. it sounds like you are unsure what to say to your partner d. your provider is required by law to notify your partner

a nurse is caring for a client who has HIV. which of the following types of isolation should the nurse implement to prevent the transmission? a. protective b. droplet c. standard d. airborne

a nurse is caring for a client who has a new diagnosis of TB and has been placed on a multi-medication regimen. which of the following instructions should the nurse give the client related to ethambutol? a. your urine can turn a dark orange b. watch for a change in the sclera of your eyes c. watch for any changes in vision d. take vitamin B6 daily

a nurse is planning care for a client who is postop following a radical mastectomy. which of the following interventions should the nurse include in the plan? a. rest arm on affected side on the bed when the client is sleeping b. instruct client to keep the affected arm flexed when ambulating c. begin exercises with the client 1 day after procedure d. maintain client on bedrest for 2 days after procedure

a nurse is teaching a client who has AIDS about the transmission of PCP. which of the following pieces of information should the nurse include in the teaching? a. "PCP is sexually transmitted from person to person." b. "You were most likely exposed to a contaminated surface such as a drinking glass." c. "PCP results from an impaired immune system." d. You might have contract PCP from a family pet."

a nurse is teaching a client who has SLE about self-care. which of the following statements by the client indicates an understanding of the teaching? a. I should limit my time to 10 minutes in the tanning bed b. I will apply powder to any skin rash c. I should use a mild hair shampoo d. I will inspect my skin once a month for rashes

a nurse is teaching a client who has TB about a new prescription for rifampin. which of the following statements by the client indicates an understanding? a. "I should take this med with food." b. "I need to take B complex vitamin while taking this med." c. "I can expect this med to turn my skin orange." d. 'I can expect this med to make my vision blurry."

a nurse is teaching a client who has leukemia and has developed thrombocytopenia. which of the following instructions should the nurse include? a. limit flossing your teeth to once a week b. gently blow your nose if you need c. use an electric razor when shaving d. wear shoes that have a soft sole

a nurse is teaching a client who was recently diagnosed with Raynaud's disease about preventing the onset of manifestations. which of the following statements by the client indicates an understanding of the teaching? a. I should limit my exposure to sunlight b. I should avoid drinking alcohol c. I should not smoke d. I should limit of intake of foods high in purine

a pt who has breast cancer is receiving immunotherapy in the form of trastuzumab, a monoclonal antibody. which med side effect is the patient most likely to experience? a. capillary leak syndrome b. hepatotoxicity c. flu like symptoms d. memory loss

a pt who is taking rifampin for TB calls the clinic and reports having orange discolored urine and tears. which is the best response by the nurse? a. ask pt if they are experiencing SOB, hives, itching b. ask pt about visual abnormalities such as red-green color discrimination c. explain orange discolored urine and tears are normal while taking this med d. advice pt to stop the drug and report s/s to HCP

a pt who is taking rifampin for TB calls the clinic and reports having orange discolored urine and tears. which is the best response by the nurse? a. ask pt is experiencing SOB, hives, itching b. ask pt about visual abnormalities such as red-green color discrimination c. explain orange colored bodily fluids are normal while taking this med d. advise pt to stop the drug and report the symptoms of the HCP

an athletic young man with pain, a low grade fever, and anemia was recently diagnosed with Ewing sarcoma. the surgeon recommended amputaiton of the right lower leg for an operable tumor. the nurse discovers the pt preparing to leave the hospital to go on a long hiking trip. what is the priority nursing concept to consider at this time? a. pain b. cellular regulation c. stress and coping d. adherence

during report, the float nurse hears that the pt is receiving IV vincristine that will finish within the next 15min. the IV site is intact, the pt is not having any problems with the infusion. the float nurse is not certified in chemo administration. what is priority action? a. ask off going nurse to stay until finished b. ask off going nurse about problems to expect with the infusion c. contact charge and discuss lack of certification d. look up drug side effects and monitor since it is almost complete

during the handoff report, the ongoing day shift nurse hears that the cancer patient is on around the clock dosing of morphine but that end of dose pain might be occurring. which question is the most important to ask the night shift nurse? a. "how many times did you have to give a bolus dose of morphine?" b. "did the pt tell you that the pain was greater than 5 out of 10?" c. "did you notify the HCP and were changes prescribed?" d. "did you try any non pharm therapies or adjuvants?"

employee health test reveals a TB skin test of 16mm induration and a negative chest xray for a staff nurse working on the pulmonary unit. the nurse has no symptoms of TB. which information would occupational health nurse teach the staff nurse? a. standard four drug therapy for TB b. need for annual repeat TB skin test c. use and side effects of isoniazid d. BCG vaccine

for a pt who is experiencing side effects of radiation, which task would be most appropriate to delegate to the AP? a. helping pt cope with fatigue and lack of energy b. encouraging participation in a walking program c. reporting amount and type of food consumed from tray d. checking skin for redness and irritation following treatment

for care of a pt who has oral cancer, which task would be appropriate to assign to an LPN? a. assist with oral hygiene b. explain when brushing and flossing are contraindicated c. giving antacids and sucralfate suspension as prescribed d. recommending saliva substitutes

the HCP writes an order for bacteriologic testing for a pt who has a positive TB skin test. what action should the nurse take? a. teach about reason for blood tests b. schedule appointment for chest xray c. teach about need to get sputum samples for 2-3 consecutive days d. instruct pt to expectorate specimens as soon as possible

the HCP writes an order for bacteriologic testing for a pt who has a positive TB skin test. which action should the nurse take? a. teach about reason for blood tests b. schedule appointment for chest xray c. teach about need to get sputum specimens for 2-3 consecutive days d. instruct pt to expectorate 3 specimens as soon as possible

the nurse is caring for a 36yo pt with pancreatic cancer. which nursing action is the highest priority? a. offer psychologic support for depression b. offer high calorie, high-protein choices c. administer prescribed opioids to relieve pain as needed d. teach about the need to avoid scratching any pruritic areas

the nurse receives change of shift report on the oncology unit. which pt should the nurse assess first? a. 35yo pt with wet desquamation associated with abdominal radiation b. 42yo pt sobbing after receiving a new diagnosis of ovarian cancer c. 24yo who received neck radiation and has blood oozing from neck d. 56yo who developed a new pericardial friction rub after chest radiation

the pt with cancer needs an initial course of treatment with continued maintenance treatments and ongoing observation for s/s over a prolonged period of time. which patient statement is cause for greatest concern? a. "my s/s will eventually be cured; I'm so happy I don't have to worry any longer." b. "my doctor is trying to help me control the s/s; I am grateful for the extension of time with my family." c. "My plan will be relieved, but I am going to die soon; I would like to have control over my own life and death." d. "initially, I may have to take some time off work for my treatments; I can probably work full time in the future."

which diet choice by the pt with an acute exacerbation of IBD indicates a need for more teaching? a. scrambled eggs b. white toast and jam c. oatmeal with cream d. pancakes with syrup

which instruction would the nurse give to the AP about caring for a pt who is experiencing chemo brain? a. "pt can understand you but cannot speak clearly" b. "be cautious, the pt may be unpredictably aggressive." c. "calmly give explanations fi the pt seems forgetful." d. "report immediately if the pt complains of a headache."

manifestations: nonspecific or none -abdominal tenderness, abdominal mass -left: rectal bleeding, changes in stool shape, feeling of incomplete evacuation -right: diarrhea, bleeding, fatigue -complications: obstruction, bleeding, perforation, fistula screening and colonoscopy are key treatment: surgery, removal of lymph nodes, restore bowel function, prevent complications, remove polyps management: infection prevention, cleanse colon, diet, f/e, oral antibiotics, pain management, return of bowel function

colorectal

IBD that can occur in any area of GI tract, but most commonly terminal ileum that leads to thickening and scarring, narrowing lumen, fistulas, ulcerations, and abscesses exacerbations and remissions

crohns

which IBD develops skip lesions?

crohns

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

A person at risk for developing hypercalcemia should be encouraged to maintain mobility because weight-bearing movement: A.Increases resorption of calcium B.Stimulates osteoclastic activity C.Increases urine acidity D.Results in osteoblastic activity

A pt with lymphoma was treated with CVP. The patient has had increased shortness of breath and a cough during the past 2 weeks. Her face looks somewhat puffy, and she says that her blouses are too tight around the neck. The most likely explanation of these symptoms is: A. Tumor lysis syndrome B. Lymphangitic pulmonary disease C. Treatment-related cardiotoxicity D. Superior vena cava syndrome

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient needs to void every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has audible crackles to the midline posterior chest.

The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? a. Maintain the patient on bed rest. b. Auscultate lung sounds every 4 hours. c. Monitor for Trousseau's and Chvostek's signs. d. Encourage fluid intake up to 4000 mL every day.

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

a client is admitted to the hospital with a suspected diagnosis of Hodgkins disease. which assessment finding would the nurse expect to note specifically for this client? a. fatigue b. weakness c. weight gain d. enlarged lymph nodes

a nurse is admitting a client who has multiple myeloma and a WBC of 2200. which of the following foods should the nurse prohibit? a. fried chicken from fast food restaurant b. case of canned nutritional supplements c. factory sealed box of chocolates d. fresh fruit basket

a nurse is caring for a client who is suspected to have TB. which of the following findings should the nurse expect? a. recent weight gain b. high fever c. rhinitis d. blood streaked sputum

a nurse is planning discharge teaching for a client who has SLE. which of the following instructions should the nurse include? a. avoid use of NSAIDs b. stop taking corticosteroids when your symptoms resolve c. exposure to UV light wil help control skin rashes d. monitor your body temp and report any elevations promptly

a nurse is preparing to administer a Mantoux skin test to a client. what is the purpose of the test? a. identify if a client lacks immunity to TB b. find out if a client has active TB c. decrease hypersensitivity of clients reaction to PPD d. identify if a client has been infected with Mycobacterium TB

a nurse is reviewing the lab data of a client who reports manifestations suggestive of SLE. the nurse should expect an increase in which of the following parameters? a. platelets b. RBC c. Hgb d. ESR

a nursing student is helping the precasting nurse work through a preop checklist for a pt with RA scheduled to have an arthrodesis. the student asks the nurse what is is and the risks associated. what is the best response? a. student not allowed to teach pt without preceptor present, so we will do it together b. surgery invovles removing affected joint and fusing the adjacent bones together c. don't worry about it, the surgeon will explain the procedure and potential risks d. well discuss it but eh surgeon will explain the procedure and risk; we witness the signature

a pt is admitted with active TB. the nurse should question a HCP order to discontinue airborne precautions unless which assessment finding is documented? a. chest xray shows no upper lobe infiltrates b. TB meds have been taken for 6mo c. Mantoux testing shows induration of 10mm d. three sputum smears for AFB are negative

a pt is diagnosed with both HIV and active TB. which information obtained by the nurse is most important to communicate to the HCP? a. Mantoux test had induration of 7mm b. chest xray showed infiltrates in lower lobes c. pt is being treated with antiretrovirals for HIV d. pt has. cough that is productive with blood tinged mucus

a pt is transferred from the recovery room to a surgical unit after a transverse colostomy. the nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. what action should the nurse take? a. place ice packs around the stoma b. notify surgeon about the stoma c. monitor stoma every 30m d. document stoma assessment findings

a pt seen in the STD clinic has just tested positive for HIV with a rapid HIV test. which action will the nurse take next? a. ask pt about risk factors for HIV infection b. send blood specimen for western blot testing c. provide information about ART d. discuss positive results with pt

a pt with HIV has been started on ART is seen in the clinic for a followup. which test will be best to monitor when determining the response to therapy? a. CD4 level b. CBC c. total lymphocyte percent d. viral load

an alcohol and homeless pt is diagnosed with active TB. which intervention by the nurse will be most effective in ensuring adherence with treatment regimen? a. arrange for a friend to administer med on schedule b. give pt written instructions about how to take the meds c. teach pt about high risk for infecting others unless treatment is followed d. arrange for a daily noon meal at a community center where the drug will be administered

an alcoholic and homeless pt is diagnosed with active TB. which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. arrange for a friend to administer the med on schedule b. give pt written instructions on how to take the med c. teach pt about high risk for infecting others unless treatment is followed d. arrange for daily noon meal at community center where the drug will be administered

an older pt needs treatment for severe localized pain related to postherpetic neuralgia secondary to chemo. the nurse is most likely to question the prescription of which type of medication? a. lidocaine patch b. gabapentinoid c. capsaicin patch d. tricyclic antidepressant

during the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? a. diarrhea b. hypermenorrhea c. abnormal bleeding d. abdominal distention

in a pt with bone metastases, which of the following s/s should alert the nurse to the presence of hypercalemia? a. muscle cramps b. edema c. dyspnea d. polyuria

the nurse is caring for a pt with RA who is taking naproxen twice a day to reduce inflammation and joint pain. which symptom is most important to communitcate to the HCP? a. joint pain worse in morning b. dry eyes bilaterally c. round and moveable nodules under skin d. dark colored stools

the nurse is performing TB skin tests in a clinic that has many pts who have immigrated to the US. which question is most important for the nurse to ask before the test? a. is there any family history of TB? b. how long have you lived in the US? c. do you take any OTC meds? d. Have you received the BCG vaccine for TB?

the nurse is providing preop teaching for a pt scheduled for an abdominal perineal resection. which info will the nurse include? a. pt will need to remain on bedrest for 3 days after surgery b. additional surgery in 8-12w will be done to create an ileal-anal reservoir c. IV antibiotics will be started at least 24h before surgery to reduce bowel bacteria d. site where the stoma will be located will be marked on the abdomen preop

the nurse manager is teaching the nursing staff about s/s related to hypercalemia in a client with metastatic prostate cancer and tells the staff that which is a late s/s of this oncological emergency? a. headache b. dysphagia c. constipation d. ECG changes

the nurse obtains this information when assessing a pt with HIV who is taking ART. which finding is most important to report to the HCP a. blood glucose is 144 b. hemoglobin 10.9 c. pt reports frequent nausea d. pts viral load has increased

the patient who is receiving chemo describes a burning sensation in the leg, which the hcp diagnoses as neuropathic pain secondary to the therapy. the nurse is most likely to question the prescription of what drug? a. imipramine b. carbamazine c. gabapentin d. morphine

what is the goal of hypercalemia treatment?

decrease calcium levels

where is crohns disease most commonly located?

distal ileum or proximal colon

-incidence: 15-35 -more common in men -cause unknown -manifestations: painless and enlarged lymph nodes, lymphadenopathy; B symptoms (poorer prognosis): night sweats, fever, weight loss, fatigue -diag: lymph node biopsy and reed stern burg cells -good prognosis-cure is goal -treatment depends on stage and disease-radiation cures most

hodgkin

manifestations: -mental status changes -lethargy, stupor, coma -n/v -depression -weakness, fatigue -ECG changes -polyuria

hypercalcemia

TB drug: se: peripheral neuritis, hepatitis, hypersensitivity *check liver enzymes interactions: phenytoin, alcohol give pyridoxine to help with neuritis

isoniazid

which drugs are used in continuation treatment for TB?

isoniazid, rifampin

TB infection: -infected but not active disease -positive skin test -asymptomatic -noninfectious -may develop active TB later usually treated with isoniazid for 6-9mo

latent

group of cancers affecting the blood and blood forming tissues of the bone marrow, lymph system, and spleen characterized by the abnormal, uncontrolled proliferation of one type of hematopoietic cell **large number of WBC but they are unable to fight infection -examine peripheral blood and bone marrow -lumbar puncture, PET, CT

leukemia

manifestations: -bone marrow failure and formation of leukemic infiltrates -inadequate production of normal bone marrow -progression leads to fewer normal blood cells -abnormal WBC continue to collect and do not go through the normal cell cycle -may infiltrate and lead to other problems

leukemia

treatment: halt proliferation and infiltration of abnormal/immature leukocytes and obtain remission watch/wait, chemo, combo drug, corticosteroids, radiation, stem cell transplant

leukemia reduce

what drug is used to force increased calcium excretion?

loop diuretic

cancer manifestations: -nonspecific and none in early stages -dependent on type/location/metastasis -may be masked by chronic smokers cough -persistent cough -hemoptysis -dyspnea -anorexia, n/v, fatigue, weight loss, palpable lymph nodes

lung

likely arises from mutated epithelial cells due to carcinogens -slow growth -normally in upper lobes Chest xray and biopsy diagnose

lung

treatment: -surgery -radiation/chemo/targeted therapy intervention: -prevent: smoking cessation -assessment and education -oxygen use -pain management -palliative care

lung

what cancer is characterized by not having manifestations or not very specific ones in the early stages, but n/v, weight loss, and palpable lymph nodes of the neck and axillae in the more advanced stages?

lung

produced in the bone marrow and migrate to lymphoid tissue, where they remain dormant until they need to form sensitized versions for cellular immunity or antibodies for humoral immunity

lymphocyte

large number of TB organisms spread via bloodstream to distant organs -occurs with primary or reactivation -fatal if untreated -manifestations progress slowly and vary depending on which organs affected (fever, cough, lymphadenopathy, hepatomegaly, splenomegaly)

miliary

interventions: -manage disease and symptoms -relieve symptoms and prolong life -meds: corticosteroids, furosemide, allopurinol, analgesic, chemo -control pain -orthopedic supports -ambulate safely -adequate hydration **weight bearing helps bones reabsorb circulating calcium -prevent infection

multiple myeloma

manifestations: -slow and insidious -s/s normally not until disease is advanced -skeletal pain (pelvis, ribs, spine) triggered by movement -diffuse osteoporosis as bone is destroyed -compressed of spinal cord d/t destroyed vertebrae -pathologic fractures d/t loss of bone integrity -hypercalcemia -high protein -s/s anemia, pancytopenia

multiple myeloma

neoplastic plasma cells infiltrate the bone marrow and destroy bone abnormal and excessive amounts of IgG plasma cell production of excessive and abnormal amounts of cytokines plays an important role in the pathologic process of bone destruction diag: M protein, bence jones protein (24h UA), MRI/PET/CT/xray, bone marrow analysis rare, commonly seen 65-74 men in midwest good survival rate

multiple myeloma

-incidence: 50-60 -immunocompromised and opportunistic -manifestations: painless lymph node enlargement, weight loss, and others dependent on location of metastases *normally have widespread disease by time of diagnosis -diag: lymph node biopsy -prognosis not as good -treatment: surgery, chemo/radiation

non hodgkin

manifestation of malignancy or result of treatment for tumor -metastases leading to thrombosis or hemorrhage -abnormal hormones or cellular products -infiltrate serous membranes with effusion -obstruct vessels, ducts, or hollow viscera -replace normal organ parenchyma

oncologic emergency

often diagnosed when more advanced manifestations: vague/none in early stage, pelvic discomfort, low back pain, weight change, abdominal pain, n/v/c, frequent urination pelvic exams help with finding mass, tumor markers intervention: surgery, chemo, radiation, palliative, education, assessment risk factor: family history, increased age, nulliparity, early menarche, late menopause, hormone replacement therapy, hx breast cancer protective effect: at least one pregnancy, breastfeeding, oral contraceptive use, avoiding high fat diet, avoid fertility drug, early age at first birth

ovarian

a 70yo male presents to the ED with complaints of abdominal pain, weight loss, and jaundice. what cancer do you expect?

pancreatic

poor prognosis vague symptoms: abdominal pain, anorexia, weight loss, jaundice treatment: surgery, radiation, palliative management: antacids, antispasmodic, PPI, pain control, nutritional support, stimulate appetite, coping

pancreatic

RA causes immune system to attack synovium, resulting in inflammation that forms an abnormal growth of tissue in the joints

pannus formation

treatment involving dipping hands into tub of paraffin wax several times, allowing a thick coating. as the wax hardens, the emollient in the wax softens the skin and the heat of the wax opens up pores allowing the moisturizing effect to penetrate deep within

paraffin drip

TB bacteria inhaled, inflammatory response occurs; if adequate immune response infection does not progress to disease

primary

active TB within 2 years of infection

primary

a 78yo male presents to the ED with dysuria, nocturne, and urinary retention. what cancer do you suspect?

prostate

slow growing, androgen dependent cancer that spreads through direction extension, the lymph system, or bloodstream manifestations: none early, dysuria, hesitancy, frequency, urgency, hematuria, nocturia, retention, pain in sacral region suggests metastases, on exam feels hard/enlarged/fixed normally unilateral interventions: PSA screening, digital exam, biopsy, watch and wait, surgery, radiation, brachytherapy, drug therapy, chemo/radiation, education, pain management, palliative, sexual counseling, support group

prostate

TB that takes 2-3 weeks to develop -initial: dry cough that becomes productive -fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats -late: dyspnea, hemoptysis get skin test within 2w of exposure for baseline-if negative repeat skin test in 3mo

pulmonary

TB drug: se: hepatoxicity, uric acid, arthralgia, GI distress *increase fluids, watch for jaundice, avoid alcohol, give allopurinol to decrease uric acid, monitor liver function

pyrazinamide

total body to prepare for bone marrow transplant-can be focused

radiation

what is the goal of treatment for SCC?

reduce pressure and prevent damage

what is the goal of SVC treatment?

reduce size and open SVC

what is the diagnosing factors for hodgkins lymphoma?

reed sternburg cells

blood test that detects INF gamma release from Tcells in response to TB -rapid results -several advantages but higher cost

release assays

TB drug: se: orange/rust colored body fluids, fever, GI upset, hepatitis *check liver function interactions: oral contraceptions, Coumadin, digoxin, oral hypoglycemics

rifampin

does RA affect smaller or larger peripheral joints first

smaller

a 70yo female with a malignant tumor in the epidural space is experiencing worsening back pain, numbness, tingling, and autonomic dysfunction. what do you suspect?

spinal cord compression

synovium of a joint becomes inflamed -s/s: joint pain, swelling, difficulty moving, thickening of tissue, increased blood flow, increased fluid production -treatment: rest, ice, immobilization, NSAIDs

synovitis

hematopoietic stem cells are removed and replaced with healthy stem cells

transplant

interventions: -adequate hydration -decrease uric acid production -dialysis -cardiac monitoring -monitor labs -assess renal function

tumor lysis

manifestations: -hyperkalemia -hyperuricemia -hyperphosphatemia -hypocalcemia -EKG changes -muscle cramps -weakness -twitching -tetany -n/v/d -oliguria -weight gain -edema

tumor lysis

results from rapid destruction of a large number of tumor cells that result in the first 24-48h after chemo -fast growing -chemo sensitive -can lead to renal failure and death

tumor lysis

what syndrome are these labs a hallmark manifestation of? hyperkalemia (>6) hyperuricemia (>10) hyperphosphatememia (>10) hypocalcemia (<6)

tumor lysis

what syndrome can occur 24-48h after chemo?

tumor lysis syndrome

how long is the continuation period for active TB?

18 w

how many drugs used in continuation treatment of TB?

normal phosphate level

2.8 - 4.5

severe immune system problems occur when the CD4 count is less than

200

immune system problems occur when the CD4 count is between

200 - 499

normal uric acid level

3.5 - 7.2

normal potassium level

3.6 - 5.2

normal HCT count

35 - 45

how many drugs used in initial treatment for TB?

normal WBC

4.5 - 11

induration: -HIV positive -recent contact with active TB -nodular or fibrotic changes on chest xray -organ transplant -immunosuppresed

5 +

in general, the immune system remains healthy with CD4 cell counts higher than ___

500

normal CD4 T cell count

500 - 1600

normal calcium level

8.5 - 10.2

how long is the initial treatment for active TB?

8w to 4m

A nurse in a clinic is teaching a client who has UC. Which of the following statements by the client indicates understanding of the teaching? A. I will plan to limit fiber in my diet B. I will restrict fluid intake during meals C. I will switch to black tea instead of drinking coffee D. I will try to eat cold foods rather than warm when my stomach feels upset

WBC normal to decreased thrombocytopenia decreased CD4 IgG increased lactate increased serum albumin decreased total protein increased cholesterol decreased

AIDS

interventions: -respiratory support and oxygen prn -maintain f/e balance -monitor for s/s infection and institute protective isolation prn -follow standard precautions -adequate nutritional support

AIDS

manifestations: -immune system severely compromised -infections -malignancies -muscle wasting -cognitive changes

AIDS

viral disease that destroys T cells, increasing susceptibility to infection and malignancy manifested clinically by opportunistic infections long incubation period, sometimes 10+ years

AIDS

blood test used for the differential diagnosis of rheumatic diseases and for the detection of anticuleoprotein factors and patterns associated with certain autoimmune diseases -positive does not necessarily confirm diagnosis

ANA

recommended as soon as possible after diagnosis adherence to regimen is critical to prevent disease progression, opportunistic disease, viral drug resistance significantly slows HIV progression but it is complex, has side effects, does not work for everyone, and is expensive

ART

A nurse is completing discharge teaching with a client who had Crohn's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie dense foods B. Drink canned protein supplements C. Increase intake of high fiber foods D. Eat high-residue foods

A nurse is assessing a client who had been taking prednisone following an exacerbation of IBD. The nurse should recognize which of the following findings as priority? A. Client reports difficulty sleeping B. Clients urine positive for glucose C. Client reports having elevated body temp D. Client reports gaining 4lbs in last 6 months

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A. Take med 2 hours after eating B. Discontinue if your skin turns yellow-orange C. Notify provider if you experience a sore throat D. Expect your stools to turn black

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