360 exam 2
Which conditions are risk factors for the development of lung cancer? (Select all that apply.) Group of answer choices Cigarette smoking Exposure to asbestos Chewing tobacco Exposure to petroleum distillates Exposure to radon
Cigarette smoking Exposure to asbestos Exposure to radon
The nurse educator asks the nursing student to explain the primary cause of anemia related to sickle cell disease (SCD). Which response by the nursing student is most accurate? Group of answer choices Deoxygenation of affected RBCs Early destruction of RBCs Deformity of RBCs Sickling of RBCs
Early destruction of RBCs
Why should the neurological assessment of an older client be modified? Group of answer choices Less efficient long-term memory Increased reaction to stimuli Easily fatigued Shorter attention span
Easily fatigued
What type of surgery is recommended for a 10-year-old client with recurring tonsillitis?? Group of answer choices Palliative Diagnostic Elective Emergency
Elective
The nurse is caring for a client diagnosed with colon cancer. The client is considered a poor surgical risk, but has a large tumor. Which intervention does the nurse anticipate will be performed to treat this client's cancer? Group of answer choices Tumor resection Electrocoagulation Local excision Laser photocoagulation
Electrocoagulation
Mr. Freeman is a 54-year-old truck driver. He is seeking care because there is a family history of colon cancer. Which diagnostic test does the nurse anticipate will be ordered for thisclient? Group of answer choices Colostomy Sigmoidoscopy Colonoscopy Fecal occult blood test
Fecal occult blood test
The nurse conducts a nursing assessment of a client with colorectal cancer. Which finding supports the current diagnosis of colorectal cancer? Group of answer choices Weight gain from last assessment An increased appetite Abdominal tenderness No history of smoking
Abdominal tenderness
What are the clinical manifestations of colon cancer? (Select all that apply.) Group of answer choices Anemia Abdominal pain Weight gain Increased appetite Change in bowel pattern
Anemia Abdominal pain Change in bowel pattern
What stimulates the compensatory mechanisms of the cerebral blood vessels to regulate cerebral pressure? Select all that apply. Group of answer choices Carbon dioxide Carbonic acid Hypokalemia Lactic acid Elevated serum uric acid level
Carbon dioxide Carbonic acid Lactic acid
A client is returning to the oncology clinic after a skin biopsy on an arm lesion that revealed melanoma. Which additional diagnostic tests would be done to evaluate this client formetastasis? (Select all that apply.) Group of answer choices Chest x-ray Bone scan CT scan of the liver Radiation therapy Liver function tests
Chest x-ray Bone scan CT scan of the liver Liver function tests
What information should the nurse include in the preoperative nutritional assessment? (Select all that apply.) Group of answer choices Use of herbal teas Current weight Food preferences Serum protein levels Body mass index
Current weight Food preferences Serum protein levels Body mass index
The nurse is educating a client with lung cancer about systemic manifestations. What manifestation associated with the gastrointestinal (GI) system should the nurse include in the teaching session? Group of answer choices Fatigue Hemoptysis Bone pain Dysphagia
Dysphagia
The nurse is caring for a client who is diagnosed with prostate cancer. Which symptom does the nurse anticipate this client will experience? Group of answer choices Weight gain Nocturia Blurred vision Weakness of upper extremities
Nocturia
Which surgical intervention removes one-fourth of the breast? Group of answer choices Radical mastectomy Segmental mastectomy Lumpectomy Quadrantectomy
Quadrantectomy
The nurse is caring for a 10-year-old client with thalassemia who had a splenectomy. Which nursing diagnosis is a priority for this client? Group of answer choices Activity intolerance Risk for cellular hypoxia Risk for sepsis Inadequate oxygenation
Risk for sepsis
Which are independent nursing interventions for an alteration in intracranial regulation? Select all that apply. Group of answer choices Shine a light into the client's eyes Raise the head of the bed Insert an indwelling urinary catheter Reduce the lights in the room Provide antianxiety medication through intravenous site
Shine a light into the client's eyes Raise the head of the bed Reduce the lights in the room
The nurse is explaining the language of the test results report to the client. The client asks, open double quote"What does that word 'hyperplasia' mean?close double quote" Which response to the client by the nurse isaccurate? Group of answer choices The cells are normal, but not in a normal location. The cells are greater in number or density than normal cells. The cells are abnormal in shape and size. The cells are more sensitive to the environment.
The cells are greater in number or density than normal cells.
Which diagnostic test is used to determine cell differentiation? Group of answer choices Fecal occult blood Tissue biopsy Sigmoidoscopy Carcinoembryonic antigen (CEA)
Tissue biopsy
Which diagnostic test would be indicated for finding and confirming both cancer of the prostate and cancer of the breast? Group of answer choices CT scan MRI X-rays Ultrasound
Ultrasound
What is the 5-year survival rate for prostate cancer confined to the prostate? Group of answer choices 85% 95% 80% 100%
100%
Mrs. Williamson is a 45-year-old woman who came to the hospital via ambulance after a car accident in which she experienced a fractured right femur, internal bleeding, and a severe head injury. Which intravenous solution would you anticipate the healthcare provider ordering? Group of answer choices 0.45% normal saline 0.9% normal saline 5% dextrose in normal saline Ringer lactate
5% dextrose in normal saline
What is the optimal position of head and neck that would promote adequate venous drainage of the cerebral tissue? Group of answer choices Slight flexion of the neck Head and neck in normal body alignment Lateral rotation of the head to either side Slight hyperextension of the neck
Head and neck in normal body alignment
Which diagnostic test is used to identify the presence of cysts or masses? Group of answer choices Breast ultrasound Biopsy Mammogram X-ray
Mammogram
What are the clinical manifestations of breast cancer? (Select all that apply.) Group of answer choices Mass in the upper outer quadrant of breast Breast burning or stinging Rash around the nipple Nipple discharge Painful area found on exam
Mass in the upper outer quadrant of breast Breast burning or stinging Rash around the nipple Nipple discharge
Which nursing assessment is appropriate for a client with urinary calculi? Group of answer choices Monitoring input and output Determining level of consciousness Assessing bowel sounds Recommending complete bed rest
Monitoring input and output
Which statement by the nurse shows a need for further education about the essentials ofgenetics? Group of answer choices DNA molecules are made up of long sequences. People have 46 chromosomes. Two copies of a Y chromosome result in a female. Identical twins have the same DNA.
Two copies of a Y chromosome result in a female.
The nurse knows that which type of radiation is used for the client with prostate cancer? Group of answer choices Orchiectomy Steroidal antiandrogens Radical prostatectomy External beam
External beam
Which treatment involves the use of electrocoagulation to shrink tumors? Group of answer choices Sigmoid colostomy Laser photocoagulation Fulguration Local excision
Fulguration
Which diagnostic test for leukemia determines the risk of bleeding? Group of answer choices Platelet count Red blood cell count Bone marrow aspiration White blood cell count
Platelet count
The nurse is caring for a client admitted for malignant melanoma on his trunk. What is the treatment of choice for malignant melanoma? Group of answer choices Immunotherapy Cryosurgery Curettage Surgical excision
Surgical excision
A nurse has provided instruction about driving safety for a client newly diagnosed with tonic-clonic seizures. What statement by the client indicates that the client understands the instruction? Group of answer choices "I will need to take the driving test again because I have had a seizure." "I can drive as soon as my antiepileptic medication is in my bloodstream." " I can drive after I have been seizure free for at least 2 years. "I will not be able to drive if I am taking medications for seizures."
" I can drive after I have been seizure free for at least 2 years.
The nurse is caring for a client admitted to an inpatient unit with fever and leukocytosis. During the initial examination, the nurse finds a suspicious-looking skin lesion possibly indicating malignancy. Which skin lesion is a form of skin cancer? (Select all that apply.) Group of answer choices Psoriasis Malignant melanoma Actinic keratosis Basal-cell carcinoma Squamous-cell carcinoma
Malignant melanoma Basal-cell carcinoma Squamous-cell carcinoma
The nurse is planning care for a client going home after prostate cancer surgery. What topic should be addressed when preparing the client and family for home care? Group of answer choices Manifestations of infection The importance of keeping appointments Radiation damage Joining a support group
Manifestations of infection
Which phrase describes a reflex? Group of answer choices Relay center for all information coming into the brain Brain matter responsible for muscle movement and balance Rapid, involuntary, predictable motor response to a stimulus Control center that regulates heart rate and blood pressure
Rapid, involuntary, predictable motor response to a stimulus
The spouse of a client with cancer asks the nurse what is meant when chemotherapy medications are referred to as cytotoxic. What is the best response by the nurse? Group of answer choices "Chemotherapy medications attack both cancerous and normal cells as they grow." "Chemotherapy medications are expected to treat cancer 100% of the time." "Chemotherapy medications are a combination of medication and implantable devices." "Chemotherapy medications attack specific types of cancer, preventing mitosis of other cancerous cells."
"Chemotherapy medications attack both cancerous and normal cells as they grow."
The nurse provides postoperative discharge instructions to a client recovering from a lumbar laminectomy. Which client statement indicates that additional teaching is required? Group of answer choices "I will take the pain medication as prescribed." "I can resume a normal diet as tolerated." "I will take a shower and leave the Steri-Strips alone." "I can drive myself home."
"I can drive myself home."
A client refuses to look at or care for her colostomy. What statement by the nurse would be most appropriate? Group of answer choices "I think we will need to teach your husband to care for your colostomy if you are not going to be able to do it." "I can see that you are upset. Would you like to share your concerns with me?" "It has been 4 days since your surgery, and you will soon be discharged. You have to learn to care for your colostomy before you leave the hospital." "I understand how you are feeling. It is important for you to feel attractive and you think having a colostomy changes your attractiveness."
"I can see that you are upset. Would you like to share your concerns with me?"
The nurse is assessing Mr. Klarke Stamos, a56-year-old male client who is of Greek heritage. Mr. Stamos was admitted to the hospital for treatment of acute exacerbation of sickle cell disease (SCD). When prioritizing nursing care and implementinginterventions, which complaint by Mr. Stamos is most appropriate for the nurse to address first? Group of answer choices "I don't eat a healthy diet." "I'm feeling really short of breath." "I'm having a lot of leg pain." "I don't have the energy to exercise."
"I'm feeling really short of breath."
The nurse instructs the parents of school-age children on ways to prevent head injuries. Which statement made by a participant indicates that additional teaching isrequired? Group of answer choices "My son should wear protective shoulder and knee pads when playing football." "My daughter needs to wear a helmet when riding the bicycle." "I need to get my son a helmet to wear when ice skating." "Even though he won't like it, I'll make sure my son wears a helmet when skateboarding."
"My son should wear protective shoulder and knee pads when playing football."
Abigail Derry is a 20-year-old woman who is diagnosed with iron deficiency anemia. Abigail states that she is vegan and wants to stay that way. She started this new diet about 6 months ago because it is "healthy." Abigail reveals that she has not really explored being vegan except that she eats only vegetables. Which suggestion might the nurse offer to Abigail? Group of answer choices "You should give up being vegan." "Increase your consumption of iron from heme iron sources only." "Eat more eggs and cheese." "Try to eat more dried beans and dried fruits."
"Try to eat more dried beans and dried fruits."
To experience status epilepticus, the client must have a continuous seizure for how long? Group of answer choices 15 minutes 20 minutes 10 minutes 35 minutes
35 minutes
A client with leukemia is scheduled to receive an autologous bone marrow transplant. When providing education, the nurse informs the family that the client will need to remain hospitalized in a private room for how long a period of time? Group of answer choices 9 to 11 weeks 1 to 3 weeks 6 to 8 weeks 3 to 5 weeks
6 to 8 weeks
Mr. Karrs sister-in-law inquires, Are there any tests you can run that will tell us why this is happening? What is the best response to her question? Select all that apply. Group of answer choices A PET scan to search for underlying structural abnormalities. An EEG to record any abnormal electrical activity in the brain. An MRI of the head to rule out structural abnormalities. A Head CT to visualize seizures. The health care provider will run a test of Mr. Karrs pacemaker.
A PET scan to search for underlying structural abnormalities. An EEG to record any abnormal electrical activity in the brain. The health care provider will run a test of Mr. Karrs pacemaker.
Which factor influences the development and manifestations of sickle cell disease (SCD) in children? Group of answer choices A high level of fetal hemoglobin in children inhibits sickling of RBCs. Sickle cell crisis is very common among children with sickle cell trait. Children with sickle cell trait have two Hb S genes. Children with sickle cell trait are commonly symptomatic at birth.
A high level of fetal hemoglobin in children inhibits sickling of RBCs.
Mr. Karr no longer requires ventilatory support; his Glasgow coma scale is 13. He awakens when you call his name and follows simple commands. He is oriented to person only and denies discomfort, but you sense he does not understand the question. His current vital signs are T 102°F, P 60 bpm, R 18 min, BP 130/82 mmHg, and he is SpO2 96% on O2 at 4 LPM per nasal cannula. A colleague remains at Mr. Karrs bedside; you introduce yourself to Mr. Karrs brother and sister-in-law in the family waiting room. Relieved to see you, his brother asks What can you tell me about these seizures hes having? What is your best response? Group of answer choices A seizure is considered a symptom of an underlying condition rather than a disease itself. There are many causes of seizures. These causes include concussions, infections, blood clots, brain tumors, or strokes. A seizure is a temporary event that consists of uncontrolled, electrical discharge of the brain neurons which interrupts normal brain function. A seizure can occur as an isolated event.
A seizure is considered a symptom of an underlying condition rather than a disease itself.
A nurse in the emergency department is providing care for a client who has increased intracranial pressure (IICP) from a traumatic brain injury from a motor vehicle crash. The nurse anticipates orders for which diagnostic tests in the care of this client? (Select all that apply.) Group of answer choices ABGs Electromyogram Cardiac monitoring CT of the head Intracranial pressure monitor
ABGs Cardiac monitoring CT of the head Intracranial pressure monitor
A client with a traumatic brain injury is intubated and placed on mechanical ventilation. What should the nurse use to evaluate the effectiveness of these respiratory interventions? Group of answer choices Glasgow Coma score Cranial nerve function Motor and sensory function Arterial blood gas results
Arterial blood gas results
Mrs. Washington is ready to be discharged. She has a follow-up visit scheduled with her surgeon. She asks, "Is there anything I should be concerned about when I'm at home? I live by myself, so I need to know when to call my doctor." Related to her surgery, in what situations should she initiate that contact? Select all that apply. Group of answer choices Diarrhea or constipation lasting a whole day Back pain Abdomen becomes swollen Dark black stools Swelling or redness in feet
Abdomen becomes swollen Dark black stools
A client presents to the emergency department with complaints of rectal bleeding for the past few days. The provider admits the client for a colonoscopy and further work-up for rectal bleeding and suspects that the client may have colorectal cancer. What are the possible manifestations of colorectal cancer? (Select all that apply.) Group of answer choices Abdominal or rectal mass Diarrhea Anorexia Abdominal pain Weight gain
Abdominal or rectal mass Diarrhea Anorexia Abdominal pain
When the results of Mrs. Walton's biopsy come back, the health care provider calls Mrs. Walton and tells her that the pathologist has confirmed she has fibrocystic breast disease, not breast cancer. Which findings confirm a diagnosis of fibrocystic breast disease? Select all that apply. Group of answer choices Ability to aspirate fluid from breast Mass consists of bloody discharge. Breast tenderness Aspirated fluid reveals no cancer cells. Mass remains palpable after aspiration.
Ability to aspirate fluid from breast Aspirated fluid reveals no cancer cells.
Oncogenes are one of several theories associated with how cancer begins. Which definition best defines oncogenes? Group of answer choices Mutation of cells that triggers DNA and RNA synthesis Abnormal genes that decrease the body's ability to produce carcinogenic agents Suppression of cells that produce enhanced parent cell growth Abnormal genes that trigger multiplication of cells
Abnormal genes that trigger multiplication of cells
A client with a traumatic brain injury is diagnosed as being brain dead. Which assessment finding supports this diagnosis? Group of answer choices Absence of spontaneous respirations Complete unawareness of self Aware of environment but unable to communicate Neck extended and the jaw is clenched
Absence of spontaneous respirations
Which is the most common type of leukemia in children and adolescents? Group of answer choices Chronic myeloid leukemia (CML) Acute myeloid leukemia (AML) Acute lymphocytic leukemia (ALL) Chronic lymphocytic leukemia (CLL)
Acute lymphocytic leukemia (ALL)
A client is diagnosed with a leukemia that is caused by uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow and the spleen. The nurse recognizes that this pathophysiology is present in which type of leukemia? Group of answer choices Chronic myeloid leukemia Chronic lymphocytic leukemia Acute lymphocytic leukemia Acute myeloid leukemia
Acute myeloid leukemia
A nurse in the intensive care unit is providing care for a client with increased intracranial pressure from a traumatic brain injury. The client has a fever of 102°F. Which interventions will the nurse use to promote normal intracranial pressure? (Select all that apply.) Group of answer choices Administer acetaminophen per order Monitor level of consciousness Suction for no more than 10 seconds per pass Flex the neck to open the airway Provide supplemental oxygen
Administer acetaminophen per order Monitor level of consciousness Suction for no more than 10 seconds per pass Provide supplemental oxygen
The nurse is preparing a plan of care for Jimmy Williams, a 30-year-old client recovering from a head injury. Which collaborative action should the nurse perform to help reduce cerebral edema? Group of answer choices Apply a cooling blanket Administer ethacrynic acid (Edecrin) as prescribed Regulate the infusion of a proton pump inhibitor Administer antihypertensive medication as prescribed
Administer ethacrynic acid (Edecrin) as prescribed
A nurse in the emergency department is providing care for a client diagnosed with increased intracranial pressure (IICP). The client is experiencing a decreasing level of consciousness. Which collaborative treatment would the nurse question for this client? Group of answer choices Administer intravenous mannitol Place client on mechanical ventilator to increase oxygen and eliminate carbon dioxide Administer intravenous 0.45% saline infusion Intubate the client with an endotracheal tube
Administer intravenous 0.45% saline infusion
What nursing interventions are appropriate to include in the plan of care for a client withanemia? (Select all that apply.) Group of answer choices Administer supplemental oxygen as ordered. Administer medications as ordered. Provide rest periods as needed. Assess for signs of hypoxia. Place the client in supine position.
Administer supplemental oxygen as ordered. Administer medications as ordered. Provide rest periods as needed. Assess for signs of hypoxia.
Which nursing diagnosis is appropriate for a client with prostate cancer? Group of answer choices Risk for body image disturbance Risk for painful intercourse Alterations in urinary elimination Altered nutritional status
Alterations in urinary elimination
What is the cause of vasogenic cerebral edema? Group of answer choices Alteration in hormonal or electrolyte balance resulting in diffuse brain swelling An increase in fluid retention of the neurons and endothelial brain cells related to sodium and water imbalance An increase in capillary permeability of cerebral vessels resulting in extracellular edema Infiltration of brain cells by bacterial microorganisms resulting in a shift in osmotic pressure
An increase in capillary permeability of cerebral vessels resulting in extracellular edema
The nurse caring for a client with prostate cancer knows that which surgical treatment might be included in the client's plan of care? Group of answer choices Brachytherapy Urinary bladder transplant Androgen deprivation via orchiectomy Radical oophorectomy
Androgen deprivation via orchiectomy
The nurse is assessing a client who leads an active, healthy lifestyle. The client has no history of chronic health conditions, but is seeking health care due to visual changes and occasional headaches over the past few weeks. Upon assessment, which question should the nurse ask the client? Group of answer choices Have you noticed an increase in thirst? Do you feel nauseated after eating? Are you having trouble moving your bowels? Are your headaches worse upon rising in the morning?
Are your headaches worse upon rising in the morning?
The nurse is planning care for a client admitted for end-stage lung cancer. Which potential problem will assist in addressing the client's psychological needs? Group of answer choices Anticipatory grieving Activity intolerance Breathing pattern Pain
Anticipatory grieving
A client recently diagnosed with cancer just arrived from another country and has few resources for support in the community. The client is admitted to the cancer unit. Which nursing diagnosis would be most appropriate for the client? Group of answer choices Anxiety Disturbed body image Potential for injury Imbalanced nutrition
Anxiety
The nurse is caring for a client who is due to undergo a biopsy of a suspicious mass in her breast. The client is crying and is tachycardic and tachypneic. Based on this assessmentdata, which problem is a priority? Group of answer choices Body image disturbance Impairment of gas exchange Anxiety Risk for infection
Anxiety
Mrs. Walton comes to the clinic for her follow-up appointment. The appointment will include client teaching for Mrs. Walton regarding her diagnosis of fibrocystic breast disease. Her daughter Sandra accompanies her to the appointment. What topics will you include in the teaching for Mrs. Walton and her daughter? Select all that apply. Group of answer choices Apply ice or heat to the affected area. Wear a support bra. Increase caffeine intake. Maintain current salt intake. Use prescribed diuretics.
Apply ice or heat to the affected area. Wear a support bra. Use prescribed diuretics.
The nurse identifies the postoperative client as being at an increased risk for impaired oxygenation. Which is the best nursing intervention to address this client's problem? Group of answer choices Medicate for pain as prescribed Apply oxygen 2 liters by face mask as prescribed Administer 1 unit platelets as prescribed Provide antibiotic as prescribed
Apply oxygen 2 liters by face mask as prescribed
Before you go to Mrs. Washington's room to tell her that her sister called, you review her plan of care. What interventions to prevent cardiovascular complications do you want to make sure have been implemented? Group of answer choices Give prophylactic subcutaneous warfarin (Coumadin). Have her lie flat as long as possible. Apply anti-embolism stockings. Monitor pain relief.
Apply anti-embolism stockings.
Ms. Hampton is a 26-year-old competitive swimmer who presents to your clinic for her annual exam. She reports that she has just returned to the state after spending the winter with her friends in Florida. While you are taking Ms. Hampton's bloodpressure, you notice multiple nevi on her shoulders and neck, and multiple irregularly shaped dark-colored lesions evident on her back; one in particular is about 7 mm in diameter. As thenurse, what would you initiate as your next step in Ms.Hampton's care? Group of answer choices Ask Ms. Hampton about family history of skin cancer; history of sunburns; sun exposure, sunscreen use, and skin examination habits; and any skin changes she has noted. Take this opportunity to educate Ms. Hampton about sun exposure, the risks of skin cancer, and prevention strategies that she should implement immediately. Prepare the room for a biopsy of the suspicious lesion, since immediate excision and biopsy is indicated. Immediately document the 7-mm dark lesion with notched edges visible on her back.
Ask Ms. Hampton about family history of skin cancer; history of sunburns; sun exposure, sunscreen use, and skin examination habits; and any skin changes she has noted.
Mr. Baker is a 60-year-old man who is seen for an annual physical examination. The nurse is completing the nursing assessment for Mr. Baker. What would the nurse include in the health history to determine the client's risk for colon cancer? Group of answer choices Asking the client if he has pain with defecation Listening for bowel sounds Assessing current weight Palpating the abdomen for tenderness
Asking the client if he has pain with defecation
A client with a stroke is demonstrating signs of increasing intracranial pressure. Which actions should the nurse take at this time? (Select all that apply.) Group of answer choices Assess cranial nerve function Assess vital signs Provide hypotonic fluids Monitor pupillary response Reduce environmental stimuli
Assess cranial nerve function Assess vital signs Monitor pupillary response Reduce environmental stimuli
Which intervention is specific to impaired tissue integrity after a surgical intervention for breast cancer? Group of answer choices Assess dressings for drainage Monitor surgical drains for amount and color of drainage Observe the surgical site for redness Assess for manifestations of lymphedema
Assess for manifestations of lymphedema
Rachel, a recent nursing graduate, is shadowing you today. She has identified that Mr. Alvarez is experiencing acute pain. She has written nursing interventions that she would like to be included in Mr. Alvarezs plan of care. She begins to discuss these with you. Which statement indicates that Rachel requires further education about pain management? Group of answer choices Administer analgesics as ordered by the health care provider. Assess effectiveness of clients pain medication and report any unrelieved pain. Assess pain severity and duration every 2 hours and as needed. Monitor clients vital signs every 2 hours and as needed.
Assess pain severity and duration every 2 hours and as needed.
A client is to be discharged from the hospital first thing in the morning. However, overnight the client developed symptoms of "not being able to see well." The client also cannot move either the left arm or the left leg to get out of bed. What is the priority response by the nurse? Group of answer choices Assist the client to dress for discharge Assess the client's vital signs Ask the client if he has a family history of strokes Instruct the client on the use of assistive devices to assist in mobility
Assess the client's vital signs
The nurse is providing education to a client with chronic myeloid leukemia about ongoing needs. Which interventions would the nurse include when educating this client? (Select all that apply.) Group of answer choices Avoid alcohol-based mouthwash Complete oral hygiene frequently Encourage participation in strenuous exercise Refrain from eating overly spicy foods Drink 5 to 8 glasses of water a day
Avoid alcohol-based mouthwash Complete oral hygiene frequently Refrain from eating overly spicy foods Drink 5 to 8 glasses of water a day
During a physical examination, the nurse assesses the reflexes of an older client. Which reflex would require notification to the healthcare provider? Group of answer choices Corneal Gag Achilles Babinski
Babinski
You have completed teaching Tani about postconcussion syndrome. Which of Tanis statements indicates a need for further teaching? Group of answer choices It is not uncommon to have personality changes, depression, and anxiety after a concussion. I could continue to have headaches, dizziness and ringing in my ears. Because my concussion was mild, I will not have any further symptoms. I may have symptoms of postconcussion syndrome for several months after my concussion, before my symptoms completely resolve.
Because my concussion was mild, I will not have any further symptoms.
A client with leukemia is prescribed a therapy that modifies the body's response to cancer cells. The nurse plans to educate the client about what therapy? Group of answer choices Stem cell transplant Complementary Radiation Biologic
Biologic
Carlos Sanchez is a 42-year-old Hispanic man who has returned to the oncology clinic after having a prostate ultrasound. If the results are positive for finding a mass, what other diagnostic test might be planned for Mr. Sanchez? Group of answer choices MRI Nuclear imaging X-rays Biopsy
Biopsy
Which diagnostic test is used to diagnose the type of lung cancer tumor? Group of answer choices Pulmonary function tests CT scan Biopsy and cytologic examination Bronchoscopy
Biopsy and cytologic examination
Which treatment options are appropriate for a client with sickle cell disease (SCD)? (Select all that apply.) Group of answer choices Insulin administration Blood transfusions Bone marrow transplantation Surgical removal of the client's spleen Hematopoietic stem cell transplantation
Blood transfusions Bone marrow transplantation Surgical removal of the client's spleen Hematopoietic stem cell transplantation
Mr. Lawrence Karr is a 77-year-old client brought to the emergency department (ED) by ambulance due to mental status changes, confusion, and somnolence. His wife explains that she found him in this state when she arrived home from the supermarket. She became alarmed when he did not meet her in the garage to unload the groceries. She states, Aside from a slight headache, he was just fine when I left the house two hours ago. He opens his eyes when the paramedics transfer him from the stretcher to the cot, mumbles incoherently, attempts to push their hands away, then quickly falls back to sleep. He takes an enteric-coated baby aspirin daily and has no known drug allergies. Surgical history includes insertion of a permanent transvenous pacemaker for complete heart block 4 years ago.Mr. Karrs vital signs are T 99.8°F, P 60 bpm, R 24 min, and BP 168/90 mmHg. His Glasgow coma scale is 11; he does not follow commands. There is no evidence of posturing or abnormal movements. Pupils are equal and nonreactive to light; nystagmus is also present. His lung fields are clear to auscultation; no accessory muscle use is noted. The cardiac monitor shows paced rhythm with 100% sensing and capture. Mr. Karr is disrobed and placed in a hospital gown; you note he has been incontinent of urine when his clothing is placed in a safety belongings bag. Mr. Karr suddenly becomes stiff, stops breathing, and then experiences approximately two minutes of generalized tonicdashclonic jerking. Which abnormal parameters could cause Mr. Karrs abnormal neurological status? Select all that apply. Group of answer choices Blood glucose: 38 mg/dL Cerebrovascular accident (CVA) Pulse oximetry SpO2 of 93% Blood glucose: 1400 mg/dL Positive blood cultures
Blood glucose: 38 mg/dL Cerebrovascular accident (CVA) Blood glucose: 1400 mg/dL Positive blood cultures
What preoperative data would cause the nurse to place a client at risk for surgical infection? (Select all that apply.) Group of answer choices Takes acetaminophen daily for arthritis pain Body mass index of 33.7 Fasting blood glucose level of 258 mg/dL Treated for gastric ulcers caused by H. pylori Prescribed steroids for chronic lung disease
Body mass index of 33.7 Fasting blood glucose level of 258 mg/dL Prescribed steroids for chronic lung disease
The nurse is caring for a client newly admitted with suspected leukemia. The nurse anticipates which tests will be ordered to confirm the diagnosis? (Select all that apply.) Group of answer choices Bone marrow aspiration Red blood cell count White blood cell count Sedimentation rate Platelet count
Bone marrow aspiration Red blood cell count White blood cell count Platelet count
Which diagnostic test is used to diagnose aplastic anemia? Group of answer choices Bone marrow examination Complete blood count Schilling test Iron levels
Bone marrow examination
You also realize that if Mrs. Walton starts on tamoxifen (Nolvadex), you will need to follow up with her on a weekly basis. Nursing implications to consider in delivery of care to a client receiving tamoxifen (Nolvadex) include which assessment findings? Select all that apply. Group of answer choices Bone pain 4 or 5 times per week Increase in weight by 5 lbs in one week Eating fast food for breakfast and lunch 4 times per week Decrease in size of current skin lesions Daily intake of glucosamine
Bone pain 4 or 5 times per week Increase in weight by 5 lbs in one week Eating fast food for breakfast and lunch 4 times per week
The nurse is conducting a presentation on the early detection of colon cancer. What should the nurse encourage members of the audience to report to their healthcare providers? (Select all that apply.) Group of answer choices Bowel changes Fatigue Unexplained weight loss with adequate nutritional intake Rectal bleeding Negative fecal occult blood testing
Bowel changes Fatigue Unexplained weight loss with adequate nutritional intake Rectal bleeding
The nurse assesses a respiratory rate of 8 breaths per minute in a client with a traumatic brain injury. Shortly thereafter the client begins hiccupping. Which part of the brain should the nurse suspect is being affected in this client? Group of answer choices Brainstem Cerebellum Thalamus Occipital lobe
Brainstem
You are teaching Mrs. Walton and her daughter about fibrocystic breast disease. What will you explain to Mrs. Walton that she will feel on palpation of her breasts? Group of answer choices Thick areas on the breast, nontender lumps, and discharge Tender lumps, rapid growth, and fixation of nipple Breast pain, tender lumps, and a thick area on the breast Breast pain, discharge, and breast warm to touch
Breast pain, tender lumps, and a thick area on the breast
A client is admitted with squamous cell lung cancer. Which type of medication should the nurse administer to reduce airway obstruction? Group of answer choices Bronchodilators Cholingergic Analgesics Chemotherapy
Bronchodilators
The healthcare provider is scheduled to perform a diagnostic test that will visualize and obtain a tissue sample of a client's lung tumor. What diagnostic test would the nurse anticipate the healthcare provider performing? Group of answer choices Bronchoscopy CT scan Pneumonectomy Chest x-ray
Bronchoscopy
Which assessment findings of the skin and mucous membranes may be noted with leukemia? (Select all that apply.) Group of answer choices Bruising Petechiae Ulcers Pruritic rash Decreased skin turgor
Bruising Petechiae Ulcers
The healthcare provider ordered diagnostic tests for a client with suspected increased intracranial pressure (IICP). Which tests should the nurse expect to show signs of IICP and help confirm the diagnosis and possible treatment needed? (Select all that apply.) Group of answer choices CT scan Arterial blood gases (ABGs) Stool guaiac test Serum osmolality Chest x-ray
CT scan Arterial blood gases (ABGs) Serum osmolality
You continue with your assessment of Tani. Which diagnostic tests do you anticipate the health care provider will order to diagnose a concussion and to rule out additional braintrauma? Group of answer choices X-ray of the head White blood count (WBC) Urinalysis CT scan of the head
CT scan of the head
Mrs. Washington did not suffer any injury from her fall and is ambulating without assistance. A laboratory technician calls your unit and explains that Mrs. Washington's postoperative lab results included a critical value. What is your first action upon receiving a critical lab value? Group of answer choices Call the lab and have the technician repeat the test on the specimen. Ask Mrs. Washington if she has had this value in the past. Collect another specimen to validate the results of the initial test result. Call the health care provider immediately.
Call the health care provider immediately.
What postoperative assessment would indicate to the nurse a change in a client's cardiovascular status? (Select all that apply.) Group of answer choices Vomiting moderate amount of green emesis Capillary refill time greater than 3 seconds Dropping blood pressure Pedal pulse non-palpable Absent gag reflex
Capillary refill time greater than 3 seconds Dropping blood pressure Pedal pulse non-palpable
Mr. Karr continues to be somnolent; his current vital signs and cardiac rhythm are unchanged. He does open his eyes to tactile stimuli; nystagmus is still present. His Glasgow coma scale is 12. Choose the measures you will implement to manage Mr. Karrs care. Select all that apply. Group of answer choices Place a padded tongue blade at the bedside. Carefully document characteristics of seizure. Observe for lack of therapeutic response to fosphenytoin (Cerebyx). Pad side rails of cot. Observe IV site for patency frequently.
Carefully document characteristics of seizure. Observe for lack of therapeutic response to fosphenytoin (Cerebyx). Pad side rails of cot. Observe IV site for patency frequently.
How does increased intracranial pressure affect brain tissue? Group of answer choices Causes an oxygen deficit that leads to changes in personality, memory, and judgment Transmits sensory and motor impulses to the cerebrum for interpretation Removes fluid from interstitial spaces to reduce excess body fluid Alters electrical discharges in the brain to cause involuntary movement
Causes an oxygen deficit that leads to changes in personality, memory, and judgment
What is the purpose of the process of differentiation of cells in the body? Group of answer choices Cells become specialized for specific tasks. Cells get immune from infection. Cells produce abnormal tumors. Cells become ready for cell reproduction.
Cells become specialized for specific tasks.
What is the most frequent cause of increased intracranial pressure (IICP)? Group of answer choices Cerebral edema Tumors Hemorrhage Abscesses
Cerebral edema
Desiree Washington is a 48-year-old-woman diagnosed with large uterine fibroids. She has undergone a total abdominal hysterectomy and is ready to be transferred from the PACU to the surgical unit. As the nurse accepting her transfer, you receive report from the PACU nurse. You learn that Mrs. Washington has no significant past medical history and has had an uneventful recovery. You note that her vital signs are within normal limits (WNL), her lungs are clear to auscultation (CTA), and her incisional dressing is dry and intact. She was medicated 2 hours ago with morphine sulfate 2 mg IV. Her IV is infusing with lactated Ringer solution at a rate of 100 mL/hr, and she has a Foley catheter draining clear yellow urine.After you get Mrs. Washington settled, you ask her if she has any pain. Sheresponds, "Yes, it's beginning to come back and is getting bad." You ask her how she would rate her pain on a scale of 1 to 10. She states it is an "8" What action should you take first? Group of answer choices Check the order for pain medication and determine what you are able to administer now. Reposition her and offer her a back massage. Sit her up in the bed and give her a pillow for coughing. Order a PCA pump and set it up as soon as it arrives.
Check the order for pain medication and determine what you are able to administer now.
The nurse discusses with the student nurse the external agents known to cause cancer. Which external agent should the nurse include in the discussion? Group of answer choices Inherited traits Hormones Immune conditions Chemicals
Chemicals
The nurse is educating a client, newly diagnosed with small-cell cancer, about treatment options. What is the treatment of choice for this type of cancer? Group of answer choices Lobectomy Brachytherapy Chemotherapy Laser bronchoscopy
Chemotherapy
What are factors that increase the risk of developing leukemia? (Select all that apply.) Group of answer choices Obesity Cigarette smoking Diagnosis of Down syndrome Previous cancer treatment Excessive caffeine ingestion
Cigarette smoking Diagnosis of Down syndrome Previous cancer treatment
The nurse is concerned that a client recovering from a stroke may have parietal lobe damage. Which observations made by the nurse support thisconcern? (Select all that apply.) Group of answer choices Client is unable to move the left hand independently. Client did not respond when foot was caught in the side rail. Client did not react when the trash can in the room caught on fire. Client did not respond when hot coffee was spilled on the hand. Client is unable to speak.
Client did not respond when foot was caught in the side rail. Client did not respond when hot coffee was spilled on the hand.
The circulating nurse is ensuring that a client is adequately positioned for surgery and determines that the procedure is going to take longer than 30 minutes to complete. What did the nurse assess to make this determination? Group of answer choices Client is wearing sequential compression devices. Client has pillows placed under the knees. Client has a device on a finger to measure oxygen saturation. Client is in the lithotomy position.
Client is wearing sequential compression devices.
A client with a minor head injury has a Glasgow Coma score of 15. What does this score indicate to the nurse? (Select all that apply.) Group of answer choices Client withdraws to pain. Client withdraws to touch. Client spontaneously opens the eyes. Client is oriented to person, place, and time. Client uses appropriate words and phrases.
Client spontaneously opens the eyes. Client is oriented to person, place, and time. Client uses appropriate words and phrases.
Which symptom indicates to the nurse that the client may still have an infection related to renal calculi? Group of answer choices Oral temperature of 99.1 degree F Right flank pain Nausea and vomiting Cloudy urine
Cloudy urine
What are the systemic clinical manifestations of lung cancer? (Select all that apply.) Group of answer choices Hemoptysis Clubbing of the nails Dysphagia Proteinuria Weight gain
Clubbing of the nails Dysphagia
As part of your routine postoperative care of Mr. Jacobi, you assess his left foots neurovascular status for the first 12-24 hours after surgery. Following the neurovascular assessment, what findings will you report to the health careprovider? Select all that apply. Group of answer choices Color Movement Sensation Odor Temperature
Color Movement Sensation Temperature
A client with colorectal cancer is exhibiting symptoms of anemia. Which diagnostic test does the nurse anticipate will be ordered for this client? Group of answer choices Hemoccult Guaiac test Complete blood count Carcinoembryonic antigen (CEA) level
Complete blood count
Which lab test is used when evaluating a client for anemia? Group of answer choices Complete blood count Blood glucose Urinalysis Arterial blood gas
Complete blood count
A female client has a grapefruit sized tumor in her abdomen. Her healthcare provider believes the tumor is life-threatening. Which diagnostic test is appropriate to determine the extent of the tumor? Group of answer choices Computerized tomography (CT scan) Tumor markers Cytological examination of aspirated tumor cells Cytological examination of exfoliated cells from epithelial surface of the tumor
Computerized tomography (CT scan)
What should the nurse do to reduce the risk of traumatic brain injury in people over the age of 65? Group of answer choices Prevent participation in contact sports Suggest a reduction in activity Conduct a home safety assessment Restrict movement with chemical restraints
Conduct a home safety assessment
What information is included in the pre-procedure hand-off report during the preoperative phase? (Select all that apply.) Group of answer choices Location of drains Correct surgical procedure Development of complications Mark of surgical site by the surgeon Name of consented procedure
Correct surgical procedure Mark of surgical site by the surgeon
A client seen in the dermatology clinic was diagnosed with actinic keratosis by the healthcare provider and sent for specialty follow-up. Which treatment option is for actinickeratosis? (Select all that apply.) Group of answer choices Phototherapy Curettage Topical creams Chemical peeling Cryotherapy
Curettage Topical creams Chemical peeling Cryotherapy
The nurse is caring for a client with a history of malignant melanoma. While performing the admission assessment, the nurse reviews ongoing self-care with the client. Which assessment parameter is a priority during the initial physical examination? Group of answer choices Detailed foot examination Mental health examination Dental examination Detailed skin assessment
Detailed skin assessment
The results of Mrs. Walton's mammography are inconclusive, and the health care provider recommends that Mrs. Walton undergo a biopsy to determine the etiology of the mass in her breast. Depending on the results coming back negative, her health care provider wants to start her on tamoxifen (Nolvadex) because of her family history of breast cancer. Mrs. Walton asks for information about the medication, because she likes to stay in control and know what to expect. You provide Mrs. Walton with information concerning possible reactions to tamoxifen (Nolvadex). Which symptoms, due to tamoxifen use, would be MOST concerning if Mrs. Walton began displaying these? Group of answer choices Decrease in urination, swollen feet, and difficulty walking up stairs Intermittent hot flashes Headaches, difficulty seeing objects at times, and weakness and numbness on one side Intermittent shortness of breath, especially after walking up stairs
Decrease in urination, swollen feet, and difficulty walking up stairs
A nurse in the intensive care unit is providing care for a client with increased intracranial pressure (IICP). The nurse monitors the client for which manifestations of IICP? (Select all that apply.) Group of answer choices Decreased level of consciousness Projectile vomiting Decreased blood pressure Increased heart rate Dilated pupils
Decreased level of consciousness Projectile vomiting Dilated pupils
What teaching does a client need before having a surgical procedure? (Select all that apply.) Group of answer choices Deep breathing and coughing exercises Surgical incision care Prevention of constipation Prevention of thromboembolic events Physical activity limitations
Deep breathing and coughing exercises Surgical incision care Prevention of constipation Prevention of thromboembolic events
Which material in the chromosomes contains genetic information? Group of answer choices Deoxyribonucleic acid (DNA) molecules Endoplasmic reticulum channels Floating ribosomes Ribonucleic acid (RNA) molecules
Deoxyribonucleic acid (DNA) molecules
A client is admitted to the hospital for vomiting large amounts of blood. Which assessment finding does the nurse associate with blood loss anemia? Group of answer choices Sore, red tongue Bradycardia Tachycardia Jaundice
Tachycardia
What is the purpose for diagnostic tests during the preoperative period? (Select all that apply.) Group of answer choices Determine acid-base balance Determine pain management approaches Evaluate cardiovascular status Evaluate the potential for bleeding Determine the presence of pregnancy
Determine acid-base balance Evaluate cardiovascular status Evaluate the potential for bleeding Determine the presence of pregnancy
Mr. Karrs fosphenytoin (Cerebyx) infusion will finish in five minutes. Which indications would require terminating Mr. Karrs infusion prior to completion? Select all that apply. Group of answer choices Second degree atrioventricular (AV) heart block Development of measles-type rash Heart rate of 40 bpm Increased somnolence Blood pressure below normal
Development of measles-type rash Blood pressure below normal
The nurse is caring for a client who reports nausea and a sudden onset of acute perineal and back pain. The client reports a history of prostate cancer in his family. Which diagnostic test does the nurse anticipate for this client? Group of answer choices Digital rectal examination X-ray and biopsy Urinalysis with differential WBC count and urine drug screen
Digital rectal examination
Jan Lewis is a 25-year-old single woman who has been prescribed carbamazepine (Tegretol) for seizure control. She is a waitress who is sexually active. What would you include in client teaching about this medication? Group of answer choices Warn about gingival hyperplasia Advise her to increase her vitamin D consumption Warn about taking warfarin (Coumadin) with Tegretol Discuss effective birth control
Discuss effective birth control
Soon after you spoke with the provider, Mrs. Washington's bleeding stopped. You recheck her BP and P and find them WNL. Shortly after, Mrs. Washington gets out of bed to go to the bathroom and trips on a luggage strap on the floor. You hear the noise of her falling and rush to her room. You assess that she has not injured herself, help her return to bed, check her vital signs, and ensure that her call light is at hand. What actions will you take in response this event? Group of answer choices Document her vital signs in the clinical record. Document that you completed an incident report in the clinical record. Have her sign a release that she is OK. Give her a choice of returning to bed rest restrictions or always asking for assistance.
Document her vital signs in the clinical record.
After a nursing assessment, the nurse documents that a client is confused. Which behaviors did the nurse assess to determine this client's level ofconsciousness? (Select all that apply.) Group of answer choices Does not know why hospitalization is required Responds to verbal stimuli but quickly falls back asleep Does not remember home address Uses inappropriate words to describe situations Moans in response to painful stimuli
Does not know why hospitalization is required Does not remember home address Uses inappropriate words to describe situations
A nurse is providing care for a client with a traumatic head injury. The nurse should monitor the client for which manifestations consistent with increased intracranialpressure? (Select all that apply.) Group of answer choices Drowsiness Double vision Headache Increased heart rate Blurred vision
Drowsiness Double vision Headache Blurred vision
The nurse is caring for a client admitted to the oncology floor with malignant melanoma. What are the types of malignant melanomas? (Select all that apply.) Group of answer choices Dysplastic nevi Lentigo maligna Congenital nevi Hyperkeratosis Solar keratosis
Dysplastic nevi Lentigo maligna Congenital nevi
The nurse is caring for a client with malignant melanoma on her leg who was recently admitted to the oncology floor for biopsy. The client says that she has heard about certain skin lesions that are precursors to melanomas, and she asks the nurse to tell her about how they typically look so that she can make sure other family members know to check themselves for moles. The nurse would tell her about which of the following skin lesions that are precursors to melanoma? (Select all that apply.) Group of answer choices Dysplastic nevi Actinic keratosis Lentigo maligna Congenital nevi Solar keratosis
Dysplastic nevi Lentigo maligna Congenital nevi
The nurse is interviewing a client admitted with a diagnosis of prostate cancer and questions the client regarding his symptoms. Which symptoms, if experienced by the client, support the diagnosis? (Select all that apply.) Group of answer choices Dysuria Frequent urination Nocturia Polyuria Reduction in urinary stream
Dysuria Frequent urination Nocturia Reduction in urinary stream
A nurse is providing care for a client newly diagnosed with tonic-clonic seizures. The healthcare provider has admitted the client for diagnostic testing to rule out a brain tumor. The nurse would anticipate orders for which diagnostic tests? (Select all that apply.) Group of answer choices Electroencephalogram (EEG) Electrocardiogram (ECG) Lumbar puncture Blood cultures CT scan
Electroencephalogram (EEG) Lumbar puncture CT scan
A pediatric client is admitted for a head injury after falling off of a skateboard. The client was at first combative but is now becoming lethargic. Which actions should the nurse take for this client who has increasing intracranial pressure? (Select all that apply.) Group of answer choices Insert a nasogastric tube Elevate the head of the bed 30 degrees Pad the side rails Install suction equipment at the bedside Raise the side rails
Elevate the head of the bed 30 degrees Pad the side rails Raise the side rails
Which position is optimal for a client with lung cancer who is experiencing difficulty breathing? Group of answer choices Elevating the head of the bed to 60 degrees Turning on the side opposite of the tumor location Sitting upright leaning forward Standing with support
Elevating the head of the bed to 60 degrees
You have created a plan of care for Mr. Alvarez. Post-operatively, you recognize that he has diminished lung sounds bilaterally. Which nursing intervention is appropriate to assist in maintaining adequate ventilation? Group of answer choices Administer anticoagulants as ordered. Administer ibuprofen (Motrin) for postoperative pain. Encourage client to ambulate 2dash3 times on postoperative day 1. Assist Mr. Alvarez to use an incentive spirometer once per shift.
Encourage client to ambulate 2dash3 times on postoperative day 1.
Which nursing intervention would address the issue of hopelessness in relation to the diagnosis and treatment of melanoma? Group of answer choices Encouraging adequate intake of protein and calories Monitoring for infection Encouraging participation in self-care Decreasing sensory stimuli
Encouraging participation in self-care
What would be used to provide respiratory support for an alteration in intracranial regulation? Select all that apply. Group of answer choices Endotracheal intubation Mechanical ventilation Nebulizer treatments Oropharyngeal airway Metered-dose inhaler
Endotracheal intubation Mechanical ventilation Oropharyngeal airway
What is the nurse's role in acquiring the client's informed consent? Group of answer choices Discuss the surgical procedure with the client Ensure that the client signed consent forms Provide preoperative medications Answer any questions the client has about the surgery
Ensure that the client signed consent forms
The intraoperative nurse is preparing a client to receive electrosurgery. What are priority nursing actions before this procedure is performed? (Select all that apply.) Group of answer choices Ensure tattoos, metal implants, and scars are not used for pad placement Cover windows and reflective surfaces with a towel Remove client's jewelry and eyeglasses Complete a baseline skin assessment Maintain strict aseptic technique
Ensure tattoos, metal implants, and scars are not used for pad placement Remove client's jewelry and eyeglasses
When assessing the client with cancer, which immune system manifestation would be a concern? Group of answer choices Absent bowel signs Evidence of infection Cyanosis Behavioral changes
Evidence of infection
The nurse is educating the student nurse about ways to educate high-school age clients to do regular self-examinations for early detection of some cancers. How do those exams use the teenagers' senses to find evidence of possible cancer? (Select all that apply.) Group of answer choices Evidence of possible cancer can be seen. Evidence of possible cancer can be heard. Evidence of possible cancer can be felt. Evidence of possible cancer can be tasted. Evidence of possible cancer can be smelled.
Evidence of possible cancer can be seen. Evidence of possible cancer can be felt.
Tani is driven to the emergency department (ED) by one of her equestrian teammates. Her vital signs are: T 98.7°F, P 87 bpm, R 22/min, and BP 114/58 mmHg. She is covered in dust and mud. No open areas are noted. Her teammate reports Tani fell off of her horse while going around the barrel, and she blacked out. Tani is moaning, My head hurts. Whathappened? Where am I? You are the ED nurse conducting her initial assessment. What questions are essential for you to explore? Group of answer choices How long has Tani been riding horses? Exactly what happened to Tani? What did Tani have for breakfast? Was Tani wearing a helmet? How long was Tani unresponsive?
Exactly what happened to Tani? Was Tani wearing a helmet? How long was Tani unresponsive?
The nurse is performing a physical assessment of a client suspected of cancer. Which component of the client's health history is most important for the nurse to consider while assessing the client for cyanosis? Group of answer choices Sun exposure Family history of colon cancer Complaints of abdominal pain Exposure to secondhand smoke
Exposure to secondhand smoke
What situation may trigger a seizure? Group of answer choices Low blood pressure Low body temperature Decreased intracranial pressure Exposure to toxins
Exposure to toxins
The nurse is conducting an assessment of a client diagnosed with melanoma. Which item will the nurse include in the client's health history? Group of answer choices Measurement of skin lesions Family history of skin cancer Inspection of skin color Palpation of skin texture
Family history of skin cancer
What preoperative data would cause the nurse to place a client at risk for surgical infection? (Select all that apply.) Group of answer choices Fasting blood glucose level of 258 mg/dL Treated for gastric ulcers caused by H. pylori Takes acetaminophen daily for arthritis pain Prescribed steroids for chronic lung disease Body mass index of 33.7
Fasting blood glucose level of 258 mg/dL Prescribed steroids for chronic lung disease Body mass index of 33.7
Which conditions are known triggers for a sickle cell crisis? (Select all that apply.) Group of answer choices Fever High altitudes Hyperventilation Emotional stress Physical stress
Fever High altitudes Emotional stress Physical stress
Mrs. Walton is hoping that the changes in her breast are due to something other than breast cancer. She asks you what other disorders have characteristics similar to breast cancer. What disorders will you discuss with Mrs. Walton? Select all that apply. Group of answer choices Fibrocystic changes Acute mastitis Duct ectasia Intraductal papilloma Fat necrosis
Fibrocystic changes Intraductal papilloma Fat necrosis
A client is admitted with a breast mass that is newly diagnosed as breast cancer. Which clinical manifestations of this disease does the nurse expect during the assessment? (Select all that apply.) Group of answer choices Flaking around the nipple Low-grade fever Skin rash around the nipple A burning sensation in the breast Nipple discharge
Flaking around the nipple Skin rash around the nipple A burning sensation in the breast Nipple discharge
The nurse is caring for a client who experienced a seizure. The client indicates that he was watching television when the seizure occurred. What condition most likely triggered the seizure? Group of answer choices Fatigue Flashing lights Hypoglycemia Fever
Flashing lights
The nurse is caring for a client receiving chemotherapeutic agents in the treatment of colorectal cancer. Which chemotherapeutic agent would the nurse expect to be administered with folinic acid (leucovorin)? Group of answer choices Fluorouracil (5-FU) Irinotecan (CPT-11) Capecitabine Oxaliplatin
Fluorouracil (5-FU)
The health care provider diagnoses Tani with a concussion. Which assessment findings would indicate a need to admit Tani to the hospital for further evaluation? Group of answer choices Focal neurological examination Nonfocal neurological examination Periods of unconsciousness Memory loss of the details c the accident T 98.8degreesF, P 84 bpm, R 20/min, and BP 110/60 mmHg
Focal neurological examination Periods of unconsciousness
The nurse manager is presenting an in-service for staff nurses about Medicaid insurance coverage. Which statements are appropriate for the nurse manager to include during thein-service? (Select all that apply.) Group of answer choices For the client who qualifies for Medicaid, home health services are typically covered. While Medicaid covers inpatient hospital services, it does not cover outpatient care. Transportation costs to healthcare appointments are not covered by Medicaid. Individuals with disabilities who meet federal and state eligibility requirements may be covered by Medicaid. Medicaid provides qualified individuals with cash for basic needs, such as food, housing, and clothing.
For the client who qualifies for Medicaid, home health services are typically covered. Individuals with disabilities who meet federal and state eligibility requirements may be covered by Medicaid.
Mr. Jacobi understands environmental factors and home hazards. However, you must now provide client teaching related to his mobility to ensure the left toes heal properly. Which topic will you NOT include as part of Mr. Jacobis discharge teaching? Group of answer choices How to totally avoid weight bearing How to practice prescribed exercises How to manage weight bearing How to use crutches or a walker
How to totally avoid weight bearing
Emily Hartford is a 56-year-old woman who was diagnosed with leukemia 8 months ago. She was treated with chemotherapy during the past 6 months and continues to experience occasional anorexia and mild weight loss. She has coped well with the gastrointestinal symptoms throughout the chemotherapy treatments, experiencing only a 12-lb weight loss. Ms. Hartford asks you what else she could do to address her nutritional needs in light of these symptoms. What intervention would you anticipate being included in the treatment plan to address her nutritional needs? Group of answer choices Frequently eat high-calorie, low-fat foods throughout the day Consume a protein snack once a day Medicate for pain within 1 hour after eating Limit beverage consumption for 60 minutes after meals
Frequently eat high-calorie, low-fat foods throughout the day
Which complementary therapy promotes wellness for a client with prostate cancer? Group of answer choices Cranberry juice Fruits and vegetables Vitamins Aspirin
Fruits and vegetables
Mr. Karr experiences another grand mal seizure as the health care provider begins her examination. She orders lorazepam (Ativan) 4 mg IV push now; you administer the medication as ordered, knowing the fosphenytoin (Cerebyx) has not completely infused and a faster-acting agent is needed to control the seizure activity. Mr. Karr's Glasgow coma scale is 6 when the seizure activity ceases. His respiratory rate is 4-6 breaths per minute with shallow efforts; his SpO2 is 88% on 100% O2. Although the lorazepam (Ativan) has terminated the seizure activity, respiratory depression is also a side effect. What will you do next? Group of answer choices Administer flumazenil (Romazicon) 0.3 mg IV Gather emergency equipment for possible intubation. Ventilate with bag-valve-mask at 100% O2 until respiratory effort is adequate. Initiate continuous positive airway pressure (CPAP) at 5 cm PEEP.
Gather emergency equipment for possible intubation.
A client recovering from a stroke is unable to swallow and has an absent gag reflex. Which cranial nerve should the nurse suspect is affected in this client? Group of answer choices Spinal accessory Trigeminal Hypoglossal Glossopharyngeal
Glossopharyngeal
The pediatric client has two siblings, one older and one younger. What impact on them would the pediatric nurse expect, after a diagnosis of the middle child? (Select all that apply.) Group of answer choices Guilt Lack of understanding of the situation Resentment Sibling rivalry Stress, causing difficulties with school progress
Guilt Lack of understanding of the situation Resentment Stress, causing difficulties with school progress
The nurse is caring for a 14-year-old female client with iron deficiency anemia. Which interventions can assist the client in obtaining normal iron levels? (Select all that apply.) Group of answer choices Help the client pick iron-rich food choices Consider starting the client on birth control Monitor blood transfusion for signs of reactions Assess client compliance with iron supplements Apply supplemental oxygen as ordered
Help the client pick iron-rich food choices Assess client compliance with iron supplements
Celine Ramirez is a 50-year-old woman who has had a lumpectomy for breast cancer. She has undergone prophylactic radiation treatment, and the healthcare provider has ordered Herceptin because it is indicated. Mrs. Ramirez states she does not want any chemotherapy. She just wants to go home and "be done with it." What would you include in your teaching about Herceptin so Mrs. Ramirez can make an informed decision? Group of answer choices Herceptin is a mild chemotherapy agent. Herceptin is used because the client is postmenopausal. Herceptin is used to reduce production of estrogen. Herceptin is used to counteract specific genetic mutations that promote cancer growth.
Herceptin is used to counteract specific genetic mutations that promote cancer growth.
You are educating Mr. Alvarez and his wife about signs that may indicate that Mr. Alvarez has developed a post-operative infection after he is discharged from the hospital. Which statement by Mrs. Alvarez indicates that she requires further education? Group of answer choices The drainage from the wound may increase and change color. His incision site may start to look swollen if he has an infection. His incision site may look pale if he develops an infection. He would probably develop a fever if he developed an infection.
His incision site may look pale if he develops an infection.
The nurse is assessing a client for risk factors associated with colorectal cancer. Which findings in the health history would indicate the client is at risk for colorectal cancer? Group of answer choices History of heart disease Long-term use of laxatives Weight gain History of polyps
History of polyps
A client is newly diagnosed with acute lymphocytic leukemia. The nurse would anticipate that the client will be started on what chemotherapy medication? Group of answer choices Prednisone with asparaginase (Elspar) Imatinib mesylate (Gleevec) All-trans retinoic acid (ATRA) Fludarabine (Fludara)
Prednisone with asparaginase (Elspar)
The nurse is caring for a 58-year-old Marc McRyan, who is diagnosed with sickle cell disease (SCD). Mr.McRyan's healthcare provider plans to use pharmacologic therapy to stimulate his production of fetal hemoglobin. Which therapy should the nurse anticipate will be ordered by Mr. McRyan's healthcareprovider? Group of answer choices Oxygen Vitamin Penicillin Hydroxyurea
Hydroxyurea
Mrs. Washington is still NPO as bowel sounds have not resumed. She has not had any visitors since she arrived. At the nursing station, you pick up the receptionist's phone to find her sister on the line. "Can I come to see my sister and bring her some homemade cookies?" she asks. You know that visit would be a morale builder, but you are aware that Mrs. Washington has not authorized staff to release information to her sister. What is your response to Mrs. Washington's sister? Group of answer choices I will go down the hall and ask your sister if she is ready for visitors. She will be happy to see you. Your sister is still on a clear liquid diet, so she cannot have any cookies today. Maybe she can have them tomorrow. By all means, come during visiting hours. She will be glad for the company. She can eat the cookies when she feels better. I am not allowed by HIPAA regulations to give out any information. Let me connect you to patient information.
I am not allowed by HIPAA regulations to give out any information. Let me connect you to patient information.
Mr. Karrs family explains that they have all planned an extended vacation in three months. They ask if he will be healthy enough to travel and share in the driving of the motor home they will be using. What is your bestresponse? Group of answer choices I will ask the social worker to help you contact the state agency that regulates driving privileges. It will depend on finding and treating the cause of his seizures. It will depend on how long it takes for Mr. Karr to reach a therapeutic drug level of his anti-epileptic drugs. As long as Mr. Karr feels ready to travel and has permission from his health care provider, he should be able drive and travel.
I will ask the social worker to help you contact the state agency that regulates driving privileges.
The health care provider decides to admit Tani overnight for observation. You begin preparing Tani to take care of herself after her discharge from the ED. Which statement indicates Tani completely understands your teaching regarding her activity level afterdischarge? Group of answer choices I can begin riding my horse right away, as long as I always wear my helmet. I plan to ride my horse in the barrel racing competition next week. I will not be able to participate in horseback riding activities until my concussion heals completely. Because I have had a concussion, I will not be able to participate in horseback riding ever again.
I will not be able to participate in horseback riding activities until my concussion heals completely.
Mr. Jacobi is at risk for other postoperative complications. Which physiological complications are most consistent with arthroplasty procedures? Group of answer choices High blood sugar Impaired circulation Nerve damage Joint dislocation Peripheral tissue damage
Impaired circulation Nerve damage Joint dislocation
The nurse is analyzing and synthesizing assessment data, related to the care of the client with sickle cell disease (SCD), to formulate client-specific nursing diagnoses. Which client problem represents the highest priority when planning nursing care of the client with SCD? Group of answer choices Altered comfort Activity intolerance Impaired oxygenation Imbalanced nutrition
Impaired oxygenation
Mrs. Martinez is a 71-year-old Hispanic woman who has received treatment for lung cancer for several months. She has had a surgical lobectomy and has received radiation. As you administer a prescribed analgesic for Mrs. Martinez, she says toyou, "At home, when I have pain, I just want my daughter to give me my pain pill and leave me alone. But instead, she insists that I change my position and offers me magazines. I know that she just wants to help, but how can it?" What is the best rationale for your response to Mrs. Martinez? Group of answer choices Nurturing is a component of Hispanic culture, and Mrs. Martinez's daughter is in a role reversal situation. Experiencing guilt and anxiety associated with her mother's illness, the daughter responds in an overly attentive manner in an attempt to meet her needs and those of her mother. Implementing comfort measures, such as repositioning; relaxation exercises; and distraction activities, such as music, watching television, and reading can provide adjunctive relief so the pain medication will be more effective or provide comfort until the medication takes effect. Using adjunctive therapy to manage pain may allow the reduction of the dosage or frequency of analgesics for the client with cancer, which is especially important so that addiction does not occur.
Implementing comfort measures, such as repositioning; relaxation exercises; and distraction activities, such as music, watching television, and reading can provide adjunctive relief so the pain medication will be more effective or provide comfort until the medication takes effect.
Mr. Jacobi is healing properly and will be discharged home within 24 hours. Mr. Jacobi lives alone and does not have a spouse or children to assist in caring for him. However, he reports that his sister will be checking on him everyday. What types of safety precautions will you discuss with Mr. Jacobi prior to discharge? Select all that apply. Group of answer choices Incorporate use of walker and elevated toilet seats Avoid getting out of bed Remove throw rugs Temporarily move to a single-story home Keep essentials in an accessible location
Incorporate use of walker and elevated toilet seats Remove throw rugs Keep essentials in an accessible location
Which assessments should the nurse include when examining a client with an alteration in intracranial pressure? Select all that apply. Group of answer choices Pupillary responses to light Level of consciousness Fluid intake for the past 24 hours Motor status and strength Vital signs
Pupillary responses to light Level of consciousness Motor status and strength Vital signs
The health care provider changed the primary dressing at the wound, but now it is time for you to examine the inflicted area for bleeding and draining. Bleeding is noted when changing the dressing, and you note from the medical file that Mr. Jacobi is on the anticoagulant warfarin to prevent blood clotting. You do not notice any signs of purulent or malodorous drainage, which is good. After a prothrombin time (PT) and international normalized ratio (INR) test is performed, it is found that the clients INR is elevated and needs to be reversed. An elevated INR puts Mr. Jacobi at risk for which complications? Group of answer choices Vitamin deficiency Increased bleeding Emotional instability Severe clotting
Increased bleeding
The nurse is caring for a client recovering from the excision of an 8-mm malignant melanoma on the face. Which nursing diagnoses are most appropriate, considering the client's condition? (Select all that apply.) Group of answer choices Increased risk of skin infection Alterations in skin integrity Improved self-acceptance Potential for increased postoperative pain Decreased anxiety
Increased risk of skin infection Alterations in skin integrity Potential for increased postoperative pain
The nurse is completing discharge teaching for a client with lung cancer. Which information should the nurse include when providing this education? Group of answer choices Increased risks with asbestos exposure Avoiding alcohol consumption Physical activity Limiting secondhand smoke exposure
Increased risks with asbestos exposure
The nurse is assessing the client with sickle cell disease (SCD) for signs and symptoms of acute chest syndrome. Which assessment finding is most reflective of a manifestation of acute chest syndrome? Group of answer choices Increased white blood cell count Oxygen saturation of > 90% Absence of adventitious breath sounds Urine output > 0.5 mL/kg/hr
Increased white blood cell count
Harold Jacobi is a 52-year-old client on your unit. He has just received arthroplasty on the toes of his left foot, due to the deterioration of the joints brought on by acute osteoarthritis. Mr. Jacobi suffered extreme pain prior to total joint replacement, and his restricted mobility made it difficult for him to walk. His surgeon recommended arthroplasty after years of Mr. Jacobi living with the pain in his toes. You are an RN on the medical-surgical unit, and you provided preoperative care and education to Mr. Jacobi. Now you are caring for him postoperatively. Mr. Jacobis vitals are T 98.8ºF, P 83 bpm, R 18/min, and BP 120/70 mmHg. He awoke from the anesthesia and is now conscious but slightly disoriented.Mr. Jacobi received a total joint replacement. Which of the following are potential complications that could occur immediately following his surgery? Group of answer choices Inflammation Vomiting Blood clotting Infection Depression
Inflammation Vomiting Blood clotting Depression
Which biological therapies are used in the treatment of leukemia? (Select all that apply.) Group of answer choices Interleukins Interferons Cyclophosphamide Imatinib mesylate Colony stimulating factors
Interleukins Interferons Colony stimulating factors
Which type of anemia produces brittle, spoon-shaped nails? Group of answer choices Blood loss anemia Aplastic anemia Iron deficiency anemia Folic acid deficiency anemia
Iron deficiency anemia
Randeep Bahara, a 29-year-old graduate student from India, received a diagnosis of pancreatic cancer 2 weeks ago. He complains of having severe nausea and vomiting. He has not been able to progress to a full diet. What is an example of a collaborative intervention that might decrease Mr. Bahara's symptoms? Group of answer choices Providing antiemetic drugs before meals Adding flavorful spices to season the food Performing regular assessments frequently Talking about macro- and micronutrients
Providing antiemetic drugs before meals
The nurse is caring for a 9-year-old client with iron deficiency anemia. When providing teaching about iron supplements, what information should the nurse provide to thecaregivers? (Select all that apply.) Group of answer choices Give with dairy products to increase absorption. Iron supplements can cause constipation. Iron supplements can cause dark stools. Iron supplements require a doctor's prescription. Give with orange juice to increase absorption.
Iron supplements can cause constipation. Iron supplements can cause dark stools. Give with orange juice to increase absorption.
A client experiences fractures of the left leg and a traumatic brain injury in a dirt bike accident and is admitted to the intensive care unit. Which assessment finding indicates increased intracranial pressure (IICP)? Group of answer choices Hypotension Irritability Oliguria Nausea
Irritability
Mr. Cheney is a 49-year-old accountant who presented to the healthcare provider's office for an annual physical examination. During the health history, the nurse notes risk factors for colon cancer. What did the nurse note during the health history of this client to determine this risk for colon cancer? Group of answer choices A diet high in fruits and vegetables Regular exercise Irritable bowel disease Diabetes mellitus
Irritable bowel disease
When teaching the client about the cause and treatments associated with hemosiderosis, which statement by the nurse is most accurate? Group of answer choices It is caused by an immune reaction to iron stored in donated tissues. Treatment may include administration of vitamin C to promote iron absorption. It is a complication that is associated with frequent blood transfusions. It may be prevented by avoiding giving iron-chelating pharmacologic agents to the client.
It is a complication that is associated with frequent blood transfusions.
A nodular basal-cell carcinoma, one type of basal-cell cancer, is characterized by which clinical manifestation? Group of answer choices It does not ulcerate and crust. It is papular in the early stages. It concentrates melanin pigment. It is an erythematous plaque.
It is papular in the early stages.
A client with colorectal cancer is scheduled to receive radiation therapy. The client asks the nurse why this is necessary since surgical intervention has already occurred. The nurse bases the response to the client on which rationale? Group of answer choices A primary treatment for colorectal cancer is radiation therapy. It is used to reduce the risk of pelvic tumors. Colorectal cancer is treated exclusively with chemotherapy. Colorectal cancer has a low rate of recurrence.
It is used to reduce the risk of pelvic tumors.
Which recommendation is most appropriate for the nurse to include in a teaching session for a client with sickle cell disease (SCD)? Group of answer choices Keep current with recommended vaccinations. Limit oral intake of fluids. Understand that splenic sequestration is a nonemergent condition. Exercise for at least 2 hours each day.
Keep current with recommended vaccinations.
The client with sickle cell disorder (SCD) is preparing to be discharged to home. Which topics are most appropriate for the nurse to include when providing home care teaching for the client with SCD? (Select all that apply.) Group of answer choices Keeping current with vaccinations Maintaining adequate nutritional intake Restricting oral fluid intake Recognizing manifestations of splenic sequestration Balancing rest with activity
Keeping current with vaccinations Maintaining adequate nutritional intake Recognizing manifestations of splenic sequestration Balancing rest with activity
Mr. Karrs vital signs are T 100.8°F, P 60 bpm, R 14 min, BP 146/84 mmHg, and SpO2 94% on 100% O2 bynon-rebreather mask. His cardiac rhythm has remained unchanged; Glasgow coma scale is 10. He is beginning to moan with limited spontaneous extremity movement. Which management strategy is indicated? Group of answer choices Administration of flumazenil (Romazicon) 5 mg IV Administration of lorazepam (Ativan) 4 mg IV 0.9% saline IV at 100 mL/hr Lateral recumbent positioning of the client
Lateral recumbent positioning of the client
The nurse notes that a client has muscle fasciculations of both bicep muscles. What additional information should the nurse assess in this client? (Select all that apply.) Group of answer choices List of medications taking Body temperature Blood pressure and pulse Urine output Last solid food intake
List of medications taking Body temperature Urine output
Which issues concerning interventions and therapies in a pediatric cancer population are based on the child's age? Group of answer choices Psychosocial needs Alopecia Oncologic emergencies Cancer survival
Psychosocial needs
The health care provider informs Mrs. Walton that she will receive a call as soon as the final pathology report on the biopsy is available, so that Mrs. Walton can come in for a follow-up appointment to review the results and discuss treatment. Mrs. Walton is anxiously waiting for the final pathology report, so she can continue with her normal routine. She leaves a message for you to call her on her cell phone. You return the call, knowing that you can provide support to Mrs. Walton during the waiting period. What intervention is appropriate for you to conduct over the phone with Mrs. Walton? Group of answer choices Listen for verbal cues of grieving. Inform Mrs. Walton that it is okay to be fearful of hearing negative results and their possible impact, but that it will be okay. Inform Mrs. Walton that this is routine and she should be patient. Inform Mrs. Walton that it is not healthy to start anticipating a diagnosis.
Listen for verbal cues of grieving.
Mr. Robertson is a 68-year-old African American man who has a 30-year history of smoking cigarettes. He has been diagnosed with adenocarcinoma and had a wedge resection for tumor removal 5 days ago. He will continue with radiation treatments after discharge. As you discuss discharge plans with Mr. Robertson, he says, "I know that my lung cancer came from my smoking habit. But I have a friend who never smoked, and he died from the same disease." The nurse bases the response on which rationale? Group of answer choices Chronic respiratory conditions such as asthma cause an increased incidence with developing lung cancer. Lung cancer develops from sources such as exposure to radiation or radon in the home or work environment or working with asbestos. There is a genetic make-up that causes more sensitivity to developing the disease early in life, even without exposure. Lung cancer occurs due to privately smoking for many years.
Lung cancer develops from sources such as exposure to radiation or radon in the home or work environment or working with asbestos.
A client is admitted with a diagnosis of breast cancer with metastasis. The client asks the nurse where the cancer has spread. Which common sites for metastasis from breast cancer will the nurse include in the response? Group of answer choices Lungs Brain Kidney Bone Liver
Lungs Brain Bone Liver
A client has a mass that has been identified by mammogram. Which test may be ordered to further differentiate the mammogram results? Group of answer choices Breast cancer genetic screening MRI Chest x-ray PET scan
MRI
A client is admitted with an L4-L5 injury. Which diagnostic tests should the nurse anticipate would be prescribed for this client? (Select all that apply.) Group of answer choices Cerebral angiogram MRI Myelogram Nerve conduction studies Brain echogram
MRI Myelogram Nerve conduction studies
A nurse is providing care for a 7-year-old client who was recently diagnosed with absence seizures. When providing discharge teaching to the parents, which clinical therapy should be implemented at home? (Select all that apply.) Group of answer choices Report weight loss in the child Maintain a ketogenic diet Restrict fluid intake Monitor urine ketones every month Notify the healthcare provider if the child is constipated
Maintain a ketogenic diet Notify the healthcare provider if the child is constipated
A 78-year-old client is scheduled for surgery to repair an abdominal aortic aneurysm. Which interventions should the nurse make a priority when planning this client's care? (Select all that apply.) Group of answer choices Maintaining a normal body temperature Promoting skin integrity Preventing infection Ensuring adequate oral intake Maximizing respiratory function
Maintaining a normal body temperature Promoting skin integrity Preventing infection Maximizing respiratory function
Roger Chen is a 57-year-old client who asks you to help him understand his diagnosis. He tells you that his healthcare provider informed him that cells on Mr.Chen's liver have invaded and destroyed the surrounding tissue. Based on this description, what type of neoplasm does Mr. Chen have? Group of answer choices Local Encapsulated Malignant Cohesive
Malignant
The nurse is drawing an arterial blood sample from Jamal Lemmington, a 22-year-old male diagnosed with a traumatic brain injury. What should the nurse explain to Jamal's father about the purpose of this blood sample? Group of answer choices Measures the amount of carbon dioxide in the blood to predict the presence of increased intracranial pressure Determines the response of medications to remove excess fluid from the brain tissue and reduce swelling Estimates the length of time it will take for the client to resume consciousness Predicts the number and depth of respirations that the client will have during one minute
Measures the amount of carbon dioxide in the blood to predict the presence of increased intracranial pressure
Which postoperative medication orders should the nurse expect to implement while a client is in the postanesthesia care unit? (Select all that apply.) Group of answer choices Antihypertensive by mouth every morning Medication to reverse anesthesia Antiemetic every 4 hours as needed Analgesic every 4 hours as needed Antibiotic while results from wound culture are pending.
Medication to reverse anesthesia Antiemetic every 4 hours as needed Analgesic every 4 hours as needed
Which postoperative medication orders should the nurse expect to implement while a client is in the postanesthesia care unit? (Select all that apply.) Group of answer choices Medication to reverse anesthesia Antiemetic every 4 hours as needed Analgesic every 4 hours as needed Antibiotic while results from wound culture are pending. Antihypertensive by mouth every morning
Medication to reverse anesthesia Antiemetic every 4 hours as needed Analgesic every 4 hours as needed
The nurse is preparing a client for a surgical procedure to remove a portion of the transverse colon. Which priority actions should the nurse include to reduce the client's risk of developing a postoperative complication? (Select all that apply.) Group of answer choices Monitor urine concentration Monitor blood pressure and heart rate Ensure aseptic technique is used for the procedure Monitor body temperature Observe for muscle twitching
Monitor blood pressure and heart rate Ensure aseptic technique is used for the procedure Monitor body temperature
Which interventions address the increased risk for bleeding in clients with leukemia? (Select all that apply.) Group of answer choices Recommend ingestion of bland foods Monitor for blood in stool Avoid taking rectal temperatures Encourage use of tampons Apply pressure to necessary injection sites
Monitor for blood in stool Avoid taking rectal temperatures Apply pressure to necessary injection sites
A nurse is administering an oral anticonvulsant medication to an adult client. Which interventions would the nurse use when administering this medication? (Select all that apply.) Group of answer choices Monitor the client for seizure activity Monitor oxygen levels Ask the client for a list of home medications Assess the client for slurred speech Administer antiepileptic medication 2 hours after antacids are administered
Monitor the client for seizure activity Ask the client for a list of home medications Assess the client for slurred speech Administer antiepileptic medication 2 hours after antacids are administered
The charge nurse is reviewing the plan of care for a client newly diagnosed with leukemia with a decreased neutrophil count. Which interventions indicate that the focus of care is to prevent infection? (Select all that apply.) Group of answer choices Monitor white blood cell values Maintain strict hand hygiene measures Implement protective isolation precautions Monitor hydration status Avoid invasive procedures
Monitor white blood cell values Maintain strict hand hygiene measures Implement protective isolation precautions
What does the Aldrete score measure in the postoperative client? (Select all that apply.) Group of answer choices Motor response Electrolyte balance Oxygen saturation Eye opening Respirations
Motor response Oxygen saturation Respirations
What action would you take to ensure adequate airway clearance and oxygenation in a client experiencing a seizure? Group of answer choices Administer oral antiepileptic medication immediately Place an oral airway between the teeth Move client into a side-lying position Hold the client's arms and chest down
Move client into a side-lying position
Thirty-year-old Juan Alvarez, who works as a delivery driver for a local appliance store, is admitted to your medicaldash-surgical unit with signs and symptoms consistent with appendicitis. You review his chart before you go to his room. You learn that before work this morning, Mr. Alvarez told his wife that he felt sick to his stomach and was complaining of pain in the lower right part of his abdomen. She brought him into the emergency department (ED). A computed tomography (CT) of his abdomen was performed while he was in the ED. When you go to assess Mr. Alvarez, you find him lying on his side with his knees drawn up. His wife is sitting beside his bed, holding his hand. Mr. Alvarez tells you, I keep throwing up. The physician in the emergency department told me that she would be contacting our health care provider and he would be coming in soon to see us. Normal saline is infusing through a peripheral intravenous (IV) line. His vital signs are T 100.9°F, P 106 bpm, R 22/min, BP 108/70 mmHg.The attending health care provider in the emergency department (ED) diagnosed Mr. Alvarez with appendicitis. You perform ahead-to-toe assessment on Mr. Alvarez, review the results of the computed tomography(CT) and the labs taken in the ED. Which assessment finding is expected with a diagnosis of appendicitis? Group of answer choices Mr. Alvarez tells you, Ive been having a lot of constipation. Mr. Alvarezs white blood cell count is 8,000 cells/mm3. Mr. Alvarez states that the pain started near his belly button and spread toward the lower right portion of his abdomen. The health care provider wrote in the progress notes that rebound tenderness in left upper quadrant was noted.
Mr. Alvarez states that the pain started near his belly button and spread toward the lower right portion of his abdomen.
You have given Mr. Alvarez and his wife discharge instructions. Which statement indicates that further education regarding home care is needed? Group of answer choices Mrs. Alvarez states, He should probably stay home from work for a few days. Mrs. Alvarez states, He may not feel like eating what we normally eat until hes healed more. Mr. Alvarez states, I should be able to go back to work tomorrow. Mr. Alvarez states, If we think I may be developing an infection, then we need to call our health care provider right away.
Mr. Alvarez states, I should be able to go back to work tomorrow.
Chad Olsen is a 28-year-old man who was in good health until a few months ago. At that time, he began to feel tired and short of breath doing activities that he previously had done with no effort. He is a construction worker who works 10-hour days 5 or 6 days of the week. He has been diagnosed with acute lymphocytic leukemia (ALL) and has received chemotherapy for the past month. He tells you that he is having a difficult time with the diagnosis, changes from his previous life, and side effects of the chemotherapeutic medications."After all this," he says, "I hope that I make it." Based on your knowledge and experience with similar clients, what do you anticipate will occur, which will guide your response to him? Group of answer choices Mr. Olsen will not likely achieve a state of remission with this disease. Mr. Olsen will probably progress to the final stage of the disease within 1 year, unless remission is achieved within the first 6 months after the diagnosis is made. Mr. Olsen will probably achieve an initial remission after prolonged treatment, which will be followed by an exacerbation that will not respond to treatment. Mr. Olsen will most likely achieve complete remission.
Mr. Olsen will most likely achieve complete remission.
The nurse educator is giving an in-service about the assessment and care of children who are diagnosed with sickle cell disease (SCD). Which information should the educator include in the in-service? Group of answer choices Newborn blood testing for sickle cell disease usually involves obtaining a blood sample by way of a heel stick. Initial diagnosis of sickle cell disease is most often made by amniocentesis testing in the prenatal period. Newborn screening for sickle cell disease is recommended and optional for children who are born in the United States. Beginning at 5 years of age, children with sickle cell disease should undergo routine ultrasound head scanning.
Newborn blood testing for sickle cell disease usually involves obtaining a blood sample by way of a heel stick.
A nurse is obtaining a health history from an adult client admitted to a community health clinic. What item places this client at a higher risk for developing cancer? Group of answer choices Exercises to reduce stress No health insurance Avoids eating red meat and saturated fat Body mass index of 19
No health insurance
The client is being treated for increased intracranial pressure (IICP). Which of these manifestations should indicate to the nurse that the outcomes are being met for thisclient? (Select all that apply.) Group of answer choices No redness or drainage at site of intraventricular catheter Blood pressure = 118/76 Lethargic Intracranial pressure = 14 mmHg Verbalizes need to increase stimuli
No redness or drainage at site of intraventricular catheter Blood pressure = 118/76 Intracranial pressure = 14 mmHg
You are completing a physical examination of Mr. Hinton, a 46-year-old male construction worker presenting to the healthcare clinic for an upper respiratory infection. You notice a small, round, shiny pink lesion on the side of his nose that has dried blood around it. You ask him how long it has been there and he states, "About a year, and every time I touch it, it starts to bleed. It is reallyannoying." What do you suspect? Group of answer choices Superficial basal-cell cancer Keratotic basal-cell cancer Nodular basal-cell cancer Morpheaform basal-cell cancer
Nodular basal-cell cancer
A client presents to the urgent care clinic with an itchy, bulky. shiny tumor on his scalp that is pink in color and ulcerated in the center. The tumor started out appearing like a pimple about 6 months ago but has since doubled in size. Based on the client's history and the appearance of the tumor, which malignant skin lesion would the nurse suspect this client might have? Group of answer choices Malignant melanoma Actinic keratosis Nodular basal-cell carcinoma Squamous-cell cancer
Nodular basal-cell carcinoma
What are some ways that the nurse can help a client with breast cancer who is experiencing anticipatory grieving before her double mastectomy? (Select all that apply.) Group of answer choices Venting Denial Nonverbal support gestures Silence Active listening
Nonverbal support gestures Silence Active listening
The nurse is conducting the preoperative assessment. The client reports having a cup of black coffee before arriving for the scheduled surgery. What should the nurse do with thisinformation? Group of answer choices Instruct the client to refrain from further intake Document the fluid intake in the medical record Notify the surgeon Administer the preoperative medication
Notify the surgeon
A client is admitted to the surgical floor with a diagnosis of blood loss anemia after having outpatient surgery earlier in the day. The nurse reviews the healthcare provider's orders and places which order at highest priority? Group of answer choices Regular diet Oxygen at 2 L via nasal cannula Intravenous normal saline at 250 mL/hr Bed rest with bathroom privileges
Oxygen at 2 L via nasal cannula
The nurse is caring for a client whose tumor is compressing a nerve. The nurse anticipates that the client is most likely experiencing which side effect? Group of answer choices Infection Anorexia-cachexia syndrome Pain Impaired tissue integrity
Pain
The nurse is caring for a client whose tumor is compressing a nerve. The nurse anticipates that the client is most likely experiencing which side effect? Group of answer choices Anorexia-cachexia syndrome Pain Infection Impaired tissue integrity
Pain
The nurse is caring for a client with cancer. The client has displayed uncomfortable symptoms related to his illness and states the desire for relief from this discomfort. Radiation therapy is ordered to reduce the client's discomfort. The nurse understands that the radiation therapy is being used in what way for the client? Group of answer choices Brachytherapy Palliation External-beam radiation Subcutaneously
Palliation
The nurse is assessing the client with sickle cell disease (SCD) for manifestations of shock. Which assessment finding is most reflective of a classic manifestation of shock? Group of answer choices Pallor Increased urine output Hypertension Persistent abdominal pain
Pallor
The nurse is assisting the healthcare provider with a physical examination of a client suspected of having cancer of the prostate. Which finding would support the diagnosis of prostate cancer? Group of answer choices Postvoid residual of 150 mL Cancer cells found in the urine Palpable mass felt on digital rectal exam (DRE) Hypoactive bowel sounds
Palpable mass felt on digital rectal exam (DRE)
The nurse is providing education to a 30-year-old female client during a well visit. Which cancer screening recommendation should the nurse suggest to the client? Group of answer choices Annual mammography starting this year Pap smear every 3-5 years Lung cancer screening every 10 years Annual fecal occult blood test starting this year
Pap smear every 3-5 years
The nurse is providing education to a 30-year-old female client during a well visit. Which cancer screening recommendation should the nurse suggest to the client? Group of answer choices Lung cancer screening every 10 years Annual mammography starting this year Annual fecal occult blood test starting this year Pap smear every 3-5 years
Pap smear every 3-5 years
Mrs. Green is being admitted for recurrent seizure activity. What assessment data is most important to obtain? Group of answer choices Occupational history Menopause status Past seizure activity Surgical history
Past seizure activity
A client scheduled for surgery is asking questions about the procedure, and expresses concern about his family, should anything go wrong. Which nursing diagnoses should the nurse use to guide this client's care? (Select all that apply.) Group of answer choices Potential for self-esteem alterations Potential for enhanced knowledge related to the surgical process Potential for ineffective coping Potential for anticipatory grieving Potential for dysfunctional family processes
Potential for enhanced knowledge related to the surgical process Potential for anticipatory grieving
The nurse measures the client's blood pressure, pulse, and capillary refill prior to sending the client to the operating room. Which concept related to perioperative care is the nurseimplementing? Group of answer choices Safety Perfusion Infection control Quality control
Perfusion
What is the primary location of prostate cancer? Group of answer choices Peripheral zone of prostate gland Lower portion of the bowel Neck of the urethra Prostate capsule
Peripheral zone of prostate gland
Which intervention will help keep a client safe during a seizure? Group of answer choices Restrain client Place client in side-lying position Insert padded tongue-blade in mouth Monitor blood pressure
Place client in side-lying position
As you continue to monitor Tani, you notice she has developed rhinorrhea. What is the appropriate action for you to take in response to this change in her condition? Group of answer choices Give Tani a tissue and ask her to blow her nose. Document the rhinorrhea in the chart and continue to observe Tani. Place the head of the bed flat and ask Tani to lay on her left side observing for an increase in the nasal drainage. Place the head of bed at 30 degrees and observe the drainage for a halo sign.
Place the head of bed at 30 degrees and observe the drainage for a halo sign.
A client recovering from a stroke has an absent gag reflex and has lost 7 lb over the last 5 days. Which intervention does the nurse anticipate for this client? Group of answer choices Administration of hypotonic intravenous fluids Intramuscular injection of a corticosteroid Placement of a feeding tube Administration of dextrose 50% and water
Placement of a feeding tube
The nurse is planning care for a client admitted for lung cancer. Which nursing intervention assists in addressing the potential problem of activity intolerance? Group of answer choices Place the client in a supine position Administer analgesics Provide chest physiotherapy Plan rest periods
Plan rest periods
A preoperative client asks if blood products will be used during the procedure. Which laboratory values should the nurse explain are used to determine the client's need for bloodproducts? (Select all that apply.) Group of answer choices Platelets Red blood cell count Hematocrit Hemoglobin Prothrombin time
Platelets Red blood cell count Hematocrit Hemoglobin
Other than cancer, which diseases are caused by problems in cellular regulation? (Select all that apply.) Group of answer choices Polycythemia Sickle cell disease Pneumonia Polio Anemia
Polycythemia Sickle cell disease Anemia
What would be included in the ongoing care of the client who has had a mastectomy for breast cancer? (Select all that apply.) Group of answer choices Keeping the affected limb immobile as much as possible Possible participation in support group Signs and symptoms of infection Importance of adequate rest periods Postmastectomy exercises
Possible participation in support group Signs and symptoms of infection Importance of adequate rest periods Postmastectomy exercises
A client scheduled for surgery is asking questions about the procedure, and expresses concern about his family, should anything go wrong. Which nursing diagnoses should the nurse use to guide this client's care? (Select all that apply.) Group of answer choices Potential for self-esteem alterations Potential for enhanced knowledge related to the surgical process Potential for anticipatory grieving Potential for dysfunctional family processes Potential for ineffective coping
Potential for enhanced knowledge related to the surgical process Potential for anticipatory grieving
A nurse is caring for a client with breast cancer with metastasis to the bones. Which therapy may be used to prevent fractures in this client? Group of answer choices Calcium supplementation Hormone therapy Chemotherapy Radiation
Radiation
The nurse is discussing chemotherapy with a client newly diagnosed with cancer. Which statements are accurate regarding chemotherapy? (Select all that apply.) Group of answer choices Pregnancy limits which kinds of chemotherapy can be used. Some chemotherapy binds with DNA. Iron supplements are part of chemotherapy. Chemotherapy can have life-threatening side effects. Chemotherapy involves the use of cytotoxic medications.
Pregnancy limits which kinds of chemotherapy can be used. Some chemotherapy binds with DNA. Chemotherapy can have life-threatening side effects. Chemotherapy involves the use of cytotoxic medications.
What assessment data should the nurse obtain when completing a health history on a client with a seizure disorder? Group of answer choices Vital signs Neurological exam Level of consciousness Presence of an aura
Presence of an aura
A nurse is performing an admission assessment for a client with a history of frequenttonic-clonic seizures. What information would the nurse obtain from the client concerning the client's history of seizures? (Select all that apply.) Group of answer choices Presence of auras Incontinence during seizure Duration of seizures Age of seizure onset Triggers for seizure
Presence of auras Age of seizure onset Triggers for seizure
What is the biggest challenge when caring for a pediatric surgical client? Group of answer choices Preventing hypothermia Preventing skin tears Reducing the risk of pneumonia Reducing the risk of venous thromboembolism
Preventing hypothermia
What is the goal when managing a client with a seizure disorder? Group of answer choices Pain management Blood pressure management Prevention of injury Maintaining urinary elimination
Prevention of injury
The nurse is presenting information about leukemia at a health fair. Which risk factors that increase the incidence of leukemia will the nurse discuss? (Select all that apply.) Group of answer choices Presence of the HIV Previous treatment for cancer Genetics Exposure to benzene Smoking
Previous treatment for cancer Genetics Exposure to benzene Smoking
Which are functions of the parietal lobe within the cerebrum? Select all that apply. Group of answer choices Processes information about temperature and pain Processes actions for speech, thought, and learning Processes information about vision Processes information for memory and interprets smell Processes information about two-point discrimination
Processes information about temperature and pain Processes information about two-point discrimination
A 78-year-old client is scheduled for surgery to repair an abdominal aortic aneurysm. Which interventions should the nurse make a priority when planning this client's care? (Select all that apply.) Group of answer choices Promoting skin integrity Ensuring adequate oral intake Preventing infection Maintaining a normal body temperature Maximizing respiratory function
Promoting skin integrity Preventing infection Maintaining a normal body temperature Maximizing respiratory function
The nursing student is creating a presentation about pharmacologic treatments used in the care of clients with sickle cell disease (SCD). Which information is most appropriate for the student to include in the presentation? (Select all that apply.) Group of answer choices Analgesics should be administered to clients with sickle cell disease only on a prn (as needed) basis. Vaccinations are contraindicated for clients with sickle cell disease. Prophylactic antibiotic therapy may be ordered for clients with sickle cell disease. Analgesics are administered to clients with sickle cell disease to help reduce blood viscosity. Patient-controlled analgesia (PCA) machines may be ordered for clients with sickle cell disease.
Prophylactic antibiotic therapy may be ordered for clients with sickle cell disease. Patient-controlled analgesia (PCA) machines may be ordered for clients with sickle cell disease.
The nurse is caring for a client receiving external-beam radiation as a treatment for cancer. The nurse understands that what is the high-energy source in this type of therapy? Group of answer choices Neutrons Protons Gamma rays Ultraviolet rays
Protons
The nurse is caring for a client receiving external-beam radiation as a treatment for cancer. The nurse understands that what is the high-energy source in this type of therapy? Group of answer choices Ultraviolet rays Protons Gamma rays Neutrons
Protons
What nursing intervention is most appropriate for the client with anemia who is experiencing activity intolerance? Group of answer choices Administer medications to client as ordered. Assess client vital signs and apical pulse. Ensure client walks the halls twice daily to prevent lung infection. Provide client adequate rest periods.
Provide client adequate rest periods.
When planning care for a client with acute lymphocytic leukemia (ALL), the nurse addresses the problem of insufficient calorie intake. What nursing intervention will assist in addressing this problem? Group of answer choices Weigh the client weekly Provide high-fat meals throughout the day Provide mouth care before meals Medicate for pain 90 minutes before meals
Provide mouth care before meals
A client is being seen in a gastrointestinal clinic for complaints of painless rectal bleeding, diarrhea, and abdominal cramping. The client asks the nurse about the risk factors for colorectal cancer. Which risk factors will the nurse include in the teaching session for thisclient? (Select all that apply.) Group of answer choices Radiation exposure Age over 30 years Alcohol use Smoking Obesity
Radiation exposure Alcohol use Smoking Obesity
Mrs. Sorkilmo is a 62-year-old woman who has been diagnosed with a pigmented basal-cell carcinoma following a skin biopsy. Mrs. Sorkilmo has already had an excision of the lesion. Which additional therapies could also be expected to be recommended by the physician? (Select all that apply.) Group of answer choices Radiation therapy Chemotherapy Laser surgery Topical creams or gels Immunotherapy
Radiation therapy Chemotherapy Immunotherapy
Thirty minutes after medicating Mrs. Washington, you tell her that it is important that she sit in the chair for about 30 minutes. How can you assist her in transferring from the bed to the chair while causing her minimal discomfort? Select all that apply. Group of answer choices Raise the head of the bed up as high as possible. Put all side rails down. Put the bed in the lowest position. Walk her to the chair across the room. Lock the wheels of the bed.
Raise the head of the bed up as high as possible. Put the bed in the lowest position. Lock the wheels of the bed.
Which components of a focused health history will the nurse include during the assessment of a client with lung cancer? Group of answer choices Nausea, dry mouth, and joint pain Restlessness, anxiety, and insomnia Recent weight loss, fatigue, anorexia, and bone pain Sudden unexplained weight gain
Recent weight loss, fatigue, anorexia, and bone pain
A nurse is preparing discharge teaching for a 25-year-old female client newly prescribed carbamazepine (Tegretol) for a seizure disorder. Which information would the nurse include in the teaching? (Select all that apply.) Group of answer choices Recognize that some antibiotics can interact with Tegretol Use a soft toothbrush to protect the gums Consider nonpharmacologic methods of birth control Provide the healthcare provider with a list of all home medications Have calcium blood levels drawn on a regular basis
Recognize that some antibiotics can interact with Tegretol Consider nonpharmacologic methods of birth control Provide the healthcare provider with a list of all home medications
In performing a nursing assessment for a client who may have lung cancer, which findings in the client's history and physical examination would support this diagnosis? (Select all that apply.) Group of answer choices Elevated blood glucose Removal of insulation in old houses Unintentional weight loss Chronic cough Visual disturbances
Removal of insulation in old houses Unintentional weight loss Chronic cough
The intraoperative nurse is preparing a client to receive electrosurgery. What are priority nursing actions before this procedure is performed? (Select all that apply.) Group of answer choices Remove client's jewelry and eyeglasses Ensure tattoos, metal implants, and scars are not used for pad placement Complete a baseline skin assessment Cover windows and reflective surfaces with a towel Maintain strict aseptic technique
Remove client's jewelry and eyeglasses Ensure tattoos, metal implants, and scars are not used for pad placement
What is obtundation? Select all that apply. Group of answer choices Unresponsive but may be aroused by vigorous, repeated, or painful stimuli Not aware of or not oriented to time, place, or person Easily bewildered, with poor memory and short attention span Responsive to stimuli but drifts back to sleep Lethargic and somnolent
Responsive to stimuli but drifts back to sleep Lethargic and somnolent
While preparing medications for a client scheduled for surgery, the nurse observes that medications are scheduled for 0800 hours, analyzes the medication vial, and reviews the client's arm band. Which rights of medication administration is the nurse performing? (Select all that apply.) Group of answer choices Right client Right teaching Right medication Right assessment Right time
Right client Right medication Right time
While preparing medications for a client scheduled for surgery, the nurse observes that medications are scheduled for 0800 hours, analyzes the medication vial, and reviews the client's arm band. Which rights of medication administration is the nurse performing? (Select all that apply.) Group of answer choices Right time Right assessment Right teaching Right client Right medication
Right time Right client Right medication
Adelphia Walton is a post-menopausal 52-year-old female, who scheduled a wellness check-up after talking with her daughter, Sandra, who recently did her senior high school project on women's health. Sandra, her oldest daughter, is 17 years old. Mrs. Walton arrives for her appointment. You are the nurse conducting her initial assessment prior to her physical exam. Mrs. Walton, who has been seen in the clinic in the past, tells you that she completed a breast self-exam yesterday for the first time in two years. She states that she felt a mass in her right breast, but did not know if she was completing the exam correctly. You have worked at the clinic for several years and have performed numerous clinical breast examinations. You initiate a clinical breast exam and palpate a mass on Mrs. Walton's right breast. The exam confirms Mrs. Walton's self-exam. You inform the health care provider of Mrs. Walton's comment concerning her breast exam and your assessment findings.During the assessment, Mrs. Walton tell you that she has two aunts and a first cousin who are breast cancer survivors; another cousin had a biopsy of a mass that turned out to be benign. Mrs. Walton has been unemployed for six months and admits that their family diet has suffered as a result. They eat a lot of high-fat, processed foods. She says that she has a couple of beers a night and "probably 3-4 on weekends." Which risk factor for breast cancer does Mrs. Walton have? Group of answer choices She has aunts who are breast cancer survivors. Mrs. Walton's diet is high in fat and she frequently drinks alcohol. Mrs. Walton has a cousin who had a breast biopsy. Women in her family began menses after the age of 12.
She has aunts who are breast cancer survivors.
Which statement best describes the effects of sickle cell disease (SCD) on RBCs? Group of answer choices Once sickled, an RBC cannot resume a normal shape. Sickled RBCs may cause ischemia along with intense vascular dilation. Sickling dramatically decreases the life span of affected RBCs. The cellular membrane of a sickled RBC becomes tough and durable.
Sickling dramatically decreases the life span of affected RBCs.
Which symptom most accurately reflects a manifestation of a potential complication associated with sickle cell disease (SCD)? Group of answer choices Skin pallor Increased urination Hypertension Hyperalertness
Skin pallor
The nurse is caring for a client immediately following a seizure. Which finding will the nurse expect? Group of answer choices Sleepy but arousable Unconsciousness Cyanotic Muscular contractions
Sleepy but arousable
The nurse is educating a student about the different types of lung cancer. The nurse asks the student which type of lung carcinoma grows rapidly and spreads early. Which response by the student indicates understanding of the teaching? Group of answer choices Squamous cell carcinoma Small-cell carcinoma Adenocarcinoma Large-cell carcinoma
Small-cell carcinoma
Which are known risk factors associated with the development of colorectal cancer? (Select all that apply.) Group of answer choices Smoking Age of 50 years Diet high in carbohydrates Inflammatory bowel disease Family history
Smoking Age of 50 years Inflammatory bowel disease Family history
Clients with seizure disorders often experience a trigger that elicits a seizure. Which situation may elicit seizure activity? Select all that apply. Group of answer choices Specific odors Lactose consumption Fever Flashing lights Menstruation
Specific odors Fever Flashing lights Menstruation
What information is a part of intraoperative documentation? (Select all that apply.) Group of answer choices Start and stop times of anesthesia Surgical counts Systems assessment Total fluid intake and output Antibiotic infusion times
Start and stop times of anesthesia Surgical counts Total fluid intake and output Antibiotic infusion times
Sally is a 14-year-old student who is being assessed after the occurrence of a grand mal seizure. This is her first seizure activity, and she and her family are frightened. You ask Sally to recount the events up to the occurrence of the seizure to try to identify a trigger that provoked the seizure. She says it was just another school day. She went to a café after school and was just talking with her friends. She was drinking a cola, and her friend asked her how she felt now that she had finally gotten her period. She went home and had dinner with her family and was just sitting down to do her homework when it happened. What do you suspect as a possible trigger for the seizure activity? Group of answer choices Caffeine from cola drink Started menstruating Stress from homework Something someone said
Started menstruating
Megestrol (Megace) is a medication used to treat prostate cancer. What type of medication is megestrol? Group of answer choices Estrogen compound Steroidal antiandrogen Luteinizing hormone-releasing hormone agonist Nonsteroidal antiandrogen
Steroidal antiandrogen
The nurse is caring for a client with a traumatic brain injury. Which assessment finding indicates that the client would benefit from a histamine H2 antagonist? Group of answer choices Blood pressure increasing to 168/88 mmHg Restlessness and easily agitated Body temperature of 101 Stool guaiac positive
Stool guaiac positive
A nurse is providing care for a 75-year-old client who has been recently diagnosed with a seizure disorder. The nurse assesses the client for which risk factor? Group of answer choices Renal failure Stroke Birth defects Infection
Stroke
The nurse is caring for a 17-year-old client with blood loss anemia. Which independent nursing interventions would be appropriate for this client? (Select all that apply.) Group of answer choices Supplement iron as ordered Encourage periods of rest Transfuse blood as soon as hemoglobin level falls below normal Assess vital signs Administer supplemental oxygen as ordered
Supplement iron as ordered Encourage periods of rest Assess vital signs Administer supplemental oxygen as ordered
A nurse is planning discharge teaching for a 30-year-old female client newly diagnosed with tonic-clonic seizures. What information would the nurse include in this teaching plan? (Select all that apply.) Group of answer choices Take showers rather than tub baths Keep a padded tongue blade at home in case of a seizure Avoid driving while taking anticonvulsants Monitor menstrual cycle Wear a bracelet that provides health information
Take showers rather than tub baths Avoid driving while taking anticonvulsants Monitor menstrual cycle Wear a bracelet that provides health information
Mrs. Washington tells you, "I have been changing my sanitary napkin every hour since I have arrived in this room. Is that normal?" You know this indicates that her rate of flow is more than the expected one napkin per four hours. What action do you take first? Group of answer choices Take the client's vital signs. Make sure she has enough sanitary napkins for the day. Document her clinical condition. Call the health care provider.
Take the client's vital signs.
The nurse is preparing to teach the client with prostate cancer. Which intervention will facilitate urinary elimination? Group of answer choices Assessing the intensity, location, and quality of pain Teaching Kegel exercises Interviewing the client about pretreatment sexual function Assessing the effects of incontinence on client's lifestyle
Teaching Kegel exercises
A client is admitted to the medical-surgical unit with a pathologic fracture of the ulna, abdominal pain, and shortness of breath. The nurse notes that the client's skin is a bronze color. The nurse recognizes these findings as manifestations of which type of anemia? Group of answer choices Sickle cell anemia Pernicious anemia Thalassemia Aplastic anemia
Thalassemia
The nurse is caring for an 8-year-old child who is diagnosed with a type of anemia that requires blood transfusions for life. Which type of anemia does this child have? Group of answer choices Folic acid deficiency anemia Thalassemia Iron deficiency anemia G6PD anemia
Thalassemia
The nurse is evaluating a client with prostate cancer. Which observation by the nurse means the client has successfully achieved his goals and outcomes? Group of answer choices The client keeps the pain of his cancer from his family. The client demonstrates urine elimination of 0.3 mL/kg/hr. The client is still incontinent of urine. The client discusses his sexual function without being embarrassed.
The client discusses his sexual function without being embarrassed.
Which example of a nursing observation during the evaluative phase best reflects the client's successful achievement of an identified outcome for sickle cell disease (SCD)? Group of answer choices The client's pain was tolerable. The client experienced improved breathing. The client maintained an oxygen saturation of > 90%. The client produced urine output of > 0.2 ml/kg/hr.
The client maintained an oxygen saturation of > 90%.
Which situation reflects that the client diagnosed with skin cancer has met goals during the evaluation phase of the nursing process? (Select all that apply.) Group of answer choices The client remains free from signs and symptoms of infection of the lesion. The client verbalizes an awareness of avoiding use of tanning equipment. The client reports that postoperative pain is not managed. The client reports an increase in anxiety. The client describes the need to examine skin lesions for changes.
The client remains free from signs and symptoms of infection of the lesion. The client verbalizes an awareness of avoiding use of tanning equipment. The client describes the need to examine skin lesions for changes.
Maria Garcia is a 50-year-old woman diagnosed with blood loss anemia secondary to injuries which occurred after a motor vehicle crash. She had a blood transfusion yesterday. At thattime, her breathing was shallow at 28 breaths/min. Her pulse was 98 beats/min and thready. Her blood pressure was 90/60 mmHg. She had 2+ pitting edema to both legs and was pale. Ms. Garcia's nurse is anticipating discharge care for the client. Which condition would indicate to the nurse that Ms. Garcia is ready for discharge? Group of answer choices The client's RBC count indicates moderate anemia instead of severe anemia. The client verbalizes increase in activity tolerance. The client verbalizes importance of decreasing the amount of red meat in her diet. The client verbalizes shortness of breath is present only with minimal activity.
The client verbalizes increase in activity tolerance.
In addition to measuring intracranial pressure, what is the purpose of inserting an intraventricular catheter for a client with alteration of intracranial pressure? Group of answer choices To shunt excess cerebrospinal fluid around an obstruction in the ventricular system To resect excess brain tissue To drain cerebrospinal fluid To administer medication to reduce cerebral inflammation
To drain cerebrospinal fluid
The nurse is evaluating a client who has completed a combined chemotherapy and radiation treatment regimen. Which action by the client indicates that client goals have been met? Group of answer choices The client's food diary is mostly blank. The client verbalizes reduced severity of nausea. The client cannot perform activities of daily living. The client eats fewer calories than prescribed.
The client verbalizes reduced severity of nausea.
A hospitalized 70-year-old female client with cancer receives combined chemotherapy and radiation therapy. During the planning phase of the nursing process, which client goal will help address the client's complaints of nausea and vomiting? Group of answer choices The client will ingest large, frequent meals. The client will utilize anti-emetics. The client will eat cold foods. The client will avoid nutritional supplements.
The client will utilize anti-emetics.
There are student nurses on your floor for their clinical rotation today. You are speaking with one of them in the nurses station. She says, Ive never taken care of anyone with appendicitis before. How would you know if the appendix ruptured? What are your best responses? Select all that apply. Group of answer choices It is common for the client to develop an elevated blood pressure. The clients temperature may become elevated. The clients pulse rate may decrease. The client may state that the pain in the right lower quadrant has greatly increased. An increased respiratory rate could indicate that the appendix has ruptured.
The clients temperature may become elevated. The client may state that the pain in the right lower quadrant has greatly increased. An increased respiratory rate could indicate that the appendix has ruptured.
The nurse is preparing to assess a 40-year-old African American client diagnosed with prostate cancer. Which assessment is part of the health history? (Select all that apply.) Group of answer choices The client's urinary elimination patterns for the last week The client's prostate through DRE The client's bladder for retention The client's risk factors for prostate cancer The client's bladder for distention
The client's urinary elimination patterns for the last week The client's risk factors for prostate cancer
Thirty-three year old Cecilia Martinez is an excitedfirst-time mother. She has just given birth to identical twin girls, with high Apgar scores. One weighed 7pounds; the other weighed 8 pounds. As she holds one for breastfeeding practice, she asks the maternity nurse about a term she heard on TV -- "the human genome." What can the nurse tell her about her newborns' genomes? Group of answer choices A high Apgar score means high genome scores. The larger newborn has a larger genome. The newborns have identical genomes. Testing is needed to assess their genomes.
The newborns have identical genomes.
The nurse is educating a client on the pathophysiology of paraneoplastic syndromes. Which statement by the client would indicate an understanding of the teaching? Group of answer choices They are symptoms that come from the action of tumor cell products on other body systems. They are problems that come from the pressure of the tumor on surrounding structures. They only occur within the central nervous system. They do not occur for clients with lung cancer.
They are symptoms that come from the action of tumor cell products on other body systems.
You are reviewing Mr. Alvarezs discharge instructions. He is going home with a prescription for acetaminophen (Tylenol) with codeine. Which statement would be LEAST appropriate to include when discussing this medication with Mr. Alvarez and his wife? Group of answer choices This medication may make you feel sick to your stomach. This medication may make you feel a little dizzy. This medication can produce diarrhea. This medication might make you feel sleepier than normal.
This medication can produce diarrhea.
The nurse is planning a smoking cessation teaching session for a group of clients scheduled for discharge soon. What should the nurse include in the session regarding the importance of smoking cessation and lung cancer? Group of answer choices Those who quit smoking before age 40 reduce their risk for developing lung cancer by 90% compared with those who continue smoking. There is little benefit to quitting smoking after the age of 50. Genetic factors play a larger role in the development of lung cancer than tobacco use. Former smokers are at the same risk for developing lung cancer as the general population.
Those who quit smoking before age 40 reduce their risk for developing lung cancer by 90% compared with those who continue smoking.
The nurse is teaching the client about the potential effects of sickle cell disease (SCD). When explaining the potential effects of sickling, which examples are most appropriate for the nurse to include in the teaching? (Select all that apply.) Group of answer choices Tissue damage Prolonged life span of RBCs Occlusion of small blood vessels Malformation of WBCs Organ damage
Tissue damage Occlusion of small blood vessels Organ damage
What is the purpose of a serum osmolality test in the diagnosis of increased intracranial pressure? Group of answer choices To identify serum lactic acid levels To assess serum pH To determine hydration status To indicate adequacy of serum protein levels
To determine hydration status
How is surgery used to stage a cancer? Group of answer choices To discover how much cancer exists and if it has spread To relieve secondary effects of the cancer As prophylaxis to remove tissue that can potentially become cancerous To remove the cancerous lesion along with removal of normal surrounding tissue
To discover how much cancer exists and if it has spread
What is the intended action of mannitol in the treatment of a client with increased intracranial pressure? Group of answer choices To create a sodium and potassium balance To draw fluid from the brain tissue To enhance renal excretion of retained protein To prevent tiny stress hemorrhages in the brain
To draw fluid from the brain tissue
What is the purpose of consulting physical therapy services for a client with an alteration in intracranial pressure? Group of answer choices To recommend interventions for resulting hemiparesis or hemiplegia To determine if transfer to skilled nursing facility is required To assess the living accommodations before the client's discharge to home To work with the nutritionist to determine effective methods to meet nutritional needs
To recommend interventions for resulting hemiparesis or hemiplegia
What is the purpose of laser bronchoscopy in the treatment of lung cancer? Group of answer choices To resect a portion of the main bronchus To resect tumors located in the main bronchus To remove a small section of peripheral lung tumors To reconstruct the cancerous portion of the main bronchus
To resect tumors located in the main bronchus
A client is newly diagnosed with acute lymphocytic leukemia. The nurse understands that the client will display which pathophysiology? Group of answer choices Transformation of B lymphocyte cells into cells that resemble immature lymphocytes but do not mature Uncontrolled proliferation of myeloblasts Proliferation of small, abnormal, mature lymphocytes, usually B lymphocytes Abnormal proliferation of all bone marrow elements
Transformation of B lymphocyte cells into cells that resemble immature lymphocytes but do not mature
Which postoperative assessment findings should the nurse immediately report to the surgeon? (Select all that apply.) Group of answer choices Urine output 10 mL/hr Complaints of pain Prolonged unresponsiveness Oxygen saturation 88% Dressing saturated in 15 minutes
Urine output 10 mL/hr Prolonged unresponsiveness Oxygen saturation 88% Dressing saturated in 15 minutes
Mr. Jacobi is awake and speaking to you. He reports feeling groggy and nauseous, which are normal side effects of anesthesia. Part of the postoperative assessment for arthroplasty involves monitoring the clients urine. Which assessment finding would be cause for concern? Group of answer choices Urine output of less than 50 mL per hour Urine output of less than 30 mL per hour Urine output of more than 50 mL per hour Urine output of more than 30 mL per hour
Urine output of less than 30 mL per hour
The nurse is caring for a client who was diagnosed with actinic keratosis. Which topic will the nurse include in the discharge teaching for this client? (Select all that apply.) Group of answer choices Avoiding indomethacin, lithium, and beta-adrenergic blocking agents Using sunscreen with at least 15 SPF Avoiding sun exposure Seeking medical attention for any shiny or scaly skin lesions Wearing long sleeves if outdoors during peak sun hours
Using sunscreen with at least 15 SPF Avoiding sun exposure Seeking medical attention for any shiny or scaly skin lesions Wearing long sleeves if outdoors during peak sun hours
The client has an increase in intracranial pressure caused by an increase in capillary permeability. The nurse should recognize this as which type of cerebraledema? Group of answer choices Hormonal Cytotoxic Bacterial Vasogenic
Vasogenic
What does the Glasgow Coma Scale assess? Select all that apply. Group of answer choices Corneal reflex Verbal response Motor response Eye opening Cerebellar function
Verbal response Motor response Eye opening
The nurse is collecting a health history of MaryWilliams, a 22-year-old female. Mary shares that she has recently experienced pallor, weakness, and difficulty maintaining her balance. She also reports some numbness and tingling in her hands. Which type of anemia does the nurse suspect that Mary isexperiencing? Group of answer choices Iron deficiency Blood loss anemia Vitamin B12 deficiency Acquired hemolytic
Vitamin B12 deficiency
The nurse is caring for a client complaining of diarrhea and a sore, beefy red tongue. Which condition does the nurse suspect? Group of answer choices Iron deficiency anemia Vitamin B12 deficiency anemia Aplastic anemia Thalassemia
Vitamin B12 deficiency anemia
Which anemia is associated with macrocytic and misshapen red blood cells (RBCs) with thin membranes? Group of answer choices Vitamin B12 deficiency anemia Blood loss anemia Thalassemia Iron deficiency anemia
Vitamin B12 deficiency anemia
Tani Becker is a 23-year-old college student majoring in equine studies. Tani has been riding horses since she was 5 years old. This evening, the equine team is practicing for the upcoming competition with events in barrel racing, pole bending, keyhole,showmanship, and trail classes. Tani does not have her helmet with her. She tells her friend she inadvertently left her helmet in the car and her sister has taken the car to work. Tani knows the team policy states that the members must wear protective headgear while riding; she has always worn a helmet. Her riding coach is teaching a class and is not at the practice. With the pressure of the upcoming competition, Tani decides to practice just this one time without a helmet. As she was rounding her first barrel, the horse swerves quickly, throwing her off.Tanis vital signs remain stable. She is drowsy, but easily aroused. She continues to complain of a headache. Which assessment findings would you need to report to the health care provider immediately? Select all that apply. Group of answer choices Vomiting without prior nausea Severe persistent headache Tani repeatedly asking Where am I? What happened? T 98.7°F, P 87 bpm, R 22/min, and BP 114/58 mmHg Nonfocal neurological assessment
Vomiting without prior nausea Severe persistent headache Tani repeatedly asking Where am I? What happened?
A client is scheduled for total hip replacement surgery the next morning. What is the appropriate skin preparation for this client? Group of answer choices Cleanse the skin with alcohol soaked swabs before the procedure Cleanse the skin with betadine before bedtime Wash the area twice with chlorhexidine gluconate Shave the client from the waist to the knee
Wash the area twice with chlorhexidine gluconate
A client is scheduled for total hip replacement surgery the next morning. What is the appropriate skin preparation for this client? Group of answer choices Wash the area twice with chlorhexidine gluconate Cleanse the skin with betadine before bedtime Cleanse the skin with alcohol soaked swabs before the procedure Shave the client from the waist to the knee
Wash the area twice with chlorhexidine gluconate
What hand hygiene is performed before participating in client care during a surgical procedure? (Select all that apply.) Group of answer choices Washing hands when the case is completed Completing a 3 to 5 minute surgical scrub before applying sterile gloves Washing hands when surgical gloves are removed Washing the gloves when saturated with blood Completing a 5 minute surgical scrub after removing the gloves
Washing hands when the case is completed Completing a 3 to 5 minute surgical scrub before applying sterile gloves Washing hands when surgical gloves are removed
The nurse is preparing to assess the cranial nerve function of Esther Moskowicz, an 85-year-old client who is experiencing a stroke. Which technique should the nurse use to determine Mrs. Moskowicz's extraocular movements? Group of answer choices Place a Snellen chart on the wall Observe for location and strength of eyelids Shine a light into each eye Watch the eyes move as an H is drawn in the air
Watch the eyes move as an H is drawn in the air
The nurse knows that treatment of prostate cancer depends on the stage of disease when the client was diagnosed. Which treatment would the nurse expect for a 60-year-old client recently diagnosed with a small benign tumor of the prostate following a DRE? (Select all that apply.) Group of answer choices Brachytherapy Surgery Watchful waiting Radiation Medication
Watchful waiting Medication
Your client has been diagnosed with prostate cancer and had radiation therapy for treatment. What home care instruction would you provide the client? Group of answer choices Increase exercise as tolerated Wear a condom Sleep with two pillows Watch for urinary tract infections
Wear a condom
While teaching a skin cancer prevention class at the local community center, which instruction should be included in the presentation? (Select all that apply.) Group of answer choices Wear broad-brimmed hats and sunglasses. Use sunscreen with SPF of 10. Perform skin self-exams. Refrain from using tanning equipment. Apply sunscreen to newborns.
Wear broad-brimmed hats and sunglasses. Perform skin self-exams. Refrain from using tanning equipment.
A client with adenocarcinoma lung cancer is scheduled for a procedure to remove peripheral lung tissue. Which procedure should the nurse educate the client about? Group of answer choices Wedge resection Laser bronchoscopy Lobectomy Mediastinoscopy
Wedge resection
The nurse is caring for a client who has stomatitis, nausea, and a poor appetite as a result of chemotherapy. Which collaborative nursing action is warranted in the care of the client? Group of answer choices Weekly studies of serum electrolytes Administering antianemic medications Measuring height and weight Providing highly seasoned foods to make them more palatable
Weekly studies of serum electrolytes
It has been 48 hours since the arthroplasty surgery, and Mr. Jacobi is finally permitted to be assisted out of bed. He expresses concern about walking on the toes of his left foot. What are some important strategies to teach Mr. Jacobi when ambulating? Group of answer choices Hopping Weight bearing avoidance Toe-touch Pivot turning Foot sliding
Weight bearing avoidance Toe-touch Pivot turning
The nurse is preparing a poster on prostate cancer for display at a health fair. Which information should the nurse include on the display? (Select all that apply.) Group of answer choices When prostate cancer is confined to the prostate, the 5-year survival rate is 100%. Prostate cancer occurs more often in Black men. Prostate cancer is the most common type of cancer among men. Prostate cancer is the second leading cause of death in North America. There is a reduced incidence of prostate cancer in men who take large amounts of vitamin A.
When prostate cancer is confined to the prostate, the 5-year survival rate is 100%. Prostate cancer occurs more often in Black men. Prostate cancer is the most common type of cancer among men. Prostate cancer is the second leading cause of death in North America.
When explaining neonatal testing for sickle cell disease (SCD), which content is most appropriate for the nurse to include in the care plan? Group of answer choices Newborn screening for sickle cell disease (SCD) is offered as an optional test in the United States. Initial diagnosis of sickle cell disease (SCD) in newborns most commonly occurs by way of amniocentesis testing. Newborns who are diagnosed with sickle cell disease (SCD) should immediately begin diagnostic testing for prevention of stroke. When testing for sickle cell disease (SCD) in newborns, a heel stick may be used to obtain blood.
When testing for sickle cell disease (SCD) in newborns, a heel stick may be used to obtain blood.
The nurse is assessing the coping skills of a client undergoing treatment for leukemia. What is the best time for the nurse to assess the client's management of issues such as nutrition, rest/sleep, medication administration, and psychosocial needs? Group of answer choices When the client is receiving radiation therapy in the clinic When the client is at home When the client is receiving IV medication in the clinic When the client is at work
When the client is receiving IV medication in the clinic
Mr. Alvarez tells the health care provider, I think the pain is a little better. Am I okay now? However, he is complaining of feeling cold, and his temperature has increased to 101.8°F. The health care provider suspects Mr. Alvarezs appendix has ruptured. He discusses an open appendectomy with Mr. Alvarez and his wife. Mr. Alvarezagrees, and the consent for surgery is signed. To prepare Mr. Alvarez and his wife for the postoperative period, what should you tell them? Select all that apply. Group of answer choices When you come back to our unit, were going to be listening to your abdomen to see if your bowel sounds are returning. Youll be receiving a narcotic analgesic, which is a medication that will help with the pain. You will have several very small incisions located on your abdomen. Your temperature will be monitored every 4 hours or as needed following surgery. You are going to continue to receive intravenous antibiotics for a few more days.
When you come back to our unit, were going to be listening to your abdomen to see if your bowel sounds are returning. Youll be receiving a narcotic analgesic, which is a medication that will help with the pain. Your temperature will be monitored every 4 hours or as needed following surgery. You are going to continue to receive intravenous antibiotics for a few more days.
You continue the assessment and learn that not only has Mrs. Walton not been doing breastself-exams regularly, she has not had a mammogram in over two years. In your teaching, which breast cancer screening practices will you discuss with Mrs. Walton? Select all that apply. Group of answer choices Women over 40 years of age should have a mammogram every year. Premenopausal women should perform breast self-exams the day after menses. Postmenopausal women should perform a breast self-exam at the same time each month. Clinical breast exams should be performed every year. Women over 40 years of age should have a mammogram every 2 years.
Women over 40 years of age should have a mammogram every year. Postmenopausal women should perform a breast self-exam at the same time each month. Clinical breast exams should be performed every year.
The nurse is providing education to a client at the primary care clinic. Which screenings are recommended for colorectal cancer? (Select all that apply.) Group of answer choices Yearly fecal occult blood test Flexible sigmoidoscopy every 5 years CT colonoscopy every 5 years Colonoscopy every 10 years Screening beginning at age 40 years
Yearly fecal occult blood test Flexible sigmoidoscopy every 5 years CT colonoscopy every 5 years Colonoscopy every 10 years
The health care provider completes Mrs. Walton's examination and schedules her for a mammogram to determine the extent and nature of the mass. Mrs. Walton becomes upset, confiding to you that she fears she might die of breast cancer. She is also worried because she is unemployed, their family's health insurance plan is not very good, and they do not have extra money for a lot of medical expenses. What is your best response to Mrs.Walton? Group of answer choices You seem upset about the financial impact that having breast cancer might have on your family. You seem concerned about your finances, but you do have some health insurance. I will contact the care coordinator to talk with you about your concerns. Do not concern yourself with the medical expenses at this time.
You seem upset about the financial impact that having breast cancer might have on your family.
A client with chromic myeloid leukemia (CML) is admitted to a clinic. The nurse understands the client is least likely to be part of which demographic group? Group of answer choices Younger than 20 years Female Older than 65 years Male
Younger than 20 years
The ABCD rule for recognizing lesions suspicious for skin cancer stands for what? Group of answer choices Asymmetry, border irregularity, color variation or dark black, and diameter > 6 mm Asymmetry, biopsy, cancer, diameter < 6 mm Asymmetry, border irregularity, color variation or dark black, and diameter < 5 mm Asymmetry, biopsy, color variation or dark black, and diameter > 6 mm
Asymmetry, border irregularity, color variation or dark black, and diameter > 6 mm
What is a modifiable risk factor associated with the development of breast cancer? Group of answer choices Long-term hormone replacement therapy Having more than one child Menstruation before the age of 12 years Breastfeeding
Long-term hormone replacement therapy
Carlos Sanchez is a 42-year-old Hispanic man who has begun pharmacologic treatment for cancer. He returns today with a chief complaint of lack of appetite and constant nausea. Explanations for Mr. Sanchez should include which statement by the nurse? Group of answer choices "You haven't seen anything yet. Wait until your hair starts falling out, or you begin to lose weight!" "All chemotherapeutic agents have side effects because they kill normal cells along with the cancer cells. Let's talk about ways to make you feel better." "It's probably your imagination. I will recommend a psychiatric evaluation for you as soon as possible." "Ask your physician to change your chemotherapeutic regimen to a drug that does not have any specific side effects."
"All chemotherapeutic agents have side effects because they kill normal cells along with the cancer cells. Let's talk about ways to make you feel better."
A client and her husband both carry the genetic trait for sickle cell disease (SCD). The client asks the nurse practitioner, "What is the risk that we will have a child with sickle celldisease?" Which response by the nurse practitioner is most accurate? Group of answer choices "All of your children will have the SCD trait, but none will have SCD." "There is a 25 percent chance that any of your children will have SCD." "All of your children will have some form of SCD, though severity will vary." "There is a 50 percent chance that any of your children will have SCD."
"There is a 25 percent chance that any of your children will have SCD."
Mr. Giles is a 38-year-old African American man who has been diagnosed with prostate cancer. He states, "I thought prostate cancer was an 'old man's' disease; how did I get it?" What is your best explanation to Mr. Giles? Group of answer choices "You have had recurrent urinary tract infections." "Your test results show you had a terrible virus last season." "You have had kidney stones in the past and this leads to cancer." "This disease occurs more often in African American men at a rate greater than 60% higher than those seen in White men."
"This disease occurs more often in African American men at a rate greater than 60% higher than those seen in White men."
Mrs. Grabowski is a middle-aged woman who was recently diagnosed with lung cancer and is receiving a diagnostic work-up to help in the process of planning her treatment. In preparing for blood tests to be drawn, she says to you, "They already know that I have cancer. Why do they have to continue to take blood?" Which response by the nurse is the most appropriate? Group of answer choices "If the healthcare providers want to put you on chemotherapy, it is important to know if your liver is damaged because it wouldn't be able to break down the medications, and another method of treatment would be better." "Although it does seem like excessive bother for you, getting more information about your blood count and electrolytes and how your liver is working will help the team identify the best treatment plan for you." "Getting these blood tests will help to determine what type of tumor is in your lung, and that will help to determine the best treatment plan." "The blood tests will tell us if the cancer cells have spread to your blood and perhaps throughout your body. That information will help to determine treatment."
"Although it does seem like excessive bother for you, getting more information about your blood count and electrolytes and how your liver is working will help the team identify the best treatment plan for you."
The nurse is preparing to conduct a neurologic assessment interview with a client. Which general questions should the nurse use when conducting thisassessment? (Select all that apply.) Group of answer choices "Are you experiencing any pain?" "Are you having any problems with your memory?" "Do you have a history of seizures or fainting?" "How many fingers am I holding up at this time?" "Do you have any problems with balance or coordination?"
"Are you experiencing any pain?" "Are you having any problems with your memory?" "Do you have a history of seizures or fainting?" "Do you have any problems with balance or coordination?"
Jan Street is a 40-year-old woman diagnosed with breast cancer. She had a radical mastectomy of the left breast. She has progressed well after surgery and is preparing for discharge. She has no signs of infection, and the incision site is clean and dry. Jan's nurse has instructed her to keep her left arm up on pillows with the hands higher than the elbow and has told her to report any signs of infection to her healthcare provider. What other instruction would be important for Jan's nurse to include? Group of answer choices "Be sure to use lotion on the right side." "Avoid using hot water on the right side." "Wear your watch on your left arm." "Avoid carrying a purse on your left arm."
"Avoid carrying a purse on your left arm."
Mr. Tacy is a 62-year-old man who developed a brain abscess and experienced an increase in intracranial pressure. His initial symptoms were headaches upon rising, blurred vision, elevated temperature, and occasional slurring of his speech. He received intravenous antibiotics and supportive treatment. In teaching Mr. Tacy about his care, which instructions would you provide? Group of answer choices "Take a laxative every other day so you do not become constipated." "When resting in bed, tighten your leg muscles and relax them several times an hour." "Push with your arms and legs when moving up in bed." "Avoid coughing and blowing your nose."
"Avoid coughing and blowing your nose."
The nurse is caring for Alishia Baldwin, a 24-year-old African American client who is pregnant with her first child. Mrs. Baldwin and her husband are talking about their family history of sickle cell disease(SCD). Mr. Baldwin asks the nurse, "What factors affect our baby's chances of having sickle celldisease?" Which response by the nurse is mostappropriate? Group of answer choices "If both you and your wife have the genetic trait for sickle cell disease, then there is a 50% chance that your baby will have the disease." "Because sickle cell disease is caused by an autosomal recessive genetic defect, you both must have the trait in order for your child to have the disorder." "There are several forms of sickle cell disease, but only one form of the disorder is influenced by factors related to inheritance of genes from the parents." "Sickle cell disease occurs only in individuals who are of African American descent and approximately 50% of African Americans are born with some form of the disorder."
"Because sickle cell disease is caused by an autosomal recessive genetic defect, you both must have the trait in order for your child to have the disorder."
The nurse educator asks a nursing student to identify the pathophysiological processes behind the development of breast cancer. Which statements by the student indicate to the educator that the student understands the pathophysiology behind the development of breast cancer? (Select all that apply.) Group of answer choices "Breast cancer creates an alteration in the regulation of cell growth." "Abnormal cells grow without the influence of hormonal regulation." "The BRCA4 gene is one of the genes believed to cause breast cancer." "Breast cancer begins as a single cell mutation." "The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue."
"Breast cancer begins as a single cell mutation." "The majority of breast cancers are adenocarcinomas that begin in the breast ductal tissue." "Breast cancer creates an alteration in the regulation of cell growth."
The spouse of a client with cancer asks the nurse what is meant when chemotherapy medications are referred to as cytotoxic. What is the best response by the nurse? Group of answer choices "Chemotherapy medications are a combination of medication and implantable devices." "Chemotherapy medications attack both cancerous and normal cells as they grow." "Chemotherapy medications attack specific types of cancer, preventing mitosis of other cancerous cells." "Chemotherapy medications are expected to treat cancer 100% of the time."
"Chemotherapy medications attack both cancerous and normal cells as they grow."
The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instructions are appropriate for the nurse to include in the teachingsession? (Select all that apply.) Group of answer choices "It is okay to carry your purse on your right arm as long as it is not heavy." "Do not allow anyone to take your blood pressure in the right arm." "You should apply hot compresses to the right arm if it is aching." "You will be able to resume playing golf with your friends." "Sleep with the right arm elevated on a pillow."
"Do not allow anyone to take your blood pressure in the right arm." "Sleep with the right arm elevated on a pillow."
Mrs. Boyer is a very active, independent 82-year-old woman who lives alone in an assisted living facility. She is in good health and has been treated for mild hypertension and anxiety in the past. She has come to the emergency department of the community hospital via ambulance after falling from a stool in her kitchen and becoming unconsciousness after the fall. During your assessment, Mrs. Boyer says to you, "The x-rays indicate that I didn't break anything, and I only have this bruise on my arm. Why all the fuss with repeatedly checking my blood pressure, my heart, and my eyes and asking me where I am and what time it is?" Which response by the nurse is the most appropriate? Group of answer choices "Even if bones are not broken, damage to your head could result in a fractured skull, which may show up on a later x-ray because of swelling of your skin." "It is common practice to neurologically assess anyone who has a head injury frequently to identify any swelling that may become visible as the bruised areas fill with fluid over time. We may then need to complete additional tests if we notice any changes." "Sometimes when a person falls, the person doesn't remember what happened and doesn't know simple things like where they are and what day it is. By asking, it helps you remember." "Even if there is no indication of external injuries and no broken bones, head trauma from your fall may cause pressure to build up in your head, which could result in some neurologic damage. We are checking frequently to see if that is happening."
"Even if there is no indication of external injuries and no broken bones, head trauma from your fall may cause pressure to build up in your head, which could result in some neurologic damage. We are checking frequently to see if that is happening."
The nurse is providing cancer prevention education to a community group. When describing healthy lifestyle choices that may help prevent cancer, which statement by the nurse is most accurate? Group of answer choices "Staying in the sun longer is acceptable because of the use of sunscreen." "Smoking is acceptable in moderation." "Exercising regularly can promote immune system function." "Drinking small amounts of wine can build the immune system and ward off cancer."
"Exercising regularly can promote immune system function."
The nurse is providing cancer prevention education to a community group. When describing healthy lifestyle choices that may help prevent cancer, which statement by the nurse is mostaccurate? Group of answer choices "Drinking small amounts of wine can build the immune system and ward off cancer." "Smoking is acceptable in moderation." "Exercising regularly can promote immune system function." "Staying in the sun longer is acceptable because of the use of sunscreen."
"Exercising regularly can promote immune system function."
A 4-year-old child is seen in the emergency department with a high fever. The child's mother states that her child began shaking and the child's eyes rolled back into her head. The mother reports she thinks her child had some type of seizure. The mother asks the nurse if the fever caused the seizure. What is the best response by the nurse? Group of answer choices "Seizures in children are usually caused by a birth defect." "Fever does not cause seizures without other risk factors being present." "Seizures are usually the result of an inherited disorder." "Fever is known to be a risk factor for seizures."
"Fever is known to be a risk factor for seizures."
A client tells the nurse, "The skin on my right breast is puckered up and looks like an orange peel." Which response by the nurse is most appropriate? Group of answer choices "Have you used a new lotion recently?" "Have you discussed these findings with your healthcare provider?" "Do you have a history of skin problems?" "When was your last mammogram?"
"Have you discussed these findings with your healthcare provider?"
The nurse is teaching the client with sickle cell disease (SCD) about hemosiderosis, which is a complication associated with frequent blood transfusions. Which statement is most appropriate for the nurse to include in the client teaching? Group of answer choices "In most cases, hemosiderosis is caused by iron-chelating medications." "Hemosiderosis occurs when your immune system reacts to antigens." "Vitamin C can increase your risk for developing hemosiderosis." "Hemosiderosis is storage of iron in tissues and organs."
"Hemosiderosis is storage of iron in tissues and organs."
The client with sickle cell disease (SCD) is ordered to receive hydroxyurea. To correctly explain the rationale for administering hydroxyurea to the client, which statement is most appropriate for the nurse to include in the teaching? Group of answer choices "Hydroxyurea decreases the production of abnormal blood cells." "Hydroxyurea decreases the body's production of fetal hemoglobin." "Hydroxyurea may cause you to have more pain." "Hydroxyurea will help decrease your nausea and vomiting."
"Hydroxyurea decreases the production of abnormal blood cells."
The nurse is reviewing discharge instructions with a client who just had a mastectomy for breast cancer. Which statement by the client indicates that teaching has been successful? Group of answer choices "To improve my stamina, I will plan on trying not to sit down too much during the day." "I will be certain to not lift my arms over my head." "I am going to see when the support group meetings are so I can attend them." "I should avoid using the arm on the surgical side if at all possible for a while."
"I am going to see when the support group meetings are so I can attend them."
The nurse provides postoperative discharge instructions to a client recovering from a lumbar laminectomy. Which client statement indicates that additional teaching is required? Group of answer choices "I can drive myself home." "I can resume a normal diet as tolerated." "I will take the pain medication as prescribed." "I will take a shower and leave the Steri-Strips alone."
"I can drive myself home."
The nurse is teaching a client about choosing dietary sources of iron. Which statement by the client indicates the need for further education? Group of answer choices "I will be sure to increase the amount of cow's milk that I drink." "I will eat a lot more spinach than I used to eat." "I can get iron from most of the meats that I eat." "Oatmeal or whole-wheat toast would be a good choice for breakfast."
"I will be sure to increase the amount of cow's milk that I drink."
Hester Jacobson is a 90-year-old woman who is returning to the oncology clinic today. Her cancer is in remission, and her final chemotherapy treatment scheduled today. She still experiences nausea and needs to regain weight lost during treatment. The nurse determines that Mrs. Jacobson demonstrates proper understanding of increasing her caloric intake if Mrs. Jacobson makes which statement? Group of answer choices "I should avoid using anti-emetics because my chemotherapy will be finished today." "I will eat as much as I can at every meal even if I feel nauseated." "I won't need to keep a food diary if I feel full every day." "I will use nutritional supplements to make sure I get enough calories each day."
"I will use nutritional supplements to make sure I get enough calories each day."
The nurse educator is discussing with a student how nutritional anemias affect the appearance of red blood cells. Which statement by the student reflects correct understanding of the teaching session? Group of answer choices "Iron deficiency anemia will cause red blood cells to be misshapen and pale." "A dietary iron deficiency will result in red blood cells that are fragile and oversized." "Nutritional anemias affect the number of red blood cells but not the size or shape of them." "A folic acid deficiency will cause the red blood cells to form a sickle shape."
"Iron deficiency anemia will cause red blood cells to be misshapen and pale."
The client asks the nurse to explain how the client's malignancy is growing so rapidly. What is the appropriate answer for the nurse to give the client? Group of answer choices "Malignant tumors contain blueprints that produce regular cell mitosis." "Malignant tumors adhere to the normal process of cell reproduction." "Malignant tumor cells reproduce faster than normal cells." "A malignant tumor's food source is located in the sternum, producing rapid cell growth."
"Malignant tumor cells reproduce faster than normal cells."
A client who is scheduled for a mastectomy asks the nurse, "Why do I need to have radiation before surgery if the doctor is just going to cut out the tumor?" Which response by the nurse is the most appropriate? Group of answer choices "Radiation will decrease the amount of pain that you will have after your surgery." "Radiation will help to prevent infection after surgery." "If the radiation works, you may not need to have the surgery." "Radiation can be used before surgery to shrink large tumors."
"Radiation can be used before surgery to shrink large tumors."
The spouse of a client who has increased intracranial pressure (IICP) asks the nurse what is happening in her husband's brain. Based on the pathophysiology, which is the best response by the nurse? Group of answer choices "There must be a tumor causing the increase in pressure we are seeing." "The blood flow to the brain has increased and is causing an increased pressure." "Something in the brain, its blood, or surrounding fluid is off balance and has caused an increased pressure." "Your husband's low blood pressure is causing the brain to have too much fluid in it."
"Something in the brain, its blood, or surrounding fluid is off balance and has caused an increased pressure."
A client is informed that she needs to have a mastectomy for breast cancer and states, "I will no longer be a woman." Which response by the nurse is the most appropriate? Group of answer choices "They are doing wonderful things with plastic surgery these days." "Do you want to talk with the priest?" "That is a very overwhelming thing to think about." "You don't want your cancer to spread, do you?"
"That is a very overwhelming thing to think about."
Sonya Kaufman, a 39-year-old Russian interpreter, has been diagnosed with cervical dysplasia. After speaking with her doctor, she asks you to explain the condition to her again. What is your best response when explaining the condition to Ms. Kaufman? Group of answer choices "The cells have regressed to an immature or undifferentiated cell type." "The cells are normal for their type but are not in the normal location." "The number or density of normal cells has increased." "The cells are abnormal in size, shape, appearance, and usual arrangement."
"The cells are abnormal in size, shape, appearance, and usual arrangement."
The mother of 2-week-old Miriam Shroeder is concerned when the nurse measures the circumference of the baby's head. Which explanation about the assessment is appropriate to share with the mother? Group of answer choices "The head circumference helps determine if there is extra fluid accumulating in the child's brain." "The size of the head helps determine if cranial nerves are developing and functioning." "This measurement helps determine when primitive reflexes are going to disappear." "The size of the head correlates to the amount of fluid that is within the body organs."
"The head circumference helps determine if there is extra fluid accumulating in the child's brain."
Mr. Jeffers came to the clinic following a surgical excision of a malignant melanoma. As part of Mr.Jeffers's follow-up appointment, the healthcare provider reviewed the finding of the presence of metastasis in the lymph nodes that were also excised. Mr. Jeffers has been told that he needs to undergo radiation therapy in addition to the surgical excision. You are preparing Mr. Jeffers for the radiation treatment. Which statement made by this client would reflect a correct understanding of the radiation therapy he is about to begin? Group of answer choices "Radiation can be used on all areas of the body." "The success of radiation depends on the site, thickness, and type of melanoma." "Radiation cannot be used to alleviate symptoms resulting from metastasis." "Radiation is not an appropriate treatment for the metastasis found in my lymph nodes."
"The success of radiation depends on the site, thickness, and type of melanoma."
Mr. Allen, a truck driver, has been diagnosed with prostate cancer and asks about sexual function. What instruction, related to sexual function, should you provide to help him? Group of answer choices "Therapy may affect sexual function, so make sure to talk about any issues with your partner." "Restrict fluids so you won't have to go to the bathroom often or during sex." "Be sure to take iron supplements." "Symptoms of impotence will subside eventually."
"Therapy may affect sexual function, so make sure to talk about any issues with your partner."
The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, cannot concentrate, and am so forgetful." Which statements made by the nurse in response to the client are true? (Select all that apply.) Group of answer choices "This is an abnormal side effect of chemotherapy and is very concerning." "This may last up to 2 years after completion of chemotherapy." "This may occur with chemotherapy, however, it is rare." "You might want to make notes if needed as a memory aid." "This is also called chemo-brain."
"This may last up to 2 years after completion of chemotherapy." "You might want to make notes if needed as a memory aid." "This is also called chemo-brain."
The nurse is providing care to a client who recently had a biopsy for colon cancer. The biopsy indicates that the tumor has invaded the submucosa and the client asks the nurse what this means. Which response by the nurse is most appropriate? Group of answer choices "This means you are Stage 1." "This means you are Stage 3." "This means you are Stage 0." "This means you are Stage 2."
"This means you are Stage 1."
The nurse teaches a client with iron deficiency anemia to ingest foods high in vitamin C. The client states, "I thought that vitamin C was used to prevent you from getting a cold. What does it have to do with anemia?" Which response by the nurse is most appropriate? Group of answer choices Vitamin C will change the aciddashbase balance in your stomach, and will allow you to absorb B vitamins." "Vitamin C will help your body to absorb iron." "Vitamin C helps your immune system so that your red blood cells will last longer." "Vitamin C will stimulate your body to produce more red blood cells."
"Vitamin C will help your body to absorb iron."
A 5-year-old client scheduled for a tonsillectomy asks the nurse if the operation is going to hurt. What is the best response by the nurse? Group of answer choices "Yes, but it will hurt less than the sore throat you have now." "Yes, but we will give you medicine to stop the pain before it starts." "No, you will have no pain." "Yes, but don't worry. I can give you a shot to help with the pain."
"Yes, but we will give you medicine to stop the pain before it starts."
Juanita Inez is a 45-year-old woman who has a family history of breast cancer. She had a baseline mammogram at age 40 years and continues to get one every year. Mammography reports have all had negative findings. Juanita is physically active. She has had no children. She does not smoke but reports drinking 2 to 3 glasses of red wine most days. She is in the clinic for her annual visit. She asks the nurse what she can do to minimize her risk for breast cancer. Which response by the nurse is the most appropriate? "You have family history, so getting the mammogram is the best thing." "You need to lose weight. Being overweight is a risk factor for developing breast cancer." "Consider having children. Having no children is a modifiable risk factor." "You are active, which is helpful, but you could cut your consumption of alcohol to 1 drink per day."
"You are active, which is helpful, but you could cut your consumption of alcohol to 1 drink per day."
The client delayed contacting her primary care physician about her breast lump. She asked the clinic nurse, open double quote"Why would I put that off?close double quote" What explanation could the nurse give to her about a possible reason for her behavior? Group of answer choices "Breast lumps grow slowly, so you could wait until your next annual exam." "Your anxiety about a possible diagnosis could have immobilized you. "Most breast lumps are benign, so you had good reason not take action." "You knew that If the lump was not painful, it wouldn't cause problems."
"Your anxiety about a possible diagnosis could have immobilized you.
Cassandra Millot is a 32-year-old woman who teaches elementary school and was in good health until 2 weeksago, when she was diagnosed with acute lymphocytic leukemia (ALL). She has a basic understanding of the treatment options. Ms. Millot asks you what the difference is between an allogeneic and autologous bone marrow transplant. Which is your best response to Ms. Millot? Group of answer choices "You do not have to wait for the reestablishment of bone marrow function after an allogeneic transplant like you do after an autologous transplant." "Chemotherapy is used before allogeneic transplants but not autologous transplants." "Bone marrow cells are transplanted before radiation therapy in allogeneic transplants and after radiation therapy in autologous transplants." "Your own bone marrow cells are used in an autologous transplant, while a matched donor's cells are used in an allogeneic transplant."
"Your own bone marrow cells are used in an autologous transplant, while a matched donor's cells are used in an allogeneic transplant."
Mr. Wright is a 75-year old who has been diagnosed with prostate cancer. He asks you why the doctor is not being aggressive with his treatment. What is your best response to Mr. Wright? Group of answer choices "You may need to change doctors." "Your tumor is growing slowly, so right now we just watch it." "You're too old for surgery." "A radical prostatectomy is the next step; he's just waiting for the surgeon's availability."
"Your tumor is growing slowly, so right now we just watch it."
The nurse is providing preoperative teaching to a client scheduled to have a Port-A-Cath installed. The client asks the nurse what type of surgery is involved in the procedure. What is the best response by the nurse? Group of answer choices 'Your surgery is considered supportive surgery. It is used in conjunction with other types of treatment." "Your surgery will include inserting specific implants that will treat your cancer." "Restorative surgery will be performed for aesthetic purposes, to repair any disfigurement." "Your surgery will consist of removing part of the cancer, followed by radiation therapy."
'Your surgery is considered supportive surgery. It is used in conjunction with other types of treatment."
Based on your assessment findings, you suspect Tani has increased intracranial pressure. Which treatment regimens do you anticipate the health care provider might order for Tani? Select all that apply. Group of answer choices 5% dextrose in water 0.9% sodium chloride Ethacrynic acid (Edecrin) Mannitol (Osmitrol) Furosemide (Lasix)
0.9% sodium chloride Ethacrynic acid (Edecrin) Mannitol (Osmitrol) Furosemide (Lasix)
The client with sickle cell disease (SCD) asks the nurse to explain vaso-occlusive crisis. Which information is most appropriate for the nurse to include in the explanation? (Select all that apply.) Group of answer choices Vaso-occlusive crisis consists of pain resulting from ischemia caused by vascular occlusion. Conditions that impair oxygen transport to tissues may lead to vaso-occlusive crisis. Infection increases the risk for developing vaso-occlusive crisis. Prolonged vaso-occlusive crisis may progress to a more severe condition called sickle cell crisis. Overhydration increases the risk for developing vaso-occlusive crisis.
Vaso-occlusive crisis consists of pain resulting from ischemia caused by vascular occlusion. Conditions that impair oxygen transport to tissues may lead to vaso-occlusive crisis. Infection increases the risk for developing vaso-occlusive crisis.
While hospitalized, the physician notices a growth on a patient's throat. Tests were completed on the growth indicating a neoplasm. Which characteristic indicates that the neoplasm is benign? Group of answer choices Noncohesive Rapid growth Invades surrounding tissues Well-defined borders
Well-defined borders
