406 E3 Practice

A 65-year-old client was diagnosed with multiple sclerosis 10 years ago. The client has difficulty ambulating and is seeking a prescription for a wheelchair. The nurse assesses the type of disability the client has is - Age-associated - Developmental - Acquired - Sensory

- Acquired Developmental disability from birth to 22 years of age Acquired happen during life. A progression. Sensory disability: is a disability of the senses. (hearing and vision)

What are the three classes of drugs used in the treatment of rheumatoid arthritis?

-NSAIDs -Glucocorticoids -DMARDs

A patient with rheumatoid arthritis is taking gold salts. What drugs should the nurse teach this patient that are contraindicated when taking gold salts? (Select all that apply.) A) Antimalarials B) Cytotoxic drugs C) Salicylates D) Penicillamine E) Anticoagulants

A) Antimalarials B) Cytotoxic drugs D) Penicillamine

You are an oncology nurse caring for a client who is taking antineoplastic agents. What adverse symptoms must you monitor for in this client? A) Symptoms of gout B) Symptoms of hypertension C) Symptoms of diarrhea D) Symptoms of anemia

A) Symptoms of gout Rationale: The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema. Administering antineoplastic agents does not cause hypertension, diarrhea, and anemia.

Cyclophosphamide (Cytoxan) is a?

Alkylating agent causes cross-linking of DNA strands, abnormal base pairing, and DNA strand breaks, thus preventing the cell from dividing.

Treatment of choice for polymyalgia rheumatica (PMR) is A. acetaminophen or NSAIDs. B. low-dose steroids. C. tricyclic antidepressants. D. antibiotics.

Answer B Treatment for PMR consists of low-dose steroids, starting with 10 to 15 mg and tapering to 5 to 7.5 mg daily for several weeks or months. PMR is not an infectious process; thus, there is no need for antibiotics. Tricyclic antidepressants do not address the underlying etiology of this condition and thus should not be ordered. Tylenol and/or NSAIDs do not provide sufficient anti-inflammatory action.

5-FU is a?

Antimetabolite o Antimetabolites are cell cycle specific, exerting their effects only in the S phase (DNA synthesis and metabolism) of the cell cycle.

The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: A. Gastric esophageal reflex B. Kidney Stones C. Heart palpitations D. Bone fractures

B. Kidney Stones The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism. Renal damage causes the kidney stones.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patients insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).

C) The patients insulin levels are inadequate. Feedback: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site

Change the needle on the pump every 3 days with sterile technique

A client with type 1 diabetes reports waking up in the middle of the night feeling nervous and confused, with tremors, sweating, and a feeling of hunger. Morning fasting blood glucose readings have been 110 to 140 mg/dL. The client admits to exercising excessively and skipping meals over the past several weeks. Based on these symptoms, the nurse plans to instruct the client to

Check blood glucose at 0300 Rationale: In the Somogyi effect, the client has a normal or elevated blood glucose concentration at bedtime, which decreases to hypoglycemic levels at 2 to 3 a.m., and subsequently increases as a result of the production of counter-regulatory hormones. It is important to check blood glucose in the early morning hours to detect the initial hypoglycemia.

After examining the physician's orders, in what sequence should the nurse provide the care to the patient admitted to the hospital?

Correct ORDER 1. Vital Signs 2.HOB 3. ABGs 4. O2 5. Lab 6. Antibiotic 7. CXR

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

Cushing syndrome Explanation:The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected

Which statement best indicates that a client understands how to administer his own insulin injections? A. "If I'm not feeling well, I can get a friend or neighbor to help me." B. "I need to be sure no air bubbles remain." C. "I need to wash my hands before I give myself my injection." D. "I wrote down the steps in case I forget what to do."

D. "I wrote down the steps in case I forget what to do." The fact that the client has written down each step of insulin administration provides the best assurance that he'll follow through with all the proper steps

The diagnosis of osteoarthritis (OA) depends on evaluation of a number of factors. A nurse understands that the first, and frequently only, sign of symptomatic OA is which of the following? a Degree of limited passive movement b Joint enlargement c Joint instability d Limb shortening

Degree of limited passive movement OA is typically diagnosed by an overall clinical impression based on the patient's age and history, location of joint abnormalities, and radiographic findings. Limited passive movement can be the first and only physical sign of symptomatic OA.

A provider prescribes a subcutaneous anabolic agent for an elderly patient to prevent fractures associated with osteoporosis. Which of the following is the most likely prescribed drug?

Forteo Explanation: Teriparatide (Forteo) is a subcutaneously administered anabolic agent that is taken once daily. The other drug choices are oral preparations.

What 2 anterior pituitary hormones act directly on target tissues?

Growth hormone (GH) & Prolactin

Which assessment findings would the nurse expect in the client with osteomalacia?

Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels.

What is a cardinal sign that a patient might have a spinal tumor?

Pain in prone position can be a cardinal signs of spinal tumor

What might the nurse have to assess during the bone marrow transplant procedure?

Psychological status Explanation: During the BMT procedure, the nurse assesses the patient's psychological status. Patients experience many mood swings and need emotional support and help throughout this process.

What symptoms would the nurse consider with tumor lysis syndrome when monitoring this client?

Symptoms of gout The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema, with the consideration of tumor lysis syndrome.

Two approved anabolic agents for osteoporosis

Teriparaide (Forteo) and abaloparatide (Tymlos)

Choose the most likely reason why a nurse should question the use of Demerol for pain management in an elderly patient?

There is (are) Decreased binding of meperidine by plasma protein

What are the dangers of long term steroid use?

Two long term effects of steroid use are muscle atrophy and osteoporosis. Also hyperglycemia and fluid retention. Must be monitored for edema

The nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnoses will most likely apply to this patient's care? Select all that apply a Alteration in self-concept b Fatigue c Pain d Fluid imbalances e Electrolyte imbalances

a Alteration in self-concept b Fatigue c Pain Patients with rheumatic diseases, which typically involve joints and muscles, cause problems with mobility, fatigue, and pain. Due to limitations of the disease, the patients often have an altered self-image and self-concept. Fluid and electrolyte imbalances are not typically associated with these types of diseases. (ch 39, p. 1054)

A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 1. No increase in TSH level after 30 minutes during the TSH stimulation test. 2. A decreased TSH level. 3. An increase in the TSH level after 30 minutes during the TSH stimulation test. 4. Below-normal levels of T3 and T4 as detected by radioimmunoassay.

1. No increase in TSH level after 30 minutes during the TSH stimulation test. Rationale: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4 as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.

The nurse is reviewing the laboratory values of a patient with bone pain for the last 4 days. Which abnormal finding would support osteomyelitis? Select all that apply. 1 Elevated calcium 2 Elevated white blood cell count (WBC) 3 Elevated phosphorous 4 Elevated erythrocyte sedimentation rate (ESR) 5 Elevated C-reactive protein (CRP)

2 Elevated white blood cell count (WBC) 4 Elevated erythrocyte sedimentation rate (ESR) 5 Elevated C-reactive protein (CRP) Rationale: White blood cells are elevated in infection and will be elevated. Rationale: The ESR is an indicator of inflammation. The WBC count and ESR are commonly elevated in osteomyelitis. Rationale: The CRP level is an indicator of inflammation. The CRP level is normally elevated in the first 7 days of infection as a direct response to the inflammatory response.

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. A Muscle weakness B Shortened QT interval C Lack of muscle coordination D Anorexia and constipation

A Muscle weakness B Shortened QT interval C Lack of muscle coordination D Anorexia and constipation Hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, incoordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes (eg, shortened QT interval and ST segment, bradycardia, heart blocks), and altered mental states (eg, confusion, lethargy, psychotic behavior). (ch 42, p. 1153)

When caring for a patient diagnosed with rheumatoid arthritis, the patient tells the nurse that he or she has had insufficient response to nonsteroidal anti-inflammatory drugs (NSAIDs) and his or her condition continues to worsen. What drug does the nurse anticipate will be ordered next for this patient? A) Auranofin (Ridaura) B) Ibuprofen (Motrin) C) Acetaminophen (Tylenol) D) Ketorolac (Toradol)

A) Auranofin (Ridaura) Gold compounds such as auranofin are prescribed when more usual anti-inflammatory therapies are ineffective and the patient's condition worsens despite weeks or months of standard pharmacological treatment. Ibuprofen and ketorolac are NSAIDs, which have been tried without good results. Acetaminophen is not an anti-inflammatory and would not be appropriate to control this patient's condition.

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for? A) Diabetes insipidus (DI) B)Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C)Pituitary tumor D)Hypothyroidism

A) Diabetes insipidus (DI) Rationale: Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL

A) Fasting plasma glucose greater than or equal to 126 mg/dL Feedback: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. A) Hormone replacement therapy B) Chemical agents C) Dietary substances D) Defective genes E) Environmental factors F) Viruses

A) Hormone replacement therapy B) Chemical agents C) Dietary substances D) Defective genes E) Environmental factors F) Viruses Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.

A client diagnosed with cancer has his tumor staged and graded based on what factors? A) How they tend to grow and the cell type B) How they spread and tend to grow C) How they differentiate the cell type D) How they spread and differentiate

A) How they tend to grow and the cell type Rationale: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer. Chapter 15: Management of Patients with Oncologic Disorders - Page 333

Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply. A) Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. B). Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. C) The pituitary gland is called the master gland because it regulates the function of the hypothalamus and other endocrine glands. D) The hypothalamus is called the master gland because it regulates the function of the pituitary gland.

A) Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. B). Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.

Health teaching for a patient with diabetes who is prescribed Humulin N, an intermediate NPH insulin, would include which of the following advice? A. "You should take your insulin after you eat breakfast and dinner." B. "Your insulin will begin to act in 15 minutes." C. "You should expect your insulin to reach its peak effectiveness by 12 noon if you take it at 8:00 AM." D. "Your insulin will last 8 hours, and you will need to take it three times a day."

A. "You should take your insulin after you eat breakfast and dinner." R:NPH (Humulin N) insulin is an intermediate-acting insulin that has an onset of 2 to 4 hours, a peak effectiveness of 6 to 8 hours, and a duration of 12 to 16 hours. See Table 30-3 in the text.

To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor? A. Bone scan B. Computed tomography C. Magnetic resonance imaging D. Electromyogram

A. Bone scan A bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain. A computerized tomography will identify soft tissue lesions and vertebral disc problems. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology. An electromyogram is used to evaluate nerve root disorders.

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

A. Epistaxis Rationale: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. A priority goal for this patient is to prevent trauma related to decreased platelet count. A soft toothbrush or an electric razor can be used. No invasive procedures should be performed. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

Which of the following would the nurse expect to find in a client with severe hyperthyroidism? A. Exophthalmos B. Striae C. Tetany D. Buffalo hump

A. Exophthalmos Explanation: Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.

Which of the following is the progressive increase in blood glucose from bedtime to morning? A. Insulin waning B. Somogyi effect C. Dawn phenomenon D. DKA

A. Insulin waning Rationale: Insulin waning is a progressive rise in blood glucose form bedtime to morning. The dawn phenomenon occurs when there is a relatively normal blood glucose until about 3 AM, when the level begins to rise. The Somogyi effect occurs when there is a normal or elevated blood glucose at bedtime, a decrease at 2 to 3 AM to hypoglycemia levels, and a subsequent increase caused by the production of counter-regulatory hormones. DKA is caused by an absence or markedly inadequate amount of insulin. This deficit of insulin results in disorders in the metabolism of carbohydrates, proteins, and fats. The primary clinical features of DKA are hyperglycemia, ketosis, dehydration, electrolyte loss, and acidosis

A nurse is providing care to a client with primary hyperparathyroidism. Which interventions would be included in the client's care plan? Select all that apply. A. Monitor gait, balance, and fatigue level with ambulation. B. Encourage intake of dairy products, seafood, nuts, broccoli, and spinach. C. Monitor for fluid overload. D. Monitor for signs and symptoms of diarrhea.

A. Monitor gait, balance, and fatigue level with ambulation. C. Monitor for fluid overload. Excessive calcium in the blood depresses the responsiveness of the peripheral nerves, accounting for fatigue and muscle weakness. A large volume of fluid is encouraged to keep the urine dilute. Possible effects include nausea, vomiting, and constipation. Client would be on a calcium-restricted diet.

Which statement best describes the relationship between the hypothalamus and the posterior pituitary in the normal functioning of the endocrine system? A. Posterior pituitary hormones are produced in the cell bodies of neurons in the hypothalamus but released from the pituitary gland. B. Posterior pituitary hormones are constituted from components of both the hypothalamus and the pituitary gland itself. C. The hypothalamus regulates the production and release of posterior pituitary hormones by the pituitary gland. D. The posterior pituitary gland regulates the release of hypothalamic hormones.

A. Posterior pituitary hormones are produced in the cell bodies of neurons in the hypothalamus but released from the pituitary gland. Explanation: The posterior pituitary hormones, ADH and oxytocin, are synthesized in the cell bodies of neurons in the hypothalamus that have axons that travel to the posterior pituitary, where they are released when needed. The two glands do not contribute components that are subsequently combined.

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur? A. Thin extremities and muscle weakness B. Muscle wasting and thickened extremities C. Muscle weakness and thickened extremities D. Thin extremities and increased strength

A. Thin extremities and muscle weakness Explanation: The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol (see Table 32-2). Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen, subclavicular fat pads or "buffalo hump" on the back, and a round, plethoric "moon face." There is muscle weakness, and the extremities are thin because of protein breakdown and muscle wasting. The other answers are incorrect.

A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with rheumatoid arthritis. Which medication does the nurse anticipate being ordered for the patient? A. methotrexate B. adalimumab C. infliximab D. etanercept

A. methotrexate (For the treatment of rheumatoid arthritis, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for those patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab)

A hospitalized, insulin-dependent patient with diabetes has been experiencing morning hyperglycemia. The patient will be awakened once or twice during the night to test blood glucose levels. The health care provider suspects that the cause is related to the Somogyi effect. Which of the following indicators support this diagnosis? Select all that apply. A. normal bedtime glucose B. rise in glucose about 3:00 AM C. increase in glucose from 3:00 AM until breakfast D. decrease in blood sugar to hypoglycemic level between 2:00-3:00 AM E. elevated glucose at bedtime

A. normal bedtime glucose C. increase in glucose from 3:00 AM until breakfast D. decrease in blood sugar to hypoglycemic level between 2:00-3:00 AM Explanation: The Somogyi effect is nocturnal hypoglycemia followed by rebound hyperglycemia in the morning.

The nurse is caring for a client diagnosed with rheumatoid arthritis who has not experienced symptom relief with nonsteroidal anti-inflammatory drugs (NSAIDs). What drug should the nurse anticipate may be ordered next for this client?

Auranofin Gold compounds such as auranofin are prescribed when more usual anti-inflammatory therapies are ineffective and the client's condition worsens despite weeks or months of standard pharmacological treatment. Ibuprofen, fenoprofen, and ketorolac are NSAIDs, which have been tried without good results.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas. Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed

A patient is admitted with an acute attack of gout. What interventions are essential for this patient? Select all that apply A Dietary consult B Probenecid C Corticosteroid therapy D Pain medication E Serum uric acid concentration

B Probenecid C Corticosteroid therapy D Pain medication E Serum uric acid concentration Steroids may be used in patients who have not had a response to other therapy. They have been shown to decrease inflammation and pain in attacks of gout. Probenecid will assist in the excretion of uric acid, the causative agent. Serum uric acid levels will guide therapy and treatment. A dietary consult can wait until the patient is over the acute, painful period. (ch 39, p. 1079)

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patient's immediate care? Select all that apply. A) Administering diuretics to prevent fluid overload B) Administering beta blockers to reduce heart rate C) Administering insulin to reduce blood glucose levels D) Applying interventions to reduce the patient's temperature E) Administering corticosteroids

B) Administering beta blockers to reduce heart rate D) Applying interventions to reduce the patient's temperature Explanation: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

A client with nonspecific signs/symptoms has gone to the primary health care provider. The client's chief complaints revolve around extreme fatigue, unplanned weight loss, and being so weak in the muscles. The diagnostic workup included a carcinoembryonic antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate the physician will order which of the following diagnostic tests related to the elevated CEA? Select all that apply. A) Testicular ultrasound B) Colonoscopy C) Mammogram D) Thyroid scan E) Brain CT

B) Colonoscopy C) Mammogram Feedback: CEA normally is produced by embryonic tissue in the gut, pancreas, and liver and is elaborated by a number of different cancers, including colorectal carcinomas, pancreatic cancers, and gastric and breast tumors.

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position to patient in what position? A) In the high Fowler's position B) In a flat side-lying position C) In the Trendelenberg position D) In the reverse Trendelenberg position

B) In a flat side-lying position Feedback: After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The Fowler's position, Trendelenberg position, and reverse Trendelenberg position are inappropriate for this patient because they would result in increased pain and complications.

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply. A) Epistaxis B) Pallor C) Rapid respiratory rate D) Bounding pulse E) Hypotension

B) Pallor C) Rapid respiratory rate E) Hypotension Feedback: The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find? A. Elevated serum sodium levels B. Decreased serum osmolarity C. Decreased urine sodium levels D. Elevated urine calcium levels

B. Decreased serum osmolarity With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.

A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? A. A serum glucose level B. Glucose tolerance test in combination with a GH measurement C. Growth hormone levels D. Bone radiographs

B. Glucose tolerance test in combination with a GH measurement

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? A. DM B. Goiter C. Dehydration D. Cushings Syndrome

B. Goiter A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line A. With a butterfly needle B. With a soft, plastic catheter C. In the client's right forearm D. In the client's left hand

B. With a soft, plastic catheter Explanation: Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle. Chapter 15: Management of Patients with Oncologic Disorders - Page 342

A patient taking vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the patient needs to be informed that he should report symptoms that would be an expected side-effect of motor neuropathy? SATA A. alopecia B. muscle weakness C. cramps and spasms in the legs D. loss of balance and coordination E. burning and tingling sensation

B. muscle weakness C cramps and spasms in the legs D. loss of balance and coordination Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? A Excess caffeine intake B Prolonged corticosteroid use C Hypothyroidism D Prolonged immobility

C Hypothyroidism Factors associated with an increased risk for osteoporosis include: family history of osteoporosis, chronic low calcium intake, excessive intake of caffeine, tobacco use, Cushing's syndrome, prolonged use of high doses of corticosteroids, prolonged periods of immobility, hyperthyroidism, hyperparathyroidism, eating disorders, malabsorption syndromes, breast cancer (especially if treated with chemotherapy that suppresses estrogen, excluding Tamoxifen, which may reduce the risk of fractures), renal or liver failure, alcoholism, lactose intolerance, and dietary deficiency of vitamin D and calcium.

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery

C) Prophylactic surgery Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome? A. Administer IV fluid slowly to prevent circulatory overload and collapse. B. Administer 10 L of IV fluid over the first 24 hours. C. Administer 2 to 3 L of IV fluid rapidly. D. Administer a dextrose solution containing normal saline solution.

C. Administer 2 to 3 L of IV fluid rapidly. Rationale: Regardless of the client's medical history, rapid fluid resuscitation is critical for maintaining cardiovascular integrity. Profound intravascular depletion requires aggressive fluid replacement. A typical fluid resuscitation protocol is 6 L of fluid over the first 12 hours, with more fluid to follow over the next 24 hours. Various fluids can be used, depending on the degree of hypovolemia. Commonly ordered fluids include dextran (in cases of hypovolemic shock), isotonic normal saline solution and, when the client is stabilized, hypotonic half-normal saline solution

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA?* A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C. Oral corticosteroids Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: A. Hypotension B. Thick, coarse skin C. deposits of adipose tissue in the trunk and dorsocervical area D. weight gain in arms and legs

C. deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? A Increased total serum complement levels B Negative antinuclear antibody test C Negative lupus erythematosus cell test D An above-normal anti-deoxyribonucleic acid (DNA) test

D An above-normal anti-deoxyribonucleic acid (DNA) test An above-normal anti-deoxyribonucleic acid (DNA) test Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive

A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers? A) "Tumor markers are a very useful screening tool, but they only exist for a very few types of cancer." B) "Tests for the presence of tumor markers are limited by the fact that they are only accurate in the very early stages of cancer." C) "Tumor markers are an excellent screening tool, but it's only practical to test for those cancers that you're at risk of." D) "Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool."

D) "Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool." Feedback: As diagnostic tools, tumor markers have limitations. Nearly all markers can be elevated in benign conditions, and most are not elevated in the early stages of malignancy. Hence, tumor markers have limited value as screening tests. Furthermore, they are not in themselves specific enough to permit a diagnosis of a malignancy.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese.

D) Lose weight, if obese. Feedback: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

A patient, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in health status would the nurse attribute to the patient's metastatic brain disease? A) Chronic pain B) Respiratory distress C) Fixed pupils D) Personality changes

D) Personality changes (Feedback: Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. Pain, respiratory distress, and fixed pupils are not among the more common neurologic signs and symptoms of metastatic brain disease.)

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? A) Suppression of the bone marrow B) Enhance action of the chemotherapy C) Decrease the need for additional adjuvant therapies D) Shorten the period of neutropenia

D) Shorten the period of neutropenia Feedback: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

A nurse is preparing to administer leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate (Trexall). Which of the following responses is appropriate when the client asks why leucovorin is being given?

D. "Leucovorin protects healthy cells from methotrexate's toxic effects." Explanation:Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity.

A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control through the regular use of celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain? A. Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord B. Blocking modulation by limiting the reuptake of serotonin and norepinephrine C. Distorting the action potential that is transmitted along the A-delta (δ) and C fibers D. Inhibiting transduction by blocking the formation of prostaglandins in the periphery

D. Inhibiting transduction by blocking the formation of prostaglandins in the periphery Feedback: NSAIDs produce pain relief primarily by blocking the formation of prostaglandins in the periphery; this is a central component of the pathophysiology of transduction. NSAIDs do not act directly on the aspects of transmission, perception, or modulation of pain that are listed.

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects? A. It inhibits ribonucleic acid (RNA) synthesis. B. It's cell cycle-phase specific. C. It inhibits protein synthesis. D. It inhibits deoxyribonucleic acid (DNA) synthesis.

D. It inhibits deoxyribonucleic acid (DNA) synthesis. Rationale: Mitomycin (Mutamycin) exerts its cytotoxic effects by inhibiting DNA synthesis rather than RNA synthesis. It's cell cycle-phase nonspecific and doesn't inhibit protein synthesis.

A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? A. Extreme anorexia B. Severe asthenia C. Starvation D. Profound protein loss

D. Profound protein loss Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).

The nurse is assessing the lab reports of a patient suspected of having osteomalacia. Which abnormal levels indicate the presence of osteomalacia? Select all that apply.

Decreased serum calcium Decreased serum phosphorous Elevated alkaline phosphatase Decreased serum calcium, decreased serum phosphorous, or elevated levels of alkaline phosphatase may indicate the presence of osteomalacia. Elevated levels of aldolase may indicate polymyositis and dermatomyositis or muscular dystrophy. Elevated levels of aspartate aminotransferase may indicate skeletal muscle trauma or progressive muscular dystrophy.

The nurse is caring for a client whose rheumatoid arthritis has not responding well to conventional therapies. The client's provider has prescribed auranofin. What health education should the nurse provide?

There is a possibility of significant and varied adverse effects. Various adverse effects are common with the use of gold salts and are probably related to their deposition in the tissues and effects at that local level: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation; gold-related bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus, and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock. The use of other NSAIDs at the same time is not necessarily contraindicated, and there is no reason why the client cannot receive vaccinations. Weekly blood work is not required.

Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?

Viscosupplementation Viscosupplementation, the intra-articular injection of hyaluronates, is thought to prevent the loss of cartilage and repair chondral defects. It may also have some anti-inflammatory effects. Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage. Capsaicin is a topical analgesic.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? a Bisphosphonates b Calcitonin c Selective estrogen receptor modulators d Anabolic agents

a Bisphosphonates Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

A client is brought to the emergency department by the paramedics. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. a Glycosuria b Dehydration c Leukocytosis d Hypernatremia e Hyperglycemia

a Glycosuria b Dehydration d Hypernatremia e Hyperglycemia :In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply. a Hydrocortisone b Acetaminophen c Methimazole d Iodine e aspirin

a Hydrocortisone b Acetaminophen c Methimazole d Iodine Salicylates (ie, aspirin) are contraindicated because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? SATA a Hyperkalemia b Hyperuricemia c Hypercalcemia d Hyperphosphatemia

a Hyperkalemia b Hyperuricemia d Hyperphosphatemia When intracellular contents are released into the bloodstream, phosphorus is elevated. This results in an inverse decline in the level of calcium, so hypercalcemia will not occur.

*A client who has a pituitary adenoma would report which symptoms related to the presence of this type of tumor? Select all that apply. a Morning headaches b Chiasmal syndrome c Polydipsia d Anorexia e fever

a Morning headaches b Chiasmal syndrome c Polydipsia d Anorexia Common symptoms reported in association with the diagnosis of a pituitary adenoma include headaches in the morning, and changes in the visual field resulting from pressure on the optic nerves, optic chiasm and optic tracts. It is the pressure on the optic chiasm that can lead to a condition called chiasmal syndrome, which is correlated with pituitary adenomas. Polydipsia is just one of the symptoms of diabetes insipidus that accompanies the presence of this type of tumor. Low appetite resulting from the pressure of the tumor can lead to anorexia. Fever is not associated with the presence of a pituitary adenoma. This finding may be associated with other serious neurological conditions if accompanied by the same symptoms (i.e., headaches, visual impairments). These conditions include meningitis or encephalitis.

The nurse is preparing a client for a thyroid test. Which medications that the client is taking should be documented on the laboratory slip as possibly affecting the thyroid test? SATA a Phenytoin b Metoclopramide c Lisinopril d Furosemide e Amphetamine

a Phenytoin b Metoclopramide d Furosemide e Amphetamine If a client has recently taken a drug that contains iodine or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate. Other drugs also affect the results of thyroid tests. Phenytoin can lower T4 values. Metoclopramide can raise TSH levels. Amphetamine can lower TSH levels. Furosemide can increase T4 level. Be sure to enter on the laboratory request slip all drugs the client is taking or has taken within the past 3 months. The other drugs do not have relevance to the thyroid test.

Which statement best describes the relationship between the hypothalamus and the posterior pituitary in the normal functioning of the endocrine system? a Posterior pituitary hormones are produced in the cell bodies of neurons in the hypothalamus but released from the pituitary gland. b Posterior pituitary hormones are constituted from components of both the hypothalamus and the pituitary gland itself. c The hypothalamus regulates the production and release of posterior pituitary hormones by the pituitary gland. d The posterior pituitary gland regulates the release of hypothalamic hormones.

a Posterior pituitary hormones are produced in the cell bodies of neurons in the hypothalamus but released from the pituitary gland. Explanation: The posterior pituitary hormones, ADH and oxytocin, are synthesized in the cell bodies of neurons in the hypothalamus that have axons that travel to the posterior pituitary, where they are released when needed. The two glands do not contribute components that are subsequently combined.

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. a Support joints with splints and pillows. b Provide assistive devices for self-feeding c Provide diversional activities. d Assist client to develop a sleep routine e Provide opportunities for the client to verbalize feelings.

a Support joints with splints and pillows. c Provide diversional activities. e Provide opportunities for the client to verbalize feelings. To manage pain, the nurse maintains normal alignment of extremities as much as possible by supporting the joints with splints and pillows. Diversional activities distract the client's focus from the pain. Providing opportunities for the client to verbalize feelings facilitates coping with pain. Assistive devices for self-feeding help the client meet nutritional needs independently. Assisting the client to develop a sleep routine promotes rest and minimizes fatigue.

The immune abnormalities that characterize SLE include which of the following? SATA a Susceptibility b abnormal innate and adaptive immune responses c autoantibodies immune complexes d inflammation e Damage

a Susceptibility b abnormal innate and adaptive immune responses c autoantibodies immune complexes d inflammation e Damage The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

After administering desmopressin to a client with diabetes insipidus, which would the nurse identify as indicating drug effectiveness? a. Decreased reports of thirst b. Elevated blood glucose levels c. Increased urination d. Decreased skin turgor

a. Decreased reports of thirst Rationale: Thirst is associated with diabetes insipidus. A decrease in the symptom would indicate that the drug is working. Diabetes insipidus causes elevated blood glucose levels. Diabetes insipidus causes polyuria. Decreased skin turgor would suggest dehydration, which is a sign of diabetes insipidus.

A patient is to receive Bacille Calmette- Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? a. For cancer of the bladder b. For cancer of the breast c. For cancer of the lungs d. For skin cancer

a. For cancer of the bladder Explanation: Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).

Which is a complication of hyperthyroidism? a. Hypothyroidism b. Acromegaly c. Myxedema coma d. Addisonian crisis

a. Hypothyroidism A potential complication of hyperthyroidism is hypothyroidism. Myxedema coma is a complication of hypothyroidism. Addisonian crisis is a complication of Addison disease. Acromegaly occurs with excess growth hormone.

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (select all that apply) a. acetaminophen b. iodine c. propylthiouracil d. synthetic levothyroxine e. dexamethasone (Decadron)

a. acetaminophen b. iodine c. propylthiouracil Rationale: Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?

adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.

Doxorubicin (Adriamycin) is a?

antitumor antibiotic o It is also a cell cycle-nonspecific agent, inhibiting protein and RNA synthesis and binding DNA, causing fragmentation. o Interfere with DNA synthesis by binding DNA; prevent RNA synthesis

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy? a. hair regrowth b fever c increased WBC count d constipation

b Fever The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

Which of the following agents suppress release of thyroid hormones? Select all that apply. a) Methimazole b) Dexamethasone c) Potassium iodide d) Sodium iodide e) Saturated solution of potassium iodide (SSKI)

b) Dexamethasone c) Potassium iodide d) Sodium iodide e) Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.

Anorexia and cachexia are common problems at the end of life. The nurse plays an important role in managing symptoms and preventing complications. Which of the following are appropriate nursing interventions for these problems? Select all that apply a) Advise the patient and family about the importance of a balanced diet. b) Encourage the patient to eat in an upright position. c) Suggest a daily weighing time to monitor treatment plan. d) Recommend that the patient eat when hungry, regardless of usual meal times. e) Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk).

b) Encourage the patient to eat in an upright position. d) Recommend that the patient eat when hungry, regardless of usual meal times. e) Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk).

Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply. a) Encouraging fluids b) Maintaining client comfort c) Arranging plans for after death d) Completing a head-to-toe assessment e) Supporting family members f) Providing personal care

b) Maintaining client comfort e) Supporting family members f) Providing personal care Nursing care of dying clients focuses on providing palliative care to the client and supporting family members. Arranging the plans after death is not a priority at this time. Completing a head-to-toe assessment may be completed for information but is not a priority at the end of life. There is no need to encourage fluids.

During an annual examination, an older patient tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on the knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the patient's plan of care? Select all that apply. a) The immune system is integrated with other psychophysiologic processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development. b) Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early. c) Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function. d) Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. e) The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early.

b) Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early. d) Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. e) The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early.

A 35 year old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with: a. cell division or mitosis during the M phase of the cell cycle. b. normal cellular processes during the S phase of the cell cycle. c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific). d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific).

b. normal cellular processes during the S phase of the cell cycle. Explanation: Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction. Chapter 15: Management of Patients with Oncologic Disorders - Page 343

The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs? a) "I will make sure I eat breakfast within two hours of taking my insulin." b) "I will need to carry candy or some form of sugar with me all the time." c) "I will eat a snack around three o'clock each afternoon." d) "I can save my dessert from supper for a bedtime snack."

c) "I will eat a snack around three o'clock each afternoon." NPH insulin peaks in 8-12 hours, so a snack should be offered at that time. NPH insulin onsets in 90-120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect, but the client should eat a bedtime snack.

A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of a) Decreased cardiac output related to hypotension secondary to Cushing's syndrome. b) Risk for imbalanced fluid volume related to excessive sodium loss. c) Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome d) Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion

c) Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome Rationale: (Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension.) Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

Metastatic calcification takes place in normal tissues as the result of increased serum calcium levels (hypercalcemia). Anything that increases the serum calcium level can lead to calcification in inappropriate places such as the lung, renal tubules, and blood vessels. What are the major causes of hypercalcemia? a. diabetes mellitus and Paget disease b. hypoparathyroidism and vitamin D intoxication c. hyperparathyroidism and immobilization d. immobilization and hypoparathyroidism

c. hyperparathyroidism and immobilization Metastatic calcification occurs in normal tissues as the result of increased serum calcium levels (hypercalcemia). Almost any condition that increases the serum calcium level can lead to calcification in inappropriate sites such as the lung, renal tubules, and blood vessels. The major causes of hypercalcemia are hyperparathyroidism, either primary or secondary to phosphate retention in renal failure; increased mobilization of calcium from a bone as in Paget disease, cancer with metastatic bone lesions, or immobilization; and vitamin D intoxication. Diabetes mellitus and hypoparathyroidism do not cause hypercalcemia; therefore, they cannot be a cause of metastatic calcification.

Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis? a.Protein b.Vitamin c.Vitamin d.Calcium

d.Calcium Explanation:A calcium deficiency increases the risk osteoporosis. This causes the bones to become softer in nature because the rate at which bone is destroyed is occurring at a faster rate than new bone is made. Protein functions in muscle tone and growth. Vitamin C promotes healing of tissues and bones. Vitamin D deficiency causes osteomalacia, softening of the bones due to defective bone mineralization. Osteomalacia in children is known as rickets.

A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:

normal cellular processes during the S phase of the cell cycle. R:Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:

rapid-acting insulin only. A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.