Adult Health PrepU Exam 1 chapters 17 and 18

An oncology nurse is contributing to the care of a client who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). The nurse should know that these achieve a therapeutic effect by what means?

Altering the immunologic relationship between the tumor and the client

Which type of shock occurs from an antigen-antibody response?

Anaphylactic

Shock occurs when tissue perfusion is inadequate to deliver oxygen and nutrients to support cellular function. When caring for patients who may develop indicators of shock, the nurse is aware that the most important measurement of shock is:

Blood Pressure

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean?

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis

Which intervention should the nurse teach a client who is at risk for hypercalcemia?

Consume 2 to 4 L of fluid daily.

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?

Excisional biopsy

Which nursing interventions would be appropriate for a client in impending shock with decreased cardiac output? Select all that apply. Restrict activity to total rest. Establish at least one IV site with a large-gauge catheter. Administer IV fluids or blood products at the prescribed rate. Control frank bleeding by applying direct pressure to the site. Suction the airway when secretions compromise gas exchange.

Restrict activity to total rest. Establish at least one IV site with a large-gauge catheter. Administer IV fluids or blood products at the prescribed rate.

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

Inspect the skin frequently.

A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with?

Intubation and mechanical ventilation

An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?

Invading healthy host tissues

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?

It lowers serum and uric acid levels.

The nurse is caring for a client in shock who is receiving enteral nutrition. What is the basis for enteral nutrition being the preferred method of meeting the body's needs?

It promotes GI function through direct exposure to nutrients.

The nurse is caring for a client who is exhibiting signs and symptoms of hypovolemic shock following injuries suffered in a motor vehicle accident. The nurse anticipates that the client will be promptly ordered the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal saline, which crystalloid fluid is commonly used to treat hypovolemic shock?

Lactated Ringers

A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread?

Lymphatic Circulation

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. When asked about the differences between normal cells and cancer cells what fact should be the basis of the nurse's response?

Malignant cells contain proteins called tumor-associated antigens.

The nurse determines that a patient in shock is experiencing a decrease in stroke volume when what clinical manifestation is observed?

Narrowed pulse pressure

Following a motor vehicle collision, a client is admitted to the emergency department with a blood pressure of 88/46, pulse of 54 beats/min with a regular rhythm, and respirations of 20 breaths/min with clear lung sounds. The client's skin is dry and warm. The nurse assesses the client to be in which type of shock?

Neurogenic

According to the tumor-node-metastasis (TNM) classification system, T0 means there is

No evidence of primary tumor

Which type of surgery is used in an attempt to relieve complications of cancer?

Palliative

When the nurse observes that the client's systolic blood pressure is less than 80 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc/hour, the nurse recognizes that the client is demonstrating which stage of shock?

Progressive

Which nursing action best demonstrates primary cancer prevention?

Promoting and providing vaccines

The nurse provides care for a client who is critically ill due to a diagnosis of pneumonia and is at risk for developing shock. Assessment data reveals a white blood cell (WBC) count of 15 × 103 cells/mm3 (15 × 109/l) (normal: 4.5 to 10.5 × 103 cells/mm3 (4.5 to 10.5 × 109/l), a temperature of 102.2°F (39°C), and warm, flushed skin. The client is at the highest risk for developing ___________ as evidenced by___________

Septic Shock Altered Mentation

The nursing instructor is talking with a group of senior nursing students about shock. When caring for a patient at risk for shock what assessment finding would the nurse consider a potential sign of shock?

Shallow, rapid respirations

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

Stage 3 pressure ulcer on the left heel

A young client has been diagnosed with cancer that has metastasized to the lungs. During client education, the client's mother asks about tumor staging and its relation to her child's condition. What stage would the nurse expect this client's tumor to be assigned?

Stage IV

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

Tumor pressure against normal tissues

What priority intervention can the nurse provide to decrease the incidence of septic shock for patients who are at risk?

Use strict hand hygiene techniques

Which of the following would be consistent with a benign neoplasm?

Usually progressive and slow

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?

blood studies

Which of the following nursing interventions helps minimize the risk for hypothermia in a patient in shock?

direct warming lights to the patients body

Which of the following is NOT a category of shock?

hepatic

The test results for a client in the early stages of shock indicate low RBCs and hemoglobin. These findings correlate with:

hypovolemic shock

What is the major clinical use of dobutamine?

increase cardiac output.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

Encourage fluid intake to dilute the urine.

Which statement is true about malignant tumors?

They gain access to the blood and lymphatic channels.

The critical care nurse is preparing to initiate an infusion of a vasoactive medication to a client in shock. The nurse knows that vasoactive medications are given in all forms of shock. What is the primary goal of this aspect of treatment?

To maintain adequate mean arterial pressure (MAP)

The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation?

To prevent the formation of new cancer cells

Which instructions are necessary for a client receiving systemic internal radiation therapy who is being discharged? Select all that apply. Wash hands carefully following toileting. Avoid all physical contact with family members. Use separate towels. Drink only clear fluids and water. Wash laundry separately.

Wash hands carefully following toileting. Use separate towels. Wash laundry separately.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:

chemotherapy exposure and risk factors

A client who is receiving chemotherapy for esophageal cancer complains of "feeling sick to my stomach all the time." What is the best suggestion the nurse can make to help alleviate this client's nausea?

eat low-fat foods

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?

eats red meat such as steaks or hamburgers every day

Which type of shock is caused by an infection?

Septic

When caring for a client in shock, one of the major nursing goals is to reduce the risk that the client will develop complications of shock. How can the nurse best achieve this goal?

Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.

The nurse is monitoring the patient in shock. The patient begins bleeding from previous venipuncture sites, in the indwelling catheter, and rectum, and the nurse observes multiple areas of ecchymosis. What does the nurse suspect has developed in this patient?

Disseminated intravascular coagulation (DIC)

A 16-year-old client experiences alopecia resulting from chemotherapy, prompting disturbed body image and situational low self-esteem. What action by the client would best indicate that the goal of improved body image and self-esteem is being met?

Requests that a favorite hat be brought to the hospital.

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

Breast cancer Esophageal cancer Liver cancer

A vasoactive medication is prescribed for a patient in shock to help maintain MAP and hemodynamic stability. A medication that acts on the alpha-adrenergic receptors of the SNS is ordered. Its purpose is to:

Constrict blood vessels in the cardiorespiratory system.

Which of the following laboratory findings, would be identified by the nurse as the greatest risk for a cancer client scheduled for implantable port? White blood cell count 10,800/mm3 Hemoglobin 10 g/dl Hematocrit 36.0% Platelet count 98,000/mm3

Platelet count 98,000/mm3 Although the WBC, HGB, and HCT are all slightly outside the normal range, the platelet count is very low and places the client at risk for bleeding. This is especially a concern with a surgical procedure.

The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock?

Septic

A client diagnosed with leukemia will begin chemotherapy. What classification of medication would the nurse plan to administer to manage the most common adverse effect of chemotherapy?

an antiemetic

A nurse is preparing a client for a hematopoietic stem cell transplantation (HSCT) scheduled for the next day. What information should the nurse emphasize as a priority to the client's family and friends to best ensure the client's safety?

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

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning."

A nurse is caring for a 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?

"I'll only need chemotherapy treatment before receiving my bone marrow transplant."

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

"I'm worried I'll expose my family members to radiation."

An elderly client has been diagnosed with metastatic cancer and has a poor prognosis of survival. The family asks the nurse for advice on whether to tell the client of the diagnosis or to keep it quiet. Which is the best response from the nurse?

"In my experience, clients who know are more likely to be involved with their plan of care."

The hospice nurse admitting a new client to the program demonstrates an understanding of the primary principle that guides hospice care when making what statement?

"The care we provide addresses your needs as well as those of your family."

The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client?

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

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic?

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

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is

"You will need to practice birth control measures."

The nurse receives an order to administer a colloidal solution for a patient experiencing hypovolemic shock. What common colloidal solution will the nurse most likely administer?

5% albumin

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 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

A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment?

Administer antiemetics in anticipation of the patient's nausea.

The nurse is caring for a client in the early stages of sepsis. The client is not responding well to fluid resuscitation measures and has a worsening hemodynamic status. Which nursing intervention is most appropriate for the nurse to implement?

Administer norepinephrine as prescribed.

The nurse is transferring a client who is in the progressive stage of shock into the intensive care unit from the medical unit. Nursing management of the client should focus on which intervention?

Assessing and understanding shock and the significant changes in assessment data to guide the plan of care

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas

The nurse observes a patient in the progressive stage of shock with blood in the nasogastric tube and when connected to suction. What does the nurse understand could be occurring with this patient?

The patient has developed a stress ulcer that is bleeding.

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?

Extravasation

The nurse is assessing an acutely ill patient. When prioritizing the patient's care, the nurse should recognize that the patient is at risk for hypovolemic shock when:

Fluid circulating in the blood vessels decreases.

A client is being cared for in the Neurological Intensive Care Unit following a spinal cord injury. Which assessment finding indicates that the client may be experiencing neurogenic shock?

HR, 48 bpm; BP, 90/60 mm Hg

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Ham and Bacon

Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes?

Head injury

The nurse is caring for a client who has progressed to the decompensation stage of shock. Which intravenous medication does the nurse anticipate as a prophylactic means to prevent complications?

Heparin

While admitting an oncology client to the unit prior to surgery, the nurse notes in the electronic health record that they have recently finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?

Impaired wound healing

A client who experienced shock remains unstable. Which medication classes would the nurse anticipate to be ordered to prevent or minimize stress ulcers? Select all that apply. antacids H2 blockers proteases proton pump inhibitors promotility agents

antacids H2 blockers Proton Pump Inhibitors

A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery?

Prophylactic surgery

The nurse, a member of the health care team in the ED, is caring for a client who is determined to be in the irreversible stage of shock. What would be the most appropriate nursing intervention?

Provide opportunities for the family to spend time with the client, and help them to understand the irreversible stage of shock.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Provide time for the patient to discuss her concerns.

The nurse in the ICU is admitting a 57-year-old with a diagnosis of possible septic shock. The nurse's assessment reveals that the client has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurse's analysis of these data should lead to what preliminary conclusion?

The client is in the compensatory stage of shock.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss?

The client should consider getting a wig or cap prior to beginning treatment

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. dietary substances environmental factors viruses gender age

dietary substances environmental factors viruses

A client receives a diagnosis of chondrosarcoma. This means that the client has a:

malignant tumor

A nurse caring for a client after epidural anesthesia observes that the client is beginning to present with dry skin and bradycardia with hypotension. What type of shock is the nurse assessing?

neurogenic

A nurse in the ICU receives report from the nurse in the ED about a new client being admitted who sustained a neck injury while diving into a lake. The ED nurse reports that blood pressure is 85/54, heart rate is 53 beats per minute, and skin is warm and dry. What does the ICU nurse recognize that that client is probably experiencing?

neurogenic shock

A nurse is assessing a client who is experiencing significant stress due to septicemia. The nurse should _________, __________, and _________.

obtain the lactate level administer oxygen therapy monitor temperatures

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?

prophylactic

A client has been diagnosed with a neoplasm and is seeking further information and possible treatment. The primary care physician described the neoplasm as "insidious." What does the word "insidious" mean?

slow-growing

When a client is in the compensatory stage of shock, which symptom occurs?

tachycardia

An immunocompromised older adult has developed a urinary tract infection and the care team recognizes the need to prevent an exacerbation of the client's infection that could result in urosepsis and septic shock. What action should the nurse perform to reduce the client's risk of septic shock?

Remove invasive devices as soon as they are no longer needed

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?

Risk for Infection

Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression?

Decreased platelets and red blood cells

An ICU nurse caring for a client experiencing distributive shock should know that the pooling of blood in the periphery leads to what pathophysiologic effect?

Decreased venous return

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?

Biopsy of the axillary lymph nodes

What is the consequence of the release of catecholamines in the skeletal muscles during the compensation stage of shock?

Blood supply to the skeletal muscles increases

A nurse is planning caring for a client who has developed erythema following radiation therapy for a lesion on the left lower leg. Which intervention would the nurse include in the client's plan of care to best support skin recovery at the affected site? Select all that apply. Periodically apply ice Keep the area cleanly shaven Wear clothing that fits snugly Cleanse with lukewarm water and pat dry Apply an emollient immediately before treatment

Cleanse with lukewarm water and pat dry

The nurse assesses a patient who experienced a reaction to a bee sting. The patient's clinical findings indicate a pre-shock condition, which is evidenced by:

Cold, clammy skin and tachycardia.

A client is responding poorly to interventions aimed at treating shock and appears to be transitioning to the irreversible stage of shock. What action should the intensive care nurse include during this phase of the client's care?

Communicate clearly and frequently with the client's family.

The nurse obtains a blood pressure of 120/78 mm Hg from a patient in hypovolemic shock. Since the blood pressure is within normal range for this patient, what stage of shock does the nurse realize this patient is experiencing?

Compensatory stage

The health care provider prescribes a vasoactive agent for a patient in cardiogenic shock. The nurse knows that the drug is prescribed to increase blood pressure by vasoconstriction. Which of the following is most likely the drug that is ordered?

Levophed It is a vasopressor agent

A critical care nurse is aware of the high incidence of ventilator-associated pneumonia (VAP) in clients who are being treated for shock. What intervention should be specified in the client's plan of care while the client is ventilated?

Performing frequent oral care