cancer/immune medsurg questions

A nurse is caring for a client who had an anaphylactic reaction after a blood transfusion. The nurse reviews the literature to further understand antibody-mediated immunity (AMI). Which of the following information should the nurse confirm about AMI?

AMI is mediated by antibodies produced by B-lymphocytes. Answer Rationale: AMI is mediated by antibodies produced by B-lymphocytes in response to an invading allergen or antigen

A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching?

avoid crowds

A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function

serum creatinine

A nurse is creating home instructions for a client who has immunodeficiency. Which of the following statements by the client indicates an understanding of the teaching?

"I will avoid people who have just received an immunization." Answer Rationale: The client should avoid people who received a vaccination, especially a live vaccine, to prevent contracting the disease.

A nurse is providing discharge teaching to a client who will be receiving total parenteral nutrition (TPN) at home. Which of the following instructions should the nurse include? (Select all that apply.)

"Keep the TPN refrigerated when not in use. "Infuse 10 percent dextrose and water if the solution runs out." "Maintain TPN infusion rate when behind schedule."

A nurse is performing discharge teaching for a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse include?

"Wash your hair with a mild protein shampoo." Answer Rationale: Clients who have SLE are prone to hair loss and should use a mild protein shampoo and avoid treatments that can damage the hair and scalp, such as dyes and permanents

nurse is teaching a client who has a new diagnosis of urge incontinence. Which of the following information should the nurse include in the teaching? (Select all that apply.)

"Your provider might prescribe anticholinergic medications." "You should limit fluids in the evening." "You should restrict your intake of caffeine."

A nurse is planning nutritional teaching for a client who is experiencing fatigue due to iron deficiency anemia. Which of the following foods should the nurse recommend to the client?

1 cup canned black beans

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse notices that the solution bag is almost empty and there is not another bag of TPN to administer. Which of the following IV solutions should the nurse administer until the next bag of TPN solution is available?

10% dextrose in water (D10W) Answer Rationale: TPN solution has a high concentration of glucose and protein and is hyperosmotic; therefore, the nurse should administer D10W or 20% dextrose in water if there is not another bag of TPN solution available. This will ensure that the client receives the adequate amount of glucose and a solution with the appropriate osmolarity until another TPN solution is available

A nurse is assisting a group of clients in an outpatient clinic. For which of the following clients should the nurse anticipate scheduling a colonoscopy?

51-year-old who is being seen for an annual physical examination

A nurse is caring for a client who has lung cancer and is scheduled for a lobectomy. The nurse should prepare the client to expect which of the following after the procedure?

A chest tube Answer Rationale: A lobectomy is major surgery that involves a large posterolateral or anterolateral incision into bone, muscle, and cartilage. Chest tubes are placed to drain air and fluid and remain in place for several days postoperatively

A charge nurse is planning to admit several clients to the medical unit. Which of the following clients should the nurse assign to a private room?

A client who is neutropenic

A nurse is reviewing the laboratory results of an adolescent female client and notes a WBC count of 16,000/mm³ with increased immature neutrophils (bands) and normal monocytes. Which of the following is the appropriate analysis of the results?

An acute infectious process

A nurse is teaching a client who has a new diagnosis of aplastic anemia. Which of the following information should the nurse include in the teaching?

Aplastic anemia results from decreased bone marrow production of RBCs. Answer Rationale: Aplastic anemia is a hypoproliferative anemia resulting from decreased production of RBC within the bone marrow

A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?

CD4-T-cell count 180 cells/mm3

A nurse is reviewing a client's laboratory results and finds the hemoglobin is 10 g/dL and the hematocrit is 30%. The nurse recognizes that the client is at risk for which of the following?

Cellular hypoxia Answer Rationale: The client's laboratory results indicate anemia, which places the client at risk for cellular hypoxia.

A nurse is reviewing a client's laboratory results and finds the hemoglobin is 10 g/dL and the hematocrit is 30%. The nurse recognizes that the client is at risk for which of the following?

Cellular hypoxia Answer Rationale: The client's laboratory results indicate anemia, which places the client at risk for cellular hypoxia

A nurse is caring for a client who had an evacuation of a subdural hematoma. Which of the following actions should the nurse take first?

Check the oximeter.

A nurse is caring for a client who is receiving cisplatin to treat bladder cancer. After several treatments, the client reports fatigue. Which of the following actions should the nurse take?

Check the results of the client's most recent CBC

A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a contributing factor to the development of the anemia?

Chronic blood loss Answer Rationale: A client with long-standing ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occurs over time, although the colitis may result in erosion of the intestine and hemorrhage. These clients often report bloody stools and are therefore at increased risk for developing anemia

A nurse is teaching a class at a community center to a group of young adult, adult, and older adult clients regarding regular screening recommendations for cancer prevention. Which of the following information should the nurse include?

Clients should have a yearly test for fecal occult blood. Answer Rationale: According to the American Cancer Society, all clients should have a yearly test to check for fecal occult blood

9)A nurse is providing teaching to a client who has a new diagnosis of testicular cancer. Which of the following information should the nurse include in the teaching? (Select all that apply.)

Close male relatives are at an increased risk of developing testicular cancer. Testicular cancer typically occurs between ages 15 and 35.

A nurse is caring for a client who has a new diagnosis of systemic lupus erythematosus (SLE) and asks where this disease originates within the body. The nurse should tell the client that SLE originates in which of the following locations in the body?

Connective tissue Answer Rationale: SLE originates in the connective tissues of the body and affects all organ systems

A nurse is caring for a client who has myasthenia gravis. The nurse should recognize that this disease is caused by which of the following types of hypersensitivities?

Cytotoxic Answer Rationale: The nurse should recognize myasthenia gravis as a cytotoxic hypersensitivity. Other examples of this hypersensitivity include autoimmune hemolytic anemia and Goodpasture's syndrome.

A nurse is reviewing the laboratory results of a client who has acute leukemia and received an aggressive chemotherapy treatment 10 days ago. Which of the following hematologic laboratory values should the nurse expect? (Select all that apply.)

Decreased platelet count Decreased leukocyte count Decreased erythrocyte count

A nurse is creating the plan of care for a client who is immunosuppressed. Which of the following precautions should the nurse include in the plan? (Select all that apply.)

Don a mask, gloves, and gown. Restrict visitors who have active infections. Instruct the client to eat cooked foods only

)A nurse is caring for a client 8 hr postoperative following a total knee replacement. Which of the following actions should the nurse take?

Encourage increased fluid intake. Answer Rationale: Increased fluid intake will prevent dehydration, which can contribute to the development of deep vein thrombophlebitis

A nurse is caring for a client who has just been diagnosed with cancer of the colon. The client asks the nurse several questions about what the provider might be planning to do. Which of the following nursing responses should the nurse make?

Encourage the client to write down questions to ask the provider

A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

Facial rash Answer Rationale: SLE affects the skin. A facial "butterfly" rash that is dry, scaly, red, and raised is a manifestation of SLE

A nurse is providing discharge instructions to a client who developed deep-vein thrombosis (DVT) postoperatively and is prescribed anticoagulant therapy. Which of the following instructions should the nurse include?

Flexing her knees and feet frequently

A nurse on the day shift is preparing to change a client's total parenteral nutrition (TPN) solution, but the new TPN solution has not arrived from the pharmacy. The client receives additional IV fat emulsion during the night shift. Which of the following actions should the nurse take?

Hang dextrose 10% in water (D10W) until the TPN solution is delivered. Answer Rationale: The nurse should hang D10W if the TPN runs out or is not available to hang. D10W is a hypertonic solution that will maintain glucose level and prevent rebound hypoglycemi

A nurse is caring for a client who is receiving a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, the nurse notes that the client is febrile, with chills and red-tinged urine. Which of the following transfusion reactions should the nurse suspect?

Hemolytic Answer Rationale: A hemolytic transfusion reaction occurs when antibodies in the recipient's blood react to foreign blood cells introduced by the transfusion. The antibodies bind to the foreign cells and destroy them in a process known as hemolysis. The destroyed cells are excreted by the kidneys (hemoglobinuria), causing the red-tinged urine. Hemolytic transfusion reactions can result in acute renal injury, disseminated intravascular coagulation, and circulatory collapse

A nurse is caring for a client who is receiving total parenteral nutrition and develops refeeding syndrome. The nurse should expect which of the following laboratory findings?

Hypophosphatemia Answer Rationale: The nurse should expect a low phosphate level in a client who has refeeding syndrome. Hypophosphatemia can result in neurologic, cardiovascular, and respiratory problems.

)A nurse is reviewing the laboratory results of a client who is postoperative. Which of the following laboratory findings should the nurse identify as an indication of postoperative infection? (Select all that apply.)

Increased band neutrophils Elevated erythrocyte sedimentation rate

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.)

Increased heart rate Increased blood pressure Increased respiratory rate

A nurse is completing a physical examination of a client and notes that laboratory values indicate leukocytosis. The nurse should recognize that which of the following manifestations is associated with leukocytosis?

Inflammation

A nurse is caring for a young female adult client who reports weakness, fatigue, and heavy menstrual periods. The client has a hemoglobin level of 8 g/dL and a hematocrit level of 28 g/dL. The nurse suspect which of the following types of anemia?

Iron-deficiency anemia

A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care?

Limit IM injections. Answer Rationale: The nurse should plan to limit IM injections or venipunctures to prevent harm to the client. If venipuncture is necessary, the nurse should hold pressure to the site for 10 min afterward.

A nurse is planning care for a client who has an absolute neutrophil count (ANC) less than 1,000/mm3. Which of the following interventions should the nurse include in the plan?

Limit visitors to healthy adults. Answer Rationale: The expected reference range of absolute neutrophil count is 2500 to 8000/ mm3. This client has a reduced absolute neutrophil count (neutropenia) and is immunosuppressed. A client who has neutropenia is at an increased risk for infection. The nurse should restrict visitors for a client who has neutropenia to healthy adults to reduce the risk for infection

A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?

Measure the circumference of both upper arms. Answer Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should measure the arm and compare the result with the circumference of the other arm. If the arm is swollen, the nurse should notify the provider who inserted the PICC line. Swelling could indicate formation of a clot above the site or even catheter rupture

A nurse is teaching about adverse effects of anastrozole with a client who has advanced breast cancer and is postmenopausal. Which of the following adverse effects should the nurse recommend the client report to the provider?

Musculoskeletal pain

A nurse is caring for a client who is receiving radiation therapy to treat lung cancer. Which of the following actions should the nurse take?

Observe for signs of infection. Answer Rationale: Radiation therapy to sites containing bone marrow (such as the sternum) can lower the WBC count (leukopenia), thus increasing the client's risk for infection. Screening the client for signs of infection is essential at this time.

A nurse is selecting a qualified staff member to double check a blood label with a client ID bracelet prior to infusing a unit of blood. The nurse should identify that which of the following persons is qualified?

Oncology nurse Answer Rationale: The nurse should ask another nurse or a provider to double check the blood label and client ID prior to an infusion

A nurse is caring for a client who is experiencing hypovolemic shock. Which of the following blood products should the nurse anticipate administering to this client?

Packed RBCs Answer Rationale: Packed RBCs are given to restore blood volume and replace hematocrit and hemoglobin levels in clients who have hypovolemic shock.

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect?

Petechiae Answer Rationale: A manifestation of advanced cirrhosis is petechiae due to impaired coagulation from a dysfunctional liver

A nurse is evaluating a client's laboratory results. The nurse should recognize that an increase in the client's prostate specific antigen (PSA) laboratory value is indicative of which of the following diagnoses?

Prostatic cancer Answer Rationale: An increased PSA level is indicative of a prostate cancer diagnosis, as well as other prostate problems

A nurse is caring for a client who has HIV. Which of the following laboratory tests should the nurse monitor to assess the effectiveness of therapy?

Quantitative RNA assay Answer Rationale: A quantitative RNA assay measures the viral load and is useful in monitoring HIV disease progression and treatment effectiveness.

A nurse is caring for a client who the provider suspects might have pernicious anemia. The nurse should expect the provider to prescribe which of the following diagnostic tests?

Schilling test Answer Rationale: The Schilling test helps determine the cause of vitamin B12 deficiency, which leads to pernicious anemia

A nurse is caring for an older adult client who has a WBC count of 2,000/mm3 after three rounds of chemotherapy. Which of the following actions should the nurse take?

Serve cooked fruit with meals. Answer Rationale: The nurse should serve cooked fruits with meals to prevent possible bacterial contamination from raw fruit

A nurse is caring for a client who requires total parenteral nutrition (TPN). Which of the following actions should the nurse take when finding that the TPN solution is infusing too rapidly?

Sit the client upright. Answer Rationale: Fluid overload can cause dyspnea. The nurse should slow the infusion rate and sit the client upright to help prevent or treat dyspnea. The nurse should also administer oxygen if necessary

A nurse is caring for a client who is scheduled for a bone marrow aspiration. The client asks the nurse about the sites the provider might use for the procedure. Which of the following locations should the nurse identify as one of the sites used for this procedure?

Sternum Answer Rationale: Providers most often extract bone marrow from the iliac crest of adults, but they sometimes use the sternum

A nurse is teaching a group of middle adult clients about early detection of colorectal cancer. The nurse should include the American Cancer Society recommendation that men and women beginning at age 50 who are at average risk should have a fecal occult blood test (FOBT) and a colonoscopy at which of the following intervals?

Ten years Answer Rationale: Ten years is the recommended interval for colonoscopy screening for clients who have an average risk

A nurse is caring for a client who has a delayed hypersensitivity reaction. The nurse should expect which of the following manifestations?

Tissue damage at the site Answer Rationale: The nurse should expect the manifestations of edema, induration, ischemia, and tissue damage at the site occurring hours to days after exposure. A positive purified protein derivative test for tuberculosis is an example of a type IV hypersensitivity reaction

A nurse is assessing a client's immune function by reviewing the laboratory value of the cellular response of the T-cells. The nurse should recognize that which of the following conditions is affected by the T-cells?

Transplant rejection Answer Rationale: Transplant rejection is affected by the cellular response, or cell-mediated immunity, of the T-cells

A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

Use a 1.2 micron filter when infusing TPN with fat emulsions added. Answer Rationale: The nurse should use a 1.2 micron filter when infusing TPN with fat emulsion added to filter out any precipitate that is too large to pass through the filter

A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

Use a 1.2 micron filter when infusing TPN with fat emulsions added. Answer Rationale: The nurse should use a 1.2 micron filter when infusing TPN with fat emulsion added to filter out any precipitate that is too large to pass through the filter

)A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse plan to implement?

Vitamin B12 injections Answer Rationale: The nurse should administer vitamin B12 injections to treat pernicious anemia when diet fails to improve the anemia due to poor absorption

A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect

fatigue

A nurse is reviewing the laboratory results of a client who has acute radiation syndrome and notes the client has leukopenia. Which of the following assessment findings should the nurse identify as being consistent with leukocytosis?

fever

A nurse is providing teaching to a client who has a new prescription for tamoxifen to treat breast cancer. The nurse should include that which of the following is an adverse effect of this medication?

hot flashes

)A nurse is teaching a client who is receiving treatment for metastatic colorectal cancer about the adverse effects of bevacizumab with. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

nosebleeds

A nurse is planning a menu for a client who has folic acid deficiency anemia. Which of the following foods should the nurse include as high in folate?

½ cup of asparagus