Exam 2 17

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? a. 56-year-old who had a colonoscopy 6 years ago b. 34-year-old who reports a new onset of constipation c. 32-year-old who has a sister who died of colon cancer d. 51-year-old who is being seen for an annual physical examination

D. 51-year-old who is being seen for an annual physical examination **Colorectal cancer (CRC) is not common prior to the age of 40 years. When an adult turns 40, the provider should begin screening the client for risk factors of CRC (e.g., family history, inflammatory bowel disease, tobacco and alcohol use, high-fat and low-fiber diet, diet high in animal fats and red meat, sedentary lifestyle). The provider also may begin fecal occult blood testing depending on the client's risk. Screening colonoscopies are recommended starting at age 50 for those clients considered to be at normal risk with no family history and repeated every 10 years. It may begin earlier and performed more often for clients at high risk.

A nurse is teaching a client about the seven warning signs of cancer. Which of the following signs should the nurse include as manifestations of cancer? (SATA) a. A nonhealing sore b. Bloating c. Change in bowel pattern d. Change in moles e. Nagging cough

a, c, d, e

A nurse is assessing a client at a dermatology clinic. Which of the following findings places the client at risk for developing malignant melanoma? a. Female gender b. Age 19 to 30 years c. Dark hair d. History of chronic skin irritation

d. Hx of chronic skin irriation **Clients who have a history of chronic inflammatory skin irritations are at increased risk for skin cancer. Other risk factors include exposure to chronic sunlight, chemical pollution, and immunosuppression.

A nurse is planning care for a client who has immunosuppression following chemo. Which of the following interventions should the nurse include in the plan of care? a. Insert an indwelling catheter to monitor sediment in the urine. b. Take the client's temperature once per shift. c. Provide the client with fresh fruit to avoid constipation. d. Limit the number of health care workers entering the room.

d. Limit the number of health care workers entering the room. **The nurse should limit the number of health care workers entering the client's room to prevent possible overexposure to microorganisms that can lead to an infection.

A nurse is instructing a client how to decrease the nausea associated with chemotherapy and radiation. Which of the following statements indicates an understanding of the teaching? a. "I will eat smaller meals if I feel nauseated." b. "I will eat foods that are served at room temperature." c. "I will drink more liquids with my meals." d. "I will increase the amount of unsaturated fats in my diet."

B. "I will eat foods that are served at room temperature." **The nurse should instruct the client to eat foods served at room temperature or chilled. Foods served hot may contribute to nausea.

The nurse is planning a diet for a client who is iron deficient. Which of the following foods high in iron should the nurse include in the plan? a. Oranges b. Cashews c. Red meat d. Yogurt

C. Red meat **Red meat is a good source of iron. If the client is vegetarian, kidney beans with a high iron content are a good substitute.

A nurse is providing teaching to a client about preventing skin cancer. Which of the following client statements indicates a need for further testing? a. "Eating a high fiber diet will reduce my risk for developing skin cancer." b. "I should check my skin monthly for any changes." c. "I should avoid the use of tanning booths." d. "I should use sunscreen even on cloudy days."

a. "Eating a high fiber diet will reduce my risk for developing skin cancer." **A high-fiber diet is recommended to reduce the risk for colon cancer.

A client who has chronic lymphocytic leukemia is starting chemo treatments and asks if she needs to make any dietary changes. Which of the following statements should the nurse make? a. "You should avoid drinking liquids an hour before the treatments." b. "Eating low-calorie foods helps prevent nausea." c. "Foods that are higher in fat are usually more appealing." d. "Raw fruits and vegetables will be easier for your body to digest."

a. "You should avoid drinking liquids an hour before the treatments." **Clients should be encouraged to decrease fluid intake just before treatments because fluids may cause nausea and vomiting.

A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include? a. Do not apply heat to the area of irradiation. b. Do not wash the area of irradiation. c. Use an antibiotic ointment to treat skin breakdown. d. Lubricate the skin lubricated with hypoallergenic lotion.

a. Do not apply heat to the area of irradiation. **This instruction will help the client avoid tissue damage. Radiated tissue becomes thinner and might lack tissue receptors that would otherwise alert the client to a potential burn injury. When outdoors in sunlight, the client should wear protective clothing over the area of irradiation.

A nurse is caring for a client following surgical treatment for a supratentorial brain tumor. Which of the following interventions should the nurse take? a. Elevate the head of the bed to 30°. b. Notify the provider for drainage greater than 80 mL/8hr. c. Place the client in a flat, lateral position. d. Provide passive range-of-motion exercises to the neck.

a. Elevate the head of the bed to 30°. **The client who has surgery to treat a supratentorial brain tumor is at risk for increased intracranial pressure (ICP). Elevation of the head of the bed to 30° assists in promoting venous and CNS fluid drainage from the head to prevent increased ICP. *The nurse should notify the provider of drainage greater than 50 mL/8hr because this can indicate a cerebrospinal fluid leak requiring surgical repair

A nurse find radioactive pellets on the floor of the surgical. Which of the following actions should the nurse take first? a. Follow safety data sheet (SDS) instructions. b. Place pellets in the biohazard area. c. Contact environmental services. d. Notify the surgical department director.

a. Follow safety data sheet (SDS) instructions **The Occupational Safety and Health Administration requires SDS to be available in all health care facilities. The SDS gives specific information about the potential hazards, first aid guidelines, and precautions for safe handling and use for each substance. Finding and following the SDS instructions is the first action the nurse should take.

a nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? a. Leuprolide b. Cyclophosphamide c. Finasteride d. Tamoxifen

a. leuprolide **Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require. *Cyclophosphamide treats leukemia, multiple myeloma, lymphomas, and head, ovary, breast, and lung cancer. *Finasteride treats benign prostatic hypertrophy and also helps reduce the risk of prostate cancer. *Tamoxifen treats breast cancer.

During a routine physical exam, a nurse observes a 1-cm lesion on a client's chest. The lesion is raised and flesh-colored with pearly white borders. The nurse should recognize that this finding is suggestive of which of the following types of skin cancer? a. Squamous cell carcinoma b. Basal cell carcinoma c. Malignant melanoma d. Actinic keratosis

b. Basal cell carcinoma **A basal cell tumor usually begins as a small, waxy nodule with rolled, translucent, pearly borders. Telangiectatic vessels can also be present. As a basal cell tumor grows, it can undergo central ulceration. *Squamous cell carcinoma A squamous cell tumor appears as a rough, thickened ulcerated tumor that can bleed.

A nurse is planning care for a client who is being treated with chemo and radiation for metastatic breast cancer, and who has neutropenia. The nurse should include which of the following restrictions in the client's plan of care? a. All visitors from entering the client's room b. Fresh flowers and potted plants in the room c. Oral fluid intake to between meals only d. Activities that could result in bleeding

b. Fresh flowers and potted plants in the room **Clients who are receiving chemotherapy and radiation therapy are likely to become immunocompromised as a result of neutropenia, a decreased white blood cell (WBC) count. Because micro-organisms are likely to be present on fresh flowers and plants, immunocompromised clients are instructed not to accept such gifts into the room. In addition, the client is instructed to eat only thoroughly cooked meats and thoroughly washed fruits and vegetables. Immunocompromised clients are more susceptible to infection and illness from food-borne bacteria than other clients.

a nurse is teaching a group of male adolescents about testicular self0examination. Which of the following information should the nurse include? a. Perform testicular self-examination twice per year. b. Pinch the testicles to feel for abnormalities. c. Examine the testicles after a bath or shower. d. Expect a moderate amount of swelling.

c. Examine the testicles after a bath or shower **The nurse should inform the adolescents to perform testicular self-examinations when the scrotal skin is relaxed.

A nurse on an oncology unit is assessing a child who has a brain tumor. Which of the following findings should the nurse expect? a. Negative Babinski reflex b. Increased appetite c. Hyporeflexia d. Tachycardia

c. Hyporeflexia **The nurse should expect a child who has a brain tumor to exhibit hyporeflexia and hyperreflexia.

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 suspects which of the following type fo anemia? a. Folic acid deficiency anemia b. Pernicious anemia c. Iron-deficiency anemia d. Sickle cell anemia

c. Iron-deficiency anemia **Iron-deficiency anemia results from poor gastrointestinal absorption of iron, a diet that is deficient in iron, or blood loss. The nurse should expect a client who has iron-deficiency anemia to have weakness, pallor, fatigue, reduced tolerance for activity, and cheilosis (ulcerations of the corners of the mouth). *The nurse should expect a client who has folic acid deficiency to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; and weight loss. This type of anemia is caused by nutritional deficiencies, malabsorption syndromes (Crohn's disease), and medications (e.g., anticonvulsants, oral contraceptives). *A client who has pernicious anemia is unable to absorb vitamin B12 due to a lack of intrinsic factors in the stomach. The nurse should expect this client to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; weight loss; and paresthesias to the hands and feet. *Sickle cell anemia is an autosomal recessive disorder in which the RBCs develop a sickle shape following conditions in which decreased oxygen is available. These sickled cells then clump together and become fragile, causing tissue ischemia leading to eventual organ damage. Manifestations of sickle cel anemia include pain, pallor, cyanosis, dyspnea, fatigue, and weakness.

A nurse is creating a plan of care for a child who has sickle cell anemia. Which of the following interventions should the nurse include in the plan. a. Discourage a high level of fluid intake. b. Apply cold compresses to painful, swollen joints. c. Observe for indications of hypokalemia. d. Administer meperidine every 4 hr for pain.

c. Observe for indications of hypokalemia **The nurse should observe the child for indications of hypokalemia. Diuresis can result in electrolyte loss, leading to hypokalemia.

A client is receiving treatment for a stage IV ovarian cancer and asks the nurse to discuss her prognosis. The client plans to have aggressive surgical, radiation, and chemotherapy Tx's. Which of the following prognoses should the nurse discuss with the client? a. Good b. Guarded c. Poor d. Very good

c. Poor **At this advanced stage, the prognosis for ovarian cancer is poor. Ovarian cancer is the leading cause of death from female reproductive cancers. Survival rates are low because it is not often discovered until its late stages.

a female adult client tells a nurse she is tested positive for a mutant BRCA1 gene. The nurse should recognize that the client is at risk for which of the following situations? a. Delivering a child who has Down syndrome b. Developing Alzheimer's disease c. Developing breast cancer d. Developing thyroid cancer

c. developing breast cancer **The BRCA1 gene is used to determine the probability of a client developing breast cancer. BRCA1 genetic testing is used for women who have a strong family history of breast cancer.