Exam 6 - Study Plans

The nurse is caring for a client with a history of nonmelanoma skin cancer. Which question during the health history should the nurse ask? "Are you exposed to any hazardous chemicals at work?" "Are you able to look forward so that I can look at your neck?" "Can you remove your shirt so that I can view the skin on your upper body?" "Can I take a photograph of this lesion on your arm?"

"Are you exposed to any hazardous chemicals at work?" ​Rationale: During a health history for a client with a history of nonmalignant​ skin, the nurse should ask specific questions related to the​ client's risk and behavior. It is known that certain chemicals have long been associated with nonmelanoma skin cancer. Asking the client to remove clothing to observe the​ skin, to take a photograph of a​ lesion, and to look forward to observe the neck are all part of the physical assessment.

A client with lung cancer asks why he is scheduled for chemotherapy prior to surgery for a wedge resection. Which response by the nurse is most accurate? "Chemotherapy is used to treat vena cava syndrome." "Chemotherapy is used to relieve cough, bone pain, or dyspnea." "Chemotherapy is used to shrink the tumor so that it can be removed more easily." "Chemotherapy is another way to remove cancer cells."

"Chemotherapy is used to shrink the tumor so that it can be removed more easily." ​Rationale: Chemotherapy is used to shrink tumors so they can more easily be removed in surgery. It is not used to remove cancer cells. Radiation therapy is used to treat vena cava syndrome and relieve​ cough, bone​ pain, or dyspnea.

A client asks the nurse, "Why is cigarette smoking the leading cause of lung cancer? What is so bad about cigarettes?" Which response by the nurse is accurate? "Cigarette smoking introduces foreign substances in the body." "Cigarettes contain more than 700 chemicals, 70 of which are known carcinogens." "Cigarette smoking is addictive." "There are other more important causes of lung cancer than cigarette smoking."

"Cigarettes contain more than 700 chemicals, 70 of which are known carcinogens." ​Rationale: Cigarette smoke contains a large amount of​ chemicals, many of which are carcinogenic. Although it is addictive and a foreign substance to the​ body, this is not what makes it a risk factor for lung cancer. The American Cancer Society states that cigarette smoking is the leading cause of lung cancer.

A pregnant woman at 10 weeks' gestation is being screen for colorectal cancer. Which statement by the nurse accurately presents to the client the diagnostic challenge? "Tumor marker level (CEA) may not be accurate, but it will not injure the fetus." "Chemotherapeutic agents may cause harm to the fetus, so we cannot use them." "Ultrasound imaging is impeded by uterine growth and may affect the fetus." "Diagnostic imaging is limited due to risks of harming the fetus."

"Diagnostic imaging is limited due to risks of harming the fetus." ​Rationale: Diagnostic imaging and other procedures are limited during pregnancy due to the use of radiation and contrast dye and their effects on the fetus. Pregnancy does not affect CEA levels. Ultrasound is used to assess tumor depth and involvement of other organs. Chemotherapeutic agents are not used in diagnosing colorectal cancer.

A client in significant pain from metastatic bone cancer begs the nurse to help him die. How should the nurse respond? "Let me get the appropriate paperwork for you to sign." "Let's talk about hospice care." "Euthanasia is illegal, but I'll have the pain management team come to see you immediately." "You must have your attorney get a court order and bring it to the hospital first."

"Euthanasia is illegal, but I'll have the pain management team come to see you immediately." ​Rationale: It is important for the nurse to address and appropriately manage the​ client's pain, even though active euthanasia is illegal in all 50 states. Signing paperwork or getting a court order will not help the client in this situation. Talking about hospice​ care, though it may be​ appropriate, dismisses the​ client's concern at this moment.

The nurse is caring for a client who has presented with a new lesion on the right foot. Which question should the nurse ask during the client interview? (Select all that apply.) "Do you wear socks to bed?" "Have you ever been badly sunburned?" "How many hours a day are you on your feet?" "Have you noticed any changes in the lesion?" "Have you been exposed to any chemicals in your job?"

"Have you ever been badly sunburned?" "Have you noticed any changes in the lesion?" "Have you been exposed to any chemicals in your job?" ​Rationale: Clients with skin cancer should undergo a skin assessment. Specific health history questions include the​ following: • Have any members of your family ever been treated for skin​ cancer? • Have you had a skin cancer removed from any part of your​ body? • Have you noticed any change in the​ size, shape, or color of a​ mole, wart,​ birthmark, or​ scar? • Do you have any​ moles, warts,​ birthmarks, or scars that​ itch, are​ painful, have​ crusting, or​ bleed? • In what parts of the country or world have you​ lived? • Do you visit tanning​ salons?

The nurse is completing an assessment on a client experiencing lower back pain for several weeks. Which question should the nurse ask to obtain more information about the client history? "Do you think that your occupation may be contributing to the back pain?" "How often does the lower back pain occur?" "How does the lower back pain affect your daily activities?" "Do you believe it may be related to another disease or condition?"

"How often does the lower back pain occur?" Rationale: Asking how often the lower back pain occurs would provide more information for the client history. Asking if it affects daily activities or if they think it is related to another disease or condition would answer questions related to the current problem. Asking if they think their occupation may be contributing to it would support lifestyle.

A nurse is caring for a client with a sleep disorder. Which question should the nurse ask about the current problem? (Select all that apply.) "How would you describe your discomfort?" "How long have you had this discomfort?" "When did your discomfort start?" "Have you had past experiences that affect the way you view this discomfort?" "Which activities make the discomfort better or worse?"

"How would you describe your discomfort?" "How long have you had this discomfort?" "When did your discomfort start?" "Which activities make the discomfort better or worse?" ​Rationale: Asking the client about past experiences related to how the client views the current problem would be a question the nurse would ask about health​ history, not the current problem. All other statements are correct.

The nurse is teaching a client with chemotherapy-induced stomatitis ways to improve oral intake. Which statement made by the client indicates a need for further instruction? "I should eat spicy foods to promote taste bud stimulation." "I should use lubricating lip moisturizers to protect my lips." "I should include Chlorhexidine mouthwash to prevent gum trauma." "I should use a soft toothbrush in order to remove the plaque."

"I should eat spicy foods to promote taste bud stimulation." ​Rationale: The client would need to consume a bland diet and avoid spicy foods. This statement indicates the client needs further education. The nurse would instruct the client to use lubricating lip moisturizers to protect the lips and a soft toothbrush and Chlorhexidine mouthwash to prevent trauma to the gums and oral cavity.

The nurse reviews sleep hygiene practices for a client with fibromyalgia. Which client statement indicates that further teaching is​ required? ​"My bedroom is restful and free of​ irritations." ​"I listen to music or read before I go to​ bed." "I make sure to go to bed and wake up at the same time each​ day." "I take a nap every​ afternoon."

"I take a nap every​ afternoon." ​Rationale: Good sleep hygiene includes going to bed and awakening at the same time each​ day, clearing the bedroom of​ irritations, and engaging in​ quiet, calming activities before bed. Daytime naps should be avoided because they disrupt nighttime sleep.

The nurse is teaching a group of older adults about the risks of colorectal cancer. Which dietary recommendation should the nurse include in the session? "Increase intake of meat proteins, some fats, fruits, and vegetables." "Increase dietary cereal fiber, fruits, and vegetables." "Increase dietary folic acid, meat proteins, and calories." "Increase intake of foods rich in calcium and folic acid, as well as fruits and vegetables."

"Increase intake of foods rich in calcium and folic acid, as well as fruits and vegetables." ​Rationale: Diets high in​ fruits, vegetables,​ calcium, and folic acid appear to reduce the risk of colorectal cancer. Cereal​ fiber, once thought to reduce colorectal cancer​ risk, now does not appear to play a role either way in its development. Diets high in​ calories, meat​ proteins, and fats are thought to increase the population of anaerobic bacteria in the gut. These anaerobes convert bile acids into carcinogens.

A client diagnosed with lung cancer states, "I'm confused. My doctor said I have adenocarcinoma of the lungs, yet my wife believes she was told that I have non-small-cell carcinoma. Can you help me understand the difference?" Which response by the nurse is accurate? "There are many different terms for the same cancer depending on who you are talking to." "It is best if you don't focus on what the cancer is called as they all present in a similar way." "It can be confusing, but adenocarcinoma is actually one type of non-small-cell carcinoma." "I think your wife is probably referring to small-cell carcinoma, which is another name for adenocarcinoma."

"It can be confusing, but adenocarcinoma is actually one type of non-small-cell carcinoma." ​Rationale: The vast majority of primary lung lesions are bronchogenic carcinomas that are tumors of the airway epithelium. These tumors are further differentiated as​ small-cell carcinomas or​ non-small-cell carcinomas, and include​ adenocarcinomas, squamous cell​ carcinomas, and​ large-cell carcinomas. It is best to answer the​ client's question and provide accurate information.

While conducting a preventive health seminar on lung cancer, a member of the audience asks, "I've been smoking for 40 years. Why stop now?" Which response by the nurse most accurately addresses the participants risk for lung cancer? "While it may not lower your risk, you will probably find that you will feel better and have less illness." "It is never too late to stop. The sooner you stop the greater the chance for lowering your risk for lung cancer. "I understand what you are saying, but your second-hand smoke can affect those around you." "Given your long history of smoking it probably won't have any effect. But for anyone under age 40, you can lower your risk by 90%"

"It is never too late to stop. The sooner you stop the greater the chance for lowering your risk for lung cancer. Rationale: There is a dose-response relationship between smoking and lung​ cancer: The more the individual smokes and the longer the individual​ smokes, the greater the risk.​ Therefore, quitting at any time may help lower the risk. Among smokers who quit before 40 years of​ age, the risk of death due to conditions associated with continued smoking decreases by approximately​ 90%. While​ second-hand smoke can increase the risk of others and with stopping smoking the individual most likely will feel better and have fewer​ illnesses, it is not the primary reason an individual should stop smoking to decrease risk of cancer.

The nurse is teaching a client about the estrogen compound (diethylstilbestrol) that has been prescribed for prostate cancer. Which statement indicates that the teaching has been successful? "It is a very expensive drug and may require insurance approval." "It may cause my breasts to enlarge." "The effects of the drug are irreversible." "This drug does not put me at risk for any cardiovascular problems."

"It may cause my breasts to enlarge." Rationale: Estrogen compounds are more likely than other hormone therapy for prostate cancer to cause gynecomastia​ (hypertrophy of breast​ tissue). Estrogen compounds can cause an increased risk of cardiovascular problems. The effects of the drug are reversible and it is not​ expensive, so there should be no insurance issue.

The nurse evaluates teaching provided to a group of community members on breast cancer awareness. Which statement indicates that teaching on risk factors has been effective? (Select all that apply.) "Not breastfeeding increases the risk of breast cancer." "Having children after age 30 increases the risk of breast cancer." "Having previous irradiation of the chest increases the risk of breast cancer." "Experiencing menopause after age 50 increases the risk of breast cancer." "Having a first- or second-degree relative with breast cancer increases the risk of breast cancer." "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer."

"Not breastfeeding increases the risk of breast cancer." "Having children after age 30 increases the risk of breast cancer." "Having previous irradiation of the chest increases the risk of breast cancer." "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer." Rationale: Not​ breastfeeding, having children after age​ 30, previous irradiation of the​ chest, and presence of harmful mutations in BRCA1 or BRCA2 suppression all increase the risk for breast cancer. Experiencing menopause after age​ 55, not​ 50, increases risk. Having a​ first-degree relative, but not having a​ second-degree relative, with breast cancer increases risk.

The nurse preceptor is reviewing the physical appearance of actinic keratosis with a graduate nurse. Which statement by the graduate nurse is accurate? "The appearance is shiny and may be scaly." "The appearance is a small, firm red nodule." "The appearance is a tumor that ulcerates and bleeds." "The appearance is the same as basal cell carcinoma."

"The appearance is shiny and may be scaly." ​Rationale: Actinic keratosis can be described as​ follows: erythematous, rough macules a few millimeters in​ diameter; often shiny but may be​ scaly; if scales are​ removed, underlying skin​ bleeds; occurs in multiple​ patches, primarily on the​ face, dorsa of the​ hands, the​ forearms, and​ sometimes, on the upper​ trunk; and, enlargement or ulceration of the lesions suggests transformation to malignancy. The other answers do not describe actinic keratosis.

A client who is scheduled to have surgery for lung cancer asks the nurse to explain the goal of the surgery. Which response by the nurse is most accurate? "The goal of surgery is to remove all involved tissue while preserving as much functional lung as possible." "The goal of surgery is to prevent the lung cancer from spreading." "The goal of surgery is to return you to the state of health you were before the diagnosis of lung cancer." "The goal of surgery is always to cure lung cancer."

"The goal of surgery is to remove all involved tissue while preserving as much functional lung as possible." ​Rationale: The goal of lung cancer surgery is always to remove involved tissue and preserve functional lung tissue. It is not always possible to cure lung​ cancer, to return clients to their previous state of​ health, or to prevent the cancer from spreading

A client suspected of having fibromyalgia asks why diagnostic tests are being prescribed. Which response should the nurse make to this​ client? "The healthcare provider is trying to rule out other causes of your​ symptoms." ​"All clients with this diagnosis have these​ tests." "The healthcare provider is just trying to determine your general state of​ health." "Fibromyalgia can be diagnosed with blood and hormone​ testing."

"The healthcare provider is trying to rule out other causes of your​ symptoms." Rationale: Blood tests and scans do come back negative in clients with fibromyalgia. The healthcare provider needs to rule out conditions that might be causing the​ client's pain and other symptoms. There are no specific tests that all clients with fibromyalgia must receive. Although certain lab tests might give information about the​ client's general state of​ health, this is not the reason for testing prior to the diagnosis of fibromyalgia.

The nurse administering a tuberculin skin test to a client who is suspected of having lung cancer explains why this is ordered. Which explanation is the most appropriate? "This test will identify if tuberculosis is the cause of your symptoms." "This test will help identify the presence of any cancer cells." "This test will provide evidence of metastatic disease so that appropriate treatment can be determined." "This test will help diagnose lung cancer."

"This test will identify if tuberculosis is the cause of your symptoms." ​Rationale: Lung cancer and tuberculosis may produce the same symptoms. A tuberculin skin test can rule out tuberculosis as the cause of these symptoms. Blood work​ (CBC, liver function​ tests, and serum​ electrolytes) is performed to evaluate for evidence of metastasis. Lung cancer is usually first identified by chest​ x-ray. Cytologic examination of a sputum specimen looks for the presence of cancer cells.

The nurse reviews concepts that are related to comfort with a group of nursing assistants. Which statement should the nurse include in teaching? (Select all that apply.) "Grief and loss is related to comfort in that loss or expected loss of a loved one creates physical discomfort." "Tissue integrity is related to comfort in that decreased tissue integrity increases the risk for pain." "Inflammation is related to comfort in that inflammation causes pain." "Ethics is related to comfort in that healthcare providers may be reluctant to prescribe opioids based on race." "Mobility is related to comfort in that decreased mobility is often caused by pain, injury, or disease."

"Tissue integrity is related to comfort in that decreased tissue integrity increases the risk for pain." "Inflammation is related to comfort in that inflammation causes pain." "Ethics is related to comfort in that healthcare providers may be reluctant to prescribe opioids based on race." "Mobility is related to comfort in that decreased mobility is often caused by pain, injury, or disease." ​Rationale: Inflammation is related to comfort in that inflammation causes pain. Mobility is related to comfort in that decreased mobility is often caused by​ pain, injury, or disease. Tissue integrity is related to comfort in that decreased tissue integrity increases the risk for pain. Ethics is related to comfort in that healthcare providers may be reluctant to prescribe opioids based on race. Grief and loss is related to​ comfort; however, the loss or expected loss of a loved one creates​ emotional, not​ physical, discomfort.

The nurse is caring for a client who states, "I know I am supposed to have a sigmoidoscopy at my age, but I do not want to experience that. Is there anything else I can do?" What is the nurse's accurate response? "The double contrast barium is an excellent alternative every 5 years." "It is painless, quick, and you will not remember the procedure." "We can perform a stool DNA test every year." "You can use a take home fecal blood test kit every year for screening."

"You can use a take home fecal blood test kit every year for screening." ​Rationale: The recommendation for testing schedules for early detection of colorectal cancer begins at age 50. There are four options to choose from. The simplest option for a client who does not want to experience a sigmoidoscopy is an annual screening with a take home fecal blood test kit. The stool DNA test can be performed every 3 years. The double contrast barium may be uncomfortable for the​ client, resulting in noncompliance with screening.

Which follow-up information will the clinic nurse provide for the client who has no family history of colorectal cancer and a negative colonoscopy? "You will not need another colonoscopy for 5 years." "Sometimes a colonoscopy can show a false negative; you may want to complete a stool DNA test to confirm the results." "You will not need another colonoscopy for 10 years." "There is no reason to repeat a colonoscopy."

"You will not need another colonoscopy for 10 years." ​Rationale: The​ follow-up information the clinic nurse can provide the client who has no familial history of colorectal cancer and a negative colonoscopy​ is, "You will not need another colonoscopy for 10​ years." The client should continue to be screened throughout their lifetime.

During a home​ visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this​ client? ​"Maybe you should get a new mattress or​ pillow." "Have you been worried about anything in particular​ lately?" "Your fatigue is most likely the result of sleep​ disturbances, particularly​ insomnia." "You are fatigued because you stay up too late at​ night."

"Your fatigue is most likely the result of sleep​ disturbances, particularly​ insomnia." ​Rationale: Fatigue in fibromyalgia is most likely caused by sleep disturbances such as​ insomnia, poor quality of​ sleep, early morning​ awakening, or nonrestorative sleep. It is not caused by​ worry, staying up too​ late, or an old mattress or pillow.

The nurse is providing a seminar to men regarding screening for prostate cancer. Which percentage should the nurse present as the 5-year survival rate for prostate cancer confined to the prostate? 85% 95% 100% 80%

100% ​Rationale: The​ 5-year survival rate for prostate cancer confined to the prostate is​ 100%. It is a commonly occurring cancer. If the cancer​ spreads, the survival rate is​ 95% after 5 years.

Which is the minimally acceptable hourly urine output for a client weighing 141 lb and undergoing treatment for colorectal cancer? 32 mL/h 40 mL/h 36 mL/h 42 mL/h

32 mL/h ​Rationale: A client maintains adequate​ hydration, as evidenced by urinary output of at least 0.5​ mL/kg/h. This is calculated as​ follows: (Step​ 1) 141 lb​ ÷ 2.2 kg​ = 64.09 kg and​ (Step 2) 64 kg x 0.5​ mL/h = 32​ mL/h.

The nurse is providing education regarding screening for prostate cancer. Which age should the nurse instruct the men with low risk factors to initiate prostate cancer screening? 40 65 35 50

50 ​Rationale: For men at average risk of prostate cancer and whose life expectancy is at least 10​ years, this discussion and informed decision should be initiated at 50 years of age.

When planning care for a client affected by​ fibromyalgia, the nurse addresses the potential problem of activity intolerance. Which should the nurse recommend to the client to most effectively address this​ problem? Nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) taken on a regular schedule Daily meditation and guided imagery Referral to physical therapy for an assistive device A program of​ regular, mild to moderate exercise

A program of​ regular, mild to moderate exercise Rationale: Meditation and guided imagery can reduce anxiety. NSAIDs address the problem of pain. Assistive devices do not increase conditioning or activity tolerance in the absence of injury or neurologic deficits.​ Regular, mild to moderate exercise improves conditioning and activity tolerance.

A client who is 30 weeks pregnant has been diagnosed with breast cancer. The client tells the nurse that the oncologist has recommended chemotherapy, but she fears for the safety of the fetus. Which response by the nurse is the most appropriate to address the client's concerns? A. "Certain types of chemotherapy can be administered in the second and third trimester. Let's talk about the safety of these options." B. "I understand that it is a difficult choice for you, but the cancer must be treated, and chemotherapy is really the only viable option for the cancer you have." C. "Surgery is really the only safe option; you should talk to the oncologist about surgical treatment only." D. "Radiation therapy can be narrowly focused so that no harm will come to the fetus. Would you prefer to try that instead?"

A. "Certain types of chemotherapy can be administered in the second and third trimester. Let's talk about the safety of these options." Rationale: Informing the client that certain types of chemotherapy can be administered in the second and third trimester and offering to discuss the safety of these options would best respond to the​ client's concerns. While surgery is the safest​ option, indicating to the client that it is the only safe option does not best respond to the​ client's concerns. Radiation therapy is generally avoided due to potential harm to the fetus. Telling the client that it is the only viable option is not necessarily a valid statement nor does it acknowledge the concerns the client is expressing.

A college-age client asks the nurse about the relationship between breast cancer and alcohol use. Which response by the nurse provides the most accurate information for this client? A. "Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink per day." B. "The amount of alcohol that increases risk varies from person to person due to differences in metabolism and alcohol tolerance." C. "If you are drinking hard liquor, you should limit it to one per day, but if you are drinking beer or wine, you can have more than one drink per day." D. "They have not established a firm link between alcohol use and breast cancer. Thus I would not be too concerned."

A. "Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink per day." ​Rationale: Alcohol is a known risk factor for breast cancer. Recommendations include limiting alcohol intake to a maximum of one drink per day. The other statements are not valid.

The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instruction is appropriate for the nurse to include in the teaching session? (Select all that apply.) A. "Sleep with the right arm elevated on a pillow." B. "You will be able to resume playing golf with your friends." C. "You should apply hot compresses to the right arm if it is aching." D. "Do not allow anyone to take your blood pressure in the right arm." E. "It is okay to carry your purse on your right arm as long as it is not heavy."

A. "Sleep with the right arm elevated on a pillow." D. "Do not allow anyone to take your blood pressure in the right arm." ​Rationale: Elevation of the affected extremity after lymph node removal will allow drainage of​ fluid, prevent​ swelling, and promote circulation. Compression of the arm on the surgical side may increase the risk of developing lymphedema. The client should avoid carrying a purse or a briefcase on the affected arm. The client should avoid hot water contact on the affected extremity. Heat promotes vasodilation and fluid accumulation. Sports such as golf should be avoided in a client with a radical mastectomy

The nurse is discussing chemotherapy with a client newly diagnosed with cancer. Which statement is accurate regarding chemotherapy? (Select all that apply.) A. "Some chemotherapy binds with DNA." B. "Iron supplements are part of chemotherapy." C. "Chemotherapy can have life-threatening side effects." D. "Chemotherapy involves the use of cytotoxic medications." E. "Pregnancy limits which kinds of chemotherapy can be used."

A. "Some chemotherapy binds with DNA." C. "Chemotherapy can have life-threatening side effects." D. "Chemotherapy involves the use of cytotoxic medications." E. "Pregnancy limits which kinds of chemotherapy can be used." ​Rationale: Chemotherapy is the use of cytotoxic medications. Pregnancy limits using antimetabolites and hormones for chemotherapy. Chemotherapy can have​ life-threatening side effects. Iron supplements are part of treatment for​ anemia, not for cancer. Alkylating agents and antitumor antibiotics are chemotherapeutic agents that bind to DNA.

The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, cannot concentrate, and am so forgetful." Which statement made by the nurse in response to the client is true? (Select all that apply.) A. "This is also called chemo-brain." B. "This may occur with chemotherapy; however, it is rare." C. "You might want to make notes if needed as a memory aid." D. "This may last up to 2 years after completion of chemotherapy." E. "This is an abnormal side effect of chemotherapy and is very concerning."

A. "This is also called chemo-brain." C. "You might want to make notes if needed as a memory aid." D. "This may last up to 2 years after completion of chemotherapy." ​Rationale: The client is experiencing a normal side effect of​ chemotherapy, also called​ chemo-brain. The nurse should suggest that the client make notes or use other memory aids as needed. These side effects may last up to 2 years after completion of chemotherapy.

A client with metastatic breast cancer asks where the cancer has spread. Which site should the nurse include in the​ response? (Select all that​ apply.) A. Bone B. Liver C. Brain D. Lungs E. Kidney

A. Bone B. Liver C. Brain D. Lungs Rationale: Common sites for metastasis from breast cancer include the​ brain, liver,​ bone, and lungs. The kidney is not considered a common site for metastasis from breast cancer.

A client with cancer is complaining about rapid weight and muscle mass loss. The nurse explains that they are experiencing which characteristic feature of cancer? A. Cachexia B. Tumor lysis syndrome C. Metastasis D. Paraneoplastic syndrome

A. Cachexia ​Rationale: Cachexia is the wasting syndrome that includes malnutrition and unexplained loss of weight and muscle mass. Metastasis refers to the spreading of malignant neoplasms to other areas of the body. Paraneoplastic syndrome is a rare disorder triggered by an altered immune system response to the neoplasm. In tumor lysis​ syndrome, cellular lysis leads to the release of intracellular contents into the circulation causing​ hyperkalemia, hyperuricemia, and hyperphosphatemia.

When assessing a client with cancer, which immune system manifestation would be a concern? A. Evidence of infection B. Absent bowel signs C. Behavioral changes D. Cyanosis

A. Evidence of infection Rationale: Evidence of infection is an immune system manifestation that would be a concern for the client with cancer. It is important for a client with cancer to maintain a healthy immune system as it plays a role in destroying the cancer. When the immune system discovers a​ neoplasm, it tries to destroy it using the resources of the body. The body mounts an​ all-out assault on the foreign​ invader, calling on many​ resources, including chemical​ mediators, hormones and​ enzymes, blood​ cells, antibodies,​ proteins, and inflammatory and immune responses. Absent bowel​ signs, behavioral​ changes, and cyanosis are concerning​ manifestations, but they are not related to the immune system.

The nurse is monitoring a client who has been using NSAIDs for treatment of chronic back pain for several months. The nurse should instruct the client to take the medicine with food and a full glass of water to address which common side effect? A. Gastric distress B. Pruritus C. Sedation D. Constipation

A. Gastric distress ​Rationale: Gastric distress is a common side effect of NSAIDS. It can be potentially prevented by taking the medication with food and a full glass of water.​ Pruritus, sedation, and constipation are all side effects of opioids.

The family of a client with cancer has contacted the nurse indicating that the client has been experiencing severe nausea with intermittent vomiting. Which intervention should the nurse encourage the family to do to address this issue? (Select all that apply.) A. Have the client avoid liquids with meals. B. Have the client sit upright for an hour after meals. C. Administer around-the-clock antiemetic drugs. D. Allow the client to eat whatever is appealing. E. Encourage the client to eat small, frequent low-fat meals with dry foods. F. Temporarily hold all foods and fluids from the client until the vomiting completely subsides.

A. Have the client avoid liquids with meals. B. Have the client sit upright for an hour after meals. C. Administer around-the-clock antiemetic drugs. E. Encourage the client to eat small, frequent low-fat meals with dry foods. ​Rationale: Clients with cancer may frequently experience nausea and vomiting. To combat​ this, clients should be encouraged to avoid liquids with​ meals, sit upright for an hour after​ meals, and to eat​ small, frequent​ low-fat meals with dry foods such as toast or crackers. In​ general, if nausea and vomiting is not​ occurring, the client should be allowed to eat whatever is appealing. Holding all foods and fluids is not currently indicated unless the identified measures do not​ work, at which point the healthcare provider may consider other measures to address the nausea and vomiting.

The nurse is discussing benign versus malignant neoplasms with a client who is being evaluated for possible malignancy. Which characteristic of a malignant neoplasm would the nurse include in the discussion? (Select all that apply.) A. Invasive B. Cohesive C. Rapid growth D. Encapsulated E. Not always easy to remove

A. Invasive C. Rapid growth E. Not always easy to remove ​Rationale: As compared with benign​ neoplasms, malignant neoplasms are​ invasive, grow​ rapidly, and are not always easy to remove. Benign​ neoplasms, not malignant​ neoplasms, are generally cohesive and encapsulated.

When assessing an adult survivor of childhood cancer, which factor should the nurse identify as increasing the risk for long-term emotional and psychologic distress? (Select all that apply.) A. Low income B. Unemployment C. Low education D. Non-intact family E. Poor health status F. Diagnosis before age 5

A. Low income B. Unemployment C. Low education E. Poor health status ​Rationale: Low​ income, unemployment, low​ education, and poor health status are correlated with the highest risk of​ long-term emotional and psychologic distress in adult survivors of childhood cancer.​ Non-intact family and diagnosis before age 5 are not correlated with the highest risk.

A client with breast cancer asks which medication will most likely be used for chemotherapy before having surgery. Which medication should the nurse explain as the most common hormone therapy used to treat breast cancer? A. Tamoxifen B. Anastrozole C. Trastuzumab D. Letrozole

A. Tamoxifen Rationale: Tamoxifen is the most common hormone therapy drug used to treat breast cancer. It works by preventing estrogen from attaching to estrogen receptors on the cancer​ cells, which inhibits tumor growth and ultimately kills tumor cells. Letrozole​ (an aromatase​ inhibitor) has Trastuzumab​ (Herceptin) is used to stop the growth of breast tumors that express the​ HER2/neu receptor. Anastrozole​ (Arimidex) is the aromatase inhibitor used as first line treatment in postmenopausal women.

The nurse is teaching the family of a soon-to-be discharged client with cancer about when to call 911 versus when to call the healthcare provider. Which signs and symptoms, if noted, would necessitate calling 911? (Select all that apply.) A. The client has become unconscious. B. The client is complaining of a severe headache. C. The client is physically abusive and hurting themself. D. The client has developed new bleeding from the rectum. E. The client has difficulty breathing accompanied by a bluish tinge of the lips and face

A. The client has become unconscious. C. The client is physically abusive and hurting themself. E. The client has difficulty breathing accompanied by a bluish tinge of the lips and face ​Rationale: If the client becomes​ unconscious, is physically abusive and hurting​ themself, or has difficulty breathing accompanied by a bluish tinge of the lips and​ face, the client or family should call 911. If a severe headache or bleeding from a new site should​ occur, the client or family should first contact the healthcare provider.

Which information should a nurse provide to new mothers about the care of their baby when they go home? Sunscreen should be applied every 2 hours if outdoors. It is important not to keep the newborn in sunlight for more than 15 minutes. Newborns should not be exposed to direct sunlight. Sunscreen may be harmful to a newborn's skin.

Newborns should not be exposed to direct sunlight. ​Rationale: Newborns should not be exposed to direct sunlight. For infants 6 months or​ older, sunscreen should be applied.

Which type of skin lesion should the nurse suspect for a client who is scheduled for cryosurgery? Superficial basal cell carcinoma Actinic keratosis Malignant melanoma Nodular basal cell carcinoma

Actinic keratosis ​Rationale: Cryosurgery is a recommended procedure for a client diagnosed with actinic keratosis. Surgical​ excision, chemotherapy,​ and/or radiation are used for malignant melanoma. Nodular basal cell carcinoma can be treated with surgical​ excision, cryotherapy, and radiotherapy. Superficial basal cell carcinoma can be treated with radiation​ therapy, biological​ therapy, and vaccines.

A client with gastric cancer receives morphine every 3 hours but is still experiencing​ pain, despite the last dose 1.5 hours ago. What should the nurse​ do? Administer the next dose of morphine a little early. Administer a fentanyl lozenge for breakthrough per a standing order. Return in an hour to administer the next dose of medicine. Provide a gentle massage to help relieve discomfort until the next dose.

Administer a fentanyl lozenge for breakthrough per a standing order. Rationale: Breakthrough pain is a common problem in clients with severe cancer pain. Clients will need a continuous medication for pain in addition to a​ fast-acting medication for breakthrough pain. A massage may not be effective against cancer breakthrough​ pain, and​ it's inappropriate to make the client wait another hour before giving another dose of pain medicine. The nurse should not administer the morphine earlier than it is ordered.

A client with sickle cell disease presents to the emergency department in sickle cell crisis. Which collaborative intervention would the nurse expect to​ perform? (Select all that​ apply.) Administer oxygen. Offer genetic counseling. Provide narcotic analgesics. Give supplemental folic acid. Infuse intravenous fluids.

Administer oxygen. Provide narcotic analgesics. Infuse intravenous fluids. Rationale: During a sickle cell​ crisis, the client is not receiving adequate oxygenation due to sickled cell production.​ Therefore, the nurse would administer oxygen. Inadequate oxygenation causes intense​ pain, so the nurse would give narcotic analgesics. It is also essential to infuse intravenous fluids to prevent sickled cells from clumping. The nurse would administer folic acid to a client with regular​ anemia, not sickle cell disease. Genetic counseling is​ important, but not during a sickle cell crisis.

The nurse recognizes the importance of promoting effective cardiorespiratory function for a client with lung cancer. Which intervention should the nurse include in the plan of care? (Select all that apply.) Elevate the head of the bed to 30 degrees. Administer supplemental oxygen as ordered. Provide chest physiotherapy with percussion and postural drainage. Suction the airway every 15 minutes. Assist the client to turn, cough, and deep breathe.

Administer supplemental oxygen as ordered. Provide chest physiotherapy with percussion and postural drainage. Assist the client to turn, cough, and deep breathe. Rationale: Administering supplemental oxygen improves oxygenation status. Chest physiotherapy with percussion and postural​ drainage, and​ turning, coughing, and deep breathing help maintain airway patency. Suctioning the airway should only be done as needed. Elevate the head of the bed to at least 60 degrees to permit optimal lung expansion.

The nurse is educating a client newly diagnosed with prostate cancer regarding the purpose of androgen deprivation therapy. Which teaching would the nurse include in this education? Androgen deprivation therapy increases tumor suppressor cells. Androgen deprivation therapy improves erectile dysfunction. Androgen deprivation therapy decreases cancer cell growth. Androgen deprivation therapy is preferred over chemotherapy.

Androgen deprivation therapy decreases cancer cell growth. ​Rationale: Most cancer cells are androgen dependent and depriving the cells of androgen hormones can cause the cells to either die or cease growing. Androgen deprivation therapy is used in conjunction with radiation and chemotherapy. Androgen deprivation will not improve erectile dysfunction.

The nurse presenting to a group of older adults on gastrointestinal conditions should present which clinical manifestation of colorectal​ cancer? (Select all that​ apply.) Anemia Weight gain Abdominal pain Increased appetite Change in bowel pattern

Anemia Abdominal pain Change in bowel pattern ​Rationale: Clinical manifestations of colon cancer include changes in bowel​ patterns, abdominal​ pain, and anemia. The client would experience decreased appetite and weight​ loss, not increased appetite and weight​ gain, with colon cancer.

Other than​ cancer, which disease is caused by problems in cellular​ regulation? (Select all that​ apply.) Polio Anemia Pneumonia Polycythemia Sickle cell disease

Anemia Polycythemia Sickle cell disease Rationale: Anemia, sickle cell​ disease, and polycythemia are caused by problems in cellular regulation. Polio is caused by a virus. Pneumonia can be caused by a virus or by bacteria.

The nurse is providing cancer education at a health fair for women. Which screening test information should the nurse include? Colonoscopy every 2 years beginning at the age of 50 Pap test and HPV exam annually beginning at the age of 21 Fecal occult blood testing yearly beginning at the age of 30 Annual mammography beginning at the age of 40

Annual mammography beginning at the age of 40 ​Rationale: Women should have mammograms annually beginning at the age of 40 years old. The nurse would instruct that fecal occult blood testing is done annually beginning at the age of 50 years or colonoscopies every 10 years. Pap and HPV testing is done every 3 years in women ages 21-​29, not annually.

The nurse is performing a physical assessment of a client suspected of cancer. Which component of the client's health history is most important for the nurse to consider while assessing the client for cyanosis? A. Sun exposure B. Exposure to secondhand smoke C. Complaints of constant migraines D. Complaints of abdominal pain

B. Exposure to secondhand smoke Rationale: Exposure to secondhand smoke is most relevant to the respiratory assessment that the nurse is performing. Sun exposure is more relevant to an integumentary assessment. Complaints of constant migraines would be more relevant to a neurological assessment. Complaints of abdominal pain are more relevant to a gastrointestinal assessment.

The nurse notices that a client who is dying is refusing to visit with family. What should the nurse consider this client is demonstrating? Unresolved family problems Anticipatory grief Major depression Dysfunctional grieving

Anticipatory grief Rationale: Anticipatory grief can result in a dying person distancing themselves from family or friends in an attempt to minimize the pain of loss. This is not a sign of unresolved family​ problems, dysfunctional​ grieving, or major depression.

Which should the nurse include in the nutritional assessment of a client receiving cancer treatment? (Select all that apply.) Any changes in weight Location and intensity of pain Pain or difficulty with defecation Presence of nausea and vomiting Total protein and serum albumin levels

Any changes in weight Presence of nausea and vomiting Total protein and serum albumin levels ​Rationale: A nutritional assessment would include looking at the​ client's overall weight for weight loss due to inadequate oral intake. The nurse should also determine if the client has experienced any nausea or vomiting. This could interfere with taking in food. Laboratory tests such as the total protein and albumin levels will indicate the presence of good or poor nutrition.

The nurse cares for a client who is approaching the end of life. Which sign indicates that the client is nearing death? (Select all that apply.) Apneic periods Increase in confusion Increase in sleeping Restlessness Periods of intense hunger

Apneic periods Increase in confusion Increase in sleeping Restlessness ​Rationale: Signs that indicate a person is nearing death include increased​ confusion, increased periods of​ sleep, apneic​ periods, and restlessness. There is a​ decreased, not an​ increased, need for food at this time.

A terminally ill client has a dry mouth and refuses to take any food or fluids by mouth. Which intervention should the nurse implement for this​ client? Place a nasogastric tube to administer artificial feeding. Apply moist sponges to the mouth and lips. Feed the client ice chips or popsicles. Administer intravenous fluids to maintain hydration level.

Apply moist sponges to the mouth and lips. Rationale: Application of moist sponges to the mouth and lips can help relieve dry mouth in clients who are refusing to eat or drink. Administration of intravenous fluids or a nasogastric tube may be possible interventions but require an order from the healthcare provider and may be refused by the client or the healthcare proxy. Attempting to feed the client ice chips or popsicles after refusal of taking in other foods or liquids is insensitive to the wishes of the client.

A client with fibromyalgia asks which type of exercise would be most effective. Which response should the nurse make to this​ client? Stretching exercises Isometric strength training Gym-based program Aquatic therapy

Aquatic therapy ​Rationale: A recent study concluded that an aquatic program is more effective for reducing fibromyalgia symptoms than a​ gym-based program, isometric strength​ training, or stretching exercises. Water prevents stress on the joints.

An adolescent client with a terminal illness wishes to discontinue further treatment. Which action should the nurse take at this time? Contact the healthcare provider for a​ DNR/DNI order. Give the consent form to the teen to sign. Explain that there is nothing that can be done until the teen turns 18. Arrange a meeting between the​ teen, the​ parents, and the healthcare team.

Arrange a meeting between the​ teen, the​ parents, and the healthcare team. Rationale: Teens, especially teens with a chronic or terminal medical​ illness, have a strong desire for autonomy and are cognitively able to participate in their​ care, despite the law not allowing them to make formal decisions until they turn 18. The nurse should arrange a meeting between the​ teen, the​ parents, and the healthcare team to discuss the​ teen's feelings and wishes and the different options available.

A client with breast cancer is scheduled for radiation prior to surgery. Which situation supports the use of radiation prior to surgery? A. The cancer has already metastasized. B. The tumor is unusually large. C. Pain from the tumor is severe. D. The tumor is expressing the HER2/neu receptor.

B. The tumor is unusually large. ​Rationale: Radiation may be done to shrink an unusually large tumor prior to surgery. Palliative radiation may be used to treat chest wall recurrences and some bone metastases to help control pain and prevent fractures. Radiation is not necessarily indicated if the tumor has already metastasized.​ Herceptin, not​ radiation, may be used to stop the growth of tumors that express the​ HER2/neu receptor.

A client is transferred from the critical care area to a general medical unit. What action should the nurse take first to help promote sleep? Encourage the client to take naps when able, to decrease the impact of the sleep disturbance. Assess the client's individual circadian rhythm. Ask the family to decrease the number of visits since the client has improved and needs to rest. Contact the healthcare provider to obtain an order for a hypnotic/sedative.

Assess the client's individual circadian rhythm. ​Rationale: It would be important at this point to assess the​ client's circadian rhythm to schedule routine​ activities, medications, and so on around the​ client's normal sleep patterns. It would not necessarily be appropriate at this point to obtain an order for a​ hypnotic/sedative or to ask the family to decrease the amount of time spent visiting. Naps should be​ avoided, not​ encouraged, because they can also disrupt sleep patterns.

The community health nurse is teaching a group of community members on the risk factors for developing lung cancer. Which information is most important for the nurse include? Limit secondhand smoke exposure. Avoid alcohol consumption. Engage in physical activity. Avoid asbestos exposure.

Avoid asbestos exposure. ​Rationale: The nurse should include information about how exposure to asbestos increases the​ client's risk for lung cancer. The nurse needs to educate the client about​ avoiding, not​ limiting, secondhand smoke. Alcohol intake is not linked to lung cancer. Physical activity does not affect the risk for lung cancer.

Which information should the nurse include in the discharge teaching for a client diagnosed with actinic keratosis? Avoid sun exposure. Use sunscreen with at least 15 SPF. Wear long sleeves if outdoors during peak sun hours. Seek medical attention for any shiny or scaly skin lesions. Avoid indomethacin, lithium, and beta-adrenergic blocking agents.

Avoid sun exposure. Use sunscreen with at least 15 SPF. Wear long sleeves if outdoors during peak sun hours. Seek medical attention for any shiny or scaly skin lesions. ​Rationale: Actinic keratosis is directly related to chronic sun​ exposure, photo​ damage, and psoriasis. The UV radiation exposure induces cellular DNA mutation in the skin. The absence of further UV light exposure may result in resolution through repair mechanisms. Additional UV light exposure may induce further DNA​ mutations, resulting in squamous cell cancer. The client should be taught to wear long​ sleeves, long​ pants, and a​ wide-brimmed hat if outdoors during sunlight hours. Using sunscreen with an SPF of at least 15 reduces the rate of the disorder. Shiny or scaly skin lesions are a manifestation of squamous cell cancer lesions.​ Indomethacin, lithium, and​ beta-adrenergic blocking agents are medications that can precipitate exacerbations of psoriasis and should be avoided if the client has a history of psoriasis. These medications do not cause an exacerbation of actinic keratosis.

A client with breast cancer asks how a modified radical mastectomy differs from a radical mastectomy. What should the nurse respond to this client? A. " A modified radical mastectomy includes removal of the breast followed by immediate breast reconstruction surgery." B. "A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact." C. "A modified radical mastectomy removes just the tumor and the surrounding margins." D. "A modified radical mastectomy removes the complete breast only."

B. "A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact." ​Rationale: A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall​ intact, whereas a radical mastectomy also removes the chest wall muscles. Removal of only the complete breast is a simple mastectomy. Removal of the tumor and surrounding margins only is a segmental mastectomy. A modified radical mastectomy does not include breast reconstruction.

The nurse is caring for a client with a diagnosis of cancer. The nurse explains a test that is ordered to determine the blood supply to the tumor. To which test is the nurse referring? A. Computed tomography (CT) scan B. Angiography C. Magnetic resonance imaging (MRI) D. X-ray

B. Angiography Rationale: Angiography is used to determine the blood supply to the tumor. A CT​ scan, MRI, and​ x-ray better show solid masses.

The nurse is caring for a client who is scheduled for a biopsy of a suspicious mass in the breast. The client is crying and is tachycardic and tachypneic. Based on this assessment data, which problem is a priority? A. Risk for infection B. Anxiety C. Impairment of gas exchange D. Body image disturbance

B. Anxiety ​Rationale: The client is exhibiting signs and symptoms of​ anxiety, which is a common nursing problem in clients with a breast disorder. The data provided do not support the nursing problems of risk for​ infection, body image​ disturbance, or impaired gas exchange.

The nurse is providing a class at the local community center for mothers of school-age children. Which evidence-based cancer screening guideline should the nurse include concerning breast cancer prevention? A. Complete monthly self-breast exams. B. Begin annual mammograms at age 45. C. Get a breast exam every 2 years by a healthcare provider. D. Obtain annual breast ultrasounds beginning at age 55.

B. Begin annual mammograms at age 45. Rationale: Annual mammograms should be done beginning at age 45. There is no clear benefit indicated by physical breast exams by either clients or healthcare providers. The nurse would not necessarily include this in the guidelines. Breast ultrasounds are generally done as a​ follow-up for abnormalities detected by a​ mammogram; they are not routinely recommended.

The nurse preceptor discusses with a new graduate the external agents known to cause cancer. Which external agent should the preceptor include in the discussion? A. Immune conditions B. Chemicals C. Inherited traits D. Hormones

B. Chemicals Rationale: Chemicals and radiation are considered external factors that are known to cause cancer.​ Hormones, immune​ conditions, and inherited mutations are internal factors that are known to cause cancer.

How is surgery used to stage cancer? A. To relieve secondary effects of the cancer B. To discover how much cancer exists and if it has spread C. As prophylaxis to remove tissue that can potentially become cancerous D. To remove the cancerous lesion along with removal of normal surrounding tissue

B. To discover how much cancer exists and if it has spread ​Rationale: Surgery is used to stage cancer by discovering how much cancer exists and if it has spread. Surgery may be used as prophylaxis to relieve​ cancer's secondary effects and to remove a cancerous​ lesion, but these procedures are not related to staging.

During an initial examination of a client, the nurse finds a suspicious-looking skin lesion, possibly indicating malignancy. Which type of skin lesion should the nurse consider? (Select all that apply.) Psoriasis Actinic keratosis Basal cell carcinoma Malignant melanoma Squamous cell carcinoma

Basal cell carcinoma Malignant melanoma Squamous cell carcinoma ​Rationale: Basal cell carcinoma is an epithelial cancerous tumor originating from the basal layer of the epidermis or from cells in the surrounding dermal structures. Squamous cell carcinoma is a malignant tumor of the squamous epithelium of the skin or mucous membranes. Malignant melanoma is a cancerous skin lesion that arises from the​ melanocytes, or the cells located at or near the basal layer of the skin. Actinic keratosis is an epidermal noncancerous skin lesion directly related to chronic sun exposure and photo damage. Psoriasis is a chronic immune noncancerous skin disorder.

A client is returning to the oncology clinic after a skin biopsy on an arm lesion revealed melanoma. Which additional diagnostic test should the nurse expect to be ordered to evaluate this client for metastasis? (Select all that apply.) Bone scan Chest x-ray Radiation therapy CT scan of the liver Liver function tests

Bone scan Chest x-ray CT scan of the liver Liver function tests ​Rationale: The client with a positive biopsy for melanoma would need further diagnostic tests to rule out metastasis and to perform staging of the malignancy. These would include a CT of the brain and​ liver, liver function​ tests, an initial chest​ x-ray, and a bone scan. Radiation therapy would be used in the treatment of inoperable lesions because of the location or for a client who is a poor surgical​ risk; it is not used to evaluate for metastasis or lesion staging.

A client with lung cancer has a respiratory rate of 28 breaths per minute and a heart rate of 90 bpm at rest. The client complains of being short of breath when walking from bed to the bathroom and asks for the head of the bed to be elevated because it makes it easier to breathe. Which nursing diagnosis should the nurse address? Grieving Gas Exchange, Impaired Breathing Pattern, Ineffective Pain, Acute

Breathing Pattern, Ineffective Rationale: Tachypnea, shortness of breath with​ exertion, and needing the head of the bed to be elevated all indicate that the client is exhibiting an ineffective breathing pattern. To assign a diagnosis of Gas​ Exchange, Impaired the nurse needs to assess the arterial blood gasses or pulse oximetry or note cyanosis. The client in this scenario does not complain of pain. These symptoms do not fit the diagnosis of grieving. ​(NANDA-I ©2014)

The nurse is caring for a client who is experiencing discomfort from the nasogastric tube that is necessary for gastric suctioning. What relaxation technique should the nurse teach the client to aid in client comfort? (Select all that apply.) Breathing exercises Laughter Guided imagery Movement techniques Muscle relaxation

Breathing exercises Guided imagery Movement techniques Muscle relaxation ​Rationale: Relaxation techniques used to aid in client comfort include movement​ techniques, breathing​ exercises, muscle​ relaxation, and guided imagery. Laughter is​ beneficial; however, it promotes psychosocial​ well-being, not relaxation.

The client care assistant tells the nurse that they think a client with cancer might have an infection. Which question asked by the nurse would help elicit information to most accurately identify early signs of infection in immunocompromised clients? A. "Has the drainage from their surgical wound increased? B. "Do they seem lethargic?" C. "Is their heart rate and respiratory rate increased?" D. "Do they have a fever?"

C. "Is their heart rate and respiratory rate increased?" Rationale: Early signs of infection in cancer clients include fever and increased respiration and pulse.​ However, in immunocompromised​ clients, fever may be absent. Lethargy and wound drainage can also be signs of infection but are not necessarily early signs of​ infection, nor the best to use to identify infection early.

A 22-year-old female contacts the nurse at the local community clinic about the need for a Pap test. The individual informs the nurse that she had a Pap test 1 ½ years ago. Which response by the nurse provides accurate information about the frequency of Pap test screenings according to current screening guidelines? A. "It is required every 5 years." B. "It is required every 2 years." C. "It is required every 3 years." D. "It is required annually."

C. "It is required every 3 years." Rationale: For women ages 21-​29, a Pap test and HPV test should be done every 3 years. For women ages 30-​65, a Pap test and HPV test should be done every 3-5 years.

While completing an assessment after administration of morphine for acute pain, the nurse notes that the client's respiratory rate is 10 and that the client is very lethargic. Which should the nurse do first in response to these assessment findings? A. Continue to monitor for any further decrease in respirations or change in level of consciousness. B. Contact the healthcare provider immediately to advise of client changes. C. Administer naloxone as prescribed in incremental doses until symptoms of overdose are resolved. D. Immediately obtain a complete set of vital signs to establish a baseline.

C. Administer naloxone as prescribed in incremental doses until symptoms of overdose are resolved. ​Rationale: Morphine can cause respiratory depression. If this​ occurs, naloxone should be immediately administered as prescribed in incremental doses until the overdose is resolved. A baseline set of vital signs should be obtained as soon as possible but vital signs are not the first priority. Once naloxone is​ begun, the healthcare provider should be contacted. The nurse would not just continue to monitor for further changes as this could result in death.

A client has a mass that has been identified by a mammogram. Which test may be ordered to further differentiate the mammogram results? A. HER2/neu testing B. PET scan C. Breast biopsy D. Chest x-ray

C. Breast biopsy ​Rationale: A breast biopsy may be used to further assess the tumor identified in the mammogram. A PET scan would not be used to further confirm the diagnosis of breast cancer.​ Rather, this test is used to assess for metastasis. A chest​ x-ray will not further differentiate mammogram results.​ HER2/neu testing is used to guide prognosis and treatment.

Upon helping assistive personnel with morning care of a client with cancer, the nurse notes that the client's gums are bleeding easily. Which intervention should the nurse include in the nursing care plan for future oral care of this client? A. Obtain a new toothbrush. B. Rinse the mouth twice daily with an alcohol-based mouthwash. C. Clean teeth with a soft cloth over the finger. D. Refer the client to a dental oncologist for assessment.

C. Clean teeth with a soft cloth over the finger. ​Rationale: Clients with cancer may experience impairment of the​ oral-pharyngeal-esophageal tissues. Oral care of the client should include measures to reduce trauma to the delicate tissues. If gums are friable and​ bleeding, cleaning should be done with a soft cloth over the finger or with toothpaste on a finger. A new toothbrush should be obtained​ monthly, but this does not address the current problem. When​ needed, the client should be seen by a dental​ oncologist, but that is not indicated at this time. Clients should use mouthwash several times a​ day, but they should be​ alcohol-free. In the case of bleeding​ gums, chlorhexidine mouthwash may be indicated.

A female client has a grapefruit-sized tumor in her abdomen. Her healthcare provider believes the tumor is life threatening. Which diagnostic test is appropriate to determine the extent of the tumor? A. Tumor markers B. Cytological examination of exfoliated cells from the epithelial surface of the tumor C. Computerized tomography (CT) scan D. Cytological examination of aspirated tumor cells

C. Computerized tomography (CT) scan ​Rationale: Diagnostic imaging tests are used to determine the extent of a tumor when it has reached a​ life-threatening size. Cytological examination of tumor cells identifies the​ classification, grading, and staging of the cancer. Tumor markers are proteins detected in body fluids that indicate a tumor may exist in the body.

The nurse is discussing early detection of breast cancer with a group of teenage women. Which information should the nurse include to decrease the risk for mortality and promote positive client​ outcomes? A. Encourage annual laboratory tests including red blood​ cell, white blood​ cell, and platelets. B. Encourage annual mammograms beginning at age 30. C. Encourage monthly​ self-breast exams. D. Encourage genetic testing for BRCA 1 and 2.

C. Encourage monthly​ self-breast exams. ​Rationale: Early detection does not prevent breast cancer but it can reduce risk for mortality and promote better outcomes. Because of​ this, clients should be encouraged to do monthly breast​ self-examinations. Genetic​ testing, annual mammograms beginning at age​ 30, and annual laboratory tests would not be recommended to detect early breast cancer.

Which intervention promotes optimal circulation after a surgical intervention for breast cancer? A. Assessing for manifestations of lymphedema B. Observing the surgical site for redness and swelling C. Encouraging range-of-motion exercises in the affected arm D. Monitoring surgical drains for amount and color of drainage

C. Encouraging range-of-motion exercises in the affected arm ​Rationale: Encouraging​ range-of-motion exercises in the affected arm will help promote optimal circulation. Assessing for manifestations of​ lymphedema, observing the surgical site for redness and​ swelling, and monitoring surgical drains for amount and color of drainage do not help promote optimal circulation.

A client is diagnosed with adenocarcinoma of the breast. Based upon this​ diagnosis, where should the nurse expect the source of the cancer to​ be? A. Nipple epithelium B. Subcutaneous fat C. Terminal section of the breast ductal tissue D. Mammary layer fatty tissue

C. Terminal section of the breast ductal tissue Rationale: Most breast cancers are adenocarcinomas and arise out of the terminal section of the breast ductal tissue.

The nurse is developing a plan of care for the family of a preschool-aged child recently diagnosed with cancer. Which information concerning the child's possible reaction to the illness should the nurse discuss with the parents based on the child's developmental stage? A. The child will try to understand the illness and is reassured by interacting with other children their own age. B. The child will not understand the severity of the disease but will be impacted by pain and separation anxiety. C. The child is beginning to understand illness but may think they caused the illness and not understand why the parents cannot make the pain go away. D. The child can understand the diagnosis and benefit from opportunities to talk about the illness in their own words.

C. The child is beginning to understand illness but may think they caused the illness and not understand why the parents cannot make the pain go away. Rationale: Preschoolers are beginning to understand illness but may think that they caused it and are confused about why the parent cannot make it go away. Infants and toddlers will not understand the severity of the disease but will be impacted by pain and separation anxiety.​ School-age children can understand the diagnosis and benefit from opportunities to discuss it. Adolescents find contact with others who have gone through the experience reassuring.

The nurse is providing health counseling to a 32-year-old woman whose mammogram indicates that she has dense breast tissue. Which information should the nurse provide to this client concerning this finding and breast health? A. Dense breast tissue is very common at this age and does not affect breast health. B. Dense breast tissue is a protective effect for breast cancer, and rates of breast cancer in women with dense breast tissue are very low. C. The presence of dense breast tissue increases the risk of breast cancer before the age of 45. D. Precancerous cells are found in dense breast tissue; thus, she should have further screening done for breast cancer.

C. The presence of dense breast tissue increases the risk of breast cancer before the age of 45. Rationale: The presence of dense breast tissue increases the risk of breast cancer before the age of 45. The statement that dense breast tissue is not necessarily common at this age and increases the risk for breast cancer is not valid. Precancerous cells are not necessarily found in dense breast​ tissue, nor does dense breast tissue provide a protective effect against cancer.

A client reports pain as being an 8 on a scale from 1 to 10. Which finding should the nurse expect when assessing this client? (Select all that apply.) Guarding Fever Facial grimaces Abnormal gait Verbal complaints Posturing

Guarding Facial grimaces Abnormal gait Verbal complaints Posturing Rationale: Observations associated with discomfort include​ guarding, posturing, abnormal​ gait, facial​ grimaces, and verbal complaints. Fever is not usually associated with discomfort​ (although it could be a source of​ discomfort).

The nurse creates a care plan for a client with fibromyalgia. Which primary goal of treatment should the nurse include in the plan of​ care? (Select all that​ apply.) Increasing restorative sleep Improving physical function Ensuring an effective breathing pattern Reducing pain Improving verbal communication

Increasing restorative sleep Improving physical function Reducing pain ​Rationale: The primary goals of treatment for a client with fibromyalgia include reducing​ pain, increasing restorative​ sleep, and improving physical function. The client with fibromyalgia does not have trouble communicating verbally or difficulty breathing.

Which behavior by the client indicates effective teaching of self-care postexcision of a skin cancer lesion? (Select all that apply.) Client verbalizes understanding of how to prevent recurrence Family verbalizes understanding of prevention measures Client is listening attentively to your teaching Client states the importance of avoiding exposure to direct sunlight Client indicates he will not use tanning machines

Client verbalizes understanding of how to prevent recurrence Family verbalizes understanding of prevention measures Client states the importance of avoiding exposure to direct sunlight Client indicates he will not use tanning machines Rationale: The client will verbalize awareness of measures to prevent skin cancer​ recurrence, including proper use of sunscreen and clothing and avoidance of artificial tanning machines. The client listening attentively is not a measurement of teaching effectiveness.

The nurse is updating the care plan for a client recovering from a mastectomy. Which should the nurse include to prevent infection? (Select all that apply.) Change dressings and IV tubing using aseptic technique. Encourage range-of-motion exercises in the affected arm each shift. Observe incision and IV sites for pain, redness, swelling, and drainage. Assess surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed.

Change dressings and IV tubing using aseptic technique. Observe incision and IV sites for pain, redness, swelling, and drainage. Assess surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed. ​Rationale: The care plan would include changing dressings and IV tubing using aseptic​ technique; observing incision and IV sites for​ pain, redness,​ swelling, and​ drainage; and assessing surgical dressings for​ bleeding, drainage,​ color, and odor every 4 hours for 24 hours. Telling the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed will also help to prevent infection. Encouraging​ range-of-motion exercises in the affected arm will help to promote optimal circulation.

Which activity should the nurse teach a client who has been diagnosed with melanoma skin cancer in the past to follow? Staying inside during the summer Checking skin routinely for any large moles Washing the skin with a special solution Reporting to the office every 6 months

Checking skin routinely for any large moles ​Rationale: One of the risk factors for melanoma skin cancer is a high number of moles or large moles.​ Therefore, routine skin assessment would be important. The client would be advised to call the health care provider if any changes in lesions or new lesions appear. Staying indoors is not practical.​ Instead, clients should be advised to wear sunscreen with a skin protection factor​ (SPF) of at least 15 and to cover vulnerable sites. The client would be advised to call the healthcare provider. The client does not need to wash with a special solution.

A 62-year-old woman has been diagnosed with a pigmented basal cell carcinoma following a skin biopsy. The client has already had an excision of the lesion. Which additional therapy should the nurse expect may be recommended? (Select all that apply.) Laser surgery Chemotherapy Immunotherapy Radiation therapy Topical creams or gels

Chemotherapy Immunotherapy Radiation therapy ​Rationale: Immunotherapy, radiation​ therapy, and chemotherapy are additional therapies that may be recommended by the healthcare provider for a nonmelanoma type of skin cancer. Laser surgery and topical creams would be appropriate for actinic keratosis.

The nurse is conducting a community program and will discuss the symptoms of lung cancer. Which symptoms should the nurse include in the teaching? (Select all that apply.) Chronic cough Hemoptysis Small amounts of yellow or green sputum Wheezing Sharp, stabbing chest pain

Chronic cough Hemoptysis Wheezing Rationale: Symptoms of lung cancer include chronic cough and hemoptysis. Wheezing is present as a result of airway obstruction. Yellow or green sputum is usually the result of a pulmonary​ infection, not lung cancer. The pain associated with lung cancer is dull and aching.

During​ hand-off communication, the charge nurse is asked questions about a​ client's diagnosis of fibromyalgia. Which disease process should the nurse explain that closely resembles this​ disorder? Muscular dystrophy Chronic fatigue syndrome Osteoarthritis Sjögren syndrome

Chronic fatigue syndrome ​Rationale: Fibromyalgia closely resembles chronic fatigue syndrome with the exception of the musculoskeletal pain typically associated with fibromyalgia. Fibromyalgia does not closely resemble​ Sjögren syndrome, muscular​ dystrophy, or osteoarthritis.

Which factor influences the expression of pain regardless of culture, and is important for the nurse to consider for all clients? (Select all that apply.) Underlying health of the client Cues from client's family or significant others Client's ability to cope with pain Client's level of trust in the healthcare provider Client's skills at reporting pain and discomfort

Client's ability to cope with pain Client's level of trust in the healthcare provider Client's skills at reporting pain and discomfort ​Rationale: The​ client's ability to cope with​ pain, skills at reporting pain and​ discomfort, and level of trust in the healthcare provider are important factors to consider for all​ clients, regardless of culture. Underlying health issues and cues from significant others are not vital to understanding how clients express pain.

The nurse is evaluating the laboratory results of a client's elevated prostate-specific antigen (PSA) test. Which statement regarding the PSA test should the nurse consider? (Select all that apply.) Clients with a normal PSA may have prostate cancer. An elevated PSA may indicate prostatitis. Fluctuating PSA test results strongly indicate prostate cancer. A urinary tract infection may elevate a client's PSA. PSA levels should be interpreted in conjunction with a client's health history.

Clients with a normal PSA may have prostate cancer. An elevated PSA may indicate prostatitis. A urinary tract infection may elevate a client's PSA. PSA levels should be interpreted in conjunction with a client's health history. ​Rationale: Until​ recently, the National Cancer Institute guidelines included considering a PSA level of 4.0​ ng/mL or lower to be normal.​ However, current research suggests that men with normal PSA levels may nevertheless have prostate cancer.​ Likewise, an elevated or fluctuating PSA​ level, which previously was considered to be a relative indication for prostate​ biopsy, has been known to occur also in conditions such as prostatitis and urinary tract infection.​ Therefore, PSA levels are now interpreted in conjunction with the​ client's health history.

A client with colorectal cancer is exhibiting symptoms of anemia. Which diagnostic test does the nurse anticipate will be ordered for this client? Hemoccult Complete blood count Guaiac test Carcinoembryonic antigen (CEA) level

Complete blood count Rationale: The nurse would anticipate that the healthcare provider would order a complete blood count to assess for anemia. The guaiac test and the hemoccult are fecal occult blood screening tests used to detect blood in the feces. The CEA is ordered to estimate​ prognosis, monitor​ treatment, and detect cancer recurrence.

The nurse is assessing a client with stage I prostate cancer. Which description is consistent with this stage? Extension into the seminal vesicle Poorly differentiated Lymph node involvement Confined to the prostate

Confined to the prostate ​Rationale: Stage I prostate cancer is confined to the prostate and is well differentiated. Stage II is poorly differentiated. Extension into the seminal vesicle occurs in stage III and lymph node involvement is in stage IV.

The nurse is caring for a client with lung cancer who asks what symptoms would indicate that the cancer has metastasized. Which symptom should the nurse include in the response? (Select all that apply.) Confusion and impaired gait Bone pain Pathologic fractures Jaundice Nausea and vomiting

Confusion and impaired gait Bone pain Pathologic fractures Jaundice Rationale: Confusion and impaired gait indicate possible metastasis to the brain. Bone pain and pathologic fractures indicate metastasis to the bone. Jaundice indicates metastasis to the liver. Nausea and vomiting are generic​ symptoms, not necessarily associated with metastasis.

A client presents to the clinic and learns that testing has revealed a precursor skin lesion that has been present since birth. The nurse should suspect that the client has which lesion? Dysplastic nevus Nodular melanoma Lentigo maligna Congenital nevus

Congenital nevus Rationale: Congenital nevi are present at birth. Some lesions are​ small; others are large enough to cover an entire body area. Their color can range from brown to black. They are often slightly​ raised, with an irregular surface and a fairly regular border. Dyplastic nevi have irregular pigmentation with mixtures of​ tan, brown,​ black, red, and pink. Lentigo maligna lesions are a tan or black patch on the skin that looks like a freckle. These lesions grow​ slowly, becoming​ mottled, dark,​ thick, and nodular. They are usually seen on one side of the face in an older adult who has had a large amount of sun exposure. Nodular melanoma presents as a papule that looks like a smooth pimple that grows at a steady rate. This lesion also has skin over the tumor that is shiny and may be pearly​ white, pink, or flesh colored.

A client diagnosed with actinic keratosis has been sent for a specialty follow-up. Which treatment should the nurse expect the client to undergo? (Select all that apply.) Curettage Cryotherapy Phototherapy Topical creams Chemical peeling

Curettage Cryotherapy Topical creams Chemical peeling Rationale: Cryotherapy is the most common treatment for actinic keratosis. Curettage is also used to scrape off damaged​ cells; it may be followed by​ electrosurgery, in which a​ pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. Topical medications used to treat actinic keratosis include creams that destroy cells by blocking essential cellular functions. Chemical peeling involves applying a chemical solution that causes the skin to blister and​ peel, allowing new skin to form. Phototherapy treatment is used for the treatment of​ psoriasis, not for the treatment of actinic keratosis.

The nurse is caring for a client with severe anemia. Which clinical manifestation of anemia would indicate the client has cardiovascular compromise? (Select all that apply.) Urticaria Cyanosis Chest pain Tachycardia Nausea and vomiting

Cyanosis Chest pain Tachycardia ​Rationale: Cardiovascular signs of anemia occur due to lack of oxygenation. This includes​ cyanosis, chest​ pain, and tachycardia.​ Urticaria, nausea, and vomiting are clinical manifestations of anaphylaxis.

The parents of a child with cancer tell the nurse that the​ child's brother is acting out since the diagnosis and the parents are looking for advice. Which instruction would be most appropriate for the nurse to give to the​ parents? Punish the child. Buy toys for the child. Praise the child. Give the child attention.

Give the child attention. ​Rationale: The sibling of a child with cancer may be afraid of getting sick as well. The sibling may also be resentful of the ill child receiving all the attention.​ Therefore, the nurse should instruct the parents to give the sibling more attention. The nurse should not instruct the parents to punish or praise the child. Buying toys for the child is not​ appropriate, as the child only wants and needs attention.

The nurse reviews a list of clients scheduled for women's health visits. For which age range should the nurse emphasize the importance of early detection and treatment of breast cancer? A. 45-49 B. 60-64 C. 50-54 D. 75-79

D. 75-79 Rationale: The incidence of breast cancer is highest in women between the ages of 75 and 79 years in the United States. Even​ so, all women should be counselled on actions for prevention and early detection of breast cancer.

The nurse understands that external-beam radiation used for treatment for cancer uses which high-energy source? A. Gamma rays B. Neutrons C. Ultraviolet rays D. Protons

D. Protons ​Rationale: External-beam radiation uses​ x-rays and may include​ high-energy protons to kill cancer cells.​ Neutrons, gamma​ rays, and ultraviolet rays are not used in​ external-beam radiation.

A client with breast cancer receives diagnostic testing and scan results that indicate a tumor that is 4.2 cm in size with evidence of metastasis to movable ipsilateral axillary nodes only. According to the TNM staging​ system, how should this​ client's breast cancer be​ staged? A. T3 N2 M1 B. Tis N1 M0 C. T1 N0 MO D. T2 N1 M0

D. T2 N1 M0 ​Rationale: This​ client's breast cancer would be staged as T2 N1 M0. T2 indicates a tumor no larger than 5​ cm, N1 indicates metastasis to movable ipsilateral axillary​ nodes, and M0 indicates no distant metastasis. T1 indicates a tumor no larger than 2 cm. This indicates a tumor in situ. T3 indicates a tumor larger than 5 cm. N0 indicates no regional lymph node metastasis. N2 indicates metastasis to ipsilateral fixed axillary nodes. M1 indicates distant metastasis.

The results of a client's biopsy indicates neoplasm. The nurse understands that which characteristic indicates that the neoplasm is benign? A. Invades surrounding tissues B. Noncohesive C. Rapid growth D. Well-defined borders

D. Well-defined borders ​Rationale: A benign neoplasm has​ well-defined borders, slow​ growth, is​ cohesive, and pushes other tissues out of the way. A malignant neoplasm invades surrounding​ tissues, is​ noncohesive, does not stop at tissue​ borders, and grows rapidly.

A client with a terminal illness does not want to receive cardiopulmonary resuscitation. Which medical order should the nurse expect to be written for this​ client? Do-not-resuscitate (DNR) Involuntary euthanasia Voluntary euthanasia Do-not-intubate (DNI)

Do-not-resuscitate (DNR) Rationale: A​ do-not-resuscitate order​ (DNR) is a medical order that states the​ client's wishes to withhold cardiopulmonary resuscitation​ (CPR) in the event of respiratory or cardiac arrest. A​ do-not-intubate order​ (DNI) prohibits endotracheal intubation in the event of severe respiratory failure or respiratory arrest. Voluntary euthanasia occurs when the client or the​ client's family gives consent for the actions that will result in death for the client. Involuntary euthanasia is defined as euthanasia performed against the wishes of the client or the​ client's family.

The nurse is caring for a pregnant client who appears to be experiencing discomfort related to the pregnancy. What content should the nurse include in the teaching plan to enhance comfort for this client? (Select all that apply.) Drinking enough water Getting enough rest Eating a balanced diet Taking over-the-counter pain medication Refraining from daily exercise

Drinking enough water Getting enough rest Eating a balanced diet Rationale: The pregnant client who is experiencing discomfort related to pregnancy should be taught the importance of adequate​ nutrition, hydration, and sleep and rest. The pregnant client should not be encouraged to take​ over-the-counter pain medication unless directed by the healthcare provider. The nurse would provide tips on daily​ activity, but the pregnant client would not need to refrain from daily exercise.

The nurse is providing education regarding dietary risk for prostate cancer. Which food would the nurse prioritize as carrying the highest risk? Fish Vegetables Fruits Dairy

Dairy ​Rationale: Diets high in animal​ fat, such as dairy​ products, increase the risk for prostate cancer.​ Vegetables, fruits, and fish would be acceptable dietary choices.

During a staff​ in-service, an attendee asks if there are any other disease processes that commonly occur with fibromyalgia. Which condition should the nurse list as a comorbidity with this health​ problem? Depression Cardiovascular disease Peptic ulcer disease Lupus

Depression Rationale: Depression is often a comorbidity with fibromyalgia that requires treatment. Peptic ulcer​ disease, cardiovascular​ disease, and lupus are not.

The nurse has been asked to serve as a point person for a family with a child who is dying in the PICU. Which function should the nurse prepare to perform in this​ role? Address the emotional and informational needs of the family. Organize care​ before, during, and after death. Articulate the​ family's wishes to the healthcare team. Develop a trusting relationship with the parents.

Develop a trusting relationship with the parents. Rationale: The point person will develop a trusting and unique relationship with the parents while their child is in the PICU. The family advocate will help to articulate the​ family's wishes to the healthcare team. The family supporter will address the emotional and informational needs of the family. The​ end-of-life coordinator will organize care​ before, during, and after death.

Which modifiable risk factor should the nurse assess to determine the risk of cancer development in a client? (Select all that apply.) Age Diet Tobacco use Sun exposure Family history

Diet Tobacco use Sun exposure ​Rationale: Modifiable risk factors are those that can be changed by the client. These include​ diet, tobacco​ use, and sun exposure. Nonmodifiable risk​ factors, such as age and family​ history, cannot be changed.

A client with fibromyalgia is prescribed a serotonin-norepinephrine reuptake inhibitor. Which side effect of the medication should the nurse include when teaching the client about this​ medication? (Select all that​ apply.) Dizziness Dry mouth Increased sleepiness Diarrhea Nausea

Dizziness Dry mouth Nausea Rationale: Common side effects of selective serotonin-norepinephrine reuptake inhibitors include dry​ mouth, nausea, and​ dizziness; constipation​ (not diarrhea) and insomnia​ (not increased​ sleepiness) are also common side effects.

The nurse is interviewing a client admitted with a diagnosis of prostate cancer and questions the client regarding his symptoms. Which symptom, if experienced by the client, supports the diagnosis? (Select all that apply.) Dysuria Polyuria Nocturia Frequent urination Reduction in urinary stream

Dysuria Nocturia Frequent urination Reduction in urinary stream Rationale: Dysuria is painful or difficult urination that occurs because of prostatic cancer. As the tumor​ grows, it can compress the​ urethra, leading to urinary obstruction. The tumor may metastasize directly into the seminal vesicles or bladder or may spread via the lymphatic and venous systems. Other manifestations of prostate cancer include​ hematuria, nocturia, increased urinary​ frequency, reduction in urinary​ stream, and abnormal prostate on digital rectal exam. Polyuria is not a symptom of prostate cancer.

The nurse admits a client from the postanesthesia care unit post wedge resection for a lung tumor. Which action should the nurse take first? Provide reassurance and emotional support. Document the pulse, respiratory rate, and blood pressure. Check the dressing for drainage. Elevate the head of the bed to 60 degrees.

Elevate the head of the bed to 60 degrees. ​Rationale: Elevating the head of the bed to 60 degrees reduces pressure on the diaphragm and allows for lung​ expansion, making it easier for the client to breathe. Airway and breathing needs always take priority. Documentation is always the last​ step, after all client needs are met. Emotional needs should be met after all physical needs are met.

The nurse is providing discharge teaching to the parent of a​ 12-year-old child with leukemia. Which recommendation by the nurse is most​ appropriate? Keep consistent meal and bedtime regimes. Explore how to teach the child at home until full recovery. Encourage the child to return to school as soon as possible. Allow the child to refrain from schoolwork during periods of hospitalization.

Encourage the child to return to school as soon as possible. ​Rationale: School-age children may show anger and sadness over the losses they are experiencing and look for more emotional and social support from their friends and family.​ Therefore, they should return to school as soon as possible after diagnosis and teachers should be made aware of their situation. Arrangements should be made for tutors to assist the child with schoolwork during hospitalization and home care if needed.​ Infants, toddlers, and young children should be assisted to maintain feeding and bedtime routines as much as​ possible, whereas a​ 12-year-old child is able to handle more independence and control.

The nurse is discussing risks of external beam radiation for prostate cancer. The nurse would include which risk in this teaching? (Select all that apply.) Increased testosterone Erectile dysfunction Improved libido Urinary incontinence Rectal damage

Erectile dysfunction Urinary incontinence Rectal damage Rationale: Erectile​ dysfunction, urinary​ incontinence, and rectal damage can occur as a result of external beam radiation. Radiation would not increase testosterone levels or improve libido.

A client diagnosed with colon cancer is preparing to undergo electrocoagulation of the tumor. The nurse understands that the client will undergo which procedure? Local excision Sigmoid colostomy Laser photocoagulation Fulguration

Fulguration ​Rationale: Fulguration is the use of electrocoagulation to shrink tumors and is used for clients who are poor surgical risks. Local excision is used for small​ tumors, performed during​ endoscopy, and does not use electrocoagulation. Laser​ photocoagulation, not​ electrocoagulation, is used during endoscopic procedures. A sigmoid colostomy is an excision of the tumor with a permanent colostomy and does not use electrocoagulation.

A 52-year-old client is admitted to the hospital and, after careful evaluation, is diagnosed with malignant melanoma. Which factor would determine the prognosis of this case? (Select all that apply.) Gender Metastasis Allergy status Family history Past medical history

Gender Metastasis Rationale: The prognosis for survival among people diagnosed with malignant melanoma is determined by several​ variables, including tumor​ thickness, ulceration,​ metastasis, site, and the​ client's age and gender. Younger clients and women have a somewhat better chance of survival.

The client asks the nurse about biofield therapies to help with chronic pain. Which information should the nurse include about the use of biofield therapies? (Select all that apply.) Biofield therapies have been around for quite a long time, but they really have no value other than people thinking that they work. There is a large repository of evidence that indicates the clinical efficacy of biofield therapy in effectively reducing pain. Evidence supports the use of these therapies to help people deal with painful experiences. This complementary alternative therapy has no side effects or interaction with other treatments. They balance the energy fields in the body that are disrupted by physiologic imbalances.

Evidence supports the use of these therapies to help people deal with painful experiences. This complementary alternative therapy has no side effects or interaction with other treatments. They balance the energy fields in the body that are disrupted by physiologic imbalances. ​Rationale: Evidence supports the use of these therapies to help people deal with painful​ experiences; they have no side​ effects, nor do they interact with other​ treatments; and they balance the energy fields in the body that are disrupted by physiologic imbalances.​ However, evidence does not yet support clinical efficacy.The statement that they really have no value is a subjective opinion and should not be included in the information provided to the client.

The nurse prepares a teaching plan for a client with fibromyalgia. Which area should the nurse include in this​ teaching? (Select all that​ apply.) Examples of mild to moderate exercise Nonpharmacologic methods of pain relief The importance of adhering to an​ around-the-clock schedule of narcotic analgesics Identification of resources and support systems Strategies for improving quality of sleep

Examples of mild to moderate exercise Nonpharmacologic methods of pain relief Identification of resources and support systems Strategies for improving quality of sleep Rationale: Narcotics are not the treatment of choice for fibromyalgia pain because their side effects may lead to tolerance and dependence and worsen other fibromyalgia symptoms such as fatigue and activity intolerance. Nonpharmacologic methods of pain​ control, support​ systems, exercise, and improved sleep patterns are effective in improving symptoms and quality of life.

The nurse could expect to prepare a client with a small rectal cancer for which procedure? (Select all that apply.) External radiation Systemic radiation Interstitial radiation Intracavity radiation Implantation radiation

External radiation Intracavity radiation Implantation radiation ​Rationale: Small rectal cancers may be treated with​ intracavity, external, or implantation radiation. Systemic radiation therapy entails a client swallowing or receiving radiation intravenously. Interstitial radiation requires the implants to be placed near or in the​ tumor, not in a body cavity.

When assessing a client diagnosed with melanoma, which assessment should the nurse include in the client's health history? Inspection of skin color Measurement of skin lesions Palpation of skin texture Family history of skin cancer

Family history of skin cancer ​Rationale: During the health history portion of the nursing​ assessment, the nurse would assess for a family history of skin cancer. Inspection of skin​ color, palpation of the​ texture, and measurement of lesions would be completed during the physical examination of the nursing assessment.

The nurse is conducting a presentation on the early detection of colon cancer. Which should the nurse encourage members of the audience to report to their healthcare​ providers? (Select all that​ apply.) Fatigue Bowel changes Rectal bleeding Negative fecal occult blood testing Unexplained weight loss with adequate nutritional intake

Fatigue Bowel changes Rectal bleeding Unexplained weight loss with adequate nutritional intake ​Rationale: Risk factors in the health history that the nurse would encourage the audience to report to their healthcare providers include unexplained weight​ loss, bowel​ changes, rectal​ bleeding, and fatigue. A negative fecal occult blood testing would not be reported to the healthcare provider.

The nurse examining a client notices a skin lesion exhibiting the characteristics of early stage malignant melanoma. Which feature would the nurse have observed? (Select all that apply.) Flat Raised Asymmetric More than 3 mm in diameter More than 6 mm in diameter

Flat Asymmetric More than 6 mm in diameter ​Rationale: Almost all malignant melanomas are more than 6 mm in​ diameter, are​ asymmetric, and initially develop within the epidermis over a long period. While confined to the​ epidermis, the lesions are flat and relatively benign.

A client is requesting to sign a document that designates someone to make healthcare decisions in case they are not able to do it. Which document should the nurse recommend to this client? Living will Healthcare proxy DNR order Durable power of attorney

Healthcare proxy Rationale: A healthcare proxy designates an individual to make healthcare decisions in case the client is not able. A durable power of attorney allows the selected individual to make legal decision for the client. A living will describes the​ client's treatment preferences for​ life-prolonging treatment. A DNR order is also known as a​ do-not-resuscitate order and allows the healthcare team to withhold​ life-saving measures in the event of a cardiac or respiratory arrest.

The nurse is assessing a client for risk factors associated with colorectal cancer. Which finding in the health history would indicate the client is at risk? History of heart disease History of polyps Long-term use of laxatives Weight gain

History of polyps ​Rationale: A history of polyps is a risk factor determined in the health history portion of the nursing assessment that supports the risk for colorectal cancer. Weight​ loss, not weight​ gain, would also support colorectal cancer.​ Long-term use of laxatives and a history of heart disease are not considered risk factors for colorectal cancer.

A client with fibromyalgia asks why a selective serotonin and norepinephrine reuptake inhibitor is prescribed for the health problem. Which should the nurse explain as the rationale for this​ medication? Increase levels of dopamine and serotonin Relax the client and promote sleep Decrease joint pain and swelling Reduce neuropathic pain

Increase levels of dopamine and serotonin Rationale: A selective serotonin and norepinephrine reuptake inhibitor​ (SSNRI) is prescribed to a client with fibromyalgia to increase serotonin and norepinephrine levels. This medication is not prescribed to reduce neuropathic​ pain, decrease swelling of​ joints, or relax the client to promote sleep. A​ gamma-aminobutyric acid​ (GABA) analog is prescribed to reduce neuropathic pain. Nonsteroidal​ anti-inflammatory drugs are prescribed to decrease swelling of joints. A selective serotonin reuptake inhibitor​ (SSRI) is prescribed to promote sleep.

The nurse observes a client who is approaching end of life. For which reason should the nurse realize this client's blood pressure is beginning to decrease? Rapid heart rate Increasing confusion Decreasing body temperature Warm, clammy skin

Increasing confusion Rationale: Signs and symptoms of hypotension include​ confusion, cool​ skin, irregular​ pulse, blurry​ vision, and dizziness. Rapid heart​ rate, decreasing body​ temperature, and clammy skin are not indicative of hypotension.

The nurse prepares an educational program on palliative care for a group of oncology nurses. For which age group should the nurse emphasize that palliative care is often neglected? Infants Children Older adults Adolescents

Infants ​Rationale: Palliative care tends to be neglected in infants and very young​ children, though they should receive this type of care in the same way that adults do. Nurses are more likely to identify​ children, adolescents,​ adults, and older adults as potential candidates for palliative care.

A 49-year-old client presented to the healthcare provider's office for an annual physical examination. During his health history, the nurse noted risk factors for colon cancer. Which did the nurse note during this client's health history to determine a risk for colon cancer? A diet high in fruits and vegetables Regular exercise Diabetes mellitus Irritable bowel disease

Irritable bowel disease Rationale: A client with a history of irritable bowel disease is at risk for colon cancer. Diabetes mellitus is not a known risk factor for colon cancer. Engaging in regular exercise and eating a diet high in fruits and vegetables are preventive factors for colon cancer.

The nurse discusses fibromyalgia with a group of community members during a health fair. Which characteristic of pain should the nurse explain to this​ group? (Select all that​ apply.) Is not the result of inflammation or damage Occurs mainly in fingers and toes Often described as superficial or achy Sensitivity to stimuli that are not normally painful Increased response to painful stimuli

Is not the result of inflammation or damage Sensitivity to stimuli that are not normally painful Increased response to painful stimuli ​Rationale: The pain in fibromyalgia presents as an increased response to painful stimuli and sensitivity to stimuli​ (heat, cold, or​ pressure) that are not normally painful. It occurs above and below the waist on both the left and right sides of the body. The pain is not the result of inflammation or tissue damage but results from the central amplification of pain signals. The pain is often described as​ deep, stabbing,​ gnawing, or burning.

The nurse is caring for a client with Lynch syndrome. Which understanding of the nurse is accurate regarding the​ cancer? It is associated with diets high in​ meat, protein, and fat. It tends to occur at a younger age. It is an autosomal recessive disorder. It primarily affects the descending colon.

It tends to occur at a younger age. ​Rationale: Lynch syndrome is a hereditary nonpolyposis colorectal cancer. Lynch syndrome is an autosomal dominant disorder that significantly increases the risk of colorectal cancers. Tumors affected by Lynch syndrome often affect the ascending colon and tend to occur at an early age. Although diets high in​ meat, protein, and fat can be a contributory factor in the development of colorectal​ cancer, it is not specifically an issue with Lynch syndrome due to its hereditary component.

Which statement regarding comfort is true? (Select all that apply.) It varies from one individual to another. It is objective. It can be associated with sleep and rest. It is subjective. It can be assessed by vital signs.

It varies from one individual to another. It can be associated with sleep and rest. It is subjective. ​Rationale: Comfort can be associated with sleep and​ rest, is​ subjective, and varies from one individual to another.​ "Normal" vital signs are unreliable in assessing comfort.

The nurse assigns a client with lung cancer the nursing diagnosis of Activity Intolerance (NANDA-I ©2014). Which intervention should the nurse include in the care plan? Encourage the client to remain in bed as much as possible. Plan care to cluster activities. Discourage the client's family from providing assistance to the client. Keep frequently-used objects within the client's easy reach.

Keep frequently-used objects within the client's easy reach. Rationale: Keeping frequently used objects within easy reach allows the client to conserve energy. Family assistance should be encouraged. The maintenance of physical activity to the level of tolerance should be encouraged. Nursing activities should be alternated with frequent rest periods.

The nurse notes that several terminally ill pediatric clients do not have advanced care planning. The nurse should recognize that which are the top three barriers that hinder the completion of this planning? (Select all that apply.) Lack of formal pediatric palliative care training by the healthcare provider Lack of parent readiness to discuss the need for palliative care Differences in understanding of the child's prognosis between clinicians and parents Lack of financial means Unrealistic parent expectations

Lack of parent readiness to discuss the need for palliative care Differences in understanding of the child's prognosis between clinicians and parents Unrealistic parent expectations ​Rationale: The top three barriers to advanced care planning for children are unrealistic parental​ expectations, differences in understanding of the​ child's prognosis between clinicians and​ parents, and lack of parent readiness to discuss the need for palliative care. Lack of financial means and lack of formal pediatric palliative care training are other barriers for care but are not among the top three.

During an assessment a client explains that discomfort only occurs when using a rowing machine at a local fitness facility. Under which area of the comfort assessment should the nurse document this finding? Client history Observation Lifestyle Current problem

Lifestyle ​Rationale: During a comfort assessment questions are used to determine lifestyle behaviors that may be related to the​ discomfort, such as discomfort that occurs during exercise.​ Thus, this information would best fit within the lifestyle assessment​ area, not​ observation, client​ history, or current problem.

The nurse is providing teaching to a client receiving brachytherapy. Which point would the nurse prioritize? (Select all that apply.) Limit close contact with others. Wear condoms during intercourse. Assess skin for irritation. Report urinary frequency. Only wear cotton underwear.

Limit close contact with others. Wear condoms during intercourse. Report urinary frequency. ​Rationale: Limiting close contact and wearing condoms will decrease exposure to others. Brachytherapy can cause urinary frequency. Skin irritation is not common with brachytherapy. The client can wear underwear that is​ comfortable; it does not have to be cotton only.

A client was diagnosed with malignant melanoma following careful evaluation of a skin lesion. The nurse explains to the client that the level of invasion of the tumor and its maximum thickness will be measured. The nurse is referring to which assessment? Biopsy Palpation Excision Microstaging

Microstaging ​Rationale: Microstaging describes the assessment of the level of invasion of a malignant melanoma and the maximum tumor thickness. In the Clark system of​ microstaging, the vertical growth of the lesion is measured from the epidermis to the subcutaneous tissue to determine the level of invasion. Biopsy is examination of tissue removed from the body to discover the​ presence, cause, or extent of disease. Palpation is using the hands to examine the body. Excision is the surgical removal of tissue.

Which potential nursing diagnosis is most likely to be considered for the client with colorectal cancer? Self-Care Deficit, Toileting Skin Integrity, Impaired Cardiac Output, Decreased Nutrition, Imbalanced: Less than Body Requirements

Nutrition, Imbalanced: Less than Body Requirements Rationale: Nursing diagnoses for clients with colorectal cancer are individualized to each​ client's needs and may include Nutrition​ Imbalanced: Less than Body Requirements due to the side effects of the treatment and disease process. Pressure injury may occur if the client is immobile​ and/or nutritional needs are not met. ​Self-Care Deficit, Toileting is a possible​ diagnosis, but imbalanced nutrition is more universally consistent for a client with colorectal cancer. Cardiac output should not be affected in a client with colorectal cancer unless there is active bleeding.

A client is being seen in a gastrointestinal clinic for complaints of painless rectal bleeding, diarrhea, and abdominal cramping. The client asks the nurse about the risk factors for colorectal cancer. Which risk factor will the nurse include in the teaching session for this client? (Select all that apply.) Obesity Smoking Alcohol use Over 30 years of age Radiation exposure

Obesity Smoking Alcohol use Radiation exposure ​Rationale: The cause of colorectal cancer is​ unknown, but there are risk factors associated with the development of the disease. These risk factors include being older than 50 years of​ age; alcohol​ use; smoking;​ obesity; family​ history; inflammatory bowel​ disease; diet high in​ calories, meat​ proteins, and​ fats; previous radiation​ exposure; history of​ colorectal, ovarian,​ breast, or endometrial​ cancer; and polyps in the colon and rectum.

The nurse is providing care for a child who is experiencing discomfort due to intermittent urinary catheterizations. Which should the nurse encourage the family to do during the procedure to most appropriately enhance comfort for the child? Explain the procedure each time before it is performed to ensure understanding. Hold the child while the procedure is being performed. Offer the child a treat such as a sticker or a small toy after the procedure. Offer a distraction during the procedure.

Offer a distraction during the procedure. Rationale: For the child experiencing discomfort during a procedure such as​ this, it would be most appropriate to encourage the parents to distract the child. Holding the child would likely complicate completion of the procedure and would not be the best option. While offering the child a treat or small toy after the procedure may help encourage them to cooperate with the​ procedure, it would not be the most appropriate option to enhance comfort. Explaining procedures can help to decrease​ anxiety, but doing so each time may not necessarily enhance comfort.

The nurse is providing care to a client who is approaching the end of life. Which intervention most directly helps to promote psychosocial comfort? Providing adequate pain relief with pharmacologic agents Reviewing advance directives to ensure end-of-life care desires Removing all tubes and medical monitoring devices Offering to arrange a visit from a spiritual leader or loved ones

Offering to arrange a visit from a spiritual leader or loved ones Rationale: Offering to arrange a visit by a spiritual leader or loved ones can help to enhance psychosocial comfort.​ Pain-relief medications can help to enhance physical comfort. Reviewing advance directives can help to ensure that​ end-of-life decisions are honored. Removing all tubes and medical devices will not necessarily enhance psychosocial comfort.

Which screening test is used to detect prostate cancer? CA 125 Sigmoidoscopy Mammography PSA

PSA Rationale: PSA is the screening test for prostate cancer. CA 125 is a tumor marker for ovarian cancer. Sigmoidoscopy is a screening test for colon cancer. Mammography is a screening test for ovarian cancer.

Which laboratory test is performed to screen for prostate cancer? BNP CBC CMP PSA

PSA ​Rationale: PSA is the screening test for prostate cancer. CBC and CMP may be performed to provide a baseline prior to​ treatment; however, they are not diagnostic for prostate cancer. BNP is a test to assess clients with heart failure.

The nurse is discussing the most common symptom associated with diagnosis of advanced prostate cancer. Which symptom would the nurse include? Nausea Edema Pain Diarrhea

Pain Rationale: Pain is the most common symptom associated with prostate cancer due to bone metastasis. Prostate cancer in the early stages is often asymptomatic.​ Nausea, diarrhea, and edema are not generally associated with prostate cancer symptoms.

Which assessment finding would the nurse expect to find in a client with a new diagnosis of pernicious anemia? (Select all that apply.) Pallor Weakness Constipation Sore, red tongue Spoon-shaped nails

Pallor Weakness Sore, red tongue ​Rationale: Pernicious anemia is a vitamin B12 deficiency due to lack of intrinsic factor. This causes​ pallor, weakness, and a​ sore, red, beefy tongue. B12 deficiency causes​ diarrhea, not constipation.​ Spoon-shaped nails are a sign of​ iron-deficiency anemia.

Which area should the nurse include when conducting the focused physical examination portion of the nursing assessment for a client with​ fibromyalgia? Pattern of fatigue Duration of pain Palpation of tenderness points Symptom severity scale

Palpation of tenderness points Rationale: Palpation is an element of the physical examination portion of the nursing assessment. Duration of​ pain, fatigue​ pattern, and symptom severity scale are elements of the health history portion of the nursing assessment.

The nurse is providing education to a client who has undergone a radical prostatectomy. Teaching on which topic is mostly likely to help decrease symptoms of urinary incontinence? The use of a condom catheter Pelvic floor exercises Estrogen cream application Placement of a urostomy

Pelvic floor exercises ​Rationale: Urinary incontinence may occur due to prostate surgery for benign prostate​ hyperplasia, or prostate cancer. Pelvic floor muscle exercises such as Kegel exercises help to strengthen the pelvic muscles. Reductase inhibitors decrease the outlet resistance in overflow incontinence. Condom catheters would be used if the client was unable to control the flow of urine. Estrogen creams are used to treat females with urge incontinence. A urostomy is performed to bypass the urethra and cure bladder incontinence after trauma or surgery.

The nurse is providing teaching to a client to promote urinary elimination following a transurethral resection of the prostate. Which instruction should the nurse include? Void at intervals of 4-6 hours. Take testosterone as prescribed. Increase fluid intake. Perform pelvic floor exercises.

Perform pelvic floor exercises. Rationale: Pelvic floor exercises will strengthen the pelvic floor and decrease stress incontinence. Increasing fluid intake can contribute to incontinence. Voiding should be every 2-4 hours. Testosterone would not be prescribed for urinary incontinence.

A nurse is caring for a client who is hospitalized because of a fractured femur. The client tells the nurse that it is difficult to get any sleep while in the hospital. What action should the nurse take to minimize environmental stimuli in the hospital environment? (Select all that apply.) Adjusting window coverings to block outside lights during the day and night Performing only essential activities in the client's room during sleeping hours Minimizing noise from staff interactions Keeping the client's door closed Placing the client in a single-bed room when possible

Performing only essential activities in the client's room during sleeping hours Minimizing noise from staff interactions Keeping the client's door closed Placing the client in a single-bed room when possible ​Rationale: To reduce environmental stimuli in the hospital​ environment, the nurse should do all the stated​ actions, except adjust window coverings to block outside lights during the day and night. The window coverings should be adjusted only at​ night; during the​ day, the window coverings should be left open to let in natural light.

The nurse reviews the universal aspects of comfort with a group of staff members. Which statement should the nurse include? (Select all that apply.) Emotional needs are higher priority than are physiological needs. Physiological needs include oxygen, shelter, food, water, and sleep. Emotional needs include love and belonging from family and friends. When physiological needs are met, other needs can be achieved. Giving and receiving respect are aspects of self-esteem needs.

Physiological needs include oxygen, shelter, food, water, and sleep. Emotional needs include love and belonging from family and friends. When physiological needs are met, other needs can be achieved. Giving and receiving respect are aspects of self-esteem needs. Rationale: Physiological needs include​ oxygen, shelter,​ food, water, and sleep. When physiological needs are​ met, other needs can be achieved. Emotional needs include love and belonging from family and friends. Giving and receiving respect are aspects of​ self-esteem needs.

The nurse is caring for a client who received chemotherapy for colon cancer and is at risk for bone marrow suppression. Which laboratory result should the nurse monitor? Vitamin B12 Platelet count Carcinoembryonic antigen (CEA) level Folic acid

Platelet count ​Rationale: The nurse would monitor the​ client's platelet count to check for signs of bone marrow suppression. The CEA level is a tumor marker detected in the blood of clients with colorectal cancer. If​ anemia, rather than colon​ cancer, were the​ problem, then monitoring folic acid and B12 levels would be appropriate.

The nurse prepares to visit the home of a client recovering from a mastectomy for breast cancer. Which should be included in the ongoing care of this​ client? (Select all that​ apply.) Postmastectomy exercises Signs and symptoms of infection Importance of adequate rest periods Possible participation in a support group Keeping the affected limb immobile as much as possible

Postmastectomy exercises Signs and symptoms of infection Importance of adequate rest periods Possible participation in a support group Rationale: The ongoing care of the client who has undergone surgical interventions for breast cancer include telling about the importance of adequate​ rest, talking about signs and symptoms of​ infection, teaching postmastectomy​ exercises, and possibly participating in a support group. The client should be encouraged to use the affected limb for daily needs to maintain function and​ strength; the client should not keep it immobile.

The nurse is teaching the client about the use of radiation for prostate cancer. Which fact would the nurse include in the teaching? (Select all that apply.) Precautions are necessary regarding pregnant women. It is unacceptable to share bathrooms with other members of the household. There is no restriction regarding close exposure with other members of the household. It is recommended that the client use condoms during intercourse. Sleep in a room alone for the first week to minimize prolonged exposure to others.

Precautions are necessary regarding pregnant women. It is recommended that the client use condoms during intercourse. Sleep in a room alone for the first week to minimize prolonged exposure to others. ​Rationale: Precautions must be taken regarding the close contact with all persons in the​ household, especially children and pregnant women. Using a separate bathroom is not required. Condoms are needed to reduce radiation exposure during intercourse. It is also recommended that the client sleep alone for the first week to minimize exposure.

The nurse is preparing a poster on prostate cancer for display at a health fair. Which information should the nurse include on the poster? (Select all that apply.) Prostate cancer occurs more often in African American men than in Caucasian American men. Prostate cancer is the most common type of cancer among men. Prostate cancer is the second leading cause of death in North America. Prostate cancer confined to the prostate has a 100% survival rate at 5 years. Prostate cancer incidence is reduced in men who take large amounts of vitamin A.

Prostate cancer occurs more often in African American men than in Caucasian American men. Prostate cancer is the most common type of cancer among men. Prostate cancer is the second leading cause of death in North America. Prostate cancer confined to the prostate has a 100% survival rate at 5 years. Rationale: Prostate cancer is the most common type of cancer among men and is the second leading cause of death in North America. When confined to the​ prostate, the​ 5-year survival rate is​ 100%. If the cancer spreads​ regionally, the survival rate is​ 95% after 5 years. This disease occurs in African American men at a rate of more than​ 60% higher than seen in Caucasian American men. Asian Americans and Native Americans have the lowest incidence of prostate cancer. Taking large amounts of vitamin A does not reduce the incidence of prostate cancer.

The nurse is caring for a client receiving chemotherapy and radiation. Which intervention should the nurse include to protect the client from​ infection? (Select all that​ apply.) Provide skin care. Administer antiemetics. Instruct the client to avoid crowds. Perform good handwashing. Include strict aseptic technique.

Provide skin care. Instruct the client to avoid crowds. Perform good handwashing. Include strict aseptic technique. ​Rationale: As the skin is a​ person's first line of​ defense, maintaining intact skin integrity is imperative. The nurse should instruct the client to avoid crowds to prevent infection. The nurse should implement good handwashing and maintain strict aseptic technique to protect the client.

The spouse of a terminally ill client who has just passed away sits at the​ bedside, holds the​ client's hand, and cries softly. What action should the nurse take to support the spouse at this​ time? (Select all that​ apply.) Provide the spouse with water and tissues. Remind the spouse that the client will need to be moved in a short while. Ask if the spouse would like to talk with someone about the​ client's death. Ask if there is anyone that should be contacted at this time. Ask if there is a particular funeral home that should be contacted.

Provide the spouse with water and tissues. Ask if the spouse would like to talk with someone about the​ client's death. Ask if there is anyone that should be contacted at this time. Ask if there is a particular funeral home that should be contacted. ​Rationale: Considerations for the family at the end of life include assisting the family to cope with the​ client's health status. Interventions should focus on providing the family with emotional support and referring the family to funeral​ homes, grief​ counseling, and support groups if appropriate. The nurse should provide the spouse with water and tissues to help meet physical needs. Asking if there is anyone that should be contacted helps to meet the​ spouse's psychosocial needs. Asking about a funeral home or if the spouse would like to talk with someone about the​ client's death helps meet the​ spouse's grieving needs. Reminding the spouse that the client will need to be moved does not support any of the​ spouse's needs at this time.

A​ 29-year-old client received a diagnosis of pancreatic cancer 2 weeks ago. He complains of having severe nausea and vomiting. He has not been able to progress to a full diet. Which is an example of a collaborative intervention that might decrease the​ client's symptoms? Providing antiemetic drugs before meals Adding flavorful spices to season the food Performing regular assessments frequently Talking about macronutrients and micronutrients

Providing antiemetic drugs before meals ​Rationale: Providing antiemetic drugs before meals is a collaborative effort with the prescribing healthcare provider. No prescription or collaboration is needed for performing regular assessments​ frequently, or for talking about macronutrients and micronutrients. Adding more spices might increase nausea and vomiting due to heightened GI sensitivity.

The nurse is caring for a client who is in pain because of a back spasm. Which independent nursing intervention should the nurse use for this client? (Select all that apply.) Providing distractions Ordering physical therapy for the client Administering analgesics as ordered Positioning the client to promote comfort Applying heat or cold as appropriate

Providing distractions Positioning the client to promote comfort Applying heat or cold as appropriate Rationale: Independent nursing interventions for a client in discomfort include applying heat or cold as​ appropriate, providing​ distractions, and positioning the client to promote comfort. Administering analgesics and ordering physical therapy are collaborative interventions.

The community health nurse conducting a teaching session on lung cancer explains that smoking is the leading risk factor for lung cancer. Which additional risk factor should the nurse include in the teaching? (Select all that apply.) Radon exposure Ionizing radiation Asbestos Exposure to the sun Lack of physical activity

Radon exposure Ionizing radiation Asbestos Rationale: Radon​ (a radioactive gas present in​ closed-in spaces in the​ environment), ionizing​ radiation, and asbestos are all risk factors for lung cancer. Exposure to the sun is a risk factor for skin cancer. Lack of physical activity is not a risk factor for lung cancer.

The nurse is interviewing a client admitted with lung cancer. Which symptom reported by the client would be consistent with this diagnosis? Recent weight loss of 10 pounds over 3 weeks Respiratory rate of 20 breaths per minute Cough of 1-week duration productive of yellow mucus Nausea and vomiting

Recent weight loss of 10 pounds over 3 weeks ​Rationale: Sudden,​ rapid, unexplained weight loss is one systemic symptom of lung cancer. Other systemic and paraneoplastic manifestations include​ anorexia, fatigue, and​ weakness; bone​ pain, tenderness, and​ swelling; clubbing of the fingers and​ toes; and various​ endocrine, neuromuscular,​ cardiovascular, and hematologic symptoms. Nausea and vomiting are generic symptoms not specific to lung cancer. A productive cough of short duration is more likely to be a symptom of a respiratory​ infection, cold, or flu. A respiratory rate of 20 breaths per minute is within the normal range.

Where do most tumors develop in colorectal​ cancer? (Select all that​ apply.) Rectum Sigmoid colon Ascending colon Transverse colon Descending colon

Rectum Sigmoid colon ​Rationale: Although any portion of the colon may be​ affected, most tumors develop in the rectum and sigmoid colon.

The nurse prepares a teaching poster for placement in a women's health clinic. Which activity should the nurse identify to help prevent breast cancer? (Select all that apply.) Refraining from smoking Engaging in physical activity Completing monthly self-breast exams Limiting hormone therapy in duration and dose Avoiding exposure to environmental pollution and radiation

Refraining from smoking Engaging in physical activity Limiting hormone therapy in duration and dose Avoiding exposure to environmental pollution and radiation ​Rationale: Refraining from​ smoking, engaging in physical​ activity, limiting hormone therapy in duration and​ dose, and avoiding exposure to environmental pollution and radiation can all help prevent the development of breast cancer. Completing monthly​ self-breast exams can help detect breast cancer early but does not prevent breast cancer.

Which plan of care does the nurse anticipate for a client with a family history of adenomatous polyposis? Annual colonoscopy Removal of colon Genetic testing Genetic counseling

Removal of colon ​Rationale: Genetic factors are strongly linked to the risk of colorectal cancer. A family history of the disease increases the risk for its​ development; therefore, genetic testing and counseling is important for the client. Individuals with familial adenomatous polyposis will inevitably develop colon cancer unless the colon is removed. An annual colonoscopy is not a plan of treatment for the individual with familial adenomatous​ polyposis; removal of the colon is recommended.

The adult daughter of a client who is nearing death questions the quality of care being provided to the client. What should the nurse do to support the​ daughter's needs during the dying​ process? Respond to the​ daughter's concerns. Ask the healthcare provider to talk with the daughter. Permit the daughter to spend uninterrupted time with the client. Suggest that the daughter go home to get some rest.

Respond to the​ daughter's concerns. Rationale: The nurse needs to support the family through the grieving process. To do​ this, the nurse should respond to the​ daughter's concerns. Suggesting that the daughter go home to get some rest does not address the​ daughter's concerns about quality of care. The nurse can talk to the daughter about the quality of care and does not need to contact the healthcare provider. Permitting the daughter to spend uninterrupted time with the client might exacerbate the feeling that care is less than optimal.

The community nurse is conducting a class on smoking cessation. The nurse discusses the danger of secondhand smoke. Which information is incorrect regarding secondhand smoke? Secondhand smoke is a cause of cancer. Secondhand smoke increases the risk of developing bladder cancer. Secondhand smoke is more detrimental to adults than to children. Secondhand smoke increases the risk of developing brain tumors.

Secondhand smoke is more detrimental to adults than to children. Rationale: Secondhand smoke is more detrimental to children than adults because​ children's cells are more rapidly growing and dividing. Secondhand smoke increases the risk of developing many types of​ cancer, including brain tumors in children and bladder cancer in adults.

The nurse uses Maslow's hierarchy of needs to help identify a client's care issues. What should the nurse recall as being the highest level of this hierarchy? Love and belonging Self-esteem Safety and security Self-actualization

Self-actualization ​Rationale: According to​ Maslow's hierarchy of​ needs, the highest level of basic human need is​ self-actualization. The other answer choices are levels of the​ hierarchy; however, they are incorrect choices.

Which nursing assessment should the nurse consider a priority for the client 2-weeks postcolostomy? Nausea and vomiting Physical mobility Sexual dysfunction Pain management

Sexual dysfunction Rationale: The risk of sexual dysfunction should be a priority concern for a client with a colostomy.​ Psychologically, clients with an ostomy experience an altered body image and may experience low​ self-esteem. The client may be concerned about odors or pouch leakage during sexual​ activity; this emotional distress can contribute to sexual dysfunction. A colostomy should not affect the​ client's physical​ mobility, cause​ nausea, vomiting, or pain​ 2-weeks postsurgery.

The nurse is providing teaching to a client who will begin radiation therapy for prostate cancer. Which information should the nurse include regarding sexual function? Testosterone will be given to assist sexual function. It is not necessary to use condoms during intercourse. Sexual function will not be impaired. Sexual function may be impaired.

Sexual function may be impaired. Rationale: Sexual function may be impaired. Testosterone would not be​ used, as tumors could be androgen dependent. Condoms would be recommended during intercourse to protect the​ client's partner from radiation.

Which of the following is a way that the nurse can help a client with breast cancer who is experiencing anticipatory grieving before her double​ mastectomy? (Select all that apply.) Denial Silence Venting Active listening Nonverbal support gestures

Silence Active listening Nonverbal support gestures Rationale: The nurse can use active​ listening, silence, and nonverbal support gestures to help the client. Neither denial nor venting is helpful.

The nurse wants to help with a terminally ill​ client's discomfort. Which complementary and alternative therapy should the nurse consider for this​ client? (Select all that​ apply.) Simple touch Acupressure Yoga Massage Biofeedback

Simple touch Massage Rationale: The interventions of massage and simple touch have been found effective to reduce pain and improve mood in the client nearing the end of life.​ Yoga, biofeedback, and acupressure are not identified as complementary and alternative therapies used during​ end-of-life nursing care.

The nurse reviews data collected during an assessment of a terminally ill client. Which nursing diagnosis should the nurse select as this client nears​ death? (Select all that​ apply.) Sleep​ Pattern, Disturbed Tissue​ Integrity, Impaired Fluid​ Volume: Deficient, Risk for Comfort, Impaired Nutrition, Imbalanced: Less than Body Requirements

Sleep​ Pattern, Disturbed Tissue​ Integrity, Impaired Comfort, Impaired Rationale: The main objective for care as a patient nears death is comfort.​ Therefore, nursing diagnoses appropriate for a client nearing death include ​Comfort, Impaired; Tissue​ Integrity, Impaired​; and Sleep​ Pattern, Disturbed. While a client nearing death will have altered nutrition and fluid volume​ deficit, these would be considered manifestations and not necessarily client problems that the nurse would address at this stage.​ (NANDA-I ©​ 2014)

Which type of lung cancer should the nurse describe as being able to synthesize bioactive products and hormones such as adrenocorticotropic or antidiuretic hormones? Squamous cell carcinomas Adenocarcinomas Large-cell carcinomas Small-cell carcinomas

Small-cell carcinomas ​Rationale: Small-cell carcinomas can synthesize bioactive products and​ hormones, such as adrenocorticotropic​ hormones; antidiuretic​ hormone, a​ parathormone-like hormone; and​ gastrin-releasing peptide.​ Adenocarcinomas, squamous cell​ carcinomas, and​ large-cell carcinomas are classified as​ non-small-cell carcinomas. They do not possess this ability.

Which assessment finding in a client receiving chemotherapy for cancer warrants immediate healthcare provider notification? Skin dryness Hair loss Temperature of 101.6°F Weight gain of 2 pounds in 1 month

Temperature of 101.6°F Rationale: Clients receiving chemotherapy for the treatment of cancer are at high risk for infection due to a suppressed immune system.​ Therefore, the nurse would notify the healthcare provider of a body temperature greater than 101.5°​F, because this signifies infection. Hair loss and skin dryness is normal and does not warrant immediate healthcare provider notification. A weight gain of 2 pounds in 1 month indicates true body weight and not fluid retention. This finding does not require the nurse to immediately notify the healthcare provider.

The nurse is planning care for a client with a terminal illness who is nearing the end of life. Which action should the nurse take to ensure the client receives the highest quality of​ care? (Select all that​ apply.) Stay with the client until intravenous pain medication takes effect. Remind the healthcare provider to discuss symptom management with the client and family. Offer family members a quiet area to express emotions. Suggest that family members return home to get rest. Explain interventions to the client and family before performing.

Stay with the client until intravenous pain medication takes effect. Remind the healthcare provider to discuss symptom management with the client and family. Offer family members a quiet area to express emotions. Explain interventions to the client and family before performing. Rationale: Nurses play an important role in providing quality​ end-of-life care to clients and their families by facilitating communication among​ clients, families, and​ providers; providing emotional​ support; and treating clients and their families with respect. The nurse should offer family members a quiet area to express​ emotions, explain interventions before performing​ them, stay with the client until pain medication takes​ effect, and remind the healthcare provider to talk with the family and client about symptom management. While it is important for family members to receive adequate​ rest, the nurse would not suggest they return home to do this. If rest is​ needed, the family can be provided with a quiet place to recharge.

The nurse is providing education about ongoing care for a client with fibromyalgia. Which information should the nurse​ include? (Select all that​ apply.) Strategies for stress reduction The use of cold therapy Information on gymnasium memberships Follow-up care Use of prescription medications

Strategies for stress reduction Information on gymnasium memberships Follow-up care Use of prescription medications ​Rationale: The nurse should teach the client about reducing stress to assist in managing the symptoms of fibromyalgia. The nurse should teach the client about the importance of keeping​ follow-up appointments with healthcare providers. The nurse should teach the client about taking medications as prescribed. Cold therapy does not improve fibromyalgia symptoms. Aquatic therapy is preferred over membership at a gym where aerobic exercises are offered.

The nurse is performing an initial assessment of a lesion on the client's right thigh. Which action is important to assess lesions that may be in the dermis? Pinch the skin between your fingers. Rub forcefully on the specific area. Stretch the client's skin tightly. Knead the area with a closed fist.

Stretch the client's skin tightly. ​Rationale: Inspect and palpate the skin. Stretching the skin tightly during assessment facilitates assessment of nodular and scaly lesions and lesions in the dermis.

A client has not been told about dying but anticipates that death is near. In which state of awareness is this​ client? Closed Mutual pretense Suspected Open

Suspected Rationale: In suspected​ awareness, no one directly tells the client about the​ condition, but the client begins to suspect that death is near. In open​ awareness, the​ client, family, and healthcare team know about the​ client's impending death and discuss it openly. In closed​ awareness, the client is unaware of impending​ death, even though the healthcare team and family are aware. In mutual pretense​ awareness, the​ client, family, and healthcare team all know that the​ client's condition is​ terminal, but no one discusses it.

A client with fibromyalgia is interested in nonpharmacologic therapies to treat the disease. Which therapy should the nurse suggest that the client​ try? Herbal therapy T'ai chi Yoga Long-distance running

T'ai chi Rationale: T'ai chi has been shown to improve fibromyalgia​ symptoms, physical​ function, quality of​ sleep, self-efficacy, and mobility. Yoga and herbal therapy have not been shown to positively affect fibromyalgia.​ Long-distance running is a​ high-level aerobic exercise. Low or moderate exercise is preferred.

The nurse is presenting to a group of young adults at a local gym on the topic of skin cancer. Which information should the nurse include? The dangers of UV rays to the skin from a tanning bed The importance of having a skin injury checked immediately The dangers of stretching the skin when using weights The importance of showering well after perspiring

The dangers of UV rays to the skin from a tanning bed ​Rationale: Primary prevention includes avoiding prolonged sun exposure and refraining from the use of artificial tanning machines. In​ fact, a study has concluded that with just one indoor tanning​ session, an​ individual's risk for developing melanoma increases by​ 20%. Perspiration, stretching the skin during​ exercise, and having a skin injury do not increase the risk of skin cancer.

A client complains that a mole on his forearm is painful. Which manifestation should lead the nurse to suspect malignant melanoma? The mole looks like a freckle. The mole ranges in color from brown to black. The mole has irregular borders. The mole appears to be bigger than a pencil eraser.

The mole appears to be bigger than a pencil eraser. ​Rationale: Malignant melanoma includes moles with a diameter greater than 6 mm​ (the size of a pencil​ eraser). Dysplastic​ nevi, a precursor to​ melanoma, have irregular borders. Congenital​ nevi, a precursor to​ melanoma, have moles that range in color from brown to black. Lentigo​ maligna, a precursor to​ melanoma, has the appearance of a freckle.

A​ 33-year-old woman has just given birth to identical twin girls. Both newborns had Apgar scores of 8. Twin A weighed 8 lbs 3​ oz, and twin B weighted 7 lbs 8 oz. During postdelivery​ assessment, the client asks the nurse about a term she heard on​ TV, "the human​ genome." What can the nurse tell her about her newborns' genomes? Testing is needed to assess their genomes. The newborns have identical genomes. A high Apgar score means high genome scores. The larger newborn has a larger genome.

The newborns have identical genomes. Rationale: The newborns have identical genomes due to having the same exact DNA. This fact is not altered by​ weight, testing, or an Apgar score.

The hospital administrator is expanding the palliative care area in a major metropolitan city hospital. When planning for this care​ area, which member of the healthcare team should the administrator realize is most likely to notice subtle changes in the​ client's condition and communicate them to the rest of the​ team? The nurse The spiritual advisor The healthcare provider The social worker

The nurse ​Rationale: Nurses interact with clients most​ frequently, so they are responsible for communicating changes to the rest of the healthcare and collaborative team. The nurse must be vigilant to these changes and ensure appropriate and timely communication with the healthcare​ provider, family​ members, social​ workers, psychologists, or spiritual advisors.

A nurse is providing education about fibromyalgia to a group of new nurses. When discussing the pathophysiology of this​ disorder, which system of the body should the nurse​ address? (Select all that​ apply.) The somatic peripheral nervous system The cardiac system The renal system The endocrine system The autonomic nervous system

The somatic peripheral nervous system The endocrine system The autonomic nervous system Rationale: The pathophysiology of fibromyalgia involves the autonomic nervous​ system, somatic peripheral nervous​ system, and endocrine system. The pathophysiology of fibromyalgia does not involve the renal or cardiac systems.

The nurse discusses the treatment of fibromyalgia with a group of staff nurses. Which information about the treatment of this disorder should the nurse​ include? The treatment that works for one client may not work for another. Treatment only includes analgesic medications. Fibromyalgia treatment can be provided only in a hospital or outpatient setting. Fibromyalgia treatment follows an algorithm that is used for every client.

The treatment that works for one client may not work for another. Rationale: The difficulty in treating fibromyalgia is that what works for one client may not work for another. Clients are encouraged to keep trying different therapies until they find what works for them. There is no one algorithm that is used for all clients. Fibromyalgia is a chronic​ condition, so clients provide​ self-care and treatment in their homes. Several classes of medications as well as complementary therapies are utilized to treat the disease.

Which diagnostic test is used to determine cell differentiation? Fecal occult blood Carcinoembryonic antigen (CEA) Sigmoidoscopy Tissue biopsy

Tissue biopsy Rationale: A tissue biopsy will confirm cancerous cells and cell differentiation. A sigmoidoscopy is used to visualize bowel​ tumors, not their differentiation. Fecal occult blood only detects blood in the​ feces, not tumor differentiation. CEA estimates prognosis and detects cancer recurrence but does not provide evidence of cellular differentiation.

A client with lung cancer who is to begin a regimen of radiation therapy asks the nurse the purpose of radiation therapy. Which should the nurse include in the response to the client? (Select all that apply.) To debulk tumors To relieve cough, bone pain, and dyspnea To attack tumor cells at different parts of the cell cycle To treat vena cava syndrome To treat cancer that has spread by direct extension to other thoracic structures

To debulk tumors To relieve cough, bone pain, and dyspnea To treat vena cava syndrome To treat cancer that has spread by direct extension to other thoracic structures Rationale: Radiation therapy is used to debulk​ tumors, to treat symptoms and complications of lung​ cancer, and to treat cancer that has spread by direct extension. Chemotherapy is used to attack tumor cells at different parts of the cell cycle

For which purpose would a client with lung cancer receive laser bronchoscopy treatment? To resect a portion of the main bronchus To resect tumors located in the main bronchus To reconstruct the cancerous portion of the main bronchus To remove a small section of peripheral lung tumors

To resect tumors located in the main bronchus Rationale: Laser bronchoscopy is used to resect tumors located in the main bronchus. Reconstruction is not part of treatment. Peripheral lung tumors are not located in the main bronchus. Resection of portions of the main bronchus is not done.

Which intervention would the nurse expect the healthcare provider to prescribe to most effectively treat a client with severe anemia related to acute blood​ loss? Erythropoietin injections up to three times a week Transfuse packed red blood cells Ferrous sulfate orally three times a day B12 injection subcutaneously

Transfuse packed red blood cells Rationale: A client with severe anemia related to acute blood loss needs fast replacement.​ Therefore, the nurse would administer a transfusion of packed red blood cells. B12 is used to treat pernicious​ anemia, not blood loss anemia. Ferrous sulfate and erythropoietin injections will not work fast to bring the​ client's blood counts to an acceptable range.

The nurse understands that which surgery involves removal of parts of the prostate gland through the penis and urethra? Transurethral prostatectomy Perineal prostatectomy Retropubic prostatectomy Radical prostatectomy

Transurethral prostatectomy Rationale: Transurethral resection of the prostate​ (TURP) involves removal of parts of the prostate gland by a surgical instrument that is inserted into the end of the penis and through the urethra. Radical prostatectomy involves removal of the​ prostate, prostate​ capsule, seminal​ vesicles, and a portion of the bladder neck. A fairly new treatment is laparoscopic radical​ prostatectomy, in which small incisions are made in the abdomen and a laparoscope is inserted and used to remove the prostate. Retropubic prostatectomy may be performed because it allows adequate control of​ bleeding, visualization of the prostate bed and bladder​ neck, and access to pelvic lymph nodes. Perineal prostatectomy is often preferred for older men or those who are poor surgical risks.

Which category is included in the staging of lung cancer tumors? (Select all that apply.) Tumor size Tumor location Lymph node involvement Type of symptoms Presence of metastatic disease

Tumor size Tumor location Lymph node involvement Presence of metastatic disease ​Rationale: The TNM system of staging tumors relies on tumor size and​ location, whether lymph nodes are​ involved, and presence or absence of distant metastasis. ​ "T" refers to the primary​ tumor, "N" refers to regional lymph​ node, and​ "M" refers to distant metastasis. Client symptoms are not used to classify tumors.

The nurse is caring for a pediatric client with a terminal illness. When should palliative care be initiated for this child? When officially diagnosed as terminal As death approaches Upon diagnosis with a life-threatening illness At the time the parents are prepared

Upon diagnosis with a life-threatening illness Rationale: Palliative care is best initiated when a child is first diagnosed with a​ life-threatening illness. This ensures that appropriate and rational care planning can occur early in the course of the​ child's disease when there​ isn't a crisis. Waiting until the child is diagnosed as terminal or death is imminent may cause conflict down the line. The parents may never decide that they are ready for palliative​ care, which can also cause conflict or poor care planning.

The nurse is caring for a client with transurethral resection of the prostate for prostate cancer. Which nursing diagnosis would the nurse prioritize? Urinary Elimination, Impaired Urinary retention Comfort, Impaired Sexual Dysfunction

Urinary retention Rationale: Urinary retention is the priority for this client. Urinary incontinence and sexual dysfunction are important but are not priorities over retention of urine. Impaired comfort could be related to the retention of​ urine; however, it would be secondary to the retention of urine.​ (NANDA-I ©2014)

Which occurrence should the nurse expect to assess as a precipitating factor for the symptoms of fibromyalgia in a​ client? Bacterial infection of affected joint Septicemia with group A streptococcus infection Recent injury to joint or bone Viral illness

Viral illness ​Rationale: The precise etiology and precipitating factors for fibromyalgia are not​ known; however, there is no correlation between strep A​ infection, mechanical injury to​ bones, or local bacterial infections and the onset of symptoms. Affected individuals often report​ viral-like illness prior to the onset of symptoms.

A client with acute lymphocytic leukemia presents to the hospital for his first dose of​ high-dose induction chemotherapy. What precaution should the nurse take during​ administration? Premedicate client for allergic reaction. Place client in a negative pressure room. Have client wear a mask during treatment. Wear personal protective equipment.

Wear personal protective equipment. ​Rationale: Individuals who handle chemotherapeutic drugs are at constant risk of exposure because of the toxicity of antineoplastic medications. This risk of exposure can be minimized through the use of personal protective equipment​ (PPE) (i.e.,​ gowns, gloves, eye and face​ shields, and respirator​ protection) and a​ needle-less system. Clients who receive chemotherapy should wear a mask if they have a low WBC and at risk for exposure to infection. Clients who exhibit a reaction to the chemotherapy should be premedicated prior to their next administration. Negative pressure rooms are used for clients with a​ disease, such as​ tuberculosis, that is transmitted through the air by droplet​ nuclei, not for clients receiving chemotherapy.

Which diagnostic test should the nurse review to determine if a client's discomfort is caused by an infection? Urine analysis White blood cell count Liver function studies Hematocrit and hemoglobin

White blood cell count ​Rationale: The white blood cell count would be the best study to use to determine if the cause of pain may be due to infection. A urine​ analysis, liver function​ studies, and hematocrit and hemoglobin can provide information about other potential​ issues, but are not the best to determine infection.

A client's biopsy revealed dysplasia of cells. The client asks the nurse, "What does this mean?" Which response by the nurse is correct? "Dysplasia means that the number of cells has increased and they have become denser." "Dysplasia refers to abnormal variations in cell size, shape, appearance, and arrangement that are often caused by irritation." "Dysplasia consists of abnormal cells for which the damage is irreversible." "Dysplasia refers to cells that have irreversible damage and will become cancerous."

​"Dysplasia refers to abnormal variations in cell​ size, shape,​ appearance, and arrangement that are often caused by​ irritation." Rationale: Dysplastic cells show abnormal variations in​ size, shape, and appearance and a disturbance in their usual arrangement. Although under certain circumstances they can become​ malignant, the dysplasia is usually reversed once the source of irritation is eliminated. Hyperplasia is an increase in the number or density of normal cells. Anaplasia is the regression of a cell to an immature or undifferentiated cell type and is often associated with malignancies. It is one of the criteria used to grade the aggressiveness of cancer cells.

The nurse assesses a client with dimpling of the skin in the left upper outer quadrant of the right breast and nipple discharge. Which question should the nurse ask to learn if the client is experiencing other clinical manifestations of breast​ cancer? ​"Does the skin in the left upper outer quadrant of the right breast feel warm to​ touch?" ​"Have you noticed any itching around the nipple or in the area affected by​ dimpling?" ​"Have you been experiencing any night sweats or​ low-grade fevers?" ​"Have you noticed a rash or skin irritation around the nipple​ area?"

​"Have you noticed a rash or skin irritation around the nipple​ area?" ​Rationale: A persistent rash near the nipple area and skin irritation can both be clinical manifestations of breast cancer. Night​ sweats, low-grade​ fevers, itching of the breast and warmth in the affected area are not common manifestations of breast cancer.

While conducting a class on health promotion and disease​ prevention, a participant asks how to prevent fibromyalgia. Which action should the nurse explain as one that reduces the risk of developing the​ disorder? "Start taking ginkgo​ biloba." ​"Take a daily vitamin​ capsule." ​"Keep your weight​ down, exercise, and get frequent​ checkups." "Follow a vegetarian​ diet."

​"Keep your weight​ down, exercise, and get frequent​ checkups." ​Rationale: Maintaining a healthy lifestyle is the best way to reduce the risk of developing fibromyalgia.​ Vitamins, following a vegetarian​ diet, and ginkgo have not been shown to reduce the risk of developing fibromyalgia.

Which statement by the nurse demonstrates understanding of older adult clients with cancer? "Older adult clients have a greater tolerance for cancer treatement." "There is no correlation between the functional ability of an older adult and predisposition to poorer outcomes." "Older adult clients usually have a comorbid condition." "Older adult clients have better outcomes for cancer treatement."

​"Older adult clients usually have a comorbid​ condition." ​Rationale: Older adults experiencing cellular regulation disorders are more likely to have comorbidities such as​ lung, kidney, or heart​ disease, which can increase their risk of treatment complications. These individuals are also less likely to tolerate the necessary treatment or its adverse reactions. Older adults with cellular regulation disorders who have a lower functional status are generally predisposed to poorer outcomes.

Which statement by the nurse shows a need for further education about the essentials of genetics? "Identical twins have the same DNA." "Two copies of a Y chromosome result in a female." "DNA molecules are made up of long sequences." "People have 46 chromosomes."

​"Two copies of a Y chromosome result in a​ female." ​Rationale: Two copies of an X​ chromosome, not a Y​ chromosome, result in a female child. Identical twins have the same DNA. People have 46 chromosomes. DNA molecules are made up of long sequences.

A client with fibromyalgia stopped participating in an aerobic exercise program because the pain and fatigue became worse. Which response should the nurse make to this​ client? ​"You may see a​ short-term increase in pain and​ fatigue; these should decrease over​ time." ​"Exercise is​ important: No​ pain, no​ gain." ​"I exercise three times a​ week; it makes me feel so much​ better." ​"You are right to​ quit; exercise should not make your pain and fatigue​ worse."

​"You may see a​ short-term increase in pain and​ fatigue; these should decrease over​ time." ​Rationale: A​ short-term increase in pain and fatigue is normal and​ expected; this should decrease over time as the client develops better tolerance of activity. Exercise improves oxygen uptake and decreases pain and​ fatigue; the client needs to continue.