lung, skin, colorectal, prostate

A patient presents at the free clinic with a black, wart-like lesion on his face, stating, "I've done some research, and I'm pretty sure I have malignant melanoma." Subsequent diagnostic testing results in a diagnosis of seborrheic keratosis. The nurse should recognize what significance of this diagnosis? A)The patient requires no treatment unless he finds the lesion to be cosmetically unacceptable. B)The patient's lesion will be closely observed for 6 months before a plan of treatment is chosen. C)The patient has one of the few dermatologic malignancies that respond to chemotherapy. D)The patient will likely require wide excision.

A Feedback:Seborrheic keratoses are benign, wart like lesions of various sizes and colors, ranging from light tan to black. There is no harm in allowing these growths to remain because there is no medical significance to their presence.

A patient has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this patient, what major nursing diagnosis should the nurse include? A)Deficient Knowledge about Early Signs of Melanoma B)Chronic Pain Related to Surgical Excision and Grafting C)Depression Related to Reconstructive Surgery D)Anxiety Related to Lack of Social Support

A Feedback:The fact that the patient's disease was not reported until an advanced stage suggests that the patient lacked knowledge about skin lesions. Excision does not result in chronic pain. Reconstructive surgery is not a certainty, and will not necessarily lead to depression. Anxiety is likely, but this may or may not be related to a lack of social support.

Which assessment finding indicates an increased risk of skin cancer? A dark mole on the client's back An irregular scar on the client's abdomen A deep sunburn White irregular patches on the client's arm

A deep sunburn Explanation:A deep sunburn is a risk factor for skin cancer. A dark mole or an irregular scar is a benign finding. White irregular patches are abnormal but aren't a risk for skin cancer.

A nurse educator is teaching a group of medical nurses about Karposi's sarcoma. What would the educator identify as characteristics of endemic Karposi's sarcoma Select all that apply A)Affects people predominantly in the eastern half of Africa B)Affects men more than women C)Does not affect children D)Cannot infiltrate E)Can progress to lymphadenopathic forms

A, B, E Feedback:Endemic (African) Kaposi's sarcoma affects people predominantly in the eastern half of Africa, near the equator. Men are affected more often than women, and children can be affected as well. The disease may resemble classic KS or it may infiltrate and progress to lymphadenopathic forms.

23. A nurse is educating a patient on how to irrigate an ostomy bag. Which statement by the patient indicates the need for further instruction? a. "I can use a fleet enema to save money because it contains the same irrigation solution." b. "Sitting on the toilet lets the irrigation sleeve eliminate into the bowl." c. "I should never attempt to reach into my stoma to remove fecal material." d. "Using warm tap water will reduce cramping and discomfort during the procedure."

ANS: A Enema applicators should never be used in the stoma because they can cause damage. A special coned irrigation device is used for ostomies. Irrigating a stoma into the toilet is an effective management technique. Fingers and other objects should not be placed into the stoma because they may cause trauma to the intestinal wall. Warm tap water will reduce cramping during irrigation.

40. The nurse is assessing a patient 2 hours after a colonoscopy. Based on the procedure done, what focused assessment will the nurse include? a. Bowel sounds b. Presence of flatulence c. Bowel movements d. Nausea

ANS: A The nurse does want to hear the presence of bowel sounds; absent bowel sounds may indicate a complication from the surgery. Bowel movements and flatulence are not expected in the hours after surgery. The nurse does want to hear the presence of bowel movements. Nausea is not a problem following colonoscopy.

27. The nurse knows that the ideal time to change an ostomy pouch is a. Before eating a meal, when the patient is comfortable. b. When the patient feels that he needs to have a bowel movement. c. When ordered in the patient's chart. d. After the patient has ambulated the length of the hallway.

ANS: A The nurse wants to change the ostomy appliance when as little output as necessary ensures a smooth procedure. Patients with ostomies do not feel the urge to defecate because the sensory portion of the anus is not stimulated. Changing the ostomy pouch is a nursing judgment decision. After a patient ambulates, stool output is increased.

2. The nurse would expect the least formed stool to be present in which portion of the digestive tract? a. Ascending b. Descending c. Transverse d.Sigmoid

ANS: A The path of digestion goes from the ascending, across the transverse, to the descending and finally passing into the sigmoid; therefore, the least formed stool would be in the ascending.

15. The nurse is emptying an ileostomy pouch for a patient. Which assessment finding would the nurse report immediately? a. Liquid consistency of stool b. Presence of blood in the stool c. Noxious odor from the stool d. Continuous output from the stoma

ANS: B Blood in the stool may indicate a problem with the surgical procedure, and the physician should be notified. All other options are expected findings for an ileostomy.

26. A nurse is pouching an ostomy on a patient with an ileostomy. Which action by the nurse is most appropriate? a. Changing the skin barrier portion of the ostomy pouch daily b. Selecting a pouch that is able to hold excess output to reduce the frequency of pouch emptying c. Thoroughly scrubbing the skin around the stoma to remove excess stool and adhesive d. Measuring the correct size for the barrier device while leaving a 1/8-inch space around the stoma

ANS: B Selecting a pouch that holds a large volume of output will decrease the frequency of emptying the pouch and may ease patient anxiety about pouch overflow. The barrier device should be changed every few days unless it is leaking or is no longer effective. Peristomal skin should be gently cleansed; vigorous rubbing can cause further irritation or skin breakdown. Approximately 1/16 of an inch is present between the barrier device and the stoma. Excess space allows fecal matter to have prolonged exposure to skin, resulting in skin breakdown.

25. A patient had an ileostomy surgically placed 2 days ago. Which diet would the nurse recommend to the patient to ease the transition of the new ostomy? a. Eggs over easy, whole wheat toast, and orange juice with pulp b. Chicken fried rice with stir fried vegetables and iced tea c. Turkey meatloaf with white rice and apple juice d. Fish sticks with macaroni and cheese and soda

ANS: C During the first week or so after ostomy placement, the patient should consume easy-to-digest low-fiber foods such as poultry, rice and noodles, and strained fruit juices. Fried foods can irritate digestion and can cause blockage. Foods high in fiber will be useful later in the recovery process but can cause blockage if the GI tract is not accustomed to digesting with an ileostomy.

36. The nurse is caring for a patient who had a colostomy placed yesterday. The nurse should report which assessment finding immediately? a. Stoma is protruding from the abdomen. b. Stoma is moist. c. Stool is discharging from the stoma. d. Stoma is purple.

ANS: D A purple stoma may indicate strangulation or poor circulation to the stoma and may require surgical intervention. A stoma should be reddish-pink and moist in appearance. It can be flush with the skin, or it can protrude. Stool is an expected outcome of stoma placement.

A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?A)Continuous inflow and outflow of irrigation solution B)Intermittent inflow and continuous outflow of irrigation solution C)Continuous inflow and intermittent outflow of irrigation solution D)Intermittent flow of irrigation solution and prevention of hemorrhage

Ans: A Feedback:For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A)A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B)HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C)Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D)Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

Ans: A Feedback:A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A)Closely monitoring the input and output of the bladder irrigation system B)Administering parenteral nutrition and fluids as ordered C)Monitoring the patient's level of consciousness and skin turgor D)Scanning the patient's bladder for retention every 2 hours

Ans: A Feedback:Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional dribbling of urine. How should the nurse best respond to this patient's concern? A)Inform the patient that urinary control is likely to return gradually. B)Arrange for the patient to be assessed by his urologist. C)Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D)Teach the patient to perform intermittent self-catheterization.

Ans: A Feedback:It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A)Provide empathy and encouragement in an effort to foster a positive outlook. B)Tell the patient it is his decision whether to accept or reject chemotherapy. C)Report the patient's statement to members of his support system. D)Refer the patient to social work.

Ans: A Feedback:Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A)Pelvic floor exercises B)Intermittent urinary catheterization C)Reduced physical activity D)Active range of motion exercises

Ans: A Feedback:Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A)Testicular cancer is a highly curable type of cancer. B)Testicular cancer is very difficult to diagnose. C)Testicular cancer is the number one cause of cancer deaths in males. D)Testicular cancer is more common in older men.

Ans: A Feedback:Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A)Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B)Have a transrectal ultrasound every 5 years. C)Perform monthly testicular self-examinations, especially after age 60. D)Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

Ans: A Feedback:The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him emasculated and a shell of a man. The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A)Disturbed Body Image Related to Effects of Surgery B)Spiritual Distress Related to Effects of Cancer Surgery C)Social Isolation Related to Effects of Surgery D)Risk for Loneliness Related to Change in Self-Concept

Ans: A Feedback:The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A)Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B)All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C)Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D)Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

Ans: B Feedback:All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action?A)Cleanse the skin surrounding the suprapubic tube. B)Inform the urologist of this finding. C)Remove the suprapubic tube and apply a wet-to-dry dressing. D)Administer antispasmodic drugs as ordered.

Ans: B Feedback:The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A)Abstaining from sexual intercourse for at least 14 days postprocedure B)Wearing a scrotal support garment C)Using sitz baths D)Applying a heating pad intermittently E)Staying on bed rest for 48 to 72 hours post-procedure

Ans: B, C Feedback:Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A)Native Americans B)Caucasian Americans C)African Americans D)Asian Americans

Ans: C Feedback:African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, My father died of prostate cancer at age 48. The nurse should instruct him on which of the following health promotion activities?A)The patient will need PSA levels drawn starting at age 55. B)The patient should have testing for presence of the CDH1 and STK11 genes. C)The patient should have PSA levels drawn regularly. D)The patient should limit alcohol use due to the risk of malignancy.

Ans: C Feedback:PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals stoney hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A)A normal finding B)A sign of early prostate cancer C)Evidence of a more advanced lesion D)Metastatic disease

Ans: C Feedback:Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A)Apply a cold compress to the pubic area. B)Notify the urologist promptly. C)Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D)Administer a smooth-muscle relaxant as ordered.

Ans: D Feedback:Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A)The patient should not be in contact with the baby after delivery. B)The patient's treatment poses no risk to his daughter or her infant. C)The patient's brachytherapy may be contraindicated for safety reasons. D)The patient should avoid close contact with his daughter for 2 months

Ans: D Feedback:Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A)Fowler's position B)Prone position C)Supine position D)Lithotomy position

Ans: D Feedback:Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A)It is most common among men over 55. B)It is one of the least curable solid tumors. C)It typically does not metastasize. D)It is highly responsive to treatment.

Ans: D Feedback:Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag?A)Red wine colored B)Tea colored C)Amber D)Light Pink

Ans: D Feedback:The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

Place the steps for an ostomy pouch change in the correct order. 1. close the end of the pouch 2. measure the soma 3. cut the hole in the wafer 4. press the pouch in place over the stoma 5. Remove the old pouch 6. trace the correct measurement onto the back of the wafer 7. assess the stoma and the skin around it 8. cleanse and dry the peristomal skin

Answer: 5, 8, 7, 2, 6, 3, 4, 1

Which skills do you teach a pt with a new colostomy before discharge form the hospital? (Select all that apply) A. How to change the pouch B. How to empty the pouch C. How to open and close the pouch D. How to irrigate the colostomy E. How to determine if the ostomy is healing appropriately

Answer: A, B, C, E Rationale: The patient must be able to do these tasks to successfully manage his or her colostomy when going home.

Which of the following symptoms are warning signs of possible colorectal cancer according to the American Cancer Society guidelines? (select all that apply) A. Change in bowel habits B. Blood in the stool C. A larger-than-normal bowel movement D. Fecal impaction E. Muscle aches F. Incomplete emptying of the colon G. Food particles in the stool H. Unexplained abd or back pain

Answer: A, B, F, H Rationale: According to the American Cancer Society current guidelines, anyone with these symptoms should seek medical evaluation because they may have colon cancer. Other conditions may also cause these symptoms; but, if colon cancer is present, early diagnosis is important.

Which nursing intervention is most important when caring for a patient with an ileostomy? A. cleansing the stoma with hot water B. inserting a deodorant tablet in the stoma bag C. selecting or cutting a pouch with an appropriate-size stoma opening D. wearing sterile gloves while caring for the stoma

Answer: C Rationale: A properly fitting pouch that does not leave skin exposed prevents peristomal skin breakdown.

A nurse is teaching a pt to obtain a specimen for fecal occult blood testing using fecal immunochemical (FIT) testing at home. How does the nurse instruct the pt to collect the specimen? A. get three fecal smears from an early-morning bowel movement B. obtain one fecal smear from an early-morning bowel movement C. collect one fecal smear from 3 separate bowel movements D. get three fecal smears when you see blood in your bowel movement

Answer: C Rationale: Samples from three separate bowel movements decrease the risk of a false-negative or a false-positive result.

A nurse is caring for a patient whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform? A)Teach the patient about early signs of secondary blistering diseases. B)Teach the patient about self-care after treatment. C)Assess the patient's risk for recurrent malignancy. D)Assess the patient for adverse effects of radiotherapy.

B Feedback:Because many skin cancers are removed by excision, patients are usually treated in outpatient surgical units. The role of the nurse is to teach the patient about prevention of skin cancer and about self-care after treatment. Assessing the patient's risk for recurrent malignancy is primarily the role of the physician. Blistering diseases do not result from cancer or subsequent excision. Excision is not accompanied by radiotherapy.

A 35-year-old kidney transplant patient comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi's sarcoma. The nurse caring for this patient recognizes that this is what type of Kaposi's sarcoma?A)Classic B)AIDS-related C)Immunosuppression-related D)Endemic

C Feedback:Immunosuppression-associated Kaposi's sarcoma occurs in transplant recipients and people with AIDS. This form of KS is characterized by local skin lesions and disseminated visceral and mucocutaneous diseases. Classic Kaposi's sarcoma occurs predominantly in men of Mediterranean or Jewish ancestry between 40 and 70 years of age. Endemic KS affects people predominantly in the eastern half of Africa. AIDS-related KS is seen in people with AIDS.

A nurse is leading a health promotion workshop that is focusing on cancer prevention. What action is most likely to reduce participants' risks of basal cell carcinoma (BCC)? A)Teaching participants to improve their overall health through nutrition B)Encouraging participants to identify their family history of cancer C)Teaching participants to limit their sun exposure D)Teaching participants to control exposure to environmental and occupational radiation

C Feedback:Sun exposure is the best known and most common cause of BCC. BCC is not commonly linked to general health debilitation, family history, or radiation exposure.

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? A)Educating participants about the relationship between general health and the risk of skin cancer B)Educating participants about treatment options for skin cancer C)Educating participants about the early signs and symptoms of skin cancer D)Educating participants about the health risks associated with smoking and assisting with smoking cessation Ans:

C Feedback:The best hope of decreasing the incidence of skin cancer lies in educating patients about the early signs. There is a relationship between general health and skin cancer, but teaching individuals to identify the early signs and symptoms is more likely to benefit overall outcomes related to skin cancer. Teaching about treatment options is not likely to have a major effect on outcomes of the disease. Smoking is not among the major risk factors for skin cancer.

A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment?A)Chemotherapy B)Immunotherapy C)Wide excision D)Radiation therapy

C Feedback:Wide excision is the primary treatment for malignant melanoma, which removes the entire lesion and determines the level and staging. Chemotherapy may be used after the melanoma is excised. Immunotherapy is experimental and radiation therapy is palliative.

A nurse is providing care for a patient who has developed Karposi's sarcoma secondary to HIV infection. The nurse should be aware that this form of malignancy originates in what part of the body?A)Connective tissue cells in diffuse locations B)Smooth muscle cells of the gastrointestinal and respiratory tract C)Neural tissue of the brain and spinal cord D)Endothelial cells lining small blood vessels

D Feedback: Karposi's sarcoma (KS) is a malignancy of endothelial cells that line the small blood vessels. It does not originate in connective tissue, smooth muscle cell

A 65-year-old man presents at the clinic complaining of nodules on both legs. The man tells the nurse that his son, who is in medical school, encouraged him to seek prompt care and told him that the nodules are related to the fact that he is Jewish.What health problem should the nurse suspect? A)Stasis ulcers B)Bullous pemphigoid C)Psoriasis D)Classic Kaposi's sarcoma

D Feedback:Classic Kaposi's sarcoma occurs predominantly in men of Mediterranean or Jewish ancestry between 40 and 70 years of age. Most patients have nodules or plaques on the lower extremities that rarely metastasize beyond this area. Classic KS is chronic, relatively benign, and rarely fatal. Stasis ulcers do not create nodules. Bullous pemphigoid is characterized by blistering. Psoriasis characteristically presents with silvery plaques.

A patient has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized? A)Maintain the patient on bed rest for the first 24 hours postoperative. B)Apply distraction techniques to relieve pain. C)Provide soft or liquid diet that is high in protein to assist with healing. D)Anticipate the need for, and administer, appropriate analgesic medications.

D Feedback:Nursing interventions after surgery for a malignant melanoma center on promoting comfort, because wide excision surgery may be necessary. Anticipating the need for and administering appropriate analgesic medications are important. Distraction techniques may be appropriate for some patients, but these are not a substitute for analgesia. Bed rest and a modified diet are not necessary.

Which is the primary preventable cause of skin cancer?Fair skin Exposure to UV radiation Skin disease Excess melanin

Exposure to UV radiation Explanation:Skin cancer is caused by exposure to UV radiation, both artificial and in sunlight. Fair-skinned individuals are more susceptible because they do not have as many melanin-producing cells within their skin. Skin diseases do not cause cancer.

The nurse is conducting a community education program on malignant melanoma. The nurse knows that the participants understand the teaching when they identify which characteristic as a risk factor? History of suntans Dark skin Mediterranean descent Family history of pancreatic cancer

Family history of pancreatic cancer Explanation:A family history of pancreatic cancer is a risk factor for malignant melanoma. Additional risk factors include fair skin, freckles, blue eyes, blond hair, Celtic or Scandinavian descent, history of sunburns, previous melanoma, family history of melanoma, and a family or personal history of multiple atypical nevi.

Development of malignant melanoma is associated with which risk factor? History of severe sunburn African American heritage Skin that tans easily Residence in the Northeast

History of severe sunburn Explanation:Ultraviolet rays are strongly suspected as the etiology of malignant melanoma. Fair-skinned, blue-eyed, light-haired people of Celtic or Scandinavian origin are at higher risk for developing malignant melanoma. People who burn and do not tan are at risk for developing malignant melanoma. Elderly individuals who retire to the southwestern United States seem to have a higher incidence of developing malignant melanoma.

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? It is more invasive than squamous cell carcinoma (SCC). It metastasizes through blood or the lymphatic system.I t begins as a small, waxy nodule with rolled translucent, pearly borders. It is a malignant proliferation arising from the epidermis.

It begins as a small, waxy nodule with rolled translucent, pearly borders. Explanation:BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders. It is less invasive than SCC. It does not metastasize through the blood or lymphatic system. SCC is a malignant proliferation arising from the epidermis.

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition? Platelet disorders Allergic reactions Kaposi sarcoma Syphilis

Kaposi sarcoma Explanation:Kaposi sarcoma is a frequent comorbidity of clients with AIDS. With platelet disorders, the nurse observes ecchymosis (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in clients with syphilis.

While performing an initial assessment of a patient admitted with appendicitis, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this lesion is consistent with what type of skin cancer? A)Basal cell carcinoma B)Squamous cell carcinoma C)Dermatofibroma D)Malignant melanoma

Malignant melanoma Malignant melanoma presents itself as a superficial spreading melanoma which may appear in a combination of colors, with hues of tan, brown, and black mixed with gray, blue-black, or white.

Which procedure done for skin cancer conserves the most amount of normal tissue? Moh's micrographic surgery Electrosurgery Cryosurgery Surgical excision

Moh's micrographic surgery Explanation:Moh's micrographic surgery is the technique that is most accurate and that best conserves normal tissue. The procedure removes the tumor layer by layer. Electrosurgery, cryosurgery, and surgical excision do not conserve the amount of normal tissue

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: Destruction of the tissue by electrical energy. Removal of the tumor, layer by layer. A process of deep-freezing the tumor, thawing and refreezing. The use of radiation therapy.

Removal of the tumor, layer by layer. Explanation:Mohs micrographic surgery removes the tumor layer by layer. The first layer excised includes all evident tumor and a small margin of normal-appearing tissue. The specimen is frozen and analyzed by section to determine if all the tumor has been removed. If not, additional layers of tissue are shaved and examined until all tissue margins are tumor-free.

A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention?A)Chemotherapy B)Radiation therapy C)Surgical excision D)Biopsy of sample tissue

Surgical excision The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely.

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response? Through the application of extreme cold, the tissue is destroyed. Freezes the growth, so the physician can remove it at the next appointment Removes the entire growth Lasers the growth off

Through the application of extreme cold, the tissue is destroyed. Explanation:Cryosurgery is the application of extreme cold to destroy tissue. The other statements are false.

A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: a) 1.4 L. b) unspecified. c) 2 L. d) 3 L.

a) 1.4 L. Explanation:Clients need to keep their secretions thin by drinking 2 to 3 L of clear liquids per day. In clients with heart failure, fluid intake shouldn't exceed 1.5 L daily.

The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective? a) Classes at community centers to teach about smoking cessation strategies b) Advertisements in public places to encourage cigarette smokers to have yearly chest x-rays c) Legislation that requires homes and apartments be checked for asbestos leakage d) Public service announcements on television to promote the use of high-efficiency particulate air (HEPA) filters in homes

a) Classes at community centers to teach about smoking cessation strategies Explanation:Lung cancer is directly correlated with heavy cigarette smoking, and the most effective approach to reducing lung cancer in the community is to help the citizens stop smoking.. The use of HEPA filters can reduce allergens, but they do not prevent lung cancer. Chest x-rays aid in detection of lung cancer but do not prevent it. Exposure to asbestos has been implicated as a risk factor, but cigarette smoking is the major risk factor.

A 23-year-old male client who has recently started working in a coal mine confides that he is concerned about his long-term health. The nurse instructs the client which of the following ways to prevent occupational lung disease? Select all that apply. a) Do not smoke or quit smoking if currently smoking. b) Wear appropriate protective equipment when around airborne irritants and dusts. c) Schedule an annual lung x-ray to monitor his health. d) Try to find another occupation as soon as possible.

a) Do not smoke or quit smoking if currently smoking. b) Wear appropriate protective equipment when around airborne irritants and dusts. Explanation:The nurse may instruct clients that the following precautions may help prevent occupational lung disease: not smoking, wearing appropriate protective equipment when around airborne irritants and dusts, scheduling lung function evaluation with spirometry as recommended, becoming educated about lung diseases, and paying attention to risk evaluation of the workplace to identify risks for lung disease.

You are an occupational nurse completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases? a) Fibrotic changes in lungs b) Hemorrhage c) Damage to surrounding tissues d) Lung contusion

a) Fibrotic changes in lungs Explanation:For a client with occupational lung diseases, a chest radiograph may reveal fibrotic changes in the lungs. Hemorrhage, lung contusion, and damage to surrounding tissues are possibly caused by trauma due to chest injuries

A nurse is preparing instructions for a patient with a lung abscess regarding dietary recommendations. Which of the following statements would be included in the plan of care? a) "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." b) "You must consume a diet rich in protein, such as chicken, fish, and beans." c) "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." d) "You must consume a diet low in fat by limiting dairy products and concentrated sweets."

b) "You must consume a diet rich in protein, such as chicken, fish, and beans." Explanation:For a patient with a lung abscess the nurse encourages a diet that is high in protein and calories to ensure proper nutritional intake. A carbohydrate-dense diet or diets with limited fats are not advisable for a patient with a lung abscess.

You are caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? a) Pain on inspiration b) Mucopurulent sputum c) Obvious trauma d) Shortness of breath

b) Mucopurulent sputum Explanation:For a client with lung cancer, a cough productive of mucopurulent or blood-streaked sputum is a cardinal sign of lung cancer. Symptoms of fractured ribs consist primarily of severe pain on inspiration and expiration, obvious trauma, and shortness of breath. These symptoms may also be caused by other disorders but are not considered indicative of lung cancer.

What dietary recommendations should a nurse provide a patient with a lung abscess? a) A diet low in calories b) A carbohydrate-dense diet c) A diet rich in protein d) A diet with limited fat

c) A diet rich in protein Explanation:For a patient with pleural effusion, a diet rich in protein and calories is pivotal. A carbohydrate-dense diet or diets with limited fat are not advisable for a patient with lung abscess.

The nurse knows the mortality rate is high in lung cancer clients due to which factor? a) Increased exposure to industrial pollutants b) Increase in women smokers c) Few early symptoms d) Increased incidence among the elderly

c) Few early symptoms Explanation:Because lung cancer produces few early symptoms, its mortality rate is high. Lung cancer has increased in incidence due to increase in number of women smokers, growing aging population, and exposure to pollutants but not indicative of mortality rates

You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company? a) Provide employees with smoking cessation materials. b) Insist on adequate breaks for each employee. c) Fit all employees with protective masks. d) Give workshops on disease prevention.

c) Fit all employees with protective masks. Explanation:The primary focus is prevention, with frequent examination of those who work in areas of highly concentrated dust or gases. Laws require work areas to be safe in terms of dust control, ventilation, protective masks, hoods, industrial respirators, and other protection. Workers are encouraged to practice healthy behaviors, such as quitting smoking. Adequate breaks, giving workshops, and providing smoking cessation materials do not prevent occupational lung diseases

A 65-year-old client who works construction, and has been demolishing an older building,is diagnosed with pneumoconiosis. The nurse is aware that his lung inflammation is most likely caused by exposure to which of the following? a) Silica b) Coal dust c) Pollen d) Asbestos

d) Asbestos Explanation:Asbestosis is caused by inhalation of asbestos dust, which is frequently encountered during construction work, particularly when working with older buildings. Laws restrict asbestos use, but old materials still contain asbestos. Inhalation of silica may cause silicosis, which results from inhalation of silica dust and is seen in workers involved with mining, quarrying, stone-cutting, and tunnel building. Inhalation of coal dust and other dusts may cause black lung disease. Pollen may cause an allergic reaction, but is unlikely to cause pneumoconiosis.

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? a) Crackles b) Wheezes c) Rhonchi d) Decreased breath sounds

d) Decreased breath sounds Explanation:In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis.

Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally? a) Bronchoalveolar carcinoma b) Adenocarcinoma c) Squamous cell carcinoma d) Large cell carcinoma

d) Large cell carcinoma Explanation:Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Bronchoalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slow growing. Adenocarcinoma presents as peripheral masses or nodules and often metastasizes. Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located

A 62-year-old female client arrives at the office complaining of dyspnea and fatigue. She tells the nurse that she's had a persistent productive cough for the last few months, which she attributes to a bout with the flu. The nurse suspects that this client may have which of the following? a) Pleurisy b) Lung abscess c) Pleural effusion d) Lung cancer

d) Lung cancer Explanation:Early diagnosis of cancer of the lung is difficult because symptoms often do not appear until the disease is well established. The sputum is examined for malignant cells. Chest x-rays may or may not show a tumor. With pleurisy, the client's respirations become shallow secondary to excruciating pain. The client may have a dry cough, fatigue easily, and experience dyspnea. Fever, pain, and dyspnea are the most common symptoms of pleural effusion. Signs and symptoms of lung abscess include chills, fever, weight loss, chest pain, and a productive cough.

Which type of pneumonia has the highest incidence in AIDS patients and patients receiving immunosuppressive therapy for cancer? a) Fungal b) Streptococcal c) TB d) Pneumocystis

d) Pneumocystis Explanation:Pneumocystis pneumonia incidence is greatest in patient with AIDS and patients receiving immunosuppressive therapy for cancer.

The nursing instructor is talking with the junior class of nursing students about lung cancer. What would be the best rationale the instructor could give for the difficulty of early diagnosis of lung cancer? a) Symptoms are often minimized by clients. b) There are no early symptoms of lung cancer. c) Symptoms often mimic other infectious diseases. d) Symptoms often do not appear until the disease is well established.

d) Symptoms often do not appear until the disease is well established. Explanation:Early diagnosis of cancer of the lung is difficult because symptoms often do not appear until the disease is well established. Option A is correct, but it is not the best answer. Option B is incorrect because it is not a true statement. Option C is incorrect because lung cancer is not an infectious disease

A 68-year-old male client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The nurse knows that the surgical team places this catheter: a) To administer IV medication b) To ventilate the client c) To remove fluid from the lungs d) To remove air from the pleural space

d) To remove air from the pleural space Explanation:After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand. A catheter placed in the pleural space provides a drainage route through a closed or underwater-seal drainage system to remove air. Sometimes two chest catheters are placed following thoracic surgery—one anteriorly and one posteriorly. The anterior catheter removes air; the posterior catheter removes fluid. Chest tubes are placed to remove anteriorly air from the pleural space following thoracic surgery. The anesthesiologist ventilates the client during surgery. Postsurgery, a chest tube is placed anteriorly to remove air from the pleural space.

Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women? a) Large cell carcinoma b) Squamous cell carcinoma c) Small cell carcinoma d) Adenocarcinoma

d)Adenocarcinoma Explanation:Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes. Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures. Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree

There is an increase in the incidence of skin cancer being reported. Which have been identified as factors that predispose to malignant changes in the skin? Select all that apply. thinning ozone layer residence in high-altitude areas where the atmosphere is thinner than at sea level prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. use of sun block

thinning ozone layer residence in high-altitude areas where the atmosphere is thinner than at sea level prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. Explanation:Contributing factors include the thinning ozone layer; residence in high-altitude areas where the atmosphere is thinner than at sea level; and prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. Use of sunblock is a protector from UV rays