MDC2 - Exam 1 - Med Surg

Which serum electrolyte finding on a newly admitted client does the nurse report immediately to the health care provider? SATA A. Potassium 2.8 mEq/L (mmol/L) B. Sodium 143 mEq/L (mmol/L) C. Calcium 9.9 mg/dL (2.59 mmol/L) D. Chloride 101 mEq/l (mmol/L) E. Chloride 98 mEq/L (mmol/L) F. Magnesium 1.2 mEq/L (0.7 mmol/L)

A, F The serum potassium and serum magnesium levels are both lower than normal (potassium = 3.5 to 5.0 mEq/L or mmol/L; magnesium = 1.8 to 2.6 mEq/L or .74 to 1.07 mmol/L). Low levels of these electrolytes can have profound effects on heart function. All other electrolytes listed are within the normal range.

Which laboratory test is a priority for the nurse to monitor when a client has advanced breast cancer with bone metastasis? A. Serum calcium level B. Serum blood glucose C. Serum potassium level D. Serum sodium level

A Bone metastasis is a common complication of advanced breast cancer. It injures bone and releases calcium into the blood leading to hypercalcemia, which is a medical emergency that can lead death. Bone metastasis does not elevate or change blood levels of sodium, potassium, or glucose.

Older Adult - Assessment - Colorectal Cancer

Ask the patient whether bowel habits have changed over the past year (e.g., in consistency, frequency, color). Ask whether the patient has noticed any obvious blood in the stool. Test at least one stool specimen for occult blood during the patient's hospitalization. Urge the patient to have a baseline colonoscopy. Encourage the patient to reduce dietary intake of animal fats, red meat, and smoked meats. Encourage the patient to increase dietary intake of bran, vegetables, and fruit.

How many milliliters will the nurse record as being lost by a client with pulmonary edema who initially weighed 178 lb and now weighs 161.6 lb? A. 1000 B. 3000 C. 5000 D. 7000

D 1 kg = 2.2 lb. 1 kg of water = 1 L (1000 mL) of water. 16.6 lb divided by 2.2 = 7000 g (7000 mL)

In which newly admitted client situations does the nurse initiate a conversation about advance directives? (Select all that apply.) Select all that apply. a. The laboring mother expecting her first child b. A client with a non-life-threatening illness c. A person who currently has advance directives d. The comatose client who was injured in an automobile crash e. The client with end-stage kidney disease

a, b, c, e

The nurse is caring for a client who is actively dying. What nursing action is appropriate? (Select all that apply.) Select all that apply. a. Do not encourage the client to stay awake. b. Offer to insert a Foley catheter for comfort. c. Place warm blankets on the client to keep them warm. d. Use moist swabs to keep the mouth and lips moist. e. Encourage the client to eat ice chips and drink as much as possible. f. Make sure the room is well-lit.

a, b, d

Fluid that has the solute (particle) concentration (osmolarity) within the normal range for human body fluids, 270 to 300 mOsm/L.

isosmotic/isotonic

Key point: Finish this sentence The decision by the person with a durable power of attorney for health care (DPOAHC) to withdraw or withhold

life-sustaining therapy is supported by the U.S. Supreme Court and other professional/religious organizations

A legal document that instructs health care providers and family members about what life-sustaining treatment is wanted (or not wanted) if the patient becomes unable to make decisions.

living will

A divalent cation that is stored mostly in bones and cartilage.

magnesium (Mg2+)

Key point: Finish this sentence Death is defined as the cessation of integrated tissue and organ function,

manifested by cessation of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction.

The ability of cancer cells to invade and spread into other tissues and organs.

metastasis

Cancer spreading into vital organs (e.g., brain, liver, bone marrow) from the primary location.

metastatic

Cancerous tumor cells that move from the primary location by breaking off from the original group and establishing remote colonies.

metastatic tumors (secondary tumors)

Inflammatory response leading to sores or ulcers of the mucus membranes.

mucositis

The period in which the bone marrow suppression is the greatest and the patient is at highest risk for complications.

nadir

The number of milliosmoles in a kilogram of solution.

osmolality

The number of milliosmoles in a liter of solution.

osmolarity

Movement of water only through a selectively permeable (semipermeable) membrane to achieve an equilibrium of osmolarity.

osmosis

A compassionate and supportive approach to patients and families who are living with life-threatening illnesses; involves a holistic approach that provides relief of symptoms experienced by the dying patient.

palliative care

A care management approach involving the administration of drugs such as benzodiazepines for the purpose of decreasing suffering by lowering patient consciousness.

palliative sedation

A death that is free from avoidable distress and suffering for patients and families, in agreement with patients' and families' wishes, and consistent with clinical practice standards.

peaceful death

The major cation of the intracellular fluid (ICF).

potassium (K+)

A type of communication that consists of listening and acknowledging the legitimacy of the patient's and/or family's impending loss and pain

presence

The use of strategies to prevent the actual occurrence of cancer.

primary cancer prevention

The original cancer cells and tumor resulting from carcinogenesis.

primary tumor

The amount of radiation absorbed by the tissue.

radiation dose

Formal belief systems that provide a framework for making sense of life, death, and suffering and responding to universal spiritual questions.

religions

The process of randomly reflecting on memories of events in one's life.

reminiscence

The use of screening strategies to detect cancer early, at a time when cure or control is more likely.

secondary cancer prevention

Hyperkalemia causes - Actual Potassium Excesses

• Overingestion of potassium-containing foods or medications: • Salt substitutes • Potassium chloride • Rapid infusion of potassium-containing IV solutions • Bolus IV potassium injections • Transfusions of whole blood or packed cells • Adrenal insufficiency • Kidney failure • Potassium-sparing diuretics • Angiotensin-converting enzyme inhibitors (ACEIs)

Corticosteroids - Dexamethasone Oral or IV - nursing implications

These drugs cause sodium retention and hypertension. Dietary sodium restriction may be necessary. Can affect quality of sleep if taken late in the day. Monitor patient's blood sugar if diabetic. These drugs cause hyperglycemia.

G1

Tumor cells are well differentiated and closely resemble the normal cells from which they arose. This grade is considered a low grade of malignant change. These tumors are malignant but are relatively slow growing.

Primary Tumor (T) staging

Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor

Loss of hair.

alopecia

Key point: Finish this sentence Medications are frequently given to control dyspnea, pain, nausea, vomiting, delirium,

and seizures in patients near death.

Negatively charged electrolytes.

anions

The nurse working on an inpatient hospice unit has received the change-of-shift report. Which client does the nurse assess first? a. A 62 year old with lung cancer who has cool, clammy, dusky skin, and blood pressure of 64/20 mm Hg. b. A 26 year old with metastatic breast cancer who is experiencing pain rated at 8 (0-10 scale) and anxiety. c. A 70 year old with cancer of the colon who has a respiratory rate of 8 with loud, wet-sounding respirations. d. A 30 year old with AIDS-associated dementia and agitation who is asking for assistance with calling family members.

b

For which client problem will the nurse question a prescription for a diuretic? A. Pulmonary edema B. Heart failure C. End-stage renal disease D. Ascites

C Diuretics are a common and effective drug for the fluid overload associated with pulmonary edema, heart failure, and ascites. They are only used when kidney function is normal or at least adequate. In end-stage kidney disease kidney function is greatly and perhaps totally impaired.

Have mechanisms of action that either are unknown or do not fit those of other drug categories.

Miscellaneous Agents

The nurse is performing a spiritual assessment on a dying client. Which question provides the most accurate data on this aspect of the client's life? a. "Do you believe in God?" b. "Where have you been attending church?" c. "Tell me about religion in your life." d. "What gives you purpose in life?"

d

Loud, wet respirations caused by secretions in the respiratory tract and oral cavity of a patient who is near death.

death rattle

The compartment composing fluids inside of the cells (cellular fluid).

intracellular fluid (ICF)

Key point: Finish this sentence Assessment of oxygen saturation for patients at the end of life

is not necessary. Oxygen should be provided based on comfort.

A structured process of reflecting on one's life that is often facilitated by an interviewer.

life review

Key point: Finish this sentence Terminal delirium may occur in a

week or two before death. Haloperidol given orally or IV is the drug of choice to manage psychosis associated with delirium

Key point: Finish this sentence Assess the patient for pain, dyspnea, agitation, nausea, and vomiting,

which are common problems at the end of life

Hypokalemia - Relative Potassium Deficits

• Alkalosis • Hyperinsulinism • Hyperalimentation • Total parenteral nutrition • Water intoxication • IV therapy with potassium-poor solutions

When a nurse is caring for a patient undergoing radiation treatment, there are precautions that the nurse needs to take.

• Time is length of exposure to the radiation field. Try to coordinate care to limit time directly at the radiation source. • Distance is how far from the radiation source you remain. The farther away from the radiation source, the less exposure. • Shielding is using a material (such as a lead apron) to avoid exposure.

Hyperkalemia causes - Relative Potassium excesses

• Tissue damage • Acidosis • Hyperuricemia • Uncontrolled diabetes mellitus

Chloride (Cl − ) - Normal Ranges

98-106 mEq/L (mmol/L)

Which cancer types are associated with human papillomavirus infection? SATA A. Breast cancer B. Cervical cancer C. Head and neck cancer D. Leukemia E. Penile cancer F. Primary brain cancer

B, C, E The human papilloma virus (HPV) has several subtypes that are carcinogenic and known as oncoviruses. Specific cancers that have HPV as one cause include cervical cancer, vulvar cancer, penile cancer, anogenital carcinomas, and head and neck cancer. Some leukemias are associated with other types of viral infection, and primary brain cancer is not associated with any viral infection.

Human papillomavirus caused malignancies

Cervical carcinoma, vulvar carcinoma, penile carcinoma, other anogenital carcinomas, and head and neck carcinoma

Older Adult - Changes/Result - Endocrine

Change - Adrenal atrophy Result - Poor regulation of sodium and potassium balance, increasing the risk for hyponatremia and hyperkalemia

Older Adult - Changes/Result - Kidney

Change - Decreased glomerular filtration Result - Poor excretion of waste products Change - Decreased concentrating capacity Result - Increased water loss, increasing the risk for dehydration

Older Adult - Changes/Result - Muscular

Change - Decreased muscle mass Result - Decreased total body water Greater risk for dehydration

Older Adult - Changes/Result - Skin

Change - Loss of elasticity Decreased turgor Decreased oil production Result - Skin becomes an unreliable indicator of fluid status Dry, easily damaged skin

Older Adult - Changes/Result - Neurologic

Change - Reduced thirst reflex Result - Decreased fluid intake, increasing the risk for dehydration

Common sign of nearing death in which apnea alternates with periods of rapid breathing.

Cheyne-Stokes respirations

Sodium (Na+) - Significance of Abnormal Values

Elevated: Hypernatremia; dehydration; kidney disease; hypercortisolism Low: Hyponatremia; fluid overload; liver disease; adrenal insufficiency

Older Adult - Assessment - Skin Cancer

Examine skin areas for moles or warts. Ask the patient about changes in moles (e.g., color, edges, sensation). Recommend use of sunscreen and protective clothing when outdoors.

Distant Metastasis (M) staging

Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Regional Lymph Nodes (N) staging

Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes

Older Adult - Assessment - Lung Cancer

Observe the skin and mucous membranes for color. How many words can the patient say between breaths? Ask the patient about: • Cough • Hoarseness • Smoking history (including use of electronic cigarettes or "vaping") • Particulate matter exposure to inhalation irritants • Exposure to asbestos • Shortness of breath • Activity tolerance • Frothy or bloody sputum • Pain in the arms, shoulders, or chest • Difficulty swallowing

Older Adult - Assessment - Leukemia

Observe the skin for color, petechiae, or ecchymosis. Ask the patient about: • Fatigue • Bruising • Bleeding tendency • History of infections and illnesses • Night sweats and/or fevers

increases function, enhances appearance, or both.

Reconstructive or restorative surgery

A client with terminal lung cancer is receiving hospice care at home. Which nursing action will the RN manager ask the LPN/LVN to do? a. Administer prescribed medications to relieve the client's pain, shortness of breath, and nausea. b. Teach the family to recognize signs of client discomfort such as restlessness or grimacing. c. Clarify family members' feelings about the meaning of client behaviors and symptoms. d. Develop a plan for care after assessing the needs and feelings of both the client and the family.

a

A client with terminal pancreatic cancer is near death and reports increasing shortness of breath with associated anxiety. Which hospice protocol order will the nurse implement first? a. Morphine sulfate sublingually as needed b. Albuterol solution per nebulizer c. Prednisone elixir 10 mg orally d. Oxygen 2 to 6 L/min per nasal cannula

a

The daughter of a client who is dying states, "I don't want my father to be uncomfortable." How will the nurse respond? a. "Your father will be closely monitored and cared for." b. "Do you want to talk to the bereavement nurse?" c. "Your father will be sedated and comfortable." d. "We will send him to hospice when the time comes."

a

Late Site-Specific Effects of Radiation Therapy

Subcutaneous and Soft Tissue • Radiation-induced fibrosis Central Nervous System • Brain necrosis • Leukoencephalopathy • Cognitive and emotional dysfunction • Pituitary and hypothalamic dysfunction • Spinal cord myelopathies Head and Neck • Xerostomia and dental caries • Trismus • Osteoradionecrosis • Hypothyroidism Lung • Pulmonary fibrosis Heart • Pericarditis • Cardiomyopathy • Coronary artery disease Breast/Chest Wall • Atrophy, fibrosis of breast tissue • Lymphedema Abdomen and Pelvis • Small and large bowel injury • Diarrhea

Serotonin Antagonists - Aprepitant Oral Fosaprepitant IV - Nursing implications

Teach patients who are also taking warfarin to have their INR checked before and after the 3 days of this therapy because this drug interferes with warfarin effectiveness. Teach women who are using oral contraceptives to use an additional form of birth control while taking this drug because it reduces the effectiveness of oral contraceptives, increasing the risk for an unplanned pregnancy.

Benzodiazepines - Lorazepam Oral or IV - nursing implications

Teach the patient and family that the patient should avoid driving, operating heavy machinery, making legal decisions, and going up and down staircases unassisted because drugs from this class induce amnesia and profound drowsiness.

Prokinetic Agents - Metoclopramide IM or IV - nursing implications

Teach the patient to avoid driving or operating heavy machinery because these drugs induce drowsiness.

Grief and mourning experienced by survivors before and after a death.

bereavement

Substances that change the activity of a cell's genes so the cell becomes a cancer cell.

carcinogens

When illness or trauma overwhelms the compensatory mechanisms of the body and the lungs and heart cease to function.

death

Body fluid volume (especially plasma volume) deficit caused by fluid intake or retention below what is needed to meet the body's daily fluid needs.

dehydration

Key point: Finish this sentence Hospice and palliative care are

different

Movement of particles (solute) across a permeable membrane from an area of higher particle concentration to an area of lower particle concentration (down a concentration gradient).

diffusion

Key point: Finish this sentence Assess the patient and family for written advance

directives such as a DPOAHC, a living will, or portable DNR/ DNAR.

Order from physician or other authorized primary health care provider, which instructs that CPR not be attempted in the event of cardiac or respiratory arrest.

do-not-resuscitate (DNR)

A chemotherapy regimen that is more frequently administered for aggressive cancer treatment.

dose-dense chemotherapy

A legal document in which a person appoints someone else to make health care decisions in the event he or she becomes incapable of making decisions.

durable power of attorney for health care (DPOAHC)

Solute particles that express and overall electrical charge (positive or negative). Also known as ions.

electrolytes (ions)

A substance that can induce nausea and vomiting.

emetogenic

Movement across a cell membrane that requires a membrane-altering system.

facilitated diffusion

Regulation of body fluid volume, osmolarity, and composition; the regulation of electrolytes by the processes of filtration, diffusion, osmosis, and selective excretion.

fluid and electrolyte balance

Fluid with an osmolarity less than 270 mOsm/L.

hypo-osmotic/hypotonic

Total serum calcium (Ca2+) level below 9.0 mg/dL or 2.25 mmol/L.

hypocalcemia

Serum sodium (Na+) level below 136 mEq/L (mmol/L)

hyponatremia

Lower than normal circulating blood volume.

hypovolemia

Adverse events related to immunotherapy.

immune-related adverse events (irAEs)

Drugs designed to activate the body's immune system to attack cancer cells, causing cell death.

immunotherapy

Key point: Finish this sentence Follow best-practice guidelines for performing postmortem care;

incorporate the patient's cultural and religious beliefs in body preparation and burial

Body water loss that has no mechanisms for control, including losses through the skin, the lungs, GI tract, salivation, drainage from fistulas and drains.

insensible water loss

The part of extracellular fluids present between cells, also called the third space, that includes blood, lymph, water in the bones and connective tissue water, and the transcellular fluids.

interstitial fluid

Key point: Finish this sentence Assess for the common physical signs

of approaching death

Proto-oncogenes promoting cell growth that no longer respond to signals from suppressor genes for cellular regulation.

oncogenes

The major cation (positively charged particle) in the extracellular fluid (ECF).

sodium (Na+)

Particles dissolved in the solvent of body fluids.

solute

The water portion of body fluids.

solvent

Key point: Finish this sentence Incorporate the patient's personal cultural practices and

spiritual beliefs regarding death and dying

Key point: Finish this sentence Provide psychosocial interventions to

support the patient and family during the dying process.

Decreased numbers of platelets leading to impaired clotting and bleeding.

thrombocytopenia

Drugs, such as cytotoxic agents, that can cause severe tissue damage to surrounding tissue if they escape into subcutaneous tissue.

vesicants

Fluid Overload - Neuromuscular Changes

• Altered level of consciousness • Headache • Visual disturbances • Skeletal muscle weakness • Paresthesias

Miscellaneous Agents examples

• Arsenic trioxide • Hydroxyurea (oral)

Hypocalcemia - Relative Calcium deficits

• Hyperproteinemia • Alkalosis • Calcium chelators or binders • Citrate • Mithramycin • Penicillamine • Sodium cellulose phosphate (Calcibind) • Aredia • Acute pancreatitis • Hyperphosphatemia • Immobility • Removal or destruction of parathyroid glands

Hypocalcemia causes - Actual Calcium deficits

• Inadequate oral intake of calcium • Lactose intolerance • Malabsorption syndromes: • Celiac disease, sprue • Crohn's disease • Inadequate intake of vitamin D • End-stage kidney disease • Diarrhea • Steatorrhea • Wound drainage (especially GI)

Hypokalemia causes - Actual Potassium deficits

• Inappropriate or excessive use of drugs: • Diuretics • Corticosteroids • Increased secretion of aldosterone • Cushing syndrome • Diarrhea • Vomiting • Wound drainage (especially GI) • Prolonged nasogastric suction • Heat-induced excessive diaphoresis • Kidney disease impairing reabsorption of potassium • Nothing by mouth

Hypermagnesemia causes

• Increased magnesium intake: • Magnesium-containing antacids and laxatives • IV magnesium replacement • Decreased kidney excretion of magnesium resulting from kidney disease

Fluid Overload - GI changes

• Increased motility (in acute fluid overload; decreased in conditions causing chronic overload) • Enlarged liver

Fluid Overload - Cardiovascular Changes

• Increased pulse rate • Bounding pulse quality • Elevated blood pressure • Decreased pulse pressure • Elevated central venous pressure • Distended neck and hand veins • Engorged varicose veins • Weight gain

Fluid Overload - Respiratory Changes

• Increased respiratory rate • Shallow respirations • Shortness of breath • Moist crackles present on auscultation

Antitumor Antibiotics - Nursing implications

• Lifetime maximum dosage for these agents. • Cardiac and pulmonary toxicity can occur. • Additional monitoring of ejection fraction or pulmonary function tests are required. • These agents are vesicants and can cause severe tissue damage with extravasation.

Metastasis sites - Colorectal cancer

• Liver • Lymph nodes • Adjacent structures

Hypomagnesemia causes

• Malnutrition • Starvation • Diarrhea • Steatorrhea • Celiac disease • Crohn's disease • Drugs (diuretics, aminoglycoside antibiotics, cisplatin, amphotericin B, cyclosporine) • Citrate (blood products) • Ethanol ingestion

Alkylating Agents - nursing implications

• May cause peripheral neuropathy. • May cause renal failure if not adequately hydrated. • May cause severe nausea and vomiting.

Antimitotics/Mitosis Inhibitors - nursing implications

• May cause peripheral neuropathy. • Patients may experience extreme constipation, and an aggressive bowel regimen may be required.

Topoisomerase Inhibitors - nursing implications

• May cause significant diarrhea.

Hospice Care vs. Palliative Care - Care/treatment

Hospice Care - Care is provided when curative treatment such as chemotherapy has been stopped. Palliative Care - A consultation is provided that is concurrent with curative therapies or therapies that prolong life.

Hospice Care vs. Palliative Care - prognosis

Hospice Care - Patients have a prognosis of 6 months or less to live. Palliative Care - Patients can be in any stage of serious illness.

Potassium (K+) - Normal Ranges

3.5-5.0 mEq/L (mmol/L)

How will the nurse interpret the finding on a client pathology report that a cancerous tumor has a mitotic index of 80%? A. The tumor is fast growing. B. Metastasis has already occurred. C. The tumor has not yet undergone carcinogenesis. D. The tumor has an abnormal number of chromosomes.

A A mitotic index of 80% means that 80% of the cells within the tumor sample are actively dividing, which represents a very high cell division rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

With which client condition will the nurse remain most alert for insensible water loss? A. Continuous GI suctioning B. Deep respirations C. Receiving oxygen therapy D. Hypothermia

A Continuous gastric suctioning removes fluid before it is absorbed into the body, which decreases fluid intake by the oral route. this ongoing fluid loss, if not measured as replaced by another route, can result in a fluid volume deficit.

By which mechanisms does parathyroid hormone (PTH) increase serum calcium levels? SATA A. Releasing free calcium from the bones B. Increasing calcium excretion in the urine C. Stimulating kidney reabsorption of calcium D. Activating vitamin D E. Increasing calcium absorption in the GI tract F. Pulling calcium out of muscle cells

A, C, D, E When more calcium is needed, parathyroid hormone (PTH) is released from the parathyroid glands and increases serum calcium levels by releasing free calcium from bone storage sites, stimulating vitamin D activation to help increase intestinal absorption of dietary calcium, inhibiting kidney calcium excretion, and promoting kidney calcium reabsorption.

Which actions does the nurse teach a client who has mucositis to reduce the discomfort? SATA A. Apply a water-based moisturizer to lips as often as you like. B. Brush teeth and tongue rigorously with a toothbrush every 8 hours. C. "Swish and spit" room-temperature tap water every 1 to 2 hours. D. Use commercial mouthwashes and glycerin swabs to refresh mouth. E. Avoid smoking while open sores are present. F. Limit your fluid intake to 1 liter or less daily.

A, C, E Recommendations are to apply only water-based moisturizers as needed, use soft-bristled toothbrushes and brush gently, swish and spit with tap water, and avoid smoking. Increasing, not decreasing, fluid intake is helpful and comforting. Using commercial mouthwashes is avoided because they contain alcohol and other drying agents.

Which are the manifestations of death? SATA A. Loss of heartbeat B. Unresponsiveness to physical or verbal stimuli C. Absence of spontaneous respirations D. Lack of deep tendon reflexes E. Irreversible brain dysfunction F. Oliguria or no urine output

A, C, E The definition of death is the cessation of tissue and organ function, manifested by no heartbeat, absence of spontaneous respirations, and irreversible brain dysfunction. A client may or may not experience unresponsiveness to stimuli, oliguria, and loss of DTRs before death occurs.

Which potential problems does the nurse assess for when caring for a client whose urine output is less than what is needed as the obligatory urine output? SATA A. Lethal electrolyte imbalances B. Alkalosis C. Urine becomes diluted D. Toxic buildup of nitrogen E. Increased infection risk F. Acidosis

A, D, F The kidney is the main way excess waste products and electrolytes are eliminated from the body. It must cause a 500 to 600 mL output daily for adequate elimination of these products daily. When these products are retained, the consequences include lethal levels of electrolytes, toxic buildup of nitrogen, and retention of hydrogen ions causing acidosis.

Human lymphotropic virus type I caused malignancies

Adult T-cell leukemia

Which client report does the nurse interpret as a possible warning sign of cancer? A. Joint soreness and stiffness on arising after sleep B. Soreness under the tongue present for 4 months C. Wheezing and coughing with seasonal asthma D. Redness to skin with pain after sun exposure

B A sore anywhere that does not heal withing 2 to 3 weeks is not normal and should be examined by a health care provider. Wheezing and coughing limited to asthma attacks is not cause for concern nor is joint stiffness or pain after a period of not moving. Skin redness and pain after sun exposure does not indicate cancer although multiple sunburns increase the risk for later skin cancer development.

Which conditions or health problems increase a client's risk for hypokalemia? SATA A. Liver failure B. Metabolic alkalosis C. Cushing syndrome D. Hypothyroidism E. Paralytic ileus F. Kidney failure

B, C Metabolic alkalosis causes a relative hypokalemia by increasing movement of potassium ions from the extracellular fluid into the intracellular fluid in exchange for hydrogen ions. Cushing syndrome involves higher than normal levels of cortisol, which increases potassium loss resulting in an actual hypokalemia. Paralytic ileus is caused by hypokalemia and does not cause it. Kidney failure causes hyperkalemia. Potassium levels are not affected directly by hypothyroidism or liver failure.

Which precautions are a priority for the nurse to teach a client who has chemotherapy induced peripheral neuropathy to prevent harm? SATA A. Avoid taking aspirin or any aspirin containing products. B. Use a bath thermometer to check bath water temperature. C. Do not use mouthwashes that contain alcohol or glycerin. D. Bathe daily using an antimicrobial soap or gel. E. Use handrails when going up or down steps. F. Wear shoes with a firm sole.

B, E, F Peripheral neuropathy reduces the ability to discriminate temperature sensation. It is very easy for a person with neuropathy to be unaware or water temperature and to become injured as a result of water for bathing/showering being too hot. When peripheral neuropathy is present in the feet (which is often where it starts), clients are at high risk for foot injury and falling because they cannot determine subtle terrain changes, be certain of food placement, or feel injuries to the feet. Aspirin, although important to avoid when platelets are low, is not contraindicated with peripheral neuropathy. Alcohol or glycerin mouthwashes are contraindicated for mucositis, not peripheral neuropathy. Bathing with an antimicrobial soap helps prevent infection but does not prevent injury.

Reduce CINV by enhancing cholinergic effects and decreasing the patient's awareness.

Benzodiazepines

For which indication of a fluid balance problem will the nurse assess in an older client at risk for fluid and electrolyte problems? A. Fever B. Elevated blood pressure C. Poor skin turgor D. Mental status changes

D Although all of the assessment findings listed may appear with a fluid balance problem, the first indication in older clients is a change in mental status.

Acute Site-Specific Effects of Radiation Therapy

Brain • Alopecia and dermatitis of the scalp • Ear and external auditory canal irritation • Cerebral edema and increased intracranial pressure • Nausea and vomiting • Blurry vision Head and Neck • Oral mucositis • Taste changes • Oral candidiasis, herpes, or other infections • Acute xerostomia • Dental caries • Esophagitis and pharyngitis Breast and Chest Wall • Skin reactions • Esophagitis Chest and Lung • Esophagitis and pharyngitis • Taste changes • Pneumonia • Cough Abdomen and Pelvis • Anorexia • Nausea and vomiting • Diarrhea • Cystitis or proctitis • Vaginal dryness/vaginitis • Sexual and fertility problems Eye • Conjunctival edema and tearing

Klinefelter syndrome (47,XXY) cancers

Breast cancer

Familial clustering cancers

Breast cancer Melanoma

Inherited cancers

Breast cancer Prostate cancer Ovarian cancer

Epstein-Barr virus caused malignancies

Burkitt lymphoma, B-cell lymphoma, nasopharyngeal carcinoma

With which client does the nurse remain most alert for an electrolyte imbalance? A. 49-year-old with intermittent asthma who also uses an albuterol inhaler PRN B. 60-year-old with a sprained wrist who also takes acetaminophen for pain C. 72-year-old with diabetes mellitus who also takes a diuretic daily. D. 80-year-old with anemia who also takes an iron supplement

C This client has three risk factors for an electrolyte imbalance: older adult, endocrine disorder, and takes a diuretic daily, which alters fluid and electrolyte excretion. Although the 80-year-old has an increased risk because of age, he or she has no other specific risk factors listed.

Which characteristic of a tumor indicates that it is benign rather than malignant? A. It does not cause pain B. It is less than 2 cm in size C. It is surrounded by a capsule D. It causes the sensation of itching

C. Benign tumors are made up of normal cells growing in the wrong place or growing at a time when they are not needed. They grow by expansion rather than invasion and often are encapsulated. The size and the fact that it is painless does not mean that the tumor is benign. Additionally, the presence of any sensation (such as itching) does not rule out malignancy.

Reduce CINV by decreasing swelling in the brain's chemotrigger zone.

Corticosteroids

removes all cancer tissue.

Curative surgery

Common Physical Signs and Symptoms of Approaching Death With Recommended Comfort Measures

Coolness of Extremities Circulation to the extremities is decreased; the skin may become mottled or discolored. • Cover the patient with a blanket. • Do not use an electric blanket, hot water bottle, or electric heating pad to warm the patient. Increased Sleeping Metabolism is decreased. • Spend time sitting quietly with the patient. • Do not force the patient to stay awake. • Talk to the patient as you normally would, even if he or she does not respond. Fluid and Food Decrease Metabolic needs have decreased. • Do not force the patient to eat or drink. • Offer small sips of liquids or ice chips at frequent intervals if the patient is alert and able to swallow. • Use moist swabs to keep the mouth and lips moist and comfortable. • Coat the lips with lip balm. Incontinence The perineal muscles relax. • Keep the perineal area clean and dry. Use disposable underpads and disposable undergarments. • Offer a Foley catheter for comfort. Congestion and Gurgling The person is unable to cough up secretions effectively. • Position the patient on his or her side. Use toothette to gently clean mouth of secretions. • Administer medications to decrease the production of secretions. Breathing Pattern Change Slowed circulation to the brain may cause the breathing pattern to become irregular, with brief periods of no breathing or shallow breathing. • Elevate the patient's head. • Position the patient on his or her side. Disorientation Decreased metabolism and slowed circulation to the brain. • Identify yourself whenever you communicate with the person. • Reorient the patient as needed. • Speak softly, clearly, and truthfully. Restlessness Decreased metabolism and slowed circulation to the brain. • Play soothing music and use aromatherapy. • Do not restrain the patient. • Talk quietly. • Keep the room dimly lit. • Keep the noise level to a minimum. • Consider sedation if other methods do not work.

Human lymphotropic virus type II caused malignancies

Hairy cell leukemia

Which is the best technique to use for assessing the skin turgor of an 80-year-old client? A. Observing the skin for a dry, scaly appearance and compare it to a previous assessment. B. Pinching the skin over the back of the and observe for tenting; count the number of seconds for the skin to recover position. C. Observing the mucous membranes and tongue for cracks, fissures, or a pasty coating. D. Pinching the skin over the sternum and observe for tenting and resumption of skin to its normal position after release.

D The skin of an older adult is usually dry and scaly. Thinning skin and loss of subcutaneous tissue on the back of the hand makes assessing skin turgor here unreliable because this skin may tent even when hydration is good. Observing mucous membranes is not assessing skin turgor. The skin on the forehand and sternum are recommended for assessing turgor on an older adult.

Which symptom in a client with psychiatric issues who is continuously drinking water will the nurse monitor as an indicator of potential hyponatremia? A. Insomnia B. Pitting edema C. Tremors D. Decreased cognition

D. Hyponatremia increases intracranial pressure and decreases central nervous system excitability. Behavioral and cognitive changes are often the first changes apparent in a person who develops hyponatremia, because of excessive water consumption in a short period of time.

Hormone Agonists - Endocrine therapy • Luteinizing hormone-releasing hormone (LHRH) • Leuprolide • Goserelin nursing implications

Injections are given to induce menopause or reduce testosterone levels in patients with prostate cancer. Educate patients on hot flashes, vaginal dryness, and sexual dysfunction.

Key point: Finish this sentence Teach the importance of having a

DPOAHC to inform health care providers of your wishes if you lack capacity.

removes part of the tumor if removal of the entire mass is not possible.

Debulking surgery

is the removal of all or part of a suspected lesion for examination and testing to confirm or rule out a cancer diagnosis.

Diagnostic surgery (e.g. excisional biopsy)

A type of abnormal cell growth in which normal cells grow in the wrong place or at the wrong time as a result of a problem with cellular regulation.

benign tumor cells

Antimetabolites - Nursing implications

• Used for some bone marrow and GI cancers. • Risk of neutropenia is high. • Patient education and assessment are crucial. • Patient will be prone to diarrhea.

Magnesium (Mg2+) - Normal Range

1.8-2.6 mEq/L (0.74-1.07 mmol/L)

Sodium (Na+) - Normal Ranges

136-145 mEq/L (mmol/L)

Osmolarity - Normal Range

270-300 mOsm/L

Cross-link DNA, making the DNA strands bind tightly together. This action prevents proper DNA and ribonucleic acid (RNA) synthesis, which inhibits cell division.

Alkylating Agents

Hypercalcemia - Relative Calcium excesses

• Hyperparathyroidism • Malignancy • Hyperthyroidism • Immobility • Use of glucocorticoids • Dehydration

Clients with which problems will the nurse assess most frequently for dehydration? SATA A. Fever of 103 F (39.4 C) B. Extensive burns C. Thyroid crisis D. Water intoxication E. Continuous fistula drainage F. Diabetes insipidus

A, B, C, E, F Common causes or risk factors for dehydration are those that increase fluid loss or interfere with fluid intake, including: hemorrhage, vomiting, diarrhea, profuse salivation, fistulas, ileostomy, profuse diaphoresis, burns, severs wounds, long-term NPO status, diuretic therapy GI suction, hyperventilation, diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever and impaired motor function. Water intoxication is related to over hydration, no dehydration.

Which body cells continue to undergo regular mitosis to maintain normal body function? SATA A. Bronchial lining B. Skeletal muscle C. Skin D. Bone marrow E. Neurons F. Intestinal lining

A, C, D, F The epithelial linings of glandular tissues (bronchial lining, intestinal lining) are often damaged and require continual replacement, as does the skin. Thus, these tissues undergo mitosis daily. The bone marrow makes more than a billion new cells daily, are the cell types Bone marrow cells undergo mitosis more often than any other normal cell type and retain this ability throughout the lifespan. the skin, being on the outside of the body, also continually loses cells that must be replaced. Skeletal muscle cells and neurons are considered nonmitotic tissue that seldom undergoes mitosis even when cell injury or death occurs

Which action is most important for the nurse to perform to prevent harm before starting an IV infusion of potassium to a client who has a low serum potassium level? SATA A. Determine IV line patency and blood return. B. Assess oxygen saturation level with pulse oximetry. C. Evaluate baseline mental status. D. Check the apical pulse for a full minute. E. Check deep tendon reflexes. F. Measure intake and output.

A, D Potassium is severe tissue irritant and can cause damage (as well as pain) if the IV line extravasates or infiltrates. The nurse must ensure the line is patent and has a good blood return before administering IV fluids containing potassium. Elevated serum potassium levels can cause bradycardia and dysrhythmias. Therefore, it is best to establish the client's baseline heart rate and rhythm before administering any IV potassium solution.

Which health problems are most likely to activate the renin-angiotensin-aldosterone system (RAAS)? SATA A. Shock B. Urinary tract infection C. Constipation D. Dehydration E. Severe asthma F. Hypertension

A, D The RAAS system is activated by an condition that causes reduced blood volume, hypotension, or reduced serum sodium levels, such as could happen with shock and dehydration. When activated, RAAS increases sodium and reabsorption to increase blood volume and serum sodium levels. It also increases vasoconstriction to help increase blood pressure. Asthma, urinary tract infection, hypertension and constipation do not induce symptoms of shock or dehydration.

With which types of cancers would a nurse expect the client to have a T, N, M report? SATA A. Breast cancer B. Colorectal cancer C. Leukemia D. Lung cancer E. Lymphoma F. Melanoma

A, D The cancers for which the tumor, node, metastasis (TMN) system is commonly used to describe the anatomic extent include lung and breast cancer. This staging system is not useful for leukemia or lymphomas, and some other cancers have more specific staging systems, such as Dukes' staging of colorectal cancer and Clark's levels method of staging skin cancer.

Plasma is part of which body fluid space compartments? SATA A. The intracellular compartment B. The extracellular compartment C. All fluid within the cells D. Interstitial fluid E. Intravascular fluid F. Fluid within joint capsules

B, E The extracellular fluid includes both the blood (plasma) volume (also known as the intravascular volume) and the interstitial fluid. Although the interstitial fluid comes from the plasma, it is not considered part of it.

Chloride (Cl − ) - Significance of Abnormal Values

Elevated: Hyperchloremia; metabolic acidosis; respiratory alkalosis; hypercortisolism Low: Hypochloremia; fluid overload; excessive vomiting or diarrhea; adrenal insufficiency; diuretic therapy

Turner syndrome (45,X) cancers

Leukemia Gonadal carcinoma Meningioma Colorectal cancer

focuses on providing symptom relief and improving the quality of life but is not curative.

Palliative surgery

A client admitted to the hospital states, "Someone asked me to fill out an advance directive when I was admitted, but I was too stressed. What is that for?" How will the nurse respond? a. "You will need to see a lawyer to complete advance directives." b. "You need to complete that paperwork before admission." c. "Advance directives allow a client to convey health care wishes." d. "Advance directives are for those individuals who are critically ill."

c

A client has died after a long hospital stay. The family was present at the time of the client's death. Which postmortem nursing action is appropriate? a. Removing dentures and any prosthetics b. Raising the head of the bed and opens the client's eyes c. Asking the family if they wish to help wash the client d. Asking the family to leave during post-death care

c

Which condition, when assessed in a client who is dying requires the nurse to take action? a. Alternating apnea and rapid breathing b. Cool extremities c. Moaning d. Anorexia

c

With which client conditions does the nurse remain alert for potential hypocalcemia? SATA A. Crohn disease B. Acute pancreatitis C. Removal or destruction of parathyroid glands D. Immobility E. Use of beta-adrenergic inhalers F. GI wound drainage

A, B, C, D, F Many conditions lead to an actual or relative hypocalcemia, especially GI conditions that interfere with calcium absorption or increase calcium loss, and anything that impairs parathyroid activity. Immobility causes bone resorption of calcium causing a whole body reduction of calcium. Beta-adrenergic drugs do not affect calcium metabolism.

For which serious complication will the nurse administering and IV potassium solution to a client carefully monitor to prevent harm? A. Pulmonary edema B. Cardiac dysrhythmia C. Postural hypotension D. Kidney failure

B If the potassium solution raises the serum potassium level too rapidly, hyperkalemia can result. Higher-than-normal serum potassium levels delay electrical conduction through the heart and can cause a variety of dysrhythmias, including asystole.

Any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues.

neoplasia

Antimitotics/Mitosis Inhibitors examples

• Docetaxel • Paclitaxel • Vinblastine • Vincristine • Vinorelbine

Hyponatremia causes - Actual Sodium deficits

• Excessive diaphoresis • Diuretics (high-ceiling diuretics) • Wound drainage (especially GI) • Decreased secretion of aldosterone • Hyperlipidemia • Kidney disease (scarred distal convoluted tubule) • Nothing by mouth • Low-salt diet • Cerebral salt-wasting syndrome • Hyperglycemia

Causes of Fluid Overload

• Excessive fluid replacement • Kidney failure (late phase) • Heart failure • Long-term corticosteroid therapy • Syndrome of inappropriate antidiuretic hormone (SIADH) • Psychiatric disorders with polydipsia • Water intoxication

Hypercalcemia - Actual Calcium Excesses

• Excessive oral intake of calcium • Excessive oral intake of vitamin D • Kidney failure • Use of thiazide diuretics

Leading Causes of Death in the United States

• Heart disease • Cancer (malignant neoplasms) • Accidents (unintentional injuries) • Chronic lower respiratory diseases • Cerebrovascular diseases • Alzheimer's disease • Diabetes mellitus • Influenza and pneumonia • Kidney disease (nephritis, nephrotic syndrome, and nephrosis) • Suicide (intentional self-harm)

Hypernatremia causes - Actual sodium excesses

• Hyperaldosteronism • Kidney failure • Corticosteroids • Cushing syndrome or disease • Excessive oral sodium ingestion • Excessive administration of sodium-containing IV fluids

Which electrolyte change does the nurse expect to see in a client who produces excessive amounts of aldosterone? A. Low serum sodium level B. High serum potassium level C. Low serum calcium level D. High serum sodium level

D Aldosterone increases sodium and water reabsorption in the kidney. Higher than normal levels of this hormone usually result in high serum sodium levels.

Which feature/characteristic of benign tumors prevents them from invading other tissues and organs? A. Have a small nuclear-to-cytoplasmic ratio B. Perform specific differentiated functions C. Retain a specific morphology D. Are tightly adherent

D Tight adherence of benign tumor cells to each other occurs because they continue to make cell adhesion molecules. This prevents them from migrating or wandering into blood vessels or any other tissue or organ for metastasis.

Decreased numbers of neutrophil white blood cells leading to immunosuppression.

neutropenia

Minimum amount of urine output per day needed to excrete toxic waste products (400 to 600 mL).

obligatory urine output

Viruses that are known to cause cancer.

oncoviruses

Metastasis site - Prostate Cancer

• Bone (especially spine and legs) • Pelvic nodes

Metastasis sites - Lung cancer

• Brain • Bone • Liver • Lymph nodes • Pancreas

Physical Signs Indicating That Death Has Occurred

• Breathing stops. • Heart stops beating. • Pupils become fixed and dilated. • Body color becomes pale and waxen. • Body temperature drops. • Muscles and sphincters relax. • Urine and stool may be released. • Eyes may remain open, and there is no blinking. • The jaw may fall open.

Alkylating Agents examples

• Carboplatin • Cisplatin • Cyclophosphamide • Dacarbazine • Ifosfamide • Temozolomide (oral)

Metastasis site - Primary Brain Cancer

• Central nervous system

Hyponatremia causes - Relative sodium deficits(dilution)

• Excessive ingestion of hypotonic fluids • Psychogenic polydipsia • Freshwater submersion accident • Kidney failure (nephrotic syndrome) • Irrigation with hypotonic fluids • Syndrome of inappropriate antidiuretic hormone secretion • Heart failure

Metastasis sites - Melanoma

• GI tract • Lymph nodes • Lung • Brain

The nurse is teaching a class on advance directives. What will the nurse include? (Select all that apply.) Select all that apply. a. A durable power of attorney for health care is the same as a durable power of attorney for one's health care. b. A living will identifies health care wishes regarding end of life treatment. c. A health care proxy can only make decisions once a person no longer has their own ability to make decisions. d. In order to make a health care decision, a person much be totally oriented. e. A living will contains funeral directives as well as last wishes for family. f. Advance directive are the same from state to state.

b, c,

Fluid Overload - Skin & Mucous Membrane changes

• Pitting edema in dependent areas • Skin pale and cool to touch

Serum potassium level higher than 5.0 mEq/L (mmol/L).

hyperkalemia

Serum sodium level over 145 mEq/L (mmol/L).

hypernatremia

Fluid with an osmolarity greater than 300 mOsm/L.

hyperosmotic/hypertonic

Fluid overload.

hypervolemia

Serum potassium level below 3.5 mEq/L (mmol/L).

hypokalemia

Serum magnesium (Mg2+) level below 1.8 mEq/L or 0.74 mmol/L.

hypomagnesemia

Pressure exerted by water molecules against the surfaces (membranes or walls) of a confining space. Also known as water pressure.

hydrostatic pressure

Total serum calcium level above 10.5 mg/dL or 2.62 mmol/L.

hypercalcemia

Serum magnesium level above 2.6 mEq/L or 1.07 mmol/L.

hypermagnesemia

outward, social expression of loss

mourning

Key point: Finish this sentence Assess the patient's emotional signs of impending death;

assess coping ability of the patient and family or other caregiver.

Interfere with the formation and actions of microtubules so cells cannot complete mitosis during cell division.

Antimitotics/Mitosis Inhibitors

Older Adult - Assessment - Bladder Cancer

Ask the patient about the presence of: • Pain on urination • Blood in the urine • Cloudy urine • Increased frequency or urgency

Key point: Finish this sentence Be aware that physician-assisted death is

legal in several countries and multiple states in the United States

Gx

Grade cannot be determined.

Disrupt an enzyme (topoisomerase) essential for DNA synthesis and cell division. When drugs disrupt the enzyme, proper DNA maintenance is prevented, resulting in increased DNA breakage and eventual cell death.

Topoisomerase Inhibitors

Cell division.

mitosis

Bloom syndrome cancers

Leukemia

G2

Tumor cells are moderately differentiated; they still retain some of the characteristics of normal cells but also have more malignant characteristics than do G1 tumor cells.

Preventing Injury or Bleeding During the time your platelet count is low:

• Use an electric shaver. • Use a soft-bristled toothbrush. • Do not have dental work performed without consulting your cancer health care provider. • Do not take aspirin or any aspirin-containing products unless prescribed. Read the label to be sure that the product does not contain aspirin or salicylates. • Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. • Avoid hard foods that would scrape the inside of your mouth. • Eat only warm, cool, or cold foods to avoid burning your mouth. • Check your skin and mouth daily for bruises; swelling; or areas with small, reddish-purple marks (petechiae) that may indicate bleeding. • Notify your cancer health care provider if you: • Are injured and persistent bleeding results • Have menstrual bleeding that is excessive for you • See blood in your vomit, urine, or bowel movement • Avoid trauma with intercourse. • Avoid anal intercourse. • Take a stool softener to prevent straining during a bowel movement. • Do not use enemas or rectal suppositories. • Do not wear clothing or shoes that are tight or that rub. • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage. • Avoid activities that increase the pressure in your brain.

Prevention of Injury for the Patient With Thrombocytopenia

• Use caution when repositioning or assisting the patient. • Use and teach assistive personnel (AP) to use a lift sheet when moving and positioning the patient in bed. • Avoid IM injections and venipunctures. If platelets are <50,000/mm3 (50 × 109/L), invasive procedures may be postponed. • When injections or venipunctures are necessary, use the smallest-gauge needle for the task. • Apply firm pressure to the needlestick site until the site no longer oozes blood. • Apply ice to areas of trauma. • Test urine and stool for the presence of occult blood as ordered. • Observe IV sites every 4 hours for bleeding. • Instruct patients to notify nursing personnel immediately if any trauma occurs and if bleeding or bruising is noticed. • Avoid trauma to rectal tissues: • Do not administer enemas. • If suppositories are prescribed, lubricate liberally and administer with caution. • Instruct the patient and AP that the patient should use an electric shaver rather than a razor. • When providing mouth care or supervising others in providing mouth care: • Use a soft-bristled toothbrush or tooth sponges. • Do not use water-pressure gum cleaners. • Make certain that dentures and other dental devices fit and do not irritate the gums. • Instruct the patient not to forcefully blow the nose or insert objects into the nose. • Instruct AP and the patient that the patient should wear shoes with firm soles whenever ambulating. • Practice fall prevention strategies according to the agency's policies. • Keep pathways and walkways clear and uncluttered.

Down syndrome (47 chromosomes) cancers

Leukemia

The Seven Warning Signs of Cancer

C Changes in bowel or bladder habits A Asore that does not heal U Unusual bleeding or discharge T Thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O Obvious change in a wart or mole N Nagging cough or hoarseness

Common Physical Signs and Symptoms of Approaching Death

Coolness of Extremities Increased Sleeping Fluid and Food Decrease Incontinence Congestion and Gurgling Breathing Pattern Change Disorientation Restlessness

Checkpoint Inhibitors: PD1, PD-L1, and CTLA-4 Inhibitors • Avelumab • Atezolizumab • Durvalumab • Ipilimumab • Nivolumab • Pembrolizumab nursing implications

Fatigue, rash, and risk of infection are common immunotherapy side effects.

Extreme tissue and muscle wasting due to malnourishment.

cachexia

The amount of radiation that is delivered to a tissue.

exposure

Metastasis sites - Breast Cancer

• Bone • Lung • Liver • Brain

What is the nurse's priority action for a client whose platelet count is 18,000/mm (18X10(9)/L)? A. Applying pressure after blood draws to prevent bleeding B. Placing the client in protective isolation C. Applying oxygen to reduce dyspnea D. Restricting fluid to prevent edema

A Excessive bleeding occurs when the platelet count is this low (thrombocytopenia). In addition to handling the client gently, pressure needs to be applied after injections, blood draws and the discontinuing of an IV. The client who only has thrombocytopenia is not at increased risk for infection. Platelets do not carry oxygen and low platelet counts do not cause hypoxia or dyspnea. Edema formation is not a result of a low platelet count.

Ankle and foot edema in a nurse who has been standing for 12 hours is a result of which type of pressure, force, or influence? A. Filtration from the plasma volume to the interstitial space as a result of increased capillary hydrostatic pressure B. Filtration from the plasma volume to the interstitial space as result of decreased capillary hydrostatic pressure C. Osmosis from the interstitial space to the plasma volume as a result of increased osmotic pressure because the nurse also was dehydrated as well as overworked D. Osmosis from the plasma volume to the interstitial space as a result of decreased cellular osmotic pressure because tissues damaged from standing released intracellular fluid.

A Gravity affects hydrostatic pressure in capillaries. When in the standing position, hydrostatic pressure increases in the dependent areas of the ankles and feet. This increased capillary hydrostatic pressure forces fluid to leave the ankle and feet capillaries into the interstitial spaces resulting in the formation of visible edema in these dependent areas.

In reviewing a client's electrocardiogram (ECG), which finding does the nurse associate with hyperkalemia? A. Tall peaked T waves B. Narrow QRS complex C. Tall P waves D. Elevated ST segment

A Hyperkalemia has deleterious effects on electrical conduction through the heart and can cause death. Some earlier changes in the ECG reflecting a rising potassium level include tall, peaked T waves, prolonged PR intervals, flat or absent P waves and wide QRS complexes.

Which additional laboratory changes does the nurse anticipate in a client who has hyperkalemia resulting from dehydration? A. Increased hematocrit and hemoglobin levels B. Decreased serum electrolyte levels C. Increased urine potassium levels D. Decreased serum creatinine levels

A In dehydration-associated hyperkalemia, the amount of total potassium is not increased but water loss from the plasma fluid increases the concentration of all electrolytes and blood cells.

When caring for a client of the Jewish faith who is dying, which cultural concept must the nurse keep in mind? A. A client who is extremely ill and dying should not be left alone. B. Upon death, a priest may say a prayer and light a candle. C. Death is viewed a dying person may wish to die facing Mecca. D. On death, the eyelids should be left open but the body should be covered.

A Individuals of Jewish faith believe a person should not be left alone at the end of life. A Greek Orthodox practice surrounding death is to have a priest say a prayer and light a candle after the death. Individuals of the Muslim faith may wish to face Mecca during the end of life. The eyelids should always be closed, not left open.

What is the nurse's best action when a client's spouse reports that the last time the client received lorazepam before receiving chemotherapy, the client didn't remember the drive home? A. Explain that this is normal response to the drug and that the client shouldn't drive home. B. Perform a mental status exam and assess pupillary responses before giving the lorazepam. C. Hold the dose of lorazepam for this round of chemotherapy until the client is seen by the oncologist. D. Document the response in a prominent place in the client's electronic health record as the only action.

A Lorazepam, a benzodiazepine, induces sedation and amnesia in addition to having antiemetic effects. Many clients have little if any memory about events occurring withing a few hours after receiving lorazepam. This is an expected side effect and does not denote any permanent reduced cognition in the client. Both the client and the spouse should be aware of this effect so that the client is not at risk for injury. Driving, cooking or operating mechanical equipment should not be performed until the drug's effects have worn off.

Which assessment findings does the nurse expect to see in a client who has severe hypermagnesemia? A. Bradycardia and hypotension B. Tachycardia and weak palpable pulse C. Hypertension and irritability D. Irregular pulse and deep respirations

A Magnesium is a membrane stabilizer that decreases depolarization of all excitable membranes. As a result, heart rate is slower and the client can become hypotensive.

Which serum value indicates to the nurse that the client has hyponatremia? A. Sodium 129 mEq/L (mmol/L) B. Chloride 98 mEq/L (mmol/L) C. Sodium 144 mEq/L (mmol/L) D. Chloride 103 mEq/L (mmol/L)

A Normal serum sodium ranges between 136 and 145 mEq/L (mmol/L). Hyponatremia is a serum sodium value lower than 136 mEq/L (mmol/L). The other values are within their normal ranges.

Which action does the nurse anticipate in the management of a client who has mild hypercalcemia? A. Administering IV normal saline (0.9% sodium chloride) B. Massaging calves to encourage blood return to the heart C. Providing vitamin D supplementation D. Monitoring for tetany

A Often the cause of hypercalcemia is dehydration. Increasing fluids, especially IV normal saline, can bring the serum calcium level back to normal. Hypercalcemia promotes excessive clot formation. Calves are not massaged to prevent movement of any existing clot. Vitamin D supplementation would increase calcium absorption and potentially worsen hypercalcemia. Tetany is associated with hypocalcemia.

Which client statement represents the symptoms most feared and perceived as distressing by dying clients? A. "I'm hoping that my health care provider prescribes a lot of pain medication." B. "I fear my family will be upset when I can no longer recognize them." C. "If I become nauseated, my wife will be distressed that I can't eat or drink." D. "Being short of breath frightens me and will scare my family members."

A Pain is the symptom that dying clients fear the most. Opioid and nonopioid drugs are important in managing pain near the end of life. Shortness of breath, nausea and in some cases clients not recognizing family or friends are also fearful symptoms and must be treated, but pain is the most feared and distressful symptom for dying clients.

Which specific discharge instruction will the nurse provide to prevent harm in a client with advanced heart failure who is at continued risk for fluid volume overload? A. Greater than 3 lb gained in a week or greater than 1 to 2 lb gained in a 24-hour period B. Greater than 5 lb gained in a week or greater than 1 to 2 lb gained in a 24-hour period C. Greater than 15 lb gained in a month or greater than 5 lb gained in a week D. Greater than 20 lb gained in a month or greater than 5 lb gained in a week

A Rapid weight gain is a good and reliable indicator of fluid retention, which would indicate worsening of heart failure that requires intervention. Usually only 0.5 lb of weight gain in a day represents true weight gain. Any amount above that is fluid retention.

Which effect on respiratory effort does the nurse expect to find in a client with severe hypokalemia? A. Shallow respirations and low oxygen saturation B. Deep, rapid respirations with high oxygen saturation C. Deep, slow respirations with high oxygen saturation D. No specific change in respiratory rate or effectiveness

A Severe hypokalemia causes profound skeletal muscle weakness. Because skeletal muscle contraction is absolutely required for the ventilation of respiration, muscle weakness reduces respiratory depth and effectiveness, leading to low oxygen saturation. The most common causes of death with severe hypokalemia is respiratory failure.

Which normal tissue or organ will nurse assess for side effects in a client who is receiving cancer therapy with an epidermal growth factor receptor inhibitor (EGFRI)? A. Skin B. Joints C. Liver D. Kidney

A The EGRFIs target and bind to epidermal growth factor receptors which, in addition to cancer cells, are strongly present in the skin. Thus, the skin is at high risk for rashes and even sloughing in clients who are receiving EGFRIs, and should be assessed at every clinic visit. Minimal EGFRs are present in the bones and joints, liver or kidneys, which have few side effects with this drug category.

The client has a durable power of attorney for health care (DPOAHC), also called a health care proxy. When would the nurse contact the designated person? A. The client is discovered at 3:00 a.m. in a comatose state. B. The client refuses to eat unless given a beer with dinner. C. The client is difficult to arouse for midnight vital signs. D. The client has an unexpected episode of dizziness.

A The designated DPOAHC does not make decisions for the client until the HCP states that the client lacks capacity to make his or her own decisions. Usually this is because of the cognitive impairment (e.g., coma). To have decision making ability, the client must be able to receive information; evaluate, deliberate and mentally manipulate information; and communicate a treatment preference. When a client can no longer make decisions, the DPOAHC steps in to make the decisions.

Which drug therapy does the nurse expect the health care provider to prescribe for a client with low serum sodium and signs of hypervolemia? A. Conivaptan B. Furosemide C. Hydrochlorothiazide D. Bumetanide

A The drug therapy should increase water loss with causing sodium loss. Furosemide, hydrochlorothiazide, and bumetanide all promote sodium loss as well as water loss.

The client receiving brachytherapy with implanted radioactive "seeds" for prostate cancer asks the nurse when these seeds will be removed. What is the nurse's best response? A. "The half-life of radiation in these seeds is so short that it is not necessary to remove them." B. "They will only be removed if their presence is painful or leads to an enlarged prostate gland." C. "When we know for certain that all cancerous cells have been killed, the seeds will be removed." D. "The seeds are small enough to be absorbed by your body and excreted in the urine or stool."

A The seeds are small and painless. The half-life of the radiation source is less than 2 weeks. Thus, it is not necessary for the seeds to be removed as they pose no health hazard to the client or anyone else. They are neither absorbed nor excreted by the body.

Which cancer type does the nurse interpret from a client's pathology report that indicates stage III osteogenic sarcoma? A. Bone B. Brain C. Breast D. Muscle

A The term "osteo" refers to bone and "sarcoma" refers to connective tissue. Thus, and osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; muscle cancer is a a rhabdomyosarcoma.

A client in hospice is deteriorating and the family is concerned about restlessness. Which are the best actions for the nurse to perform? A. Assess for pain, provide analgesics, and make the client as comfortable as possible. B. Initiate intravenous hydration to provide the client with the necessary fluids. C. Notify the health care provider and request an order for transfer to the hospital. D. Encourage family members to assist the client to eat in order to gain energy.

A When dying clients become restless or agitated, the cause is often pain. The nurse should assess for pain, provide prescribed pain medication (remember this is the greatest fear of dying clients), and perform actions to make the client as comfortable as possible (e.g., repositioning, playing soothing music, speaking quietly, and keeping the room dim and noise to a minimum). The other three options do not attempt to solve the problem.

Which sign of symptom does the nurse expect to see in a client who has mild hypernatremia? A. Muscle twitching and irregular muscle contractions B. Inability of muscles and nerves to respond to a stimulus C. Muscle weakness occurring bilaterally with no specific pattern D. Reduced or absent bilateral deep tendon reflexes

A movement of sodium into the intracellular fluid from the extracellular fluid is a trigger for depolarization of excitable membranes. Higher than normal sodium levels increase muscle twitching and contractions with a lower stimulus and sometimes even without a stimulus.

Which symptom does the nurse expect to see first in a client whose plasma volume has an increased hydrostatic pressure? A. Dependent edema B. Decreased urine output C. Poor skin turgor with "tenting" D. Greatly increased sensation of thirst

A Hydrostatic pressure is a "water pushing" pressure and will move water from an area of higher hydrostatic pressure to an area of lower hydrostatic pressure. When the plasma volume hydrostatic pressure increases, the water will first move into the interstitial space and cause edema formation.

Multikinase Inhibitors • Crizotinib (oral) • Sorafenib (oral) • Sunitinib (oral) nursing implications

A common side effect of this class of drugs is hypertension. Other side effects include nausea and vomiting, diarrhea, constipation, mucositis, erythematous rash on the hands and feet (palmar-plantar erythrodysesthesia), and mild neutropenia and thrombocytopenia.

Which characteristics are most associated with malignant tumors rather than with benign tumors? SATA A. Have more or fewer than normal chromosomes B. Arise from normal parent tissues C. Have growth that is orderly with normal growth patterns D. Perform their differentiated function E. Invade other tissues F. Do not respond to signals for contact inhibition

A, E, F Malignant tumor cells are usually aneuploid, not contact-inhibited, and invade other tissues and organs. They do arise from normal parent tissues, like benign tumors, but do not have an orderly growth pattern and do not continue to perform their differentiated functions.

Which foods does the nurse teach a client to include in his or her diet to help prevent future episodes of hypokalemia? Select all that apply. A. Soybeans B. Bananas C. Cantaloupe D. Potatoes E. Peaches F. Lettuce

A, B, C, D Soybeans, bananas, cantaloupe, and potatoes are good sources of potassium. Peaches and lettuce contain little, if any potassium.

Which statements about development of neoplasms are correct? SATA A. Cancer cells are considered neoplasms B. All neoplasms are considered abnormal C. Neoplasms are derived from normal cells D. Benign tumors are considered neoplasms. E. Neoplasms represent new tissue growth F. Neoplasms occur when suppressor genes prevent normal growth factors from stimulating cell division

A, B, C, D, E Neoplasia is any new or continued cell growth not needed for normal development or replacement of dead tissues. Although all neoplastic cells are derived from (come from) normal cells, they are always considered abnormal even if they cause no harm (are benign). Thus, some neoplasia's (or neoplastic cells) are benign and others are malignant (cancer cells), which means that normal cellular regulation has been disrupted. The major disruption is when suppressor genes are not able to do their functions of controlling cell growth. Suppressor genes prevent cell division from occurring when it is not needed. They do not suppress normal cell growth.

Which assessment findings would indicate to the nurse that the client may have hyponatremia? SATA A. Hyperactive bowel sounds on auscultation B. Acute-onset confusion C. Muscle weakness D. Decreased deep tendon reflexes E. Abdominal cramping F. Nausea

A, B, C, D, E, F Low serum sodium levels reduce membrane excitability and result in confusion, muscle weakness, and decreased deep tendon reflexes. GI changes include nausea, increased motility, and cramping.

Which factors interact to increase the risk for cancer? SATA A. Advancing age B. Exposure to carcinogens C. Genetic predisposition D. Presence of allergies E. Reduced immunity F. Vaccination status for childhood illnesses and tetanus

A, B, C, E Cancer is a disease of aging and advancing age represents and increased risk for cancer development, as does exposure to carcinogens. A genetic predisposition greatly increases the risk for cancer although relatively few people have this risk factor. Reduced immunity increases the risk for cancer development. Allergies do not increase cancer risk and, in fact, represents greater immunity, not reduced immunity. Vaccination for general childhood disorders and tetanus does not affect cancer risk. Obtaining a vaccination against the human papilloma virus reduces, not increases t, the risk for cancer development.

Which findings indicate to the nurse that a client may have hypervolemia (fluid overload)? SATA A. Increased, bounding pulse B. Jugular venous distention C. Presence of crackles D. Excessive thirst E. Elevated blood pressure F. Orthostatic hypotension

A, B, C, E Common symptoms and problems associated with fluid overload first appear in the cardiopulmonary systems. These include: increased pulse rate, bounding pulse quality, elevated blood pressure, decreased pulse pressure, elevated central venous pressure, distended neck and hand veins, engorged varicose veins, weight gain, increased respiratory rate, shallow respirations, shortness of breath and moist crackles on auscultation. Excessive thirst and hypotension are associated with dehydration.

Which information will the nurse tell a client, who has been diagnosed with cancer, that can be learned by surgery for staging even though the type of cancer is established? SATA A. Assessment of tumor size B. Number of tumors C. Sites of tumors D. types of tumors E. Pattern of spread of tumors F. Sensitivity of cancer therapies

A, B, C, E Surgical staging provides information about the tumor size, number, sites, and possible spread that has occurred at the time of surgery. It is not required for establishment of tumor or cancer type after this has been determined by a biopsy. Surgical staging does not provide any information on the sensitivity of the cancer to any therapy.

Which conditions does the nurse teach a client that are some of the seven warning signs of cancer? SATA A. Bleeding between periods B. Increasing size of a mole C. Hoarseness that last longer than 6 weeks D. Difficulty swallowing when eating dry foods E. Change in bowel habits that persist for several months F. Bleeding from the gums with tooth brushing or flossing

A, B, C, E The seven warning signs of cancer include persistent changes in bowel habits, unusual bleeding or discharge, obvious change in a wart or mole, nagging cough, or hoarseness. Although difficultly swallowing can be a warning sign of cancer, this means a persistent change regardless of what type of food is eaten. Most people have difficulty swallowing dry foods without drinking something at the same time. Bleeding from the gums with brushing or flossing is usually associated with poor hygiene and not cancer.

The use of cannabinoid-based medicines (CVM, medical marijuana) is increasing in palliative and end-of-life care. For which symptoms would the nurse expect to see these drugs prescribed for a dying client? SATA A. Pain B. Fatigue C. Difficulty with breathing D. Loss appetite E. Anxiety F. Difficultly sleeping G. Decrease in urine output

A, B, D, E, F Most clients have CBM prescribed for pain. Other symptoms for which these drugs have been positively effective include fatigue, anorexia, sleep problems, anxiety and nausea and vomiting. Lots of research is continuing with regard to effectiveness of CBM in palliative and end-of-life care.

Which types of fluid loss are considered "insensible fluid loss?" SATA A. Sweat B. Salivation C. Urine D. Diarrhea E. Vomit F. Wound drainage

A, B, D, E, F Of all these fluid loss routes, the only one that adjusts or is regulated is urine output. The others represent fluid loss that has no regulatory or control mechanisms, also known as insensible.

Which cancer types are most important for a nurse to include when creating a cancer risk reduction pamphlet for the clients who come a client that serves a large African-American population? SATA A. Breast B. Bone C. Lung D. Prostate E. Esophageal F. Skin

A, C, D Both the incidence and death rates from lung and prostate cancers in the African-American population are greater than for any other racial group. Although the incidence of breast cancer is not higher among African Americans, it is usually found at a later stage, is more aggressive and has a higher death rate that in other racial or ethnic groups. The incidence of lung cancer has been proven to be reduced by smoking cessation and deaths from prostate cancer, as well as breast cancer, can be reduced by early detection. Thus, targeting information for these three cancers specifically among an African-American population may have the greatest impact for reduction of cancer risks and cancer deaths.

Which assessment findings in a client who has neutropenia from cancer chemotherapy indicates to the nurse that severe disseminated intravascular coagulation (DIC) is present? SATA A. The client is bleeding from the nose, IV sites and rectum. B. The client's temperature is 99 F (37.2 C) C. The client's pulse rate is 130 beats/min D. The client's respiratory rate is 24 breaths/min. E. The client's white blood cell count is 3200/mm (3.2 X 10(9)/L). F. The client's hourly urine output is 100 mL.

A, C, D DIC is a condition in which widespread microthrombi form and use all available circulating clotting factors. When these factors are gone, clotting cannot occur and the client bleeds from any site of trauma, no matter how minor the trauma. Spontaneous bleeding can also occur. The elevated pulse rate is consistent with the hypovolemic shock phases of DIC, as is the increased respiratory rate. Both are attempting to maintain oxygenation to vital organs.

Which client assessment findings are related to hypercalcemia? SATA A. Increased heart rate B. Paresthesia C. Decreased deep tendon reflexes D. Hypoactive bowel sounds E. Shortened QT interval F. Profound muscle weakness

A, C, D, E, F Hypercalcemia at first causes increased heart rate and blood pressure and later causes depressed electrical conduction, slowing heart rate and shortening the QT interval. Deep tendon reflexes and GI motility are decreased. Paresthesia's are associated with hypocalcemia. The excess calcium stabiles skeletal muscle membranes lowing or preventing depolarization, which leads to severs muscle weakness.

Which precautions are a priority for the nurse to teach a client undergoing 6 weeks of daily external beam radiation for breast cancer? SATA A. Do not remove the markings. B. Use lotions liberally to keep skin soft and moist. C. Avoid direct skin exposure to sunlight for up to a year. D. wash the area with your hand using only mild soap and water. E. Apply a heating pad to treated areas to stimulate circulation F. Avoid wearing a tight-fitting bra during treatment and when the area is irritated.

A, C, D, F The skin in the path of radiation is injured by the treatment. The degree of injury is related to the intensity and duration of treatments. Six weeks of daily radiation treatment is a large does and usually results in skin redness, tenderness and peeling during the treatment period and for weeks afterward. The area remains sensitive to sun damage, heat damage, and direct contact damage for up to a year after therapy is complete. It is important for the client to avoid trauma to the area by using only mild soap and water to cleanse the area with hands rather than a cloth, as well as avoiding clothing that rubs. If markings are present, they must remain in place through the treatment to appropriately direct the radiation beam. Some lotions and other products can disrupt the direction of the radiation beam and are not to b used unless approved by the radiology department. Heat to the area will make the skin reaction worse.

The nurse will monitor which clients for the development of hyponatremia. SATA A. Postoperative client who has been NPO (nothing by mouth) for 24 hours with no IV fluid infusing B. Client with decreased fluid intake for 3 days C. Client receiving excessive intravenous fluids with 5% dextrose in water D. Client with diabetes who has a blood glucose of 250 mg/dL E. Client with overactive adrenal glands F. Tennis player in 100 F (37.7 C) weather who has been drinking water

A, C, D, F Without sodium intake, hyponatremia can develop. Although dextrose 5% in water is technically isotonic, as soon as it is infused the dextrose is metabolized and the fluid is very hypotonic, capable of diluting blood and causing it to be hyponatremic. The high blood glucose level makes the blood hyperosmotic, which then pulls fluid from the interstitial and intracellular spaces into the plasma volume, diluting both the glucose and the sodium levels. Heavy sweating results in both water and sodium losses. Replacing the loss with only water can hyponatremia.

Which actions are examples of passive euthanasia? SATA A. Terminating the IV fluids B. Giving a large dose of intravenous morphine C. Suspending telemetry heart monitoring D. Administering a drug that will stop the heart E. Discontinuing a mechanical ventilator F. Turning off a temporary pacemaker

A, C, E, F Withholding or withdrawing life-sustaining therapy (passive euthanasia) involves discontinuing one of more therapies that might prolong the life of a client who cannot be cured by the therapy. Withdrawing the interventions does not directly cause death. The cause of death is the progression of the client's disease and poor status. Examples include discontinuing heart monitoring, IV fluids, and mechanical ventilation or turning off a temporary pacemaker. Active euthanasia involves the HCP taking action that purposefully and directly causes death. Examples include giving drugs that can stop the heart or large doses of morphine sulfate.

Which interventions are most important for the nurse to teach a client who is receiving chemotherapy with an agent that causes thrombocytopenia to prevent harm? SATA A. Use an electric shaver, not a safety razor. B. Avoid eating raw meat, fish, or poultry. C. Take your temperature daily. D. Use a soft-bristled toothbrush and do not floss. E. Do not use enemas or rectal suppositories. F. Be sure to get an annual influenza vaccination.

A, D, E Thrombocytopenia means that the client's platelets are greatly decreased, increasing the client's risk for prolonged bleeding in response to even minor injury, especially from highly vascular areas, such as the gums or rectal tissues. Clients must avoid injury, such as using a safety razor, whenever possible. Taking temperature daily; avoiding raw meat, fish, and poultry; and getting an annual influenza vaccine help to prevent infection but not injury that could lead to excessive bruising or bleeding.

Which statements regarding care of the client receiving radiotherapy in the form of unsealed radioactive isotopes guides the nurse's care? SATA A. The client may have restrictions on who can visit and for how long. B. The client must be in total isolation while the isotopes are in place. C. When "seeds" are used for prostate cancer therapy, the client must have them removed before he leaves the hospital. D. The client's urine and stool must be handled as radioactive material. E. The nurse must ensure that all personnel entering the client's room use appropriate precautions. F. Only those female nurses who are past menopause can be assigned to care for this client.

A, D, E While the radioactive elements are within the client, he or she does emit radiation and is a hazard to others. Children and pregnant women may not visit. Other visitors are limited to 30 minutes or less daily. With an unsealed source, the isotopes enter body fluids and are excreted in the urine and stool as radioactive substances. Because the client does emit radiation, all personnel entering the room can be exposed and must use the appropriate precautions, regardless of how short a time period they are present in the room.

The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

Answer: 1 Rationale: A client with lactose intolerance is at risk for developing hypocalcemia, because food products that contain calcium also contain lactose. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea. Test-Taking Strategy: Focus on the subject, a suspected diagnosis of hypocalcemia. Note that the incorrect options are comparable or alike in that they reflect a hypoactivity or are associated with myocardial infarction. The option that is different is the correct option.

The nurse caring for a client with heart failure who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? 1. Weight loss and poor skin turgor 2. Lung congestion and increased heart rate 3. Decreased hematocrit and increased urine output 4. Increased respirations and increased blood pressure

Answer: 1 Rationale: A fluid volume deficit occurs when the fluid intake is insufficient to meet the fluid needs of the body. Assessment findings in a client with a fluid volume deficit include increased respirations and heart rate, decreased central venous pressure (CVP), weight loss, poor skin turgor, dry mucous membranes, decreased urine volume, increased specific gravity of the urine, increased hematocrit, and altered level of consciousness. Lung congestion, increased urinary output, and increased blood pressure are all associated with fluid volume excess. Test-Taking Strategy: Focus on the subject, assessment findings in fluid volume deficit. Think about the pathophysiology for fluid volume deficit and fluid volume excess to answer correctly. Note that options 2, 3, and 4 are comparable or alike and are manifestations associated with fluid volume excess.

The nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is most likely at risk for a fluid volume deficit? 1. A client with an ileostomy 2. A client with heart failure 3. A client on long-term corticosteroid therapy 4. A client receiving frequent wound irrigations

Answer: 1 Rationale: A fluid volume deficit occurs when the fluid intake is insufficient to meet the fluid needs of the body. Causes of a fluid volume deficit include vomiting, diarrhea, conditions that cause increased respirations or increased urinary output, insufficient intravenous fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. A client with heart failure or on long-term corticosteroid therapy or a client receiving frequent wound irrigations is most at risk for fluid volume excess. Test-Taking Strategy: Note the strategic words, most likely. Read the question carefully, noting the subject, the client at risk for a deficit. Read each option and think about the fluid imbalance that can occur in each. The clients with heart failure, on long-term corticosteroid therapy, and receiving frequent wound irrigations retain fluid. The only condition that can cause a deficit is the condition noted in the correct option.

The nurse reviews a client's laboratory report and notes that the client's serum phosphorus (phosphate) level is 1.8 mg/dL (0.58 mmol/L). Which condition most likely caused this serum phosphorus level? 1. Malnutrition 2. Renal insufficiency 3. Hypoparathyroidism 4. Tumor lysis syndrome

Answer: 1 Rationale: The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia. Test-Taking Strategy: Note the strategic words, most likely. Focus on the subject, a serum phosphorus level of 1.8 mg/dL (0.58 mmol/L). First, you must determine that the client is experiencing hypophosphatemia. From this point, think about the effects of phosphorus on the body and recall the causes of hypophosphatemia in order to answer correctly.

Which client is at risk for the development of a sodium level at 130 mEq/L (130 mmol/L)? 1. The client who is taking diuretics 2. The client with hyperaldosteronism 3. The client with Cushing's syndrome 4. The client who is taking corticosteroids

Answer: 1 Rationale: The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). A serum sodium level of 130 mEq/L (130 mmol/L) indicates hyponatremia. Hyponatremia can occur in the client taking diuretics. The client taking corticosteroids and the client with hyperaldosteronism or Cushing's syndrome are at risk for hypernatremia. Test-Taking Strategy: Focus on the subject, the causes of a sodium level of 130 mEq/L (130 mmol/L). First, determine that the client is experiencing hyponatremia. Next, you must know the causes of hyponatremia to direct you to the correct option. Also, recall that when a client takes a diuretic, the client loses fluid and electrolytes.

Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions would the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 3. Prepare the medication for bolus administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled with the volume of potassium in the solution.

Answer: 1, 2, 4, 5, 6 Rationale: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride is always labeled with the volume of potassium it contains. The IV site is monitored closely, because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse needs to monitor for infiltration. The nurse monitors urinary output during administration and contacts the physician if the urinary output is less than 30 mL/hr. Test-Taking Strategy: Focus on the subject, the preparation and administration of potassium chloride intravenously. Think about this procedure and the effects of potassium. Note the word bolus in option 3 to assist in eliminating this option.

The nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L (2.5 mmol/L). Which patterns would the nurse watch for on the electrocardiogram (ECG) as a result of the laboratory value? Select all that apply. 1. U waves 2. Absent P waves 3. Inverted T waves 4. Depressed ST segment 5. Widened QRS complex

Answer: 1, 3, 4 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level lower than 3.5 mEq/L (3.5 mmol/L) indicates hypokalemia. Potassium deficit is an electrolyte imbalance that can be potentially life-threatening. Electrocardiographic changes include shallow, flat, or inverted T waves; ST segment depression; and prominent U waves. Absent P waves are not a characteristic of hypokalemia but may be noted in a client with atrial fibrillation, junctional rhythms, or ventricular rhythms. A widened QRS complex may be noted in hyperkalemia and in hypermagnesemia. Test-Taking Strategy: Focus on the subject, the ECG patterns that may be noted in a client with a potassium level of 2.5 mEq/L (2.5 mmol/L). From the information in the question, you need to determine that the client is experiencing severe hypokalemia. From this point, you must know the electrocardiographic changes that are expected when severe hypokalemia exists.

The nurse reviews a client's record and determines that the client is at risk for developing a potassium deficit if which situation is documented? 1. Sustained tissue damage 2. Requires nasogastric suction 3. Has a history of Addison's disease 4. Uric acid level of 9.4 mg/dL (557 mcmol/L)

Answer: 2 Rationale: The normal serum potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known as hypokalemia. Potassium-rich gastrointestinal fluids are lost through gastrointestinal suction, placing the client at risk for hypokalemia. The client with tissue damage or Addison's disease and the client with hyperuricemia are at risk for hyperkalemia. The normal uric acid level ranges from 2.7 to 8.5 mg/dL (160 to 501 mcmol/L). Test-Taking Strategy: Note the subject, causes of potassium deficit. First recall the normal uric acid levels and the causes of hyperkalemia to assist in eliminating option 4. For the remaining options, note that the correct option is the only one that identifies a loss of body fluid.

The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? 1. Weight loss and dry skin 2. Flat neck and hand veins and decreased urinary output 3. An increase in blood pressure and increased respirations 4. Weakness and decreased central venous pressure (CVP)

Answer: 3 Rationale: A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. Assessment findings associated with fluid volume excess include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit. Dry skin, flat neck and hand veins, decreased urinary output, and decreased CVP are noted in fluid volume deficit. Weakness can be present in either fluid volume excess or deficit. Test-Taking Strategy: Focus on the subject, fluid volume excess. Remember that when there is more than one part to an option, all parts need to be correct in order for the option to be correct. Think about the pathophysiology associated with a fluid volume excess to assist in directing you to the correct option. Also, note that the incorrect options are comparable or alike in that each includes manifestations that reflect a decrease.

The nurse is reading a physician's progress notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800 mL daily." The nurse plans to monitor the client, knowing that insensible fluid loss occurs through which type of excretion? 1. Urinary output 2. Wound drainage 3. Integumentary output 4. The gastrointestinal tract

Answer: 3 Rationale: Insensible losses may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs. Sensible losses are those of which the person is aware, such as through urination, wound drainage, and gastrointestinal tract losses. Test-Taking Strategy: Note that the subject of the question is insensible fluid loss. Note that urination, wound drainage, and gastrointestinal tract losses are comparable or alike in that they can be measured for accurate output. Fluid loss through the skin cannot be measured accurately; it can only be approximated.

The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional sign would the nurse expect to note in a client with hyponatremia? 1. Muscle twitches 2. Decreased urinary output 3. Hyperactive bowel sounds 4. Increased specific gravity of the urine

Answer: 3 Rationale: The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Hyponatremia is evidenced by a serum sodium level lower than 135 mEq/L (135 mmol/L). Hyperactive bowel sounds indicate hyponatremia. The remaining options are signs of hypernatremia. In hyponatremia, muscle weakness, increased urinary output, and decreased specific gravity of the urine would be noted. Test-Taking Strategy: Focus on the data in the question and the subject of the question, signs of hyponatremia. It is necessary to know the signs of hyponatremia to answer correctly. Also, think about the action and effects of sodium on the body to answer correctly. Remember that increased bowel motility and hyperactive bowel sounds indicate hyponatremia.

The nurse reviews the electrolyte results of a client with chronic kidney disease and notes that the potassium level is 5.7 mEq/L (5.7 mmol/L). Which patterns would the nurse watch for on the cardiac monitor as a result of the laboratory value? Select all that apply. 1. ST depression 2. Prominent U wave 3. Tall peaked T waves 4. Prolonged ST segment 5. Widened QRS complexes

Answer: 3, 5 Rationale: The client with chronic kidney disease is at risk for hyperkalemia. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level greater than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Electrocardiographic changes associated with hyperkalemia include flat P waves, prolonged PR intervals, widened QRS complexes, and tall peaked T waves. ST depression and a prominent U wave occur in hypokalemia. A prolonged ST segment occurs in hypocalcemia. Test-Taking Strategy: Focus on the subject, a client with chronic kidney disease and the electrocardiographic changes that occur in a potassium imbalance. From the information in the question you need to determine that this condition is a hyperkalemic one. From this point, you must know the elec trocardiographic changes that are expected when hyperkalemia exists. Remember that tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR interval are associated with hyperkalemia.

On review of the clients' medical records, the nurse determines that which client is at risk for fluid volume excess? 1. The client taking diuretics who has tenting of the skin 2. The client with an ileostomy from a recent abdominal surgery 3. The client who requires intermittent gastrointestinal suctioning 4. The client with kidney disease that developed as a complication of diabetes mellitus

Answer: 4 Rationale: A fluid volume excess is also known as overhydration or fluid overload and occurs when fluid intake or fluid retention exceeds the fluid needs of the body. The causes of fluid volume excess include decreased kidney function, heart failure, use of hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds and body cavities, and excessive ingestion of sodium. Kidney disease is a complication of diabetes mellitus and as a result of the kidney disease, the elimination of fluid is affected and the client retains fluid. The client taking diuretics, the client with an ileostomy, and the client who requires gastrointestinal suctioning are at risk for fluid volume deficit. Test-Taking Strategy: Focus on the subject, fluid volume excess. Think about the pathophysiology associated with fluid volume excess. Read each option, and think about the fluid imbalance that can occur in each. Clients taking diuretics or having ileostomies or gastrointestinal suctioning all lose fluid. The only condition that can cause an excess is the condition noted in the correct option.

Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)? 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

Answer: 4 Rationale: The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). A serum potassium level higher than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia. Test-Taking Strategy: Eliminate the client with colitis and the client overusing laxatives first, because they are comparable or alike, with both reflecting a gastrointestinal loss. From the remaining options, recalling that cell destruction causes potassium shifts will assist in directing you to the correct option. Also, remember that Cushing's syndrome presents a risk for hypokalemia and that Addison's disease presents a risk for hyperkalemia.

The nurse is caring for a client with Crohn's disease who has a calcium level of 8 mg/dL (2 mmol/L).Which patterns would the nurse watch for on the electrocardiogram? Select all that apply. 1. Peaked T wave 2. Widened T wave 3. Prominent U wave 4. Prolonged QT interval 5. Prolonged ST segment

Answer: 4, 5 Rationale: A client with Crohn's disease is at risk for hypocalcemia. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged QT interval and prolonged ST segment. Peaked T waves occur with myocardial infarction. A shortened ST segment and a widened T wave occur with hypercalcemia. ST depression and prominent U waves occur with hypokalemia. Test-Taking Strategy: Focus on the subject, the electrocardiographic patterns that occur in a client with Crohn's disease who has a calcium level of 8 mg/dL (2 mmol/L). It is necessary to know that this client is at risk for hypocalcemia and that a level of 8 mg/dL (2 mmol/L) is low. Then it is necessary to recall the electrocardiographic changes that occur in hypocalcemia. Remember that hypocalcemia causes a prolonged ST segment and prolonged QT interval.

Closely resemble normal metabolites and act as "counterfeit" metabolites that fool cancer cells into using the antimetabolites in cellular reactions.

Antimetabolites

Damage the cell's DNA and interrupt DNA or RNA synthesis. The exact mechanism of interruption varies with each agent.

Antitumor Antibiotics

Older Adult - Assessment - Prostate Cancer

Ask the patient about: • Hesitancy • Change in the size of the urine stream • New onset pain in the lower back or legs • History of persistent urinary tract infections

What is the nurse's best response when the spouse of a dying client expresses concern that the client has no appetite and eats very little? A. Keep fluids and finger foods at the bedside for easy access when a dying client is hungry or thirsty. B. Explain to the spouse that the loss of appetite is normal when a client nears death and teach about the risk for aspiration. C. Encourage the spouse to feed the client as much as he will take to maintain adequate nutrition. D. Request that the health care provider prescribe a dietary nutrition consult to include foods that the client prefers.

B As death approaches, anorexia is one of the symptoms that normally occurs. Combined with dysphagia (difficulty swallowing), the risk for aspiration increases. While giving the client something to eat when hunger occurs, avoid forcing the client to eat too much.

What change in respiratory function does the nurse expect to find in a client who is dehydrated from severe diarrhea and vomiting? A. No changes, because the respiratory system is not involved B. Increased respiratory rate, because the body perceives dehydration as hypoxia C. Hypoventilation, because the respiratory system is trying to compensate for low pH D. Normal respiratory rate, but a decreased oxygen saturation.

B Blood pressure decreases with dehydration because of a low blood volume. This condition is perceived by the body as hypoxia and impending shock. The respiratory rate increases to ensure adequate oxygenation even when blood pressure is low.

What is the nurse's best response to a client who says that she has heard that the origin of most cancers is "genetic?" A. "the development of most cancers is predetermined and not affected by environmental factors." B. "Cancers arise in cells that have alterations in the genes." C. "Cancer is more common among males than females." D. "The majority of cancers are inherited."

B Cancer development involves a change in the expression of normal genes. Usually this change is a result of gene damage to either oncogenes or suppressor genes. Thus, cancer is "genetic" in origin although this does not mean that cancers are directly inherited from one human generation to the next.

The client who received combination chemotherapy 7 days ago for breast cancer calls the oncology clinic to report a temperature of 100.5 F (38.6 C) and has no other symptoms of infection. What is the nurse's best response? A. "This is a normal immune-related response to the chemotherapy" B. "Please go to the nearest emergency room for a full workup for infection." C. "You are most likely dehydrated. Come to the clinic now for IV fluids." D. "There is no concern at this time but call if your temperature reaches 101.5 F (38.6 C)

B Clients with neutropenia, and with this being the 7th day after chemotherapy for breast cancer, this client is very likely to be neutropenic, have so few white blood cells that they often do not have the typical symptoms of inflammation and infection. Anti-infective therapy is started when the client's temperature reaches 100 F (37.8 C) to prevent sepsis.

Which action is most important for the nurse to take to prevent extravastion in a client receiving IV chemotherapy infusion? A. Identify the specific antidote and make sure it is readily available. B. Frequently assess the site for a blood return and ease of infusion. C. Use an intravenous pump or controller to deliver the chemotherapy infusion. D. Avoid administering any drugs or fluids that are tissue irritants or vesicants.

B Frequent site assessment to ensure the access is in the vein and infusing well is the best action for prevention of extravasation. Using a pump or controller does not prevent extravasation nor does having the antidote available. Many traditional chemotherapies are either tissue irritants and vesicants and, if they are the prescribed therapy, must be given.

Which tumor grade will the nurse interpret from the pathology report of a client's biopsy of a lymph node with the features of: "moderately differentiated; lung epithelia tissue; euploid? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

B Grade 2 tumor cells are moderately differentiated and still retain enough of the characteristics of normal cells to be able to identify the tissue from which it arose. In this case, the tumor in the lymph node is from lung tissue and still has normal chromosomes.

Which client and family have the most accurate understanding of hospice care? A. Family expects that client will resist hospice and therefore, an involuntary order is needed. B. Dying client and family believe it is important to focus on facilitating quality of life. C. Family believes that dying client receives home care when no funds are available for care in a facility D. Client and family expect round-the-clock nursing care from hospice staff.

B Hospice does provide care for dying clients, but the focus of hospice care is quality of life. Actions are planned to meet the clients' needs (physical, social, psychological or spiritual). A coordinated interdisciplinary team works together to meet these needs and provide the best quality of care for the time the client has left.

Which GI complication will the nurse monitor for in a client who has a serum potassium level of 2.4 mEq/L (mmol/L)? A. Hyperactive bowel sounds B. Paralytic ileus C. Esophageal reflux D. Excessive flatus

B Hypokalemia reduces GI motility and greatly increases the risk for a paralytic ileus.

Which serum laboratory value does the nurse expect to see in the client with hypokalemia? A. Sodium less 8.0 mEq/L (mmol/dL) B. Potassium less than 3.5 mEq/L (mmol/dL) C. Chloride less than 100.0 mEq/L (mmol/dL) D Calcium less than 9.0 mg/dL (2.25 mmol/dL)

B Hypokalemia refers to a lower than normal serum potassium level, not sodium, chloride, or calcium. The normal serum potassium level is 3.5 to 5.0 mEq/L or mmol/L.

Which IV potassium solution can the nurse safely administer to a client with server hypokalemia? A. KCI 5 mEq in 20 mL NS B. KCI 10 mEq in 100 mL NS C. KCI 15 mEq in 50 mL NS D. KCI 20 mEq in 100 mL NS

B Intravenous potassium is a high-alert dangerous drug that can lead to death if administered too rapidly or a high concentration. It must always be diluted. The maximum allowable concentration of the drug is 1 mEq (mmol) per 10 mL of solution.

The pharmacy sends a 250-mL IV bag of dextrose in water with 40 mEq of potassium, marked "to infuse over 1 hour" for a client with hypokalemia. What is the nurse's best action? A. Obtain a pump and administer the solution. B. Double-check the prescription and call the pharmacy. C. Recheck the client's potassium level to ensure the IV is safe to administer. D. Recalculate the rate so that it is safe for the client.

B Intravenous potassium is a high-alert dangerous drug that can lead to death if administered too rapidly or at too a high concentration. The maximum allowable infusion rate is 5 to 10 mEq (mmol) per hour. The rate of 50 mEq (mmol) in 1 hour is completely unsafe even if it is administered with a pump or controller. Whether or not the label matches the health care provider's prescription and label must be clarified. The nurse is not the prescriber and cannot change the prescribed infusion rate.

Which client report prompts the nurse to create a three-generation pedigree to assess for the possibility of an increased risk for cancer? A. Has one first-degree relative and two second-degree relatives with lung cancer B. Has a father and paternal grandfather with colorectal cancer C. Has a history of cervical cancer treatment 5 years ago D. Worked as a chemical engineer for 20 years

B Lung cancer and cervical cancers are from environmental or lifestyle causes and do not represent an increased genetic risk for the client to develop cancer. Exposure to chemicals would also be an environmental risk factor, not a genetic one. Colorectal cancer can occur sporadically and also has an association with specific inherited gene mutations. Having a father and paternal grandfather with a history of colorectal cancer warrants more investigation as a possible indicator of increased genetic risk.

Which adult would normally be expected to have the highest total body water volume? A. 25-year-old woman B. 25-year-old man C. 75-year-old woman D. 75-year-old man

B Men have higher percentage of total body water at any age because they have more muscle mass than women and muscle cells contain a high concentration of water. Women have more body fat than men, and fat cells contain practically no water. As adults age, their total body water volume decreases because both older men and older women lose muscle mass with aging.

What is the minimum amount of urine output per day needed to excrete toxic waste products? A. 200 to 300 ml B. 400 to 600 ml C. 500 to 1000 ml D. 1000 to 1500 ml

B Much of the body's waste products, especially nitrogen, is excreted in the urine. Depending on body size, 400 to 600 mL/day of urine must be generated to ensure waste product excretion. This is known as the obligatory urine output. Less than this amount of urine will result in retained waste products that could lead to toxic levels.

For which problem will the nurse expect to prepare a client for palliative cancer surgery? A. Extensive scarring after treatment for head and neck cancer B. An intestinal obstruction and continuous vomiting C. Irritated mole rubbed continually by a bra strap D. A rapid growing skin lesion with irregular borders

B Palliative cancer surgery focuses on providing symptom relief and improving the quality of life but is not curative. Surgery to correct an intestinal obstruction meets these criteria. Revising scars is reconstructive surgery and removing a precancerous lesion is prophylactic surgery. Removal of tissue with abnormal features is diagnostic surgery.

Which instruction will the nurse emphasize to assistive personnel (AP) about the hygiene needs of a client who is neutropenic? A. Do not enter the room unless absolutely necessary and then minimize time spent in the room. B. Mouth care and washing of the axillary and perianal regions must be done during every shift. C. If the client seems very tired, assist with toileting but defer all other aspects of hygienic care. D. Be sure to soak the client's feet in warm sudsy water for at least 30 minutes daily.

B The client with neutropenia is a high risk for developing an opportunistic infection from overgrowth of his or her own normal flora in the mouth, perineal area, and skinfold areas. Cleansing these areas every shift is vital for client safety and cannot be deferred. There is no need for a healthy AP to stay out of the client's room. Soaking the feet does not reduce the risk for developing an infection.

Which possible imbalance does the nurse suspect when assessment findings on a newly admitted client include pitting dependent edema, engorged neck and hand veins, and headache? A. Dehydration B. Hypervolemia C. Fluid volume deficit D. Hemoconcentration

B The client's assessment findings are consistent with hypervolemia (fluid overload) and opposite of dehydration (fluid volume deficit), hemoconcentration is a manifestation of dehydration a type of fluid imbalance.

What is the nurse's first action to prevent harm when finding the sealed radiation implant for cervical cancer in the 74-year-old client's bed? A. Assess the client's mental status B. Use tongs to place the implant in the radiation container. C. Notify the radiologist and move the client to a different room D. Don gloves and attempt to reposition the implant and positioning device.

B The implant does emit radiation and should not be touched directly. If the room has the proper equipment, the nurse uses long-handled tongs to move the implant to an appropriate lead-lined container. If the proper equipment is not available in the client's room, the radiation department must be notified. The second action is to assess the client's mental status because she may have removed the implant and positioning fixing device as a result of acute confusion. Repositioning the implant is not within the scope of nursing practice. The client does not need to be moved to a different room.

Which statement made by a client who was treated for breast cancer 2 years ago indicates to the nurse the client's cancer may have metastasized? A. "I seem to be hungry all the time." B. "My ribs hurt but I haven't had any injuries." C. "My skin is dry and it feels itchy and irritated." D. "I feel like I need to urinate all of the time."

B The most common sites for metastasis for breast cancer are the bone, brain, lungs and liver. Skin, kidney, and bladder are rarely involved in breast cancer metastasis. A decreased appetite rather than a increased one is more common when metastasis occurs.

What response does the nurse expect to see in the blood volume and blood osmolarity of a client whose secretion of antidiuretic hormone (ADH) is extremely low? A. Decreased blood volume; decreased blood osmolarity B. Decreased blood volume; increased blood osmolarity C. Increased blood volume; decreased blood osmolarity D. Increased blood volume; increased blood osmolarity

B The normal action of ADH is making kidney nephrons more permeable to water and increasing water reabsorption that is returned to the blood. With less ADH available, the client excretes more water in the urine leading to decreased blood volume and osmolarity of the blood is increased.

What sign or symptom does the nurse expect to see in a client whose blood osmolarity is 310 mOsm/L (mOsm/kg)? A. Body temperature is below normal B. Increased thirst C. Pitting edema D. Diarrhea

B The normal blood osmolarity is 270 to 300 mOsm/L (MOsm/kg). The value of 310 is hyperosmolar, which will cause cells to move water into the extracellular fluid compartment and shrink slightly. When the osmoreceptor cells in the hypothalamus shrink, the thirst center is stimulated so the client will drink more to dilute the hyperosmolarity.

What is the nurse's interpretation of a client's urine specific gravity of 1.039? A. Overhydration B. Dehydration C. Normal value for an adult D. Renal disease

B With dehydration, the urine is usually concentrated, with a specific gravity greater than 1.030 and has a dark amber color and a strong odor. A urine specific gravity is reflective of dehydration. Overhydration (fluid overload usually is associated with a very low specific gravity. Renal disease is based on parameters other than urine specific gravity.

Which assessment findings does the nurse expect to see in a client who has mild hyperkalemia? SATA A. Wheezing on exhalation B. Numbness in hands, feet, and around the mouth C. Hyperactive bowel sounds D. Irregular heart rate E. Skeletal muscle twitching F. Excessive skin dryness

B, C, D, E Hyperkalemia increases GI motility and changes electrical conduction through the hearth, which induces an irregular heart rate. In the early stages of hyperkalemia (mild potassium elevations), paresthesia are present as is skeletal muscle twitching. The respiratory muscles are not affected until potassium levels are very high. Potassium excesses do not result in skin manifestations.

Which personal protective equipment (PPE) is the nurse required to use when administering intravenous chemotherapy to a client with cancer? SATA A. Head cover B. Eye protection C. Mask D. Gown E. Chemo-designated gloves F. Shoe coverings

B, C, D, E The purpose of PPE when administering (or preparing) IV chemotherapy agents is to prevent the nurse from having direct skin or mucous membrane contact with these drugs because they can be absorbed through intact tissue. The Oncology Nursing Society and governmental protection groups require eye protection, mask (over nose and mouth), gowns with long, cuffed sleeves, and either special chemotherapy gloves or double gloving with standard gloves. Head coverings and food covering are not needed to prevent skin and mucous membrane absorption of these drugs.

Which foods does the nurse recommend to a client who remains at continued risk for hyperkalemia? SATA A. Avocado B. Butter C. Cranberries D. Lettuce E. Eggs F. Dried beans G. Grapefruit H. Strawberries

B, C, D, E, G, H Avocados and dried beans are a rich source of potassium and should avoided by clients requiring potassium restriction. Many clients believe that all fruit contains high levels of potassium. This is not true. The fruits listed are all low in potassium as are butter and eggs.

Which signs and symptoms does the nurse expect in a client whose cancer has invaded the bone marrow? SATA A. Diarrhea and vomiting B. Fatigue and weakness C. Low white blood cell counts D. Confusion with memory loss E. Bruises or other bleeding signs F. Tachycardia and shortness of breath

B, C, E, F Cancer that invades the bone marrow crowds out the stem cells responsible for generating all the blood cells. As a result, the client has low red blood cell counts leading to anemia, which causes fatigue, weakness, tachycardia, and shortness of breath; low platelets, which enhances bleeding tendencies and causes bruising and petechiae; and low white blood cell counts, which increases infection risk. Decreased blood cell formation does not cause vomiting and diarrhea nor does it result in confusion until the client is severely hypoxic.

The electrolyte magnesium is responsible for which functions? SATA A. Formation of hydrochloric acid B. Carbohydrate metabolism C. Contraction of skeletal muscle D. Regulation of intracellular osmolarity E. Vitamin activation F. Blood coagulation

B, C, E, F Magnesium is important for skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, and cell growth. Adequate amounts of intracellular magnesium are particularly essential for health and maintenance of cardiac muscle.

Which actions will the nurse teach a client receiving chemotherapy who has myelosuppression and neutropenia to prevent harm from development of an opportunistic infection? SATA A. Avoid drinking cold or cool liquids. B. Bathe daily using an antimicrobial soap. C. Wear gloves when digging in the garden. D. Be sure to wear sufficient clothing in cold weather. E. Wash dishes in hot sudsy water or in a dishwasher. F. Clean your toothbrush daily in the dishwasher or with bleach. G. Wear a medical alert bracelet indicating you are immunosuppressed. H. Get a yearly influenza vaccination and the recommended pneumonia vaccination.

B, C, E, F Opportunistic infections are those caused by overgrowth of the neutropenic client's normal flora. These infections also include exogenous microorganism in the environment that unusually cause no problems to adults with healthy immune systems. Bathing daily and using an antimicrobial soap will help decrease the risk for opportunistic infections by reducing the number of normal flora bacteria found on the skin. Soil contains many microorganisms that can cause opportunistic infections in an immunocompromised client. Wearing gloves when digging or working with soil helps reduce this risk. Washing dishes well prevents infection from exposure to residual microbiome organism after eating. Cleaning a toothbrush daily by either rinsing it with liquid bleach (and then rinsing out the bleach) or having it go through a dishwasher cycle reduces residual organisms. Getting an influenza or pneumonia vaccination prevents pathogenic infections, not opportunistic infections. Drinking cold or cool liquids does not promote opportunistic infection. Wearing warm clothing in cold weather does not prevent opportunistic infection and neither would wearing a medical alert bracelet for immunosuppression.

Which client factors affect the amount and distribution of body fluids? SATA A. Race B. Age C. Gender D. Height E. Body fat F. Muscle mass

B, C, E, F Total body water in adults varies by age, gender, degree of muscle mass and precent of body fat. Water makes up about 55% to 60% of total weight for younger adults and 50% to 55% of total weight for older adults. Women of all ages usually have a lower percentage of body water than do men of the same ages because of greater muscle mass. Fat cells contain little or no water. The higher the percentage of body fat, the lower the percentage of total body water. Neither race nor height affect total body water.

Which actions will the nurse teach to the spouse of a client with reduced cognition who has been treated twice in the emergency department for dehydration to prevent this condition? SATA A. Avoid offering fluids after 6:00 pm B Weight the client daily to check fluid status C. Offer frequent snacks to gelatins and ice cream D. Give the client salty crackers to increase his or her sensation of thirst. E. Offer four ounces of the client's favorite fluids every hour while awake. F. Watch the client while he or she drinks any fluids to ensure it is ingested. G. Estimate or measure the number of liquid ounces ingested daily to ensure an intake of at least 1500 mL.

B, C, E, F, G Options B, C, E, F and G are recommended to help clients drink more fluids throughout the day and prevent dehydration. Avoiding fluids after early evening, a technique some families believe will reduce the risk for night time incontinence, does not reduce incontinence and may result in a lower daily intake of fluids. Salty food may not increase the sensation of thirst, especially in an older adult, and may induce an electrolyte imbalance.

Which side effects in a client receiving traditional chemotherapy will the nurse report to the oncologist for reduction of the chemotherapy dose? SATA A. Alopecia B. Bone marrow suppression C. Chemo brain D. Mucositis E. Nausea and vomiting F. Peripheral neuropathy

B, D Although doses can be reduced when requested by clients experiencing unpleasant side effects, the two side effects that require dose reduction are bone marrow suppression greatly increases the client's risk for bleeding, sepsis and death. The side effect of mucositis cannot be prevented nor are there any therapies to actually treat it. All that is available are some comfort measures. When mucositis is severe, the client may have inadequate food and fluid intake, leading to a variety of problems. The open sores also increase infection risk and the pain can be unbearable.

Which statements are true about the nature of death in the United States? SATA A. Most deaths occur suddenly and unexpectedly. B. Most people die after a long period of chronic illness. C. Most people die after the age of 75. D. The most common cause of death is heart disease. E. Medicare covers the cost of death for most people F. Most people die at home just as they wish.

B, D, E In the United States, most deaths occur after a long chronic illness (few die suddenly or unexpectedly). Most people die after the age of 65 and are eligible for Medicare. The most common cause of death is heart disease. While most people wish for a peaceful death at home, most die in acute, long-term, and hospice facilities.

Which common signs and symptoms will the nurse be sure to assess for in the older client whose serum sodium level is 152 mEq/L? SATA A. Intact recall of recent events B. Increased pulse rate C. Weight loss D. Hypertension E. Muscle weakness F. Difficulty palpating peripheral pulse

B, D, E, F Elevated sodium levels increase vascular volume "where sodium goes, water follows." increasing heart rate and blood pressure. With increased edema associated with hypernatremia, pulses may be difficult to palpate. Although mild hypernatremia increases the irritability of excitable membranes causing muscle twitching and irregular contraction, higher levels of sodium dehydrate excitable tissues, including muscle cells, to the extent that they may not be able to contract. Confusion and weight gain are associated with hypernatremia, especially when it is accompanied by hypervolemia.

For which side effects will the nurse prepare the client who is to receive 6 weeks of external beam radiation therapy for uterine cancer? SATA A. Dry mouth B. Taste changes C. Scalp alopecia D. Bowel changes E. Increased fatigue F. Skin rash and redness G. Difficulty swallowing H. Numbness and tingling in fingers and toes

B, D, E, F Radiation therapy is local therapy, and most effects on normal tissues are those in the radiation path, which , in this case, is the lower abdomen. Changes in tissues in the radiation path are the skin and the bowel. Generalized side effects from radiation therapy include taste changes and intense fatigue over time, although the exact mechanisms responsible for these effects are not clear. Although skin in the radiation path is affected, scalp alopecia will not occur from abdominal external beam radiation. Dry mouth and difficulty swallowing do not occur because the salivary glands and esophagus are not in the radiation path, nor are the fingers and toes.

Which actions would the nurse assign to the assistive personnel (AP) for postmortem care of a client? SATA A. Ask family if they wish to help wash the client's body. B. Straighten the client and lower the bed to a flat position. C. Remove dentures, then clean and carefully store them. D. Wash the client and comb the hair. E. Place pads under the hips and around the perineum. F. Place a pillow under the client's head. G. Clean and straighten up the client's room or unit.

B, D, E, F, G The AP's scope of practice would include manipulating client beds, washing the client (if the family does not wish to participate), placing a pillow under the head, straightening the room, and placing pads under the client's hips and perineum. The nurse should ask the family if the would like to assist in washing the body. Dentures should be inserted if the client wore them.

How will the nurse respond to a client with cancer in the right breast who, when told she has a tumor in her left lung, says "How can I have lung cancer when I have never smoked in my life?" A. "Not all lung cancers are caused by smoking cigarettes." B. "Many of the same carcinogens that cause breast cancer also cause lung cancer." C. "This tumor may be breast cancer that has moved to your lungs and not a new cancer." D. "This is probably a result of the radiation treatment you received as cancer treatment."

C Although it is true that not all lung cancers are caused by cigarette smoking, this client slung cancer is most likely a metastatic tumor from the breast cancer. Most of the carcinogens known to cause lung cancer are not associated with breast cancer. Radiation therapy has resulted in cancer development, but this usually takes a long time and would occur only in the area treated with radiation, which was the right breast, not the left one.

What is the main reason a nurse caring for a post operative surgical client in the recovery room carefully monitoring the clients urine output? A. Decreasing urine output indicates poor kidney function B. Increasing urine output can indicate excessive IV fluid during surgery. C. Decreasing urine output may mean hemorrhage and risk for shock. D. Increasing urine output may mean that kidney function is returning to normal.

C Because urine output is related to blood pressure remaining high enough to perfuse the kidneys, urine output is a sensitives indicator of adequate fluid volume. When blood volume starts to decreases, the body attempts to conserve volume by decreasing urine output. Although decreasing output can be reflective of poor kidney function, that is not the reason it is measured so carefully after surgery when clients have an increased risk for hemorrhage.

What possible role could estrogen play in cancer development? A. Estrogen, a female hormone, can cause cancer in males? B. Estrogen is a normal hormone that has no role in cancer development. C. Cancers that are estrogen dependent undergo mitosis more often in the presence of estrogen. D. It can be given to men with prostate cancer to help reduce the growth of prostate cancer cells

C Estrogen is a natural hormone that is a growth factor for estrogen-dependent tissues, such as the endometrium and breast ductal cells. When cancer cells have estrogen receptors, such as some breast, uterine and ovarian cancers, estrogen promotes growth of those cancer cells. It does not cause cancer. Although it is used as hormone therapy for some prostate cancer, that is a therapeutic use and does not describe its role in cancer development.

What factor or conditions make normal cells euploid? A. Are unable to migrate B. Retain contact inhibition C. Have the normal number of chromosome pairs D. Only undergo mitosis when new cells needed

C Euploid means that cells have the correct number of chromosomes (chromosome pairs) for the species. In the case of humans, all somatic body cells with a nucleus have 46 chromosomes (23 pairs)

Which system is most important for the nurse to monitor closely for a client who has severe hypomagnesemia? A. Autonomic nervous system B. Gastrointestinal C. Cardiovascular D. Renal/urinary

C cardiovascular changes associated with hypomagnesemia are serious. Low magnesium levels increase the risk for hypertension, atherosclerosis, hypertrophic left ventricle, and a variety of dysrhythmias. The dysrhythmias include premature contractions, atrial fibrillation, ventricular fibrillation and long QT intervals

Which client statement indicates to the nurse a correct understanding of the management of hypokalemia? A. "My wife does all the cooking. She shops for food high in calcium." B. "When I take the liquid potassium in the evening. I'll eat a snack beforehand." C. "I will avoid bananas, orange juice, and salt substitutes." D. "If I switch to a vegetarian diet, I can stop taking the liquid potassium."

C In option A, the client is confusing calcium with potassium. Foods with more potassium include bananas, orange juice, and organ meats. Salt substitutes are about 50% potassium.

What immediate response does the nurse expect as a result of infusing 1 liter of an isotonic intravenous solution into a client over a 3-hour time period if urine output remains at 100 mL per hour? A. Extracellular fluid (ECF) osmolarity increases; body weight increases B. Extracellular fluid (ECF) osmolarity decreases; body weight decreases C. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases D. Extracellular fluid (ECF osmolarity is unchanged; body weight decreases

C Isotonic solutions have the same tonicity as plasma and other extracellular fluids. Therefore, the intravenous fluid would not change the ECF osmolarity. When 1000 mL is infused withing 3 hours and the client only urinates 300 mL, the extra fluid would increase the client's weight. Remember that 1 liter of fluid is equal to 2.2 lb.

The client receiving high-dose chemotherapy who has neutropenia asks the nurse whether he and his wife can have sexual intercourse while he is receiving chemotherapy. What is the nurse's best response? A. "No, this activity will increase the side effects of the chemotherapy." B. "No, the danger in impregnating your wife is too great." C. "Yes, as long as you feel like it and use a condom." D. "Yes, if you do not have an infection."

C Many people do not feel well enough to have sexual intercourse during the months they are taking chemotherapy. This activity is fine as long as the client takes precautions to limit chemotherapy drug exposure to his partner and protects himself from infection or trauma. Wearing a condom reduces chemotherapy drug exposure to his partner (as a result of any drugs entering the seminal fluid or that are in the urethra from presence in the urine) and also reduces his risk for developing an ascending urinary tract infection.

Which precaution is most important for the nurse to teach a client at continued risk for hypernatremia? A. Avoid salt substitutes B. Avoid aspirin and aspirin-containing products. C. Read labels on canned or packaged foods to determine sodium content. D. Increase daily intake of caffeine-containing food and beverages.

C Most canned and prepared packaged foods contain high levels of sodium and their intake should be limited. Salt substitutes have a much lower sodium content than standard table salt and is recommended for clients who need to limit sodium intake. Aspirin has no influence on serum sodium levels. Caffeinated food and beverages can increase water excretion without increasing sodium excretion and lead to higher serum sodium levels.

Which serum value indicates to the nurse that the client has hypernatremia? A. Potassium 3.9 mEq/L (mmol/L) B. Chloride 103 mEq/L (mmol/L) C. Sodium 149 mEq/L (mmol/L) D. Potassium 4.9 mEq/L (mmol/L)

C Normal serum sodium ranges between 136 and 145 mEq/L (mmol/L). Hypernatremia is a serum sodium value higher than 145 mEq/L (mmol/L). The other electrolytes values are within their normal ranges.

Which client report indicates to the nurse that spinal cord compression may be present? A. Teh client reports having a headache for the past 7 hours. B. The client has reduced breath sounds in the left lung. C. The client has worsening mid-thoracic back pain. D. Pedal edema is now present bilaterally.

C One of the first symptoms of spinal cord compression in a patient with cancer is new-onset or worsening back pain as the disintegrating bones press and compress spinal nerves. Headache is not associated with spinal cord compression.

A client is talking to the nurse about sodium intake. Which statement by a client indicates to the nurse a correct understanding of high sodium food sources? A. "I have bacon and eggs every morning for breakfast." B. "We never eat seafood because of the salt water." C. "I love Chinese food, but I gave it up because of the soy sauce." D. "Pickled herring is a fish, and my doctor told me to eat a lot fish."

C Soy sauce is a source of sodium because 1 tablespoon (15 mL) has nearly 900 mg of sodium. Clients who are to restrict sodium intake should be taught to avoid foods that contain significant amounts of soy sauce. Seafood itself does not contain high concentrations of sodium. Bacon and pickled herring do contain higher concentrations of sodium.

Which assessment is a priority for the nurse to perform for a client who is taking an antiemetic from the serotonin antagonist (5-HT3 receptor blocker) class of drugs? A. Urine output B. Serum calcium level C. Heart rate and rhythm D. White blood cell count

C The serotonin antagonists can cause cardiac changes, especially a prolonged QT interval. These drugs are not known to have adverse effects on calcium balance or white blood cell count. Although urine output could be decreased if the client is dehydrated from excessive vomiting, this is not a side effect of the antiemetic therapy.

Which body fluid compartment is considered the "third space?" A. Extracellular fluid B. Intracellular fluid C. Interstitial fluid D. Blood (plasma)

C The extracellular fluid includes both the blood (plasma) volume and the interstitial fluid. Another term for the interstitial fluid is the third space, which is between the cells rather than inside the cells or in the blood (plasma).

Which serum calcium level in a client laboratory findings does the nurse interpret as normal? A. 3.7 mEq/L (1.05 mmol/L) B. 1.05 mEq/L (3.75 mmol/L) C. 9.5 mEq/L (2.38 mmol/L) D. 2.38 mEq/L (9.5 mmol/L)

C The normal range for serum calcium levels is 9.0 to 10.5 mEq/L (or 2.25 to 2.75 mmol/L).

Which possible problem does the nurse suspect when a client who has been treated for prostate cancer reports that he is now having a lot of pain in his lower back and legs? A. Arthritis B. urinary retention C. metastasis to the bone D. Muscle atrophy from inactivity

C The primary site of metastasis for prostate cancer is the bone of the spine and legs. Pain in these areas in a client with prostate cancer is highly suggestive of cancer progression and metastasis. Arthritis is generally a joint disorder. Urinary retention usually causes lower abdominal pain. Muscle atrophy is painless.

Which is the correct technique for the nurse to use when assessing the client for a positive Chvostek sign? A. Client flexes arms against the chest and the nurse attempts to pull the arms away from the chest. B. The nurse inflates a blood pressure cuff around the upper arm to higher than the client's systolic pressure. C. The nurse taps the client's face just below and in front of the ear. D. The nurse lightly taps the client's patellar tendon with a reflex hammer and measures the movement.

C To test for Chvostek sign, the nurse taps the face just below and in front of the ear to trigger facial twitching of one side of the mouth, nose and cheek (a positive response). Option A is a test of muscle strength. Option B describes correct technique for measuring Trousseau sign. Option D describes correct technique for assessing a deep tendon reflex.

which change in health status indicates to the nurse that the client's superior vena cava syndrome is worsening? A. The client's systolic blood pressure is rising and the diastolic pressure is decreasing. B. The client's severe nausea and vomiting no longer responds to antiemetics C. The client has experienced four nose bleeds in the past 2 days. D. Pedal edema is now present.

C With superior vena cava syndrome, blood flow through the vena cava is compromised as a result of tumor growth. As blood backs up in the venous system drained by the superior vena cava, pressure in the veins increase and nose bleeds (epistaxis) occur easily and frequently. The increased venous pressure would not increased systolic pressure. Response to antiemetics is not affected by superior vena cava syndrome. Pedal edema could occur in response to a blockage in the inferior vena cava but not the superior vena cava.

The nurse observes client with which of the following conditions for potential hypernatremia? SATA A. Chronic constipation B. Heart failure C. Severe diarrhea D. Decreased kidney function E. Profound diaphoresis F. Cushing's syndrome

C, D, E, F Severe diarrhea and profound diaphoresis cause both water loss and some sodium loss. However, water loss is greater than sodium loss and can result in a relative hypernatremia. Cushing syndrome with increased levels of cortisol causes an increased reabsorption of sodium from the kidneys leading to hypernatremia. Decreased kidney function reduces the normal amount of sodium that is excreted in the urine leading to hypernatremia. Constipation has no effect on loss or reabsorption of sodium. heart failure is affected by excess sodium but does not lead to excess sodium.

Which actions or behaviors represent to the nurse that the client is engaging in primary cancer prevention practices? A. Reducing cigarette smoking B. Getting a mammogram annually C. Having a mole removed from the neck D. Obtaining a colonoscopy every 5 years. E. Having a health checkup, including chest x-ray, annually F. Electing to have bilateral mastectomies in a person who has a BRCA1 mutation

C, D, F Reducing exposure to a carcinogen, rather than totally avoiding it, does not really represent primary prevention. Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or breasts when a person has a specific mutation in a BRCA1 gene) does represent primary cancer prevention. Mammograms and health checkups represent secondary prevention in the form of possible early detection.

What effect does a "driver" mutation in a gene have on cancer development? A. Driver mutations are another term for suppressor gene mutations. B. These mutations protect against cancer development by reversing the effects of initiation. C. These mutations occur later in cancer progression and enhance cancer cell survival. D. The driver mutation increases an initiated cell's latency period, amplifying the effect of the carcinogen.

C. As tumor cells continue to divide, some of the new cells undergo further genetic mutations that change features from the original, initiated cancer cell and from different groups. Driver mutations provide these cell groups with specific selection advantages that allow them to live and divide no matter how the conditions around them changes. These mutations are not protective, cannot reverse initiation, and do not increase latency.

Which priority HCP-prescribed action would the nurse expect for a dying client with dyspnea, crackles on auscultation, peripheral edema, and other signs of heart failure? A. Antibiotics to prevent a possible respiratory infection B. Insertion of a urinary catheter for accurate measurement of output. C. Administration of the diuretic furosemide D. Offer an electric fan as a comfort measure

C. When a dying client shows symptoms of heart failure, the HCP may prescribe a diuretic such as furosemide to decrease blood volume, reduce vascular congestion and decrease the workload on the heart. It can be given orally, intravenously, or subcutaneously. IV is the preferred route because it works very quickly (within minutes) and can help the client feel more comfortable. Other nonpharmacological measures could include limiting exertion, inserting a urinary catheter, elevating the client's head of bed or placing the client in a reclining chair, applying cool cloths to the face, and encouraging therapies such as imagery and deep breathing.

Familial polyposis cancers

Colorectal cancer

Proteasome Inhibitors • Bortezomib nursing implications

Common side effects are nausea, vomiting, anorexia, abdominal pain, bowel changes, hypotension, and peripheral neuropathy. Other side effects include headache, rash, back and bone pain, muscle aches, and tumor lysis syndrome.

Which client will the nurse assess most frequently for sepsis? A. 34-year-old who has received high-dose radiation to the left chest area B. 53-year-old with hypercalcemia and dehydration C. 66-year-old with small cell lung cancer and hyponatremia D. 72-year-old patient with neutropenia and a low-grade fever

D A client with neutropenia is always at risk for sepsis regardless of age. However, this risk is increased in older adults. In addition, this client already has a low-grade fever. Neutropenic clients often do not develop a fever with infection. The fact that this client has any temperature elevation is an indicator of more severe infection. Radiation to the left chest does not significantly impair bone marrow production of neutrophils. Neither dehydration nor hyponatremia increase the risk for sepsis.

Which action will the nurse perform when the assistive personnel (AP) reports that the client now has a "death rattle?" A. Perform oropharyngeal suctioning to remove the secretions. B. Call the health care provider and family to notify them that the client has died. C. Instruct the AP to bring a postmortem pack to the client's bedside. D. Have the AP assist the nurse in turning the client on the side to reduce gurgling.

D A death rattle is heard with loud, wet respirations and this is upsetting to family, friends, and care providers. Repositioning the client to one side reduces the gurgling. The nurse should also place a small towel under the clients mouth to collect the secretions. One other action that may help is to administer an anticholinergic (e.g. 1% atropine ophthalmic) to help dry the secretions. Suctioning is not recommended because it is not effective and is often upsetting to the client.

What is the nurse's best actin when a client, with a living will and do-not-resuscitate order, is dying and the daughter tells the nurse that she wants everything done to save her parent's life? A. Call and notify the HCP about the daughter's wishes and change the plan of care? B. Initiate a CODE and bring the crash cart to the client's bedside. C. Inform the daughter that further actions are not warranted. D. Respect the client's wishes and ask the chaplain to stay with the daughter.

D A living will identifies what a client wants and does not want when near death. A DNR order, signed by a physician or the primary HCP instructs that CPR is not to be attempted. These are meant for clients with life-limiting conditions where resuscitation is not wise. The nurse should notify the HCP but the plan of care should not be changed. Asking the chaplain or someone else to sit with the daughter is a good move. A CODE should not be initiated. CPR can be violent and uncomfortable, as well as prevent a peaceful death.

Which intervention does the nurse anticipate for a client who has hypernatremia caused by reduced kidney sodium excretion? A. IV administration of 0.9% sodium chloride solution B. IV administration of Ringer's lactate solution C. Administration of convaptan D. Administration of furosemide

D Both IV solutions contain isotonic levels of sodium chloride and would not significantly reduce the hypernatremia. The fluid may be problematic if the client's kidney function is low. Convaptan would increase water excretion and not induce sodium excretion, which would make the sodium level even higher. Furosemide increases both water and sodium excretion along with other electrolytes.

For which type of cancer is chemotherapy most beneficial? A. Brain tumors B. Superficial cancers on the outside of the body C. Cancers that are localized to one tissue or body area D. Cancers that are large with evidence of distance metastasis

D Chemotherapy is considered systemic therapy and is used as primary therapy or adjuvant therapy for cancers that may not be confined to a localized body area. Because chemotherapy is systemic, it circulates through many body areas and can harm cancer cells that may be some distance from the primary tumor. Many types of chemotherapy, however, are not able to cross the blood-brain barrier and are not useful for tumors that either develop in the brain or metastasize to the brain.

Which IV fluid does the nurse expect to administer to a client who is prescribed to receive hypotonic fluids? A. 9% saline B. 3% saline C. 0.9% saline D. 0.45% saline

D Isotonic saline is 0.9%. The options of 9% saline and 3% saline are hypertonic. Only 0.45% saline is a hypotonic solution.

How does the nurse prepare to administer the prescribed magnesium sulfate (MgSO4) for a client with severe hypomagnesemia? A. Orally B. Subcutaneously C. Intramuscularly D. Intravenously

D Magnesium sulfate is a severe irritant and is no longer administered subcutaneously or intramuscularly. Oral administration takes too long to achieve the desired outcome and would cause severe diarrhea.

Which action is most likely to be implemented first when a client near dying tells the nurse about an uncomfortable feeling of breathlessness? A. 10 mg furosemide IV B. 2 L oxygen by nasal cannula C. Albuterol puff by metered-dose inhaler D. 5 mg morphine sulfate IV

D Opioids like morphine sulfate are the standard treatment for dyspnea near death. Morphine works by altering the sense of air hunger, reducing anxiety and associated oxygen consumption, and reducing pulmonary congestion. Furosemide is a diuretic and albuterol is a bronchodilator. Oxygen therapy for dyspnea near death is not a standard of care for all dying clients, however, if a client does not respond to morphine therapy, he or she may be placed on oxygen (2 to 6 L nasal cannula).

How will the nurse instruct a client who is prescribed to receive an oral chemotherapy agent for colorectal cancer to dispose of unused or expired drug to prevent harm? A. Place in a puncture-proof container and throw out with the regular trash. B. Crush the drugs and mix them with kitty litter before placing the zippered bad in the trash. C. Flush down the toilet, taking care to wear gloves while wiping up splash areas on the toilet or walls. D. Take them back to the oncology clinic in the container in which they were dispensed for disposal with other medical waste.

D Oral chemotherapy agents pose a toxic hazard to others and cannot be thrown out ion the trash or flushed down the toilet. Instruct the patient to bring them back to the hospital or clinic in the container in which they were dispensed, and the hospital or clinic will dispose of them as hazardous medical waste.

Which comment made by a client with breast cancer indicates to the nurse a need for clarification regarding cancer causes and prevention? A. "I will eat a low-fat diet from now on." B. "I know that nothing I did or didn't do caused this cancer." C. "I hope my daughter doesn't have this problem when she grows up." D. "I will have regular mammograms on my other breast to prevent cancer."

D Regular mammography can help detect breast cancer at an early stage, it does not prevent breast cancer. High-fat diets have a slight connection to breast cancer development, as does obesity. For the most part, the cause of breast cancer is unknown. Breast cancer has familial and hereditary forms. Having a mother with breast cancer does increase a woman's overall risk.

Which electrolyte plays the largest role in maintaining blood osmolarity? A. Calcium B. Chloride C. Potassium D. Sodium

D Sodium is the electrolytes in the blood. This high concentration keeps more of the chloride ions in the blood. As a result, sodium keeps the blood osmolarity within the normal range. Both calcium and potassium have low blood levels.

Which medication of class of drugs taken regularly at home does the nurse associate with a newly admitted client's laboratory finding of hyperkalemia? A. Insulin B. Beta blocker C. Cephalosporin antibiotic D. Spironolactone

D Spironolactone is a potassium sparing diuretic that increases its reabsorption in the kidney. Taking it daily can lead to hyperkalemia. Insulin is associated with hypokalemia. The beta blocker and antibiotic are not associated with disturbances of potassium.

What is the nurse's best response when a client asks how does a chemical carcinogen cause cancer? A. By allowing cells to produce more than two cells when undergoing normal cell division B. By limiting the immune system from recognizing cancer cells C. By preventing normal cells from obtaining essential nutrients D. By damaging genes that control how and when cells divide

D The main effect of chemical carcinogens is entering cells and damaging the DNA in the genes that control or regulate normal cell growth. Even cancer cells, when they divide, only produce two new cells at each cell division. Although the immune system may fail to recognize cancer cells as abnormal, this is not the action that changes normal cells to cancer cells, nor do the carcinogens prevent or interfere with normal cell's nutrition.

Which serum potassium value indicates to the nurse that client has hyperkalemia? A. 2.9 mEq/L (mmol/L) B. 3.9 mEq/L (mmol/L) C. 4.9 mEq/L (mmol/L) D. 5.9 mEq/L (mmol/L)

D The normal range for serum potassium level is 3.5 to 5.0 mEq/L (mmol/L). Hyperkalemia is a serum potassium level higher than 5.0 mEq/L (mmol/L).

Which statement by a client taking an oral cancer agent indicates to the nurse that more education is needed? A. "This drug is much more convenient that my old IV drugs." B. "I understand that not skipping dose is very important in controlling my cancer." C. "My husband wants to help me but I told him that only I should touch this drug." D. "I have been crushing the drug and putting it in my tea because it is hard to swallow."

D These drugs should not be crushed, cut, or chewed. Other actions that can make them easier to swallow include taking them with a spoonful of pudding, some other "slippery" food, or thick drink. The client is correct that missed doses can reduce therapy outcomes. These drugs can be absorbed through the skin and only the client should have direct contact with them.

A dying client receiving morphine sulfate for pain is at increased risk for acute renal failure. Which assessment finding will the nurse observe that indicates worsening of renal failure and failure to excrete the morphine? A. Adequate pain relief B. Crackles and wheezes in the lungs C. Color, clarity, and amount of urine D. Signs of confusion or delirium

D When a client develops kidney failure, the failing kidney is unable to excrete the metabolites of morphine; therefore, the level of the drug increases and this leads to delirium and confusion. When this happens, the HCP considers changing pain drug from morphine to fentanyl which does not have active metabolites and can be administered transdermally.

Which action would the nurse take when assessing a dying client with findings including coldness of extremities that are also mottled and cyanotic? A. Gently rub the extremities to stimulate circulation. B. Administer warmed oral and intravenous fluids. C. Reposition the client with the lower extremities dependent. D. Cover the client with a warm blanket.

D When death is approaching, a comfort measure for coolness of extremities that may become discolored or mottled is to cover the client with a warm blanket. avoid the use of electric blankets, hot water bottles or electric heating pads to war the extremities.

Which measure put into place by the nurse while caring for a client with sever hypocalcemia is most likely to prevent harm? A. Urge to client to eat foods high in calcium content. B. Instruct the client to increase his or her intake of water. C. Instruct assistive personnel (AP) to avoid taking blood pressures. D. Use a lift sheet to move or reposition the client.

D With hypocalcemia, calcium leaves bone storage sites, causing a loss of bone density. Bones are less dense, more brittle and fragile, and may break easily with slight trauma. Using a lift sheet rather than pulling the client helps prevent harm. Eating a high-calcium diet can help the hypocalcemia but does not directly prevent harm. Hypocalcemia is not caused by water loss, and increasing fluid intake may dilute the already low serum calcium level. Clients with hypocalcemia are at risk for hypotension and orthostatic hypotension. Blood pressure sill needs to be measured and does not pose a risk to safety.

What are the nurse's priority actions to prevent harm for a client receiving IV chemotherapy into a peripheral line with an agent that is an irritant, who says the site burns terribly at and around the IV site? SATA A. Check for a blood return B. Slow the rate of infusion. C. Apply ice to the site. D. Discontinue the infusion. E. Call the pharmacist. F. Raise the arm above the level of the heart.

D, E Irritants and vesicants can both cause tissue damage. Even if the IV has a good blood return, some of the chemotherapy can sill be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent further leakage and damage. Applying ice may or may not be the correct action, depending on the specific agent; however, the application would only be done after the infusion has been discontinued. The pharmacist would know precisely what action or antidote should be used for the specific agent involved.

Potassium (K+) - Significance of Abnormal Values

Elevated: Hyperkalemia; dehydration; kidney disease; acidosis; adrenal insufficiency; crush injuries Low: Hypokalemia; fluid overload; diuretic therapy; alkalosis; insulin administration; hyperaldosteronism

Magnesium (Mg2+) - Significance of Abnormal Values

Elevated: Hypermagnesemia; kidney disease; hypothyroidism; adrenal insufficiency Low: Hypomagnesemia; malnutrition; alcoholism; ketoacidosis

Hospice Care vs. Palliative Care - providers

Hospice care - Ongoing care is provided by registered nurses, social workers, chaplains, and volunteers. Palliative Care - Care is in the form of a consultation visit by a primary health care provider who makes recommendations; follow-up visits may be provided.

Osmolarity - Significance of Abnormal Values

High: Dehydration; hypernatremia; hyperglycemia Low: Fluid overload; hyponatremia; hypoproteinemia; malnutrition

Hospice Care vs. Palliative Care - time of care

Hospice Care - Care is provided in 60- and 90-day periods with an opportunity to continue if eligibility criteria are met. Palliative Care - Care is not limited by specific time periods.

Angiogenesis/mTOR Kinase Inhibitors • Everolimus (oral) • Lenalidomide (oral) • Pomalidomide (oral) • Temsirolimus nursing implications

Hyperglycemia, hyperlipidemia, and hypersensitivity reactions to these drugs are common. Bone marrow suppression is moderate to severe. Other general side effects include headache, nausea and vomiting, back pain, muscle and joint pain, mucositis, diarrhea, hepatic impairment and skin problems. Lenalidomide is highly regulated, and prescribers must be enrolled in the Risk Evaluation and Mitigation Strategy (REMS) program.

Monoclonal Antibodies • Daratumumab • 90Y ibritumomab tiuxetan • Pertuzumab • Rituximab • Trastuzumab nursing implications

Infusion-related reactions, or hypersensitivity reactions (HSRs), may occur in patients receiving monoclonal antibodies. Nursing assessment is key for early recognition of a potentially life-threatening infusion-related reaction. Infusion reactions usually occur during the infusion. Premedications, such as diphenhydramine and acetaminophen, can decrease the incidence of infusion-related reactions.

Vascular Endothelial Growth Factor Receptor Inhibitor (VEGFRI) • Bevacizumab nursing implications

This drug inhibits formation of new blood vessels within a tumor. As a result, tumor cells are poorly nourished and growth is inhibited. The most common side effects are hypertension and impaired wound healing. Patients must not have surgery within 28 days of receiving bevacizumab. Serious and life-threatening complications include gastrointestinal perforation and hemorrhage.

Hepatitis B virus caused malignancies

Primary liver carcinoma

Hepatitis C virus caused malignancies

Primary liver carcinoma, possibly B-cell lymphomas

Reduce CINV by blocking dopamine receptors in the brain's chemotrigger zone.

Prokinetic Agents

Prevent CINV by blocking the 5-HT3 receptors of the chemotrigger zones in the brain and intestines. This action prevents serotonin from binding to the receptors and activating the nausea and vomiting centers.

Serotonin Antagonists

Tyrosine Kinase Inhibitors (TKIs) Some examples are: • Dasatinib (oral) • Erlotinib (oral) • Imatinib (oral) • Lapatinib (oral) Nursing implications

Side effects common to most TKIs include nausea, vomiting, fluid retention, electrolyte imbalances, and bone marrow suppression.

Hormone Antagonists - Endocrine therapy • Antiestrogens • Fulvestrant (oral) • Raloxifene (oral) • Tamoxifen (oral) nursing implications

Side effects include bone pain, hot flashes, increased cardiovascular risks, risk of thrombotic events (deep vein thrombosis, pulmonary embolism), and increased risk of uterine cancer.

G4

Tumor cells are poorly differentiated and retain no normal cell characteristics. Determination of the tissue of origin is difficult and perhaps impossible.

G3

Tumor cells are poorly differentiated, but the tissue of origin can usually be established. The cells have few normal cell characteristics.

Erythropoietin-Stimulating Agents (ESAs) • Epoetin alfa • Darbepoetin nursing implications

Used for chemotherapy-induced anemia. Used for anemia induced by renal failure. Use caution for patients receiving curative cancer treatment as these agents may shorten survival or increase tumor progression.

Colony-Stimulating Factors (CSFs) • Filgrastim • Pegfilgrastim • Sargramostim nursing implications

Used for chemotherapy-induced neutropenia or leukopenia. Pegfilgrastim is a long-acting dose given the day after chemotherapy to help reduce incidence of neutropenia in regimens known to have at least 20% risk of febrile neutropenia. Bone pain is a troublesome side effect. Educate patients on management of this unpleasant side effect.

Hormone Antagonists - Endocrine therapy • Antiandrogens • Abiraterone (oral) • Bicalutamide (oral) • Enzalutamide (oral) nursing implications

Used for prostate cancer. Side effects include infertility, osteoporosis, hot flashes, sexual dysfunction (including loss of libido and erectile dysfunction).

Epidermal Growth Factor Receptor Inhibitors (EGFRIs) Some examples are: • Cetuximab • Panitumumab • Trastuzumab nursing implications

Used for some lung and colon cancers. Common side effects include hypersensitivity reactions and a variety of skin reactions; as mild as a rash or progressing to excessive skin peeling and fissures. A good skin regimen needs to be started at the time of the infusion and maintained during treatment. Patient education is crucial to maintain skin integrity. EGFRI treatments cause significant skin rashes, and although these may look like acne, they are not treated like acne. Using a moisturizing lotion and avoiding sun exposure are key elements.

Aromatase Inhibitors - endocrine therapy • Anastrozole (oral) • Exemestane (oral) • Letrozole (oral) nursing implications

Used in postmenopausal women who have hormone-positive breast cancer. Side effects include fatigue, arthralgias, joint stiffness, and/or bone pain, hot flashes, and sexual dysfunction.

Common Emotional Signs of Approaching Death

Withdrawal The person is preparing to "let go" of surroundings and relationships. Vision-Like Experiences The person may talk to people you cannot see or hear and see objects and places not visible to you. These are not hallucinations or drug reactions. • Do not deny or argue about what the person claims. • Affirm the experience. Letting Go The person may become agitated or continue to perform repetitive tasks. Often this indicates that something is unresolved or is preventing the person from letting go. As difficult as it may be to do or say, the dying person takes on a more peaceful demeanor when loved ones are able to say things such as "It's okay to go. We'll be alright." Saying Goodbye When the person is ready to die and the family is ready to let go, saying "goodbye" is important for both the patient and the family. Touching, hugging, crying, and saying "I love you," "Thank you," "I'm sorry," or "I'll miss you so much" are all natural expressions of sadness and loss. Verbalizing these sentiments can bring comfort both to the dying person and to those left behind.

A client who is dying cannot swallow and is accumulating audible mucus in the upper airway (death rattles). These noises are upsetting to family members. What nursing action is appropriate? a. Place the client in a side-lying position so secretions can drain. b. Use a Yankauer suction tip to remove secretions from the client's upper airway. c. Position the client in a high-Fowler position to minimize secretions. d. Assist the family in leaving the room so that they can compose themselves.

a

A client who is dying is having difficulty swallowing oral medications. Which intervention will the nurse implement for this client? a. Ask the provider if the medications can be discontinued or substituted. b. Do not administer the medications and document: "Unable to swallow." c. Ask the pharmacy to substitute intramuscular (IM) equivalents for the medications. d. Crush the pills, open the sustained-release capsules, and mix them with a spoonful of applesauce.

a

The nurse is coordinating interprofessional palliative care interventions for the client who is dying. Which goal is the nurse seeking to meet? a. Facilitating a peaceful death for the client b. Ensuring an expedited death c. Meeting all of the client's needs d. Avoiding symptoms of client distress

a

The nurse manager for home health and hospice is scheduling daily client visits. Which client is appropriate for the assistive personnel to visit? a. Aggressive brain tumor and needs daily assistance with ambulation and bathing b. Advanced cirrhosis of the liver and just called the hospice agency reporting nausea c. Inoperable lung cancer and considering whether to have radiation and chemotherapy d. Prostate cancer with bone metastases and has new-onset leg weakness and tingling

a

Key point: Finish this sentence Common complementary and integrative therapies used for symptom management at the end of life include

aromatherapy, music therapy, and energy therapies such as Therapeutic Touch.

A process by which patients and families discuss end-of-life care, clarifying values and goals and then expressing those goals in an advance directive.

advance care planning

A written document prepared by a competent person to specify what, if any, extraordinary actions he or she would want when no longer able to make decisions about personal health care.

advance directive (AD)

Key point: Finish this sentence Hospice care uses an interprofessional approach to medical care, pain management,

and emotional and spiritual support expressly tailored to each patient's needs and wishes, including family and loved ones

A condition in which cells have abnormal structures or numbers.

aneuploidy

A dying client becomes increasingly withdrawn and begins to refuse to eat and drink. What intervention will the nurse implement? a. Administer intravenous hydration. b. Call the family to come in right away. c. Offer ice chips. d. Bring in the client's favorite food.

c

A hospice client becomes too weak to swallow. What does the nurse do initially to increase the client's comfort? a. Explains to the family that aspiration may be a concern. b. Administers nutrition and fluids through a nasogastric tube. c. Teaches the family how to provide oral care. d. Obtains a physician order to initiate an IV line.

c

The family of a client who is unconscious and dying realizes that their mother will die soon. The client's children are having a difficult time letting go. How will the nurse respond to the needs of this family? a. "She will soon be in a better place." b. "She would not want you to cry; she needs you to be strong." c. "This must be difficult for you." d. "Things will be ok, just try to enjoy your time together."

c

An important body electrolyte ion having two positive charges (divalent cation).

calcium (Ca2+)

A type of abnormal cell growth in which cellular regulation is lost, resulting in new tissues that serve no useful function, are harmful to the function of normal cells and organs, and can lead to death if left untreated.

cancer (malignancy)

Cancer development with changing of a normal cell into a cancer cell.

carcinogenesis (oncogenesis, malignant transformation)

Positively charged electrolytes.

cations

Genetic and physiologic processes that control cellular growth, replication, differentiation, and function to maintain homeostasis.

cellular regulation

Cytotoxic drugs aimed to reduce tumor burden and destroy cancer cells.

chemotherapy

The loss of sensory perception or motor function of peripheral nerves associated with exposure to certain anticancer drugs.

chemotherapy-induced peripheral neuropathy (CIPN)

Unit of measurement for an absorbed radiation dose.

gray

The emotional feeling related to the perception of the loss.

grief

An interprofessional approach to facilitate quality of life and a "good" death for patients near the end of their lives, with care provided in a variety of settings.

hospice

Term used to describe the process of ending life. Active euthanasia implies that primary health care providers take action (e.g., give medication or treatment) that purposefully and directly causes the patient's death.

euthanasia

Key point: Finish this sentence Nurses have an ethical obligation to provide timely information about

expected care outcomes so patients and families can make the best end-of-life decisions

The compartment composing fluids outside of the cells (interstitial fluid and plasma volumes).

extracellular fluid (ECF)

Key point: Finish this sentence Teach the patient and family that an advance directive is a written document that specifies what, if any,

extraordinary actions the patient would want if he or she could no longer make decisions about care.

Leakage or infiltration of a vesicant into the surrounding tissue.

extravasation

Key point: Finish this sentence Be aware that people facing death may experience

fear and anxiety about their impending death and have difficulty coping

filtration Movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure (water pressure) differences.

filtration

Key point: Finish this sentence Recognize that older adults are often undertreated

for pain or other symptoms at the end of life

Key point: Finish this sentence Because of the risk for delirium, particularly in older adults, providers may avoid use of benzodiazepines

for treatment of anxiety, even at the end of life. Development of increased agitation after receiving benzodiazepine could represent a paradoxical reaction.

Care of the Patient With Sealed Implants of Radioactive Sources

• Assign the patient to a private room with a private bath. • Place a "Caution: Radioactive Material" sign on the door of the patient's room. • If portable lead shields are used, place them between the patient and the door. • Keep the door to the patient's room closed as much as possible. • Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient). • If you are attempting to conceive, do not perform direct patient care, regardless of whether you are male or female. • Nurses who are pregnant should not care for these patients; do not allow women who are pregnant or children younger than 16 years to visit. • Limit each visitor to 1 half-hour per day. Be sure visitors stay at least 6 feet from the source. • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. • After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people.

Prevention of Infection During the times your white blood cell counts are low:

• Avoid crowds and other large gatherings of people who might be ill. • Do not share personal toiletries. • If possible, bathe daily. If total bathing is not possible, wash the armpits and entire perineal area twice a day with an antimicrobial soap. • Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. • Do not drink perishable liquids that have been standing at room temperature for longer than an hour. • Use food safety when preparing meals. • Wash fresh fruits and vegetables prior to eating. • Do not change pet litter boxes or clean up after pets. Wear gloves if necessary. • Take your temperature at least once a day and whenever you do not feel well. • Report any of these indicators of infection to your oncologist immediately: • Temperature greater than 100.4°F (38°C) • Persistent cough (with or without sputum) • Pus or foul-smelling drainage from any open skin area or normal body opening • Presence of a boil or abscess • Urine that is cloudy or foul smelling or that causes burning on urination • Take all drugs as prescribed. • Wear gardening gloves when working in the garden or with houseplants. • Wear a condom when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom.

Examples of Antimetabolites

• Azacitidine • Capecitabine (oral) • Cytarabine • Decitabine • 5-Fluorouracil • Gemcitabine

Basic Beliefs Regarding Care at End of Life and Death Rituals for Selected Religions - Islam

• Based on belief in one God, Allah, and his prophet Muhammad. Qur'an is the scripture of Islam, composed of Muhammad's revelations of the Word of God (Allah). • Death is seen as the beginning of a new and better life. • God has prescribed an appointed time of death for everyone. • Qur'an encourages humans to seek treatment and not to refuse treatment. Belief is that only Allah cures but that Allah cures through the work of humans. • At death the eyelids are to be closed, and the body should be covered. Before moving and handling the body, contact someone from the person's mosque to perform rituals of bathing and wrapping body in cloth.

Antitumor Antibiotics examples

• Bleomycin • Daunorubicin • Doxorubicin • Doxorubicin liposomal • Epirubicin

Mouth Care for Patients With Mucositis

• Examine your mouth (including the roof, under the tongue, and between the teeth and cheek) regularly. • If sores or drainage is present, contact your cancer health care provider. • Brush the teeth and tongue with a soft-bristled brush or sponges at least every 8 hours and after meals. • Avoid the use of mouthwashes that contain alcohol. • "Swish and spit" room-temperature tap water, normal saline, or salt and soda water on a regular basis (at least four times a day) and as needed according to changes in the oral cavity. • Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake. • Take all drugs, including antibiotics and drugs for nausea and vomiting, as prescribed. • Use topical analgesic drugs as prescribed. • Take pain medications on schedule as needed. • Apply a water-based moisturizer to your lips as needed. • Use prescribed "artificial saliva" or mouth moisturizers as needed. • Avoid using tobacco or drinking alcoholic beverages. • Avoid spicy, salty, acidic, dry, rough, or hard food. • Use caution when drinking and eating hot foods to prevent burns. • If you wear dentures, keep them clean and make sure they fit well.

Causes of dehydration

• Hemorrhage • Vomiting • Diarrhea • Profuse salivation • Fistulas • Ileostomy • Profuse diaphoresis • Burns • Severe wounds • Long-term NPO status • Diuretic therapy • GI suction • Hyperventilation • Diabetes insipidus • Difficulty swallowing • Impaired thirst • Unconsciousness • Fever • Impaired motor function

Topoisomerase Inhibitors - examples

• Irinotecan • Topotecan

Pronouncement of Death

• Note time of death—the time at which the family or staff reported the cessation of respirations. • Identify the patient by identification (ID) tag if in facility. Note the general appearance of the body. • Ascertain that the patient does not rouse to verbal or tactile stimuli. Avoid overtly painful stimuli, especially if family members are present. • Auscultate for the absence of heart sounds; palpate for the absence of carotid pulse. • Look and listen for the absence of spontaneous respirations. • Document the time of pronouncement and all notifications in the medical record (i.e., to attending physician). Document if the medical examiner needs to be notified (may be required for unexpected or suspicious death). Document if an autopsy is planned per the attending primary health care provider and family. • If your state and agency policy allows an RN to pronounce death, document as indicated on the death certificate.

Hypernatremia - Relative sodium excesses

• Nothing by mouth • Increased rate of metabolism • Fever • Hyperventilation • Infection • Excessive diaphoresis • Watery diarrhea • Dehydration

Care of the Patient With Myelosuppression and Neutropenia

• Place the patient in a private room whenever possible. • Use good handwashing technique or alcohol-based hand rubs before touching the patient or any of the patient's belongings. • Ensure that the patient's room and bathroom are cleaned at least once each day. • Limit the number of health care personnel entering the patient's room. • Monitor vital signs every 4 hours, including temperature. • Inspect the patient's skin and mucous membranes for the presence of fissures and abscesses per facility policy. • Inspect IV sites for indications of infection. • Change wound dressings daily or as ordered. • Use strict aseptic technique for all invasive procedures. • Promptly notify the primary health care provider if any area appears infected and obtain order for culture, per protocol. • Encourage activity at a level appropriate for the patient's current health status. • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer). • Visitors with signs or symptoms of illness should be restricted. • Monitor the white blood cell count daily. • Avoid the use of indwelling urinary catheters if possible. Provide perineal hygiene per protocol and at least daily. • Follow agency policy for restriction of fresh flowers and potted plants in the patient's room.

Chemotherapy-Induced Peripheral Neuropathy care

• Protect feet and other body areas where sensation is reduced; always wear shoes with a protective sole. • Be sure that shoes are well fitting to prevent creating sores or blisters from friction. • Inspect your feet daily (with a mirror, if needed) for open areas or redness. • Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears. • Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105°F or 40.6°C). • Use gloves when washing dishes or gardening. • Do not eat foods that are too hot; allow them to cool before placing them in your mouth. • Eat foods that are high in fiber (e.g., fruit, whole-grain cereals, vegetables). • Drink 2 to 3 liters of fluid (nonalcoholic) daily unless your primary health care provider orders a fluid-restricted diet. • Get up slowly from a lying or sitting position. If you feel dizzy, sit back down until the dizziness fades before standing; then stand in place for a few seconds before walking or using the stairs. • To prevent tripping or falling, look at your feet and the floor or ground where you are walking to assess how the ground, floor, or step changes. • Avoid using area rugs, especially those that slide easily. • Keep floors free of clutter that could lead to a fall. • Use handrails when going up or down steps.

Postmortem Care

• Provide all care with respect to communicate that the person was important and valued. • Ask the family or significant others if they wish to help wash the patient or comb his or her hair; respect and follow their cultural practices for body preparation. • If no autopsy is planned, remove or cut all tubes and lines according to agency policy. • Close the patient's eyes unless the cultural or religious practice is for a family member or other person to close the eyes. • Insert dentures if the patient wore them. • Straighten the patient and lower the bed to a flat position. • Place a pillow under the patient's head. • Wash the patient as needed and comb and arrange the patient's hair unless the family desires to perform bathing and body preparation. • Place waterproof pads under the patient's hips and around the perineum to absorb any excrement. • Clean the patient's room or unit. • Allow the family or significant others to see the patient in private and to perform any religious or cultural customs they wish (e.g., prayer). • Assess that all who need to see the patient have done so before transferring to the funeral home or morgue. • Notify the hospital chaplain or appropriate religious leader if requested by the family or significant others. • Ensure that the nurse or physician has completed and signed the death certificate. • Prepare the patient for transfer to either a morgue or a funeral home; wrap the patient in a shroud (unless the family has a special shroud to use), and attach identification tags per agency policy.

Care for patient with dehydration

• Provide oral fluids that meet the patient's dietary restrictions (e.g., sugar-free, low-sodium, thickened). • Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period. • Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours. • Teach assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent incontinence. • Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems. • Monitor the patient's response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for continuing therapy, especially: • Pulse quality and pulse pressure • Urine output • Weight (every 8 hours) • Monitor for and report indicators of fluid overload, including: • Bounding pulse • Difficulty breathing • Neck vein distention in the upright position • Presence of dependent edema • Assess IV infusion site hourly for indications of infiltration or phlebitis (e.g., swelling around the site, pain, cordlike veins, reduced drip rate). • Give drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics, antipyretics).

Miscellaneous Agents - nursing implications

• Side effects are based on specific drug profile. • Usually used for blood, bone marrow, and lymph system cancers.

Basic Beliefs Regarding Care at End of Life and Death Rituals for Selected Religions - Judaism

• The dying person is encouraged to recite the confessional or the affirmation of faith, called the Shema. • According to Jewish law, a person who is extremely ill and dying should not be left alone. • The body, which was the vessel and vehicle of the soul, deserves reverence and respect. • The body should not be left unattended until the funeral, which should take place as soon as possible (preferably within 24 hours). • Autopsies are not allowed by Orthodox Jews, except under special circumstances. • The body should not be embalmed, displayed, or cremated.

Basic Beliefs Regarding Care at End of Life and Death Rituals for Selected Religions - Christianity

• There are many Christian denominations, which have variations in beliefs regarding medical care near the end of life. • Roman Catholic tradition encourages people to receive Sacrament of the Sick, administered by a priest at any point during an illness. This sacrament may be administered more than once. Not receiving this sacrament will not prohibit them from entering heaven after death. • People may be baptized as Roman Catholics in an emergency situation (e.g., person is dying) by a layperson. Otherwise they are baptized by a priest. • Christians believe in an afterlife of heaven or hell once the soul has left the body after death.

Skin Protection During Radiation Therapy

• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team. Rinse soap thoroughly from your skin. • Avoid friction to the area being treated. Use your hand rather than a washcloth. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the treatment area with patting rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology department on your skin at the radiation site. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun: • Protect this area by wearing clothing over it. • Try to go outdoors in the early morning or evening to avoid the more intense sun rays. • When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 a.m. to 4 p.m.). • Avoid heat exposure.