Part 2 of practice problems for Exam 2 Cancer 2024
A nurse is caring for a client who is receiving intravenous famotidine (Pepcid) for stress ulcer prophylaxis. Which of the following adverse effects should the nurse monitor for in this client? A. Hypertension B. Bradycardia C. Thrombocytopenia D. Hyperkalemia
Answer: C. Thrombocytopenia, or a low platelet count, is a rare but serious adverse effect of famotidine that can increase the risk of bleeding. The nurse should monitor the client's platelet count and report any signs of bleeding, such as petechiae, ecchymosis, or hematuria. Famotidine does not cause hypertension, bradycardia, or hyperkalemia.
During a health promotion event, a nurse is asked about symptoms that may indicate lung cancer. Which symptom would the nurse identify as a common early sign of lung cancer? a) Peripheral edema b) Chronic cough or change in a previous cough c) Frequent nosebleeds d) Sudden weight gain
Answer: b) Chronic cough or change in a previous cough Rationale: A chronic cough or a change in a previous cough can be an early sign of lung cancer. This symptom, often overlooked because it is common with other conditions such as colds or allergies, can be persistent and should be evaluated if it does not resolve.
At the end of the shift, 2535 mL were emptied from the drainage bag of the irrigation system. The amount of irrigant in the hanging bag was 3000 mL at the beginning of the shift. There was 1175 mL left in the bag 8 hours. What was the amount of actual urine output for the shift?
Actual urine output (mL) = Total volume of fluid in drainage bag (mL) - Amount of irrigant used (mL) Actual urine output (mL) = 2535 - (3000 - 1175) Actual urine output (mL) = 710
At the beginning of a 12-hour night shift, a nurse notes that the total volume in a patient's continuous bladder irrigation system is 2500 mL. By the end of the shift, the nurse measures 3200 mL of fluid in the drainage bag. If the irrigation bag needed a refill during the shift and now has 1500 mL remaining from the second bag, calculate the patient's actual urine output for the shift.
Actual urine output (mL) = Volume in drainage bag - Total irrigant used Actual urine output (mL) = 3200 mL - (2500 mL + 1000 mL) Actual urine output (mL) = 3200 mL - 3500 mL Actual urine output (mL) = -300 mL
A nurse is teaching a client who is taking Warfarin (Coumadin) about dietary modifications. Which of the following foods should the nurse instruct the client to limit or avoid? A. Spinach B. Bananas C. Cheese D. Eggs
Answer: A. The nurse should instruct the client to limit or avoid spinach, as it is a rich source of vitamin K, which can antagonize the effect of Warfarin and increase the risk of clotting3. Foods that are high in vitamin K and that the client should limit or avoid are: • Broccoli • Brussels sprouts • Cabbage • Collard greens • Green beans • Kiwi • Lettuce • Mustard greens • Prunes • Soybean oil • Swiss chard
A nurse is caring for a client who has an ear infection and is prescribed Pen V K (penicillin V potassium). The nurse should instruct the client to report which of the following signs of a hypersensitivity reaction to the medication? A. Rash B. Headache C. Constipation D. Drowsiness
Answer: A. The nurse should instruct the client to report rash, as it is a sign of a hypersensitivity reaction to penicillin A nurse is teaching a client who is prescribed oral ferrous sulfate for iron deficiency anemia. The nurse should instruct the client to take which of the following actions to prevent staining of the teeth? A. Chew the tablets thoroughly before swallowing. B. Rinse the mouth with water after taking the medication. C. Use a straw to drink the liquid form of the medication. D. Brush the teeth with baking soda after taking the medication. Answer: C. The nurse should instruct the client to use a straw to drink the liquid form of the medication, as this can help avoid direct contact of the medication with the teeth and prevent staining of the enamel1. The nurse should not instruct the client to chew the tablets, rinse the mouth with water, or brush the teeth with baking soda, as these actions can either damage the teeth or be ineffective in preventing staining.
A nurse is instructing a client who is taking iron supplements for the treatment of iron-deficiency anemia. The client also takes famotidine (Pepcid) for gastroesophageal reflux disease. Which of the following instructions should the nurse include in the teaching? A. "Take the iron supplement with a glass of orange juice." B. "Take the iron supplement with a glass of milk." C. "Take the iron supplement at the same time as the famotidine." D. "Take the iron supplement one hour before or two hours after the famotidine."
Answer: D. The client should take the iron supplement one hour before or two hours after the famotidine, as famotidine can reduce the absorption and effectiveness of iron by lowering the acidity level in the stomach
A nurse is caring for a client who is taking ferrous sulfate for iron deficiency anemia. The client reports having black stools and is concerned about having gastrointestinal bleeding. What should the nurse do first? A. Stop the medication and notify the provider. B. Obtain a stool sample and send it for occult blood testing. C. Assess the client's vital signs and hemoglobin level. D. Educate the client that this is an expected side effect of the medication.
Answer: D. The nurse should do first educate the client that having black stools is an expected side effect of ferrous sulfate and does not indicate gastrointestinal For toxicity, administer a chelating agent, deferoxamine (Desferal), parenterally
A nurse is caring for a client receiving palliative care who has a continuous intravenous (IV) infusion of opioid analgesics for chronic pain management. The client reports experiencing sudden, severe pain between scheduled doses. What is the most appropriate nursing action to manage this breakthrough pain? a) Administer an additional dose of the IV opioid analgesic as a bolus. b) Increase the rate of the continuous IV opioid infusion. c) Recommend nonpharmacological interventions for pain management. d) Wait until the next scheduled dose of the IV opioid analgesic.
Answer: a) Administer an additional dose of the IV opioid analgesic as a bolus. Rationale: In palliative care, managing sudden episodes of severe pain, known as breakthrough pain, effectively and rapidly is crucial. Administering an additional dose of the IV opioid analgesic as a bolus is the most appropriate action.
A nurse is caring for a client who has breast cancer and is receiving chemotherapy. The nurse should monitor the client for which of the following adverse effects of chemotherapy? a) Alopecia b) Hyperkalemia c) Hypertension d) Hypercalcemia
Answer: a) Alopecia Rationale: Chemotherapy targets rapidly dividing cells, including hair follicles, leading to hair loss, which can be distressing for patients.
A nurse is administering trastuzumab (Herceptin) to a client with metastatic breast cancer. Which adverse effect should the nurse monitor for in this medication? a) Anaphylaxis b) Nephrotoxicity c) Ototoxicity d) Osteoporosis
Answer: a) Anaphylaxis Rationale: Trastuzumab is a monoclonal antibody that targets the HER2/neu receptor on the surface of cancer cells, inhibiting their growth. However, it can cause anaphylaxis, especially during the first infusion.
A nurse is teaching a client who is scheduled for a prostate-specific antigen (PSA) test for the screening of prostate cancer. Which of the following instructions should the nurse include in the teaching? a) Avoid ejaculation for 24 hours before the test. b) Drink plenty of fluids before the test. c) Take aspirin or ibuprofen before the test. d) Fast for 8 hours before the test.
Answer: a) Avoid ejaculation for 24 hours before the test. Rationale: Ejaculation and DRE can temporarily increase PSA levels, which could affect the test's accuracy.
A nurse is teaching a client who is scheduled to undergo a mammogram for the screening of breast cancer. Which of the following instructions should the nurse include in the teaching? a) Avoid using deodorant, powder, or lotion on the day of the test. b) Drink plenty of fluids before and after the test. c) Take a mild analgesic one hour before the test. d) Wear a two-piece outfit on the day of the test
Answer: a) Avoid using deodorant, powder, or lotion on the day of the test. Rationale: Substances like deodorants and powders can obscure mammogram images, potentially leading to inaccurate results.
A nurse is giving a common medication to a client with severe mucositis from radiation therapy. What side effect should be monitored? a) Bone pain b) High blood pressure c) Low platelet count d) High calcium levels
Answer: a) Bone pain Rationale: Monitor for bone pain when administering medications for severe mucositis, as they can increase bone marrow activity and pressure. Assess pain level and location, and manage with prescribed analgesics. Other listed side effects are less common with mucositis management medications.
A nurse is administering trastuzumab (Herceptin) to a client who has metastatic breast cancer. The nurse should monitor the client for which of the following adverse effects of this medication? a) Cardiotoxicity b) Nephrotoxicity c) Ototoxicity d) Osteoporosis
Answer: a) Cardiotoxicity Rationale: Trastuzumab can affect heart function, requiring monitoring for symptoms of cardiotoxicity during treatment.
A nurse is educating a patient about the risk factors for melanoma. Which of the following should the nurse include as risk factors? a) Having a history of one or more severe, blistering sunburns b) Living in a climate with minimal sunlight year-round c) Regular use of high SPF sunscreen during all outdoor activities d) Wearing protective clothing that covers most of the skin surface
Answer: a) Having a history of one or more severe, blistering sunburns Rationale: A history of severe, blistering sunburns, especially in childhood or adolescence, increases the risk of melanoma by damaging DNA in skin cells. Protective measures like sunscreen and clothing reduce risk, not increase it.
A nurse is monitoring a client with colorectal cancer who is being treated with 5-fluorouracil. What adverse effect should the nurse closely watch for? a) Mucositis b) Hyperkalemia c) Hypertension d) Hypercalcemia
Answer: a) Mucositis Rationale: Mucositis, or the inflammation and ulceration of the oral and gastrointestinal mucosa, is a common adverse effect of 5-fluoracil, methotrexate, and cytarabine. It results from the damage to rapidly dividing mucosal cells, leading to pain, difficulty swallowing, infection, and nutritional problems. Hyperkalemia, hypertension, and hypercalcemia are not directly associated with chemotherapy-induced mucositis.
A nurse is looking after a patient who is getting chemotherapy for acute lymphoblastic leukemia. The nurse knows the patient is at risk for tumor lysis syndrome when they see which lab result? a) Potassium level at 6.2 mEq/L (normal range: 3.5-5.0 mEq/L) b) Calcium level at 10.5 mg/dL (normal range: 8.6-10.2 mg/dL) c) Phosphorus level at 2.8 mg/dL (normal range: 2.5-4.5 mg/dL) d) Uric acid level at 4.5 mg/dL (normal range: 2.4-6.0 mg/dL)
Answer: a) Potassium level at 6.2 mEq/L (normal range: 3.5-5.0 mEq/L) Rationale: A potassium level of 6.2 mEq/L, which is higher than the normal range, suggests the patient could develop tumor lysis syndrome. This syndrome happens when cancer cells break down very quickly, releasing potassium into the blood, potentially leading to serious heart and muscle problems.
A nurse reviews a breast cancer patient's lab results and notes HER2 positivity. This makes the patient a candidate for which therapy? a) Trastuzumab (Herceptin) b) Bevacizumab (Avastin) c) Imatinib (Gleevec) d) Rituximab (Rituxan)
Answer: a) Trastuzumab (Herceptin) Rationale: Trastuzumab is effective against HER2-positive breast cancer, improving treatment response and survival.
A nurse is monitoring a client with acute myeloid leukemia (AML) who is undergoing induction chemotherapy. For which of the following complications should the nurse vigilantly observe? a) Tumor lysis syndrome b) Superior vena cava syndrome c) Spinal cord compression d) Syndrome of inappropriate antidiuretic hormone (SIADH)
Answer: a) Tumor lysis syndrome Rationale: Tumor lysis syndrome is a potential complication in patients receiving induction chemotherapy for AML due to the rapid breakdown of malignant cells, leading to metabolic imbalances. The nurse should monitor serum electrolytes, uric acid levels, creatinine, and BUN, and manage with fluids, allopurinol, or sodium bicarbonate as prescribed.
A nurse is caring for a client who is receiving a continuous heparin infusion for deep vein thrombosis. The nurse notes that the client's aPTT is 120 seconds, which is above the therapeutic range. What should the nurse do first? a) assess the client for signs of bleeding and apply pressure to any bleeding sites b) check the client's platelet count and hemoglobin level c) decrease the heparin infusion rate and notify the provider d) stop the heparin infusion and administer protamine sulfate as an antidote
Answer: a) assess the client for signs of bleeding and apply pressure to any bleeding sites Rationale: Immediate assessment for signs of bleeding is paramount when a client's aPTT exceeds the therapeutic range, indicating a high risk of bleeding due to heparin. Prompt intervention to control potential hemorrhage takes precedence. Following this, the nurse should notify the healthcare provider for further orders, which may include stopping the heparin infusion or administering protamine sulfate to reverse its effects. Adjusting the infusion rate or checking laboratory values, while important, are subsequent steps that should not precede direct bleeding management.
A nurse is planning care for a patient with neutropenia due to chemotherapy. Which interventions should be included in the teaching? (Select all that apply.) a) Practice strict hand hygiene b) Perform daily nasal swabs for culture c) Monitor temperature every hour d) Maintain daily skin and oral hygiene e) Encourage the consumption of raw foods to increase nutrient intake f) Stay in a private room with HEPA filtration
Answer: a), d), f) Rationale: Strict hand hygiene and maintaining cleanliness of the skin and oral cavity are crucial to prevent infections in neutropenic patients. A private room with HEPA filtration can help reduce exposure to environmental pathogens. Monitoring temperature is important but not necessarily every hour unless indicated by severe neutropenia or other risk factors. Raw foods should be avoided due to the risk of infection.
When teaching about early detection of melanoma, what key feature should the nurse instruct the patient to report? a) A mole that is smaller than 6mm b) A lesion that changes in size, shape, or color c) Moles that are uniform in color d) Skin lesions that heal quickly
Answer: b) A lesion that changes in size, shape, or color Rationale: Changes in the size, shape, or color of a mole or skin lesion are critical warning signs of melanoma, according to the ABCDE rule (Asymmetry, Border, Color, Diameter, Evolving).
A nurse is caring for a patient with advanced lung cancer. Which of the following would be an appropriate nursing diagnosis? a) Impaired skin integrity b) Acute pain c) Risk for aspiration d) Deficient fluid volume
Answer: b) Acute pain Rationale: Lung cancer can cause significant pain due to tumor growth, metastasis to bones or other organs, or as a side effect of treatment. Managing pain is a critical component of the nursing care plan for patients with advanced lung cancer.
During a seminar on ethical considerations in palliative care, a nurse discusses various challenges. Which ethical issue should the nurse include as a significant consideration in palliative care? a) The promotion of aggressive treatment measures at all costs b) Advance care planning and decision making c) Encouraging families to pursue all forms of experimental treatment d) Discouraging the use of pain medication to avoid addiction
Answer: b) Advance care planning and decision making Rationale: Ethical issues in palliative care often revolve around advance care planning and decision-making, respecting patient autonomy, informed consent, managing withholding and withdrawing life-sustaining therapies, and addressing do-not-resuscitate orders. These considerations are crucial in ensuring that care aligns with the patient's values and preferences while providing comfort and dignity at the end of life.
A nurse is discussing prevention strategies for skin cancer. Which recommendation is most effective in preventing skin cancer? a) Using indoor tanning beds to control UV exposure b) Applying a broad-spectrum sunscreen of at least SPF 30 c) Increasing sun exposure gradually to build a base tan d) Avoiding outdoor activities to eliminate UV exposure
Answer: b) Applying a broad-spectrum sunscreen of at least SPF 30 Rationale: Applying broad-spectrum sunscreen of at least SPF 30 is effective in protecting against UVA and UVB rays, significant risk factors for skin cancer. Indoor tanning and intentional sun exposure without protection are discouraged due to the increased risk of skin cancer.
A nurse is educating a client with acute myeloid leukemia (AML) about their care plan. What should the nurse emphasize as the primary focus of care? a) Leukapheresis b) Attaining remission c) Using a single chemotherapy agent d) Waiting with active supportive care
Answer: b) Attaining remission Rationale: The initial goal of care for AML is to achieve remission. This involves intensive treatment, possibly including leukapheresis or hydroxyurea to reduce white blood cell counts and prevent thrombosis. Aggressive chemotherapy is used to eradicate leukemia cells and minimize drug toxicity.
A nurse is teaching a patient who is starting allopurinol (Zyloprim) to help prevent and treat tumor lysis syndrome. What should the nurse include in the instructions? a) Eat a meal before taking the medication to increase its effectiveness. b) Drink a lot of fluids to avoid crystal formation in your urine. c) Use another method of birth control if you're taking oral contraceptives. d) Stop taking the medication once your symptoms improve.
Answer: b) Drink a lot of fluids to avoid crystal formation in your urine. Rationale: Allopurinol works by reducing uric acid levels, which can build up during tumor lysis syndrome. However, it can also lead to crystals forming in the urine, which can harm the kidneys. Drinking plenty of water helps prevent this. The other suggestions are not directly related to managing the risks associated with allopurinol.
A nurse is caring for a patient undergoing treatment for metastatic cancer and notes a hemoglobin level of 8.7 g/dL (LOW) and hematocrit of 26% (LOW). Which clinical manifestation is the patient most likely to exhibit? a) Thirst b) Fatigue c) Headache d) Abdominal pain
Answer: b) Fatigue Rationale: A low hemoglobin level and hematocrit indicate anemia, which is common in patients with metastatic cancer due to the disease itself or as a side effect of treatment. Fatigue is a primary symptom associated with anemia and is due to the reduced capacity of the blood to carry oxygen to tissues.
A nurse is preparing a client with breast cancer for a sentinel lymph node biopsy. The purpose of this procedure is to: a) Remove all axillary lymph nodes b) Identify the first node that drains the tumor site c) Inject dye into the tumor to mark its location d) Sample multiple axillary nodes
Answer: b) Identify the first node that drains the tumor site Rationale: The sentinel lymph node biopsy identifies the first draining node to assess if the cancer has spread to the lymphatic system.
When educating patients about the risks of skin cancer and sun exposure, the nurse should highlight that which group is at higher risk? a) Individuals with dark skin who tan easily b) Individuals with fair skin who burn easily c) Individuals who use tanning beds occasionally d) Individuals who apply sunscreen with low SPF occasionally
Answer: b) Individuals with fair skin who burn easily Rationale: Individuals with fair skin have less melanin, which provides some protection against the harmful effects of UV radiation. Those who burn easily have an increased risk of skin damage and subsequent skin cancer from sun exposure. Using sunscreen with adequate SPF, avoiding tanning beds, and wearing protective clothing are all important preventive measures.
A patient with a history of lung cancer is scheduled for a follow-up CT scan. The nurse understands that this screening method is particularly important for individuals at high risk for lung cancer because: a) It is less expensive and more available than other methods b) It can detect lung cancer at an earlier, more treatable stage c) It is the only method to differentiate between small cell and non-small cell lung cancers d) It provides a definitive diagnosis without further testing
Answer: b) It can detect lung cancer at an earlier, more treatable stage Rationale: CT scans are a part of screening protocols for individuals at high risk for lung cancer, as they can detect the disease at an earlier and more treatable stage compared to other methods, which can significantly improve prognosis.
A nurse is assessing a client with a history of colorectal cancer. Which of the following should the nurse report to the provider as a potential sign of cancer recurrence? a) A weight gain of 2 kg in one month b) Occult blood in the stool c) A hemoglobin level of 14 g/dL d) Abdominal cramps after meals::
Answer: b) Occult blood in the stool Rationale: Occult blood in the stool is a significant indicator that could suggest the recurrence of colorectal cancer. It represents blood that is not visible but can be detected through testing, possibly indicating bleeding from a tumor or polyps in the colon or rectum. Weight gain, a normal hemoglobin level, and postprandial abdominal cramps are not specific indicators of colorectal cancer recurrence.
A nurse is educating a group of nursing students about palliative care. Which common symptoms managed by palliative care should the nurse include in the education session? a) Excessive energy and hyperactivity b) Pain, nausea and vomiting, fatigue, and dyspnea c) Increased appetite and weight gain d) Hyperglycemia and insulin resistance
Answer: b) Pain, nausea and vomiting, fatigue, and dyspnea Rationale: Palliative care focuses on the management of symptoms that affect quality of life for patients with serious illnesses. Common symptoms managed include pain, nausea and vomiting, fatigue, dyspnea, as well as psychological symptoms like anxiety and depression. This approach aims to alleviate suffering and improve the living conditions of both patients and their families.
Which of the following best describes the principles of palliative care? a) Emphasizing cure and prolongation of life over comfort. b) Providing relief from pain and other distressing symptoms while affirming life and regarding dying as a normal process. c) Offering a support system only to the patient, not the family, through the course of the illness and dying process. d) Using a team approach to address only the physical needs of patients and not their families.
Answer: b) Providing relief from pain and other distressing symptoms while affirming life and regarding dying as a normal process. Rationale: The principles of palliative care include affirming life and regarding dying as a normal process; providing relief from pain and other distressing symptoms; integrating the psychological and spiritual aspects of patient care; offering a support system to help patients live as actively as possible until death; and using a team approach to address the needs of patients and their families, thereby enhancing quality of life, and possibly influencing the course of illness.
A nurse is assessing a patient with a history of lung cancer who presents with new onset of lower back pain and difficulty walking. The nurse should recognize that these symptoms may indicate which of the following complications? a) Hypercalcemia leading to bone pain and potential fractures b) Spinal cord compression from metastatic disease c) Side effects of chemotherapy causing neuropathy d) Pulmonary embolism due to immobility and DVT formation
Answer: b) Spinal cord compression from metastatic disease Rationale: In patients with lung cancer, new onset of back pain and difficulty with ambulation may indicate spinal cord compression, a serious condition that can occur when cancer metastasizes to the spinal bones or directly compresses spinal nerves. This requires immediate assessment and intervention to preserve neurological function.
A patient asks about the primary treatments for melanoma. Which of the following should the nurse include? a) High-dose vitamin therapy and sunlight avoidance b) Surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy c) Application of topical herbal remedies d) Strict diet modifications and physical exercise
Answer: b) Surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy Rationale: The primary treatments for melanoma include surgery to remove the tumor, chemotherapy, radiation therapy to kill cancer cells, immunotherapy to boost the immune system, and targeted therapy aimed at specific cancer cell genes or proteins.
A nurse is discussing pain relief for mucositis with a client undergoing radiation therapy. What should be included? a) Apply ice packs to sore areas for 15 minutes hourly. b) Swish with ice chips or cold water during and after therapy. c) Consume cold drinks or frozen desserts before and after therapy. d) Rinse with cold saline solution before and after therapy.
Answer: b) Swish with ice chips or cold water during and after therapy Rationale: Swishing ice chips or cold water can reduce mucositis pain by constricting blood vessels and lessening oral mucosa exposure to radiation. Perform for at least 30 minutes during and post-therapy. Other methods, such as applying ice packs, consuming cold items, or rinsing with cold solutions, are less effective for mucositis cryotherapy.
A nurse is preparing a client for a colonoscopy, a screening procedure for colorectal cancer. What instruction is crucial for the client? a) Only drink clear liquids for 24 hours before the procedure. b) Take a laxative the evening before and the morning of the procedure. c) Avoid aspirin and NSAIDs for a week before the procedure. d) Expect a bowel movement during the procedure.
Answer: b) Take a laxative the evening before and the morning of the procedure Rationale: Laxative use before a colonoscopy is essential to clear the colon, allowing for better visualization of the mucosa. The instruction is part of the bowel preparation to ensure the colon is empty. Drinking clear liquids, avoiding aspirin or NSAIDs, and expecting a bowel movement during the procedure are less critical or inaccurate instructions for colonoscopy preparation.
A nurse is caring for a client on tamoxifen (Nolvadex) for breast cancer. The client should report which symptom indicative of a serious adverse effect? a) Hot flashes b) Vaginal bleeding c) Weight loss d) Hair thinning
Answer: b) Vaginal bleeding Rationale: Vaginal bleeding can be a sign of endometrial changes, including cancer, which is a known risk of tamoxifen therapy.
A nurse is caring for a client who is receiving ondansetron (Zofran) intravenously for chemotherapy-induced nausea and vomiting. The nurse should monitor the client for which of the following adverse effects of this medication? a) dehydration b) hypokalemia c) hyponatremia d) hypotension
Answer: b) hypokalemia Rationale: Ondansetron (Zofran), used to prevent nausea and vomiting caused by chemotherapy, can lead to hypokalemia, or a low level of potassium in the blood. This condition is significant because ondansetron can cause a prolonged QT interval on the electrocardiogram, which may lead to torsades de pointes, a potentially fatal ventricular arrhythmia. Hypokalemia exacerbates QT prolongation, increasing the risk of cardiac complications. Therefore, the nurse should closely monitor the client's serum potassium levels and electrocardiogram, reporting any abnormalities to the healthcare provider. Hypotension, hyponatremia, and dehydration are not directly associated as common or severe adverse effects of ondansetron.
A nurse is providing education on the types of skin cancer. Which type is noted for its rapid growth and potential for early metastasis? a) Basal cell carcinoma b) Squamous cell carcinoma c) Malignant melanoma d) Actinic keratosis
Answer: c) Malignant melanoma Rationale: Malignant melanoma is known for its rapid growth and high potential for early metastasis, making it the most dangerous type of skin cancer. Early detection and treatment are critical for improving outcomes.
A nurse is evaluating a patient with acute myelogenous leukemia (AML) for potential complications. Which laboratory finding is most indicative of an increased risk for tumor lysis syndrome? a) Elevated white blood cell count b) Low hemoglobin level c) Presence of blast cells in the blood d) Decreased platelet count
Answer: c) Presence of blast cells in the blood Rationale: The presence of blast cells in the blood of a patient with AML suggests a high tumor burden, which can increase the risk of tumor lysis syndrome when chemotherapy is initiated. Tumor lysis syndrome occurs when large numbers of cancer cells are destroyed rapidly, releasing their contents into the bloodstream and potentially leading to renal failure and electrolyte imbalances.
A nurse is caring for a client who has stomatitis from chemotherapy. Which oral rinse should the nurse recommend to ease symptoms? a) Hydrogen peroxide b) Chlorhexidine c) Room temperature tap water d) Alcohol-based mouthwash
Answer: c) Room temperature tap water Rationale The nurse should advise the client to swish and spit with tap water for rinsing four times daily. Avoid hydrogen peroxide, chlorhexidine, or alcohol-based mouthwashes, as they may irritate and dry the oral mucosa, worsening symptoms.
A patient with a history of prostate cancer is scheduled for a Transrectal Ultrasound (TRUS). What is the purpose of this diagnostic procedure? a) To provide immediate treatment for prostate cancer b) To evaluate the effectiveness of chemotherapy c) To image the prostate gland and guide needle biopsies if needed d) To determine the exact cause of urinary incontinence
Answer: c) To image the prostate gland and guide needle biopsies if needed Rationale: TRUS is used to create images of the prostate using sound waves. It is particularly useful in guiding needle biopsies when an abnormality is suspected, aiding in the diagnosis of prostate cancer.
A nurse is administering leuprolide (Lupron) to a client who has advanced prostate cancer. The nurse should monitor the client for which of the following adverse effects of this medication? a) Hot flashes b) Gynecomastia c) Osteoporosis d) All of the above.
Answer: d) All of the above. Rationale: Leuprolide can cause these side effects due to low testosterone levels.
A nurse is caring for a client who has prostate cancer and is receiving brachytherapy. The nurse should implement which of the following precautions to protect herself and others from radiation exposure? a) Wear a lead apron and gloves when providing direct care to the client. b) Limit the time spent in the client's room to 30 minutes per shift. c) Place the client in a private room with a sign that indicates radiation hazard. d) All of the above.
Answer: d) All of the above. Rationale: These measures reduce radiation exposure for healthcare workers and visitors.
A nurse is caring for a client who is scheduled to undergo a paracentesis for the relief of ascites. The client reports having severe abdominal pain and dyspnea. What should the nurse do first? a) Administer analgesics as prescribed. b) Position the client in Fowler's or semi-Fowler's position. c) Prepare the equipment and supplies for the procedure. d) Assess the client's vital signs and oxygen saturation
Answer: d) Assess the client's vital signs and oxygen saturation Rationale: The initial step in caring for a client experiencing severe abdominal pain and dyspnea, especially when scheduled for a procedure like paracentesis, is to assess vital signs and oxygen saturation. This assessment helps in evaluating the client's condition and the need for immediate interventions, such as oxygen therapy. Ascites can increase intra-abdominal pressure, impairing diaphragmatic movement and lung expansion, which can lead to respiratory distress and hypoxia. Monitoring vital signs and oxygen saturation provides crucial information for prioritizing care and interventions to ensure client safety and address urgent needs.
A nurse is providing education on lung cancer to a group of high school students. Which risk factor should the nurse emphasize as the most significant for the development of lung cancer? a) Air pollution b) Asbestos exposure c) Family history of lung cancer d) Cigarette smoking
Answer: d) Cigarette smoking Rationale: Cigarette smoking is the leading risk factor for lung cancer, with a substantial body of evidence supporting the strong correlation between tobacco use and the development of both small cell and non-small cell lung cancers.
A nurse is treating a client with tumor lysis syndrome and high potassium levels using sodium polystyrene sulfonate. What adverse effect should the nurse watch for? a) High blood pressure b) Slow heart rate c) Low platelet count d) High sodium levels
Answer: d) High sodium levels Rationale: Sodium polystyrene sulfonate is used to reduce high potassium levels by exchanging potassium with sodium in the gastrointestinal tract. This treatment can lead to an increase in sodium levels in the blood, known as hypernatremia. Symptoms of hypernatremia include thirst, dry mucous membranes, and in severe cases, confusion or seizures. The nurse should monitor the client's serum sodium levels and overall fluid balance.
A nurse is giving sodium polystyrene sulfonate (Kayexalate) to a patient with tumor lysis syndrome and high potassium levels. Which side effect should the nurse watch for in this patient? a) High blood pressure b) Slow heart rate c) Low platelet count d) High sodium levels
Answer: d) High sodium levels Rationale: Sodium polystyrene sulfonate works by exchanging sodium for potassium in the intestines, which can lower potassium levels but may lead to high sodium levels, a condition known as hypernatremia. This can cause symptoms like thirst, confusion, and in severe cases, seizures or coma. The nurse should monitor the patient's sodium levels and overall fluid balance.
A nurse is assessing a client who has a family history of breast cancer. Which of the following factors should the nurse identify as increasing the client's risk of developing breast cancer? a) Early menarche and late menopause b) Multiparity and breastfeeding c) Low-fat diet and regular exercise d) Oral contraceptive use and hormone replacement therapy
Answer: d) Oral contraceptive use and hormone replacement therapy Rationale: Hormonal factors, such as the use of oral contraceptives and hormone replacement therapy, can increase exposure to estrogen and progesterone, which may increase the risk of breast cancer development.
A nurse is preparing a presentation on end-of-life care options. Which statement should be included to explain the difference between palliative care and hospice care? a) Both palliative care and hospice care can only be initiated after all treatment options are exhausted. b) Hospice care is available to patients at any stage of a serious illness, not just the terminal phase. c) Palliative care focuses on comfort and quality of life for those with a terminal illness and a prognosis of six months or less. d) Palliative care can be provided at any stage of a serious illness, focusing on relieving symptoms and stress, regardless of prognosis.
Answer: d) Palliative care can be provided at any stage of a serious illness, focusing on relieving symptoms and stress, regardless of prognosis. Rationale: Palliative care aims to improve the quality of life for patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, impeccable assessment, and treatment of pain and other problems, physical, psychosocial, and spiritual. Hospice care, a specific type of palliative care, is for patients who are in the final months of life and have chosen to forgo curative treatments.
A nurse is providing discharge teaching to a client who has prostate cancer and has undergone a radical prostatectomy. Which of the following instructions should the nurse include in the teaching? a) Avoid lifting objects heavier than 10 pounds for 6 weeks. b) Expect to have erectile dysfunction and urinary incontinence permanently. c) Drink cranberry juice daily to prevent urinary tract infections. d) Perform pelvic floor exercises to strengthen the sphincter muscles and improve bladder control.
Answer: d) Perform pelvic floor exercises to strengthen the sphincter muscles and improve bladder control. Rationale: Kegel exercises can help with recovery from urinary incontinence post-surgery.
A 68-year-old African American male with a family history of prostate cancer has a PSA level of 5 ng/mL(HIGH). What is the most appropriate nursing action? a) Reassure the patient that this is a normal finding b) Schedule an immediate prostate biopsy c) Monitor the PSA levels annually d) Recommend a digital rectal exam (DRE) and further urologic evaluation
Answer: d) Recommend a digital rectal exam (DRE) and further urologic evaluation Rationale: Given the patient's age, African American heritage, family history, and elevated PSA levels, a DRE and further evaluation by a urologist are warranted to assess for possible prostate cancer.
A nurse is caring for a client who has mucositis due to chemotherapy. What oral hygiene practice should the client avoid? a) Brushing the teeth with a soft-bristled toothbrush b) Rinsing the mouth with saline solution c) Gently flossing the teeth d) Using mouthwash that contains alcohol
Answer: d) Using mouthwash that contains alcohol Rationale: Clients with mucositis, an inflammation of the mucous membranes in the mouth, should avoid alcohol-based mouthwashes. Alcohol can irritate and dry out the oral mucosa, worsening the condition. Instead, using a saline solution or non-alcohol-based mouthwash can help keep the mouth clean without causing additional irritation. Gentle oral hygiene practices like using a soft-bristled toothbrush and flossing gently can help maintain oral health without exacerbating mucositis.
A nurse is reviewing the laboratory results of a client who is taking Warfarin (Coumadin) and notes that the client's PT is 18 seconds and the INR is 1.8. The normal PT is 11 to 13 seconds and the normal INR is 0.75 to 1.25 for a person who is not taking Warfarin. How should the nurse interpret these results? A. The client's PT and INR are within the normal range and indicate adequate anticoagulation. B. The client's PT and INR are below the normal range and indicate inadequate anticoagulation. C. The client's PT and INR are above the normal range and indicate excessive anticoagulation. D. The client's PT and INR are not reliable indicators of anticoagulation and require further testing.
C. The client's PT and INR are above the normal range and indicate excessive anticoagulation. Rationale: PT (Prothrombin Time) measures the time it takes for blood to clot. A prolonged PT indicates that the blood is taking longer to clot, which can be a sign of excessive anticoagulation. INR (International Normalized Ratio) is a standardized measure of PT. An INR of 1.8 is higher than the normal range (0.75 to 1.25), indicating that the client's blood is more prone to bleeding due to excessive anticoagulation.
