Questions

Which teaching about initial treatment will the nurse plan when a patient has been diagnosed with stage 1A Hodgkin's lymphoma? 1 Expect two to four cycles of chemotherapy. 2 Plan for six to eight cycles of chemotherapy. 3 Anticipate weekly external beam radiation therapy. 4 Prepare for hematopoietic stem cell transplantation.

1 Expect two to four cycles of chemotherapy. The patient with favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). More advanced Hodgkin's lymphoma would be treated with six to eight cycles of chemotherapy. Radiation may be used as a supplement for early stage Hodgkin's lymphoma but is not usually the initial treatment. Hematopoietic stem cell transplantation would typically be used for more advanced or refractory Hodgkin's lymphoma.

When caring for a patient who underwent a mastectomy, which nursing interventions would be performed to prevent shoulder joint complications and restoration of arm movements? Select all that apply. 1 Pour warm water on the involved shoulder. 2 Place the patient in a prone position. 3 Keep the affected arm elevated on a pillow. 4 Keep the affected shoulder immobile after surgery to prevent pain. 5 Administer analgesics 30 minutes before the initiation of shoulder exercises

1 Pour warm water on the involved shoulder. 3 Keep the affected arm elevated on a pillow. 5 Administer analgesics 30 minutes before the initiation of shoulder exercises Restoring arm function on the affected side after a mastectomy is a desired nursing outcome. When the patient is able to shower, pouring warm water on the involved shoulder often relaxes the muscle and reduces joint stiffness. The arm on the affected side is kept elevated on a pillow. Postoperative pain in the involved shoulder can be minimized by administering analgesics regularly when the patient is in pain and about 30 minutes before initiating exercises. The patient should not be placed in a prone position; a semi-Fowler's position is the most beneficial position. Restoring arm function is desired; therefore, keeping the affected shoulder immobile does not facilitate restoration.

A patient with ovarian cancer is receiving radiation therapy. A nurse finds that the patient has developed anemia as a side effect of radiation therapy. What interventions are appropriate for this patient? Select all that apply. 1. Monitor hemoglobin and hematocrit levels. 2.Monitor WBC count, especially neutrophils. 3. Administer iron supplements and erythropoietin. 4. Promote foods that increase hemoglobin levels. 5. Teach the patient to avoid large crowds and people with infections.

1. Monitor hemoglobin and hematocrit levels. 3. Administer iron supplements and erythropoietin. 4. Promote foods that increase hemoglobin levels. The hemoglobin and hematocrit levels should be monitored to determine the severity of anemia and the effectiveness of the treatment. Iron supplements and erythropoietin are administered to increase hemoglobin levels. Promoting foods that increase hemoglobin levels help to treat anemia. Monitoring WBC counts and teaching the patient to stay away from crowds are management techniques done in cases of leukopenia.)

When caring for a patient undergoing chemotherapy, which nursing actions should the nurse take to manage fatigue in the patient? Select all that apply 1. Pace activities in accordance with energy level 2. Encourage strenuous exercise to build strength 3. Encourage the patient to be active even when tired 4. Maintain usual lifestyle patterns as much as possible 5. Reassure the patient that fatigue is a common side effect

1. Pace activities in accordance with energy level 4. Maintain usual lifestyle patterns as much as possible 5. Reassure the patient that fatigue is a common side effect

A nurse is caring for a patient undergoing brachytherapy for prostate cancer. What actions should the nurse take to protect his or herself from radiation hazards? Select all that apply. 1. Use shielding when providing any care to the patient. 2. Organize care to limit the time spent in direct contact with the patient. 3. Share the film badge with a colleague who forgot his or her own badge. 4. Wear the film badge at all places of work to indicate your nature of work. 5. Limit close proximity to the patient to only those care tasks that must be performed near the source.

1. Use shielding when providing any care to the patient. 2. Organize care to limit the time spent in direct contact with the patient. 5. Limit close proximity to the patient to only those care tasks that must be performed near the source.

A patient with breast cancer has been prescribed tamoxifen. Which side effects would the nurse advise the patient to monitor for while taking this medication? Select all that apply. 1 Chest pain 2 Blurred vision 3 Leg cramps 4 Gastrointestinal disturbances 5 Irregular vaginal bleeding

2 Blurred vision 3 Leg cramps 5 Irregular vaginal bleeding Patients receiving tamoxifen may experience blurred vision, leg cramps, and irregular vaginal bleeding. Visual symptoms may be irreversible. It also increases the risk of blood clots; therefore monitoring for leg cramps is very important. Irregular vaginal bleeding or spotting is a side effect of tamoxifen. Chest pain and gastrointestinal disturbances are not associated with this medication.

Which side effects may be experienced by a patient having external beam radiation therapy? Select all that apply. 1 Pain 2 Edema 3 Fatigue 4 Redness 5 Lymphedema

2 Edema 3 Fatigue 4 Redness The patient undergoing external beam radiation therapy may experience edema, fatigue, and skin changes including redness. Pain occurs from the surgical procedure itself. Lymphedema can happen when lymph nodes are removed during a mastectomy.

hich diagnostic test result indicates a diagnosis of Hodgkin's lymphoma? 1 Lymphoblasts in the cerebrospinal fluid 2 Reed-Sternberg cells in the lymph node 3 Hypercellular bone marrow with myeloblasts 4 Philadelphia chromosome in the bone marrow cells

2 Reed-Sternberg cells in the lymph node

A patient with breast cancer is having external beam radiation treatments. Which information would the nurse teach the patient about the care of the skin? 1 Use antibacterial soap to feel clean. 2 Scented lotion can be used on the area. 3 Avoid heat and cold to the treatment area. 4 Wear a new bra to comfort and support the area.

3 Avoid heat and cold to the treatment area. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing, such as a bra, over the treatment field and will want to expose the area to air as often as possible.

A patient has been diagnosed with breast cancer and has been prescribed doxorubicin. Which assessments would the nurse make before administering the drug? Select all that apply. 1 Check cholesterol levels. 2 Check for high glucose levels. 3 Check for signs and symptoms of infections. 4 Check for the administration of recent live vaccinations. 5 Check for recent contact with anyone who has received live attenuated virus.

3 Check for signs and symptoms of infections. 4 Check for the administration of recent live vaccinations. 5 Check for recent contact with anyone who has received live attenuated virus. Doxorubicin is a cytotoxic drug that also causes suppression of the immune system. Therefore, any existing infections could become more severe due to the effect of this drug. Vaccinations may become ineffective when this drug is used; moreover, doxorubicin can worsen the side effects of the vaccinations. Doxorubicin lowers the immunity and increases the chances of contracting infections. Therefore, it is important to ask whether the patient has been in contact with any person who has received live attenuated virus. Doxorubicin does not affect the cholesterol or glucose levels in the body.

Which condition is associated with tumor lysis syndrome (TLS)? 1 Hypokalemia 2 Hypouricemia 3 Hypocalcemia 4 Hypophosphatemia

3 Hypocalcemia

A patient's laboratory report indicates excess human epidermal growth factor receptor 2 (HER-2). What does the nurse interpret from this finding? 1. The patient has lung cancer 2. The patient has colon cancer 3. The patient has breast cancer 4. The patient has prostate cancer

3. The patient has breast cancer

When positron emission tomography (PET) for a patient with Hodgkin's lymphoma shows enlarged mediastinal lymph nodes, the nurse will plan to assess for which complication? 1 Bone pain 2 Paraplegia 3 Renal failure 4 Superior vena cava syndrome

4 Superior vena cava syndrome Enlarged mediastinal lymph nodes may lead to compression of the superior vena cava; the nurse will assess for neck vein distension, facial and upper extremity swelling, cough, and dyspnea. Bone pain may occur with Hodgkin's lymphoma but is not necessarily associated with mediastinal node enlargement. Paraplegia may occur with spinal cord compression but would occur with nodal enlargement below the diaphragm. Renal failure may occur with hypercalcemia secondary to bone involvement but would not be typically associated with mediastinal lymphadenopathy.

The nurse is volunteering at a community center to teach women regarding breast cancer. The nurse would include which of the following when discussing risk factors (select all that apply)? A. Nulliparity B. Age 30 or over C. Early menarche D. Late menopause E. Personal history of colon cancer

A. Nulliparity C. Early menarche D. Late menopause E. Personal history of colon cancer

A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). Which of the following points should the nurse emphasize when teaching the patient about her new drug regimen? A. "You may find that your medication causes some breast sensitivity." B. "It's important that you let your care provider know about any changes in vision." C. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." D. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen.

B. "It's important that you let your care provider know about any changes in vision." BTamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

Which best indicates that treatment for cancer of the prostate is effective? A. Increase in urinary stream B. Decrease of PSA to 2 ng/mL C. Decreased blood in the urine D. White blood cell (WBC) count of 10,000/μL

B. Decrease of PSA to 2 ng/mL

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. Which of the following interventions would the nurse use to decrease the lymphedema? A. Keep affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure on unaffected arm only. D. Restrict exercise of the affected arm for 1 week

C. Assess blood pressure on unaffected arm only. C. Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended to reduce fluid volume in the arm.

Which measures would the nurse take to reduce the occurrence of lymphedema in a patient who underwent a radical mastectomy? Select all that apply. 1 IV injections should be given on the affected arm. 2 Isometric exercises of the affected side should be performed. 3 Regular BP readings should be taken from the affected arm. 4 The affected side should be washed with soap and water if trauma occurs. 5 The affected arm should not be placed in the dependent position for a long period of time.

Isometric exercises of the affected side should be performed. The affected side should be washed with soap and water if trauma occurs. The affected arm should not be placed in the dependent position for a long period of time. Isometric exercises on the affected side with the arm kept elevated would be useful in draining the excess lymphatic fluid toward the heart. If trauma to the arm occurs, then the area should be washed thoroughly with soap and water and observed. A topical antibiotic ointment and a bandage or other sterile dressing may also be applied. Keeping the affected arm in the dependent position for a long time would cause increased accumulation of fluid. BP readings, venipunctures, or injections on the affected arm should not be performed so as to avoid any occurrence of trauma or infection.

While admitting a patient with a basal skull fracture, the nurse notes clear drainage from the patient's nose. Which of these admission orders should the nurse question? a. Insert nasogastric tube. b. Turn patient every 2 hours. c. Keep the head of bed elevated. d. Apply cold packs for facial bruising.

a. Insert nasogastric tube. Rhinorrhea may indicate a dural tear with cerebrospinal fluid (CSF) leakage, and insertion of a nasogastric tube will increase the risk for infections such as meningitis. Turning the patient, elevating the head, and applying cold pack are appropriate orders.

When a patient's intracranial pressure (ICP) is being monitored with an intraventricular catheter, which information obtained by the nurse is most important to communicate to the health care provider? a. Oral temperature 101.6° F b. Apical pulse 102 beats/min c. Intracranial pressure 15 mm Hg d. Mean arterial pressure 90 mm Hg

a. Oral temperature 101.6° F Infection is a serious consideration with ICP monitoring, especially with intraventricular catheters. The temperature indicates the need for antibiotics or removal of the monitor. The ICP, arterial pressure, and apical pulse are all borderline high but require only ongoing monitoring at this time.

When admitting a patient who has a tumor of the right frontal lobe, the nurse would expect to find a. judgment changes. b. expressive aphasia. c. right-sided weakness. d. difficulty swallowing.

a. judgment changes. The frontal lobes control intellectual activities such as judgment. Speech is controlled in the parietal lobe. Weakness and hemiplegia occur on the contralateral side from the tumor. Swallowing is controlled by the brainstem.

When a patient is admitted to the emergency department following a head injury, the nurse's first priority in management of the patient once a patent airway is confirmed is a. maintaining cervical spine precautions b. determining the presence of increased ICP c. monitoring for changes in neurologic status d. establishing IV access with a large-bore catheter

a. maintaining cervical spine precautions In addition to monitoring for a patent airway during emergency care of the patient with a head injury, the nurse must always assume that a patient with a head injury may have a cervical spine injury. Maintaining cervical spine precautions in all assessment and treatment activities with the patient is essential to prevent additional neurologic damage.

A newly admitted patient who has suffered a right sided brain stroke has a nursing diagnosis of disturbed visual sensory perception related to homonymous hemianopsia. Early in the care of the patient, the nurse should a. place objects on the right side within the patient's field of vision b. approach the patient from the left side to encourage the patient to turn the head c. place objects on the patient's left side to assess the patient's ability to compensate d. patch the affected eye to encourage the patient to turn the head to scan the environment

a. place objects on the right side within the patient's field of vision

A patient with possible cerebral edema has a serum sodium level of 115 mEq/L (115 mmol/L) and a decreasing level of consciousness (LOC) and complains of a headache. Which of these prescribed interventions should the nurse implement first? a. Draw blood for arterial blood gases (ABGs). b. Administer 5% hypertonic saline intravenously. c. Administer acetaminophen (Tylenol) 650 mg orally. d. Send patient for computed tomography (CT) of the head.

b. Administer 5% hypertonic saline intravenously. The patient's low sodium indicates that hyponatremia may be causing the cerebral edema, and the nurse's first action should be to correct the low sodium level. Acetaminophen (Tylenol) will have minimal effect on the headache because it is caused by cerebral edema and increased intra-cranial pressure (ICP). Drawing ABGs and obtaining a CT scan may add some useful information, but the low sodium level may lead to seizures unless it is addressed quickly.

After suctioning, the nurse notes that the intracranial pressure for a patient with a traumatic head injury has increased from 14 to 16 mm Hg. Which action should the nurse take first? a. Document the increase in intracranial pressure. b. Assure that the patient's neck is not in a flexed position. c. Notify the health care provider about the change in pressure. d. Increase the rate of the prescribed propofol (Diprovan) infusion.

b. Assure that the patient's neck is not in a flexed position. Since suctioning will cause a transient increase in intracranial pressure, the nurse should initially check for other factors that might be contributing to the increase and observe the patient for a few minutes. Documentation is needed, but this is not the first action. There is no need to notify the health care provider about this expected reaction to suctioning. Propofol is used to control patient anxiety or agitation; there is no indication that anxiety has contributed to the increase in intracranial pressure.

Which assessment information will the nurse collect to determine whether a patient is developing postconcussion syndrome? SATA a. Muscle resistance b. Short-term memory c. Glasgow coma scale d. Pupil reaction to light e. Headache f. Personality Changes

b. Short-term memory e. Headache f. Personality Changes

At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer. b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes. d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.

b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer.

When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a a. cousin who was diagnosed with breast cancer at age 38. b. mother who was diagnosed with breast cancer at age 42. c. sister who died from ovarian cancer at age 56. d. grandmother who died from breast cancer at age 72.

b. mother who was diagnosed with breast cancer at age 42. Rationale: A significant family history of breast cancer means that the patient has a first-degree relative who developed breast cancer, especially if the relative was premenopausal.

A diagnosis of a ruptured cerebral aneurysm has been made in a patient with manifestations of a stroke. The nurse anticipates that treatment options that would be evaluated for the patient include a. hyperventilation therapy b. surgical clipping of the aneurysm c. administration of hyperosmotic agents d. administration of thrombolytic therapy

b. surgical clipping of the aneurysm

A patient with a head injury has bloody drainage from the ear. To determine whether CSF is present in the drainage, the nurse a. examines the tympanic membrane for a tear b. tests the fluid for a halo sign on a white dressing c. tests the fluid with a glucose identifying strip or stick d. collects 5 mL of fluid in a test tube and sends it to the laboratory for analysis

b. tests the fluid for a halo sign on a white dressing Tests the fluid for a halo sing on a white dressing- Testing clear drainage for CSF in nasal or ear drainage may be done with a Dextrostik or Tes-Tape strip, but if blood is present, the glucose in the blood will produce and unreliable result. To test bloody drainage, the nurse should test the fluid for a halo or ring that occurs when a yellowish ring encircles blood dripped onto a white pad or towel

Which information about a patient who is hospitalized after a traumatic brain injury requires the most rapid action by the nurse? a. Intracranial pressure of 15 mm Hg b. Cerebrospinal fluid (CSF) drainage of 15 mL/hour c. Pressure of oxygen in brain tissue (PbtO2) is 14 mm Hg d. Cardiac monitor shows sinus tachycardia, with a heart rate of 126 beats/min

c. Pressure of oxygen in brain tissue (PbtO2) is 14 mm Hg The PbtO2 should be 20 to 40 mm Hg. Lower levels indicate brain ischemia. An intracranial pressure (ICP) of 15 mm Hg is at the upper limit of normal. CSF is produced at a rate of 20 to 30 mL/hour. The reason for the sinus tachycardia should be investigated, but the elevated heart rate is not as concerning as the decrease in PbtO2.

When caring for a patient following a radical prostatectomy with a perinealapproach, what is the priority nursing intervention the nurse should use to preventcomplications? a. Use chemotherapy to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction. c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention

c. Provide wound care after each bowel movement to prevent infection.

A patient has a systemic BP of 108/51 mm Hg and an intracranial pressure (ICP) of 14 mm Hg. Which action should the nurse take first? a. Elevate the head of the patient's bed to 60 degrees. b. Document the BP and ICP in the patient's record. c. Report the BP and ICP to the health care provider. d. Continue to monitor the patient's vital signs and ICP.

c. Report the BP and ICP to the health care provider. The patient's cerebral perfusion pressure is 56 mm Hg, below the normal of 60 to 100 mm Hg and approaching the level of ischemia and neuronal death. Immediate changes in the patient's therapy such as fluid infusion or vasopressor administration are needed to improve the cerebral perfusion pressure. Adjustments in the head elevation should only be done after consulting with the health care provider. Continued monitoring and documentation also will be done, but they are not the first actions that the nurse should take.

The earliest signs of increased ICP the nurse should assess for include a. Cushing's triad b. unexpected vomiting c. decreasing level of consciousness (LOC) d. dilated pupil with sluggish response to light

c. decreasing level of consciousness (LOC)

The nurse is alerted to possible acute subdural hematoma in the patient who a. has a linear skull fracture crossing a major artery b. has focal symptoms of brain damage with no recollection of a head injury c. develops decreased LOC and a headache within 48 hours of head injury d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing LOC

c. develops decreased LOC and a headache within 48 hours of head injury

A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to a. teach the patient about the need to monitor serum electrolyte levels. b. ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers. c. instruct the patient to call if she notices ankle swelling. d. have the patient schedule frequent eye examinations.

c. instruct the patient to call if she notices ankle swelling. Rationale: Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. OTC pain relievers do not interact with Herceptin. Changes in visual acuity may occur with tamoxifen, but not with Herceptin.

A carotid endarterectomy is being considered as a treatment for a patient who has had several TIAs. The nurse explains to the patient that this surgery a. is used to restore blood to the brain following an obstruction of a cerebral artery b. involves intracranial surgery to join a superficial extracranial artery to an intracranial artery c. involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroked. is sue d to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation

c. involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroked. is sue

While the nurse performs ROM on an unconscious patient with increased ICP, the patient experiences severe decerebrate posturing reflexes. The nurse should a. use restraints to protect the patient from injury b. administer CNS depressants to lightly sedate the patient c. perform the exercises less frequently because posturing can increase ICP d. continue the exercises because they are necessary to maintain musculoskeletal function

c. perform the exercises less frequently because posturing can increase ICP

While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent? a. "Do you currently smoke cigarettes? "b. "Have you ever had any breast injuries? "c. "Is there any family history of fibrocystic breast changes?" d. "At what age did you start having menstrual periods?"

d. "At what age did you start having menstrual periods?" Rationale: Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

A patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take? a. Administer IV furosemide (Lasix). b. Initiate high-dose barbiturate therapy. c. Type and crossmatch for blood transfusion. d. Prepare the patient for immediate craniotomy.

d. Prepare the patient for immediate craniotomy. The principal treatment for epidural hematoma is rapid surgery to remove the hematoma and prevent herniation. If intracranial pressure (ICP) is elevated after surgery, furosemide or high-dose barbiturate therapy may be needed, but these will not be of benefit unless the hematoma is removed. Minimal blood loss occurs with head injuries, and transfusion is usually not necessary.

Which assessment finding in a patient who was admitted the previous day with a basilar skull fracture is most important to report to the health care provider? a. Bruising under both eyes b. Complaint of severe headache c. Large ecchymosis behind one ear d. Temperature of 101.5° F (38.6° C)

d. Temperature of 101.5° F (38.6° C) Patients who have basilar skull fractures are at risk for meningitis, so the elevated temperature should be reported to the health care provider. The other findings are typical of a patient with a basilar skull fracture.

A patient's wife asks the nurse why her husband did not receive the clot busting medication (tPA) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What should the nurse respond? a. He didn't arrive within the time frame for that therapy b. Not every is eligible for this drug. Has he had surgery lately? c. You should discuss the treatment of your husband with your doctor d. The medication you are talking about dissolves clots and could cause more bleeding in your husband's head

d. The medication you are talking about dissolves clots and could cause more bleeding in your husband's head

A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about a. raloxifene (Evista). b. estradiol (Estrace). c. trastuzumab (Herceptin). d. tamoxifen (Nolvadex).

d. tamoxifen (Nolvadex). Rationale: Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used post-mastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2/neu antigen.