Unit 5 Questions

A benign breast condition that includes dilation and inflammation of the collecting ducts is called: а. Ductal ectasia. b. Chronic-cystic disease. c. Intraductal papilloma. d. Fibroadenoma.

A a. Ductal ectasia

A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed? a. "I am glad that these tubes will fall out at home when I finally shower." b. "I should measure the drainage each day to make sure it is less than an ounce (30 mL)." c. "I should be careful how I lie in bed so that I will not kink the tubing." d. "If there is a foul odor from the drainage, I will contact my primary health care provider."

A a. "I am glad that these tubes will fall out at home when I finally shower."

The nurse has educated a client on precautions to take with thrombocytopenia. What statement by the client indicates a need to review the information? a. "I will be careful if I need enemas for constipation." b. "I will use an electric shaver instead of a razor." c. "I should only eat soft food that is either cool or warm." d. "I won't be able to play sports with my grandkids."

A a. "I will be careful if I need enemas for constipation." The thrombocytopenic client is at high risk for bleeding even from minor trauma. Due to the risk of injuring rectal and anal tissue, the client should not use enemas or rectal thermometers.

The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates understanding about those changes? a. "I'll increase animal proteins like fish and meat." b. "I'll work on increasing my fats and carbohydrates." c. "I'll avoid eating green leafy vegetables. d. "I'll limit my intake of citrus fruits."

A a. "I'll increase animal proteins like fish and meat."

A client asks why tamoxifen is so effective for the treatment of breast cancer. Which response should the nurse provide the client? a. "Tamoxifen works by blocking estrogen receptors on breast tissue." b. "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." c. "Tamoxifen works by inhibiting the metabolism of breast cancer cells." d. "Tamoxifen works by binding to the DNA of breast cancer cells."

A a. "Tamoxifen works by blocking estrogen receptors on breast tissue."

The nurse is teaching a 45-year-old woman about her fibrocystic breast changes. Which statement by the client indicates a lack of understanding? a. "This condition will become malignant over time." b. "I understand that hormone-based drugs have serious adverse effects." c. "One cup of coffee in the morning should be enough for me." d. "This condition makes it more difficult to examine my breasts."

A a. "This condition will become malignant over time."

The client calls the nurse and is very frantic. "I think something is wrong! My stools are black, and they have never been this color before!" The client is receiving ferrous sulfate (Feosol). What is the best response by the nurse? a. "This is an expected side effect of ferrous sulfate (Feosol); it is okay." b. "This sounds serious; you may have started bleeding again." c. "Do you have hemorrhoids? That could be the problem." d. "I will speak with your doctor and call you right back."

A a. "This is an expected side effect of ferrous sulfate (Feosol); it is okay."

Which instruction is most appropriate for the nurse to teach a client with persistent thrombocytopenia who is being discharged? a. "Use a soft-bristled toothbrush." b. "Avoid large crowds." c. "Drink at least 2 L of fluid per day." d. "Elevate your lower legs when sitting."

A a. "Use a soft-bristled toothbrush."

What is the nurse's best response when a client with anemia asks "Why am I feeling tired all the time?" a. "Your brain is not getting enough oxygen." b. "How many hours are you sleeping at night?" c. "You are probably dehydrated." d. "When you are sick, you need to rest more."

A a. "Your brain is not getting enough oxygen."

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best? a. 0.45% normal saline b. 0.9% normal saline c. Dextrose 50% (D50) d. Lactated Ringer's solution

A a. 0.45% normal saline

Which client will the nurse identify as having the greatest risk for development of acute leukemia? a. 50 year old being treated with cyclophosphamide for a chronic autoimmune disease. b. 20 year old with cystic fibrosis who has been on continuous enzyme replacement therapy since infancy. c. 55 year old with diabetes mellitus type 1 who has received insulin injections for 43 years. d. 38 year old who has used combination oral contraceptives without a break for 15 years.

A a. 50 year old being treated with cyclophosphamide for a chronic autoimmune disease.

Which finding should the nurse instruct the client receiving tamoxifen to immediately report to the healthcare provider? a. A temperature of 101.1°F b. Weight gain of 3 pounds in 1 week c. Size increase of the tumor d. Nausea and vomiting

A a. A temperature of 101.1°F

The most appropriate nursing diagnosis for a child with anemia is: a. Activity Intolerance r/t generalized weakness b. Decreased Cardiac Output r/t abnormal hemoglobin c. Risk for Injury r/t depressed sensorium d. Risk for Injury r/t dehydration and abnormal hemoglobin

A a. Activity Intolerance r/t generalized weakness

A client presents to the emergency department in sickle cell disease crisis. What intervention by the nurse takes priority? a. Administer oxygen. b. Initiate pulse oximetry. c. Give pain medication. d. Start an IV line.

A a. Administer oxygen.

In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

A a. Aplastic anemia

A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate? a. Assess the client's fears and coping mechanisms. b. Reassure the client that this is a common test. c. Sedate the client prior to the procedure. d. Tell the client that he or she will be asleep.

A a. Assess the client's fears and coping mechanisms.

A nurse is assessing a dark-skinned client for pallor. What nursing assessment is best to assess for pallor in this client? a. Assess the conjunctiva of the eye. b. Have the patient open the hand widely. c. Look at the roof of the patient's mouth. d. Palpate for areas of mild swelling.

A a. Assess the conjunctiva of the eye.

A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What nursing action takes priority at this time? a. Call the Rapid Response Team. b. Take a set of vital signs. c. Institute bleeding precautions. d. Place the client on bedrest.

A a. Call the Rapid Response Team.

A nurse is caring for four clients with leukemia. After hand-off report, which client would the nurse assess first? a. Client who had two bloody diarrhea stools this morning. b. Client who has been premedicated for nausea prior to chemotherapy. c. Client with a respiratory rate change from 18 to 22 breaths/min. d. Client with an unchanged lesion to the lower right lateral malleolus.

A a. Client who had two bloody diarrhea stools this morning.

A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory test results. Which finding would the nurse report to the primary health care provider? a. Creatinine: 2.9 mg/dL (256 mcmol/L) b. Hematocrit: 30% c. Sodium: 146 mEq/L (146 mmol/L) d. White blood cell count: 12,000/mm3

A a. Creatinine: 2.9 mg/dL (256 mcmol/L)

Which assessment finding will the nurse associate as a complication of a client having three episodes of sickle cell crisis in the past 3 months? a. Deeply yellowed sclera b. Worsening hypertension c. Several episodes of priapism d. Increased deep tendon reflexes

A a. Deeply yellowed sclera

Which new-onset symptom in a client with sickle cell disease (SCD) will the nurse report immediately to the health care provider to prevent harm? a. Distention of neck veins in the sitting position b. Itching of the extremities c. Priapism lasting 30 minutes d. Increased urinary output

A a. Distention of neck veins in the sitting position

The nurse is caring for a patient with leukemia who has severe fatigue. What action by the client best indicates that an important outcome to manage this problem has been met? a. Doing activities of daily living (ADLs) using rest periods b. Helping plan a daily activity schedule c. Requesting a sleeping pill at night d. Telling visitors to leave when fatigued

A a. Doing activities of daily living (ADLs) using rest periods

A possible cause of acquired aplastic anemia in children is: a. Drugs b. Injury c. Deficient diet d. Congenital defect

A a. Drugs

A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase 125 U/L (2.2 mckat/L) Total calcium 12 mg/dL (3 mmol/L) Hematocrit 39% (0.39) Hemoglobin 14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed? a. Elevated alkaline phosphatase and calcium suggests bone involvement. b. Only alkaline phosphatase is decreased, suggesting liver metastasis. c. Hematocrit and hemoglobin are decreased, indicating anemia. d. The elevated hematocrit and hemoglobin indicate dehydration.

A a. Elevated alkaline phosphatase and calcium suggests bone involvement.

A client hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe that the client is drug seeking. When the client requests pain medication, what action by the nurse is best? a. Give the client pain medication if it is time for another dose. b. Instruct the client not to request pain medication too early. c. Request the primary health care provider leave a prescription for a placebo. d. Tell the client that it is too early to have more pain medication.

A a. Give the client pain medication if it is time for another dose.

Which electrolyte imbalance will the nurse expect to find in a client with polycythemia vera (PV)? a. Hyperkalemia b. Hypokalemia c. Hyponatremia d. Hypernatremia

A a. Hyperkalemia

Which laboratory trend indicates to the nurse that drug therapy with hydroxyurea is effective in the client who has sickle cell (SCD)? a. Increasing hemoglobin-F levels b. Decreasing blood osmolarity c. Increasing platelet levels d. Increasing blood iron levels

A a. Increasing hemoglobin-F levels

Which statement best explains why iron deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron b. Iron cannot be stored during fetal development c. Fetal iron stores are depleted by age 1 month d. Dietary iron cannot be started until age 12 months

A a. Milk is a poor source of iron

A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

A a. Nausea, hot flashes, and vaginal bleeding

The physician has ordered sargramostim (Leukine) intravenously for the client. What is a priority plan by the nurse prior to administering this drug? a. Plan to monitor the client's ECG readings. b. Plan to insert a Foley catheter and monitor urine output. c. Plan to administer 10% oxygen during the infusion. d. Plan to have a white blood cell (WBC) count drawn every 30 minutes.

A a. Plan to monitor the client's ECG readings.

With which member of the interprofessional team will the nurse collaborate when providing instructions for a client who has anemia cause by vitamin B12 acid deficiency? a. Registered dietitian nutritionist b. Mental health professional c. Physical therapist d. Wound care specialty nurse

A a. Registered dietitian nutritionist

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

A a. Relax any eating pressures.

Which client laboratory trend indicates to the nurse that the prescribed erythropoietin therapy is effective? a. Rising reticulocyte count b. Rising platelet count c. Decreasing albumin levels d. Decreasing white blood cell count

A a. Rising reticulocyte count

A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide, and fluorouracil for breast cancer. Which side effect seen in the client would the nurse report to the primary health care provider immediately? a. Shortness of breath b. Nausea and vomiting c. Hair loss d. Mucositis

A a. Shortness of breath

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately b. Recheck rate of drug infusion c. Observe child closely for next 10 minutes d. Explain to child that this is an expected side effect

A a. Stop drug infusion immediately

What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the womans side.

A a. The blood pressure (BP cuff should not be applied to the affected arm.

The physician has prescribed epoetin alfa (Epogen) for the client. What is the priority assessment by the nurse? a. The client's blood pressure b. The client's report of a headache, indicating a stroke c. The client's ability to use the proper injection techniques for self-administration d. The client's hemoglobin and hematocrit levels

A a. The client's blood pressure

A client who has been diagnosed with breast cancer tells the nurse she wishes to use only natural and complementary interventions. What teaching will the nurse provide? a. This type of therapy would not replace standard treatment. b. If chemotherapy has been recommended, complementary therapies are contraindicated. c. Complementary therapies can only be used after surgery. d. There are many natural herbs that have been shown to treat cancer.

A a. This type of therapy would not replace standard treatment.

In monitoring clients receiving erythropoiesis-stimulating agents, it is most important for the nurse to monitor for: a. Thromboembolus. b. TIA (transient ischemic attack). c. MI (myocardial infarction). d. Stroke

A a. Thromboembolus

Colony-stimulating factors (CSFs) are named according to a. Type of blood cell stimulated. b. Type of hormone secreted. c. Type of homeostatic control. d. Type of stem cell stimulated.

A a. Type of blood cell stimulated.

Which clinical finding indicates the nurse should hold the dose of methotrexate (MTX)? a. Ulcerative stomatitis b. Elevated serum uric acid level c. Deep vein thrombosis d. Elevated white blood cell count

A a. Ulcerative stomatitis

The mechanism of action of colony-stimulating factors, such as filgrastim (Neupogen), is to: a. increase neutrophil production. b. supplement iron in the body. c. replace vitamin B12 factor. d. increase erythrocyte production.

A a. increase neutrophil production.

Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: а. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.

A а. Diuretic administration.

The nurse is assessing a client with chronic leukemia. Which laboratory test result(s) is (are) expected for this client? (Select all that apply.) a. Decreased hematocrit b. Abnormal white blood cell count c. Low platelet count d. Decreased hemoglobin e. Increased albumin

A, B, C, D a. Decreased hematocrit b. Abnormal white blood cell count c. Low platelet count d. Decreased hemoglobin

A client's blood work shows an anemia that was not present at the last clinic visit 6 months ago. Which questions should the nurse ask this client? Select all that apply. a. "Have you had a significant dietary change in the last 6 months?" b. "Do you handle chemicals in your new job?" c. "Have your stools changed in appearance?" d. "Have you been eating more carbohydrates than usual?" e. "Are your menstrual periods heavier than normal for you?"

A, B, C, E a. "Have you had a significant dietary change in the last 6 months?" b. "Do you handle chemicals in your new job?" c. "Have your stools changed in appearance?" e. "Are your menstrual periods heavier than normal for you?"

Which risk factor(s) places a client at risk for leukemia? (Select all that apply.) a. Chemical exposure b. Genetically modified foods c. Ionizing radiation exposure d. Vaccinations e. Viral infections

A, C, E a. Chemical exposure c. Ionizing radiation exposure e. Viral infections

The nurse is preparing to administer a blood transfusion. Which action(s) by the nurse is (are) most appropriate? (Select all that apply.) a. Hang the blood product using normal saline and a filtered tubing set. b. Take a full set of vital signs prior to starting the blood transfusion. c. Tell the client that someone will remain at the bedside for the first 5 minutes. d. Use gloves to start the client's IV if needed and to handle the blood product. e. Verify the client's identity, and checking blood compatibility and expiration time.

A, B, D a. Hang the blood product using normal saline and a filtered tubing set. b. Take a full set of vital signs prior to starting the blood transfusion. d. Use gloves to start the client's IV if needed and to handle the blood product.

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached? Select all that apply. a. The client's hemoglobin values have risen. b. The client reports less shortness of breath on exertion. c. The client has not had an episode of epistaxis in over 3 weeks. d. The client reports enjoying a walk with family for the first time in months. e. The client has not had a fever since treatment began.

A, B, D a. The client's hemoglobin values have risen. b. The client reports less shortness of breath on exertion. d. The client reports enjoying a walk with family for the first time in months.

The nurse is caring for a client receiving a unit of whole blood. Which nursing action(s) is (are) appropriate regarding infusion administration. (Select all that apply.) a. Use a dedicated filtered blood administration set. b. Stay with the client for the first 15 to 20 minutes of the infusion. c. Infuse the blood over a 30-minute period of time. d. Monitor and document vital signs per agency policy. e. Use a 21-gauge or smaller catheter to administer the blood. f. Infuse the transfusion with intravenous normal saline.

A, B, D, F a. Use a dedicated filtered blood administration set. b. Stay with the client for the first 15 to 20 minutes of the infusion. d. Monitor and document vital signs per agency policy. f. Infuse the transfusion with intravenous normal saline.

Which therapeutic interventions should the nurse include when teaching a client about the primary treatments for cancer? Select all that apply. a. Surgery b. Chemotherapy c. Nutrition therapy d. Alternative medicine e. Radiation therapy

A, B, E a. Surgery b. Chemotherapy e. Radiation therapy

The nurse if taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) a. Age greater than 65 years b. Increased breast density c. Osteoporosis d. Multiparity e. Genetic factors f. Early menarche

A, B, E, F a. Age greater than 65 years b. Increased breast density e. Genetic factors f. Early menarche

A nurse is preparing to administer a packed red blood cell transfusion to an older adult. Understanding age-related changes, what alteration(s) in the usual protocol is (are) necessary for the nurse to implement? (Select all that apply.) a. Assess vital signs at least every 15 minutes. b. Avoid giving other IV fluids. c. Premedicate to prevent transfusion reaction. d. Transfuse smaller bags of blood. e. Transfuse each unit over 8 hours. f. Assess the client for fluid overload.

A, B, F a. Assess vital signs at least every 15 minutes. b. Avoid giving other IV fluids. f. Assess the client for fluid overload.

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child (Select all that apply)? a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

A, C, D a. Chlorhexidine gluconate (Peridex) c. Antifungal troches (lozenges) d. Lip balm (Aquaphor)

A nurse working with clients diagnosed with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factor(s) should clients be taught to avoid? (Select all that apply.) a. Dehydration b. Exercise c. Extreme stress d. High altitudes e. Pregnancy

A, C, D, E a. Dehydration c. Extreme stress d. High altitudes e. Pregnancy

After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the client's electronic medical record? (Select all that apply.) a. Peau d'orange b. Dense breast tissue c. Nipple retraction d. Mobile mass at 2 o'clock e. Nontender axillary nodes f. Skin ulceration

A, C, D, F a. Peau d'orange c. Nipple retraction d. Mobile mass at 2 o'clock f. Skin ulceration

A cousin arrives to visit a client recently diagnosed with leukemia. Which responses will the nurse suggest when the cousin asks, "What should I say to her?" (Select all that apply.) a. "Just talk about the things you usually talk about with her." b. "Remind her to be brave and to not cry." c. "Ask how she is feeling." d. "Explain what you know about leukemia." e. "Ask if you can get or do anything for her." f. "Express how sorry you are that this has happened to her."

A, C, E a. "Just talk about the things you usually talk about with her." c. "Ask how she is feeling." e. "Ask if you can get or do anything for her."

When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) a. Bruises b. Fever c. Epistaxis d. Pallor e. Petechiae

A, C, E a. Bruises c. Epistaxis e. Petechiae

The community health nurse is providing education to a group of women about risks for breast cancer. Which factor will the nurse include in the education session? (Select all that apply.) a. High breast density b. First child at age 25 c. Male with gynecomastia d. Nulliparity e. Middle-age woman

A, D a. High breast density d. Nulliparity

A client is scheduled to have chemotherapy Thursday at 9 a.m. Filgrastim (Neupogen) has also been ordered. The nurse should plan which dosing time for the Neupogen? Select all that apply. a. No later than 9 a.m. on Wednesday b. At the time of the chemotherapy infusion c. Immediately following the chemotherapy d. No earlier than 9 a.m. Friday e. Immediately before the chemotherapy

A, D a. No later than 9 a.m. on Wednesday d. No earlier than 9 a.m. Friday

A nurse has just initiated a patient's first dose of doxorubicin (Adriamycin). Which assessment finding would cause the nurse to stop the infusion and seek immediate collaboration with the oncologist? Select all that apply. a. The patient's cardiac monitor reveals sinus bradycardia. b. The patient reports being nauseated. c. The patient mentions drinking green tea for breakfast. d. The patient becomes dyspneic. e. The patient becomes pale.

A, D a. The patient's cardiac monitor reveals sinus bradycardia. d. The patient becomes dyspneic.

A woman is interested in alternative and complementary treatments for the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies wound the nurse suggest? (Select all that apply.) a. Acupuncture b. Chiropractic c. Journaling d. Aromatherapy e. Shiatsu f. Black cohosh

A, D, E a. Acupuncture d. Aromatherapy e. Shiatsu

The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods would be included in the plan? (Select all that apply.) a. Annual mammogram b. Magnetic resonance imaging (MRI) c. Breast ultrasound d. Breast self-awareness e. Clinical breast examination f. Self-breast examination

A, D, E a. Annual mammogram d. Breast self-awareness e. Clinical breast examination

The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a womans chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? а. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

A, D, E а. Family history d. Race e. Nulliparity or first pregnancy after age 30

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? (Select all that apply.) a. Do not permit fresh flowers or plants in the room. b. Do not allow the client's 16-year-old son to visit. c. Observe for bleeding. d. Teach the client to omit raw fruits and vegetables from the diet. e. Administer pegfilgrastim. f. Assess for fever.

A, D, E, F a. Do not permit fresh flowers or plants in the room. d. Teach the client to omit raw fruits and vegetables from the diet. e. Administer pegfilgrastim. f. Assess for fever.

A client with leukemia asks the nurse where the cancer in her body is located. Which response should the nurse provide the client? a. Epithelial tissue b. Bone marrow c. Connective tissue d. Lymphoid tissue

B b. Bone marrow

Which adverse effect should the nurse monitor the client receiving doxorubicin (Adriamycin) for? a. Neurotoxicity b. Cardiotoxicity c. Nephrotoxicity d. Hepatotoxicity

B b. Cardiotoxicity

Which body area on a client with darker skin is most appropriate for the nurse to examine for indications of pallor and cyanosis? a. Earlobes and bridge of the nose b. Palms and soles c. Conjunctiva of the eyes d. Tongue

C c. Conjunctiva of the eyes

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client would the nurse assess first? a. Client with a blood pressure of 180/98 mm Hg b. Client who reports shortness of breath c. Client who reports calf tenderness and swelling d. Client with a swollen and painful left great toe

B b. Client who reports shortness of breath

What is the nurse's interpretation of when the blood laboratory values a client who has chronic myelogenous leukemia (CML) shows a high percentage of blast cells and promyelocytes? a. Infection risk is decreasing. b. Disease is progressing. c. Leukemia type is now lymphocytic. d. Drug therapy is effective.

B b. Disease is progressing.

A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? a. "You do not need to worry about lymphedema since you did not have radiation therapy." b. "Be careful not to injure that arm or get any infection in that arm." c. "Numbness, tingling, and swelling are common sensations after a mastectomy." d. "The risk for lymphedema is a real threat and can be very self-limiting."

B b. "Be careful not to injure that arm or get any infection in that arm."

Which question will the nurse ask to assess a client's endurance in performing ADLs? a. "Do you usually eat supper at home or at a restaurant?" b. "How would you rate your energy level compared with last year?" c. "What medications do you take daily, weekly, and monthly?" d. "Have you lost any weight this past year?"

B b. "How would you rate your energy level compared with last year?"

The client receives filgrastim (Neupogen). He asks the nurse, "That is such a funny name; where do you suppose it comes from?" What is the best response by the nurse? a. "It comes from the interleukins it stimulates; this one stimulates neuocytes." b. "It comes from the blood cell it stimulates; this one stimulates neutrophils." c. "It comes from the stem cells it stimulates, such as filgrastims." d. "It is a complicated process; the drug companies are secretive about it."

B b. "It comes from the blood cell it stimulates; this one stimulates neutrophils."

The client is pregnant and has been told by her physician that she needs cyanocobalamin (Nascobal). She asks the nurse, "Will this hurt my baby?" What is the best response by the nurse? a. "No, this medication will not hurt your baby as long as you take it with ascorbic acid." b. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby." c. "No, this medication will not hurt your baby as long as you take the pills only in the third trimester." d. "No, this is safe in either pill or injectable form; it is a Pregnancy Category A drug which means it is safe for your baby."

B b. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby."

The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse? a. "No, we do not give blood for anemia anymore." b. "No, this medication stimulates your body to make red blood cells." c. "Yes, this small amount of red blood cells will stimulate your bone marrow to produce more cells in the kidney." d. "No, this medication promotes clotting so you will not lose even more red blood cells."

B b. "No, this medication stimulates your body to make red blood cells."

The client is receiving chemotherapy for cancer. The physician has prescribed oprelvekin (Neumega). The nurse has completed medication education and evaluates it as effective when the client makes which statement? a. "This medication will help my chemotherapy work better." b. "This medication will help increase my platelet count." c. "This medication will help me regain the weight I have lost." d. "This medication will help increase my red blood cell count."

B b. "This medication will help increase my platelet count."

With which client will the nurse be most alert for the development of glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia? a. 55-year-old man who had a myocardial infarction 5 years ago. b. 28-year-old man Saudi Arabia whose mother had the disorder. c. 55-year-old woman who had a partial gastrectomy for stomach cancer last year. d. 28-year-old woman from Ireland whose father had the disorder.

B b. 28-year-old man Saudi Arabia whose mother had the disorder.

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include: a. Correction of acidosis b. Adequate hydration and pain management c. Pain management and administration of heparin d. Adequate oxygenation and replacement of factor VIII

B b. Adequate hydration and pain management

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called? a. Syngeneic b. Allogeneic c. Monoclonal d. Autologous

B b. Allogeneic

The family of a neutropenic client reports that the client "is not acting right." What action by the nurse is the priority? a. Ask the client about pain. b. Assess the client for infection. c. Take a set of vital signs. d. Review today's laboratory results.

B b. Assess the client for infection.

A client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client's coping is maladaptive? a. Requesting a temporary prosthesis b. Avoiding eye contact with staff c. Saying, "I feel like less of a woman" d. Saying, "This is the ugliest scar ever"

B b. Avoiding eye contact with staff

Which describes the action of aromatase inhibitors? a. Block the estrogen receptors that stimulate the growth of ER-positive tumors b. Block an enzyme that catalyzes the final step in the synthesis of estrogen c. Suppress the ovary and adrenal gland from producing estrogen d. Weaken the effect of estrogen on ER-positive tumors

B b. Block an enzyme that catalyzes the final step in the synthesis of estrogen

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

B b. Bone involvement

What action will the nurse take when a client's laboratory results indicate the platelet count is 180,000/mm3? a. Apply oxygen to improve gas exchange. b. Document the result as the only action. c. Instruct assistive personnel (AP) to handle client gently. d. Immediately inform the health care provider because of possible spontaneous bleeding.

B b. Document the result as the only action.

A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important? a. Document the events in the client's medical record. b. Double-check the client and blood product identification. c. Place the client on strict bedrest until the pain subsides. d. Review the client's medical record for known allergies.

B b. Double-check the client and blood product identification.

A nurse if preparing to administer a blood transfusion. What action is most important? a. Correctly identify client using two identifiers. b. Ensure that informed consent is obtained. c. Hang the blood product with Ringer's lactate. d. Stay with the client for the entire transfusion.

B b. Ensure that informed consent is obtained.

A client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority? a. Administer pain medication first. b. Ensure that valid consent is in the medical record. c. Have the client shower in the morning. d. Premedicate the client with sedatives.

B b. Ensure that valid consent is in the medical record.

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child? a. Do not let the child have chewing gum b. Flowers, plants, and produce are not allowed c. The child can only have one visitor at a time d. Toys and items from home cannot be brought in

B b. Flowers, plants, and produce are not allowed

Which medication will the nurse prepare to administer to a client who is in sickle cell crisis and requests "something for pain"? a. Intramuscular (IM) meperidine b. Intravenous (IV) hydromorphone c. Oral ibuprofen d. Oral morphine sulfate

B b. Intravenous (IV) hydromorphone

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider? a. Difficulty staying asleep at night b. Left-sided abdominal enlargement c. Polyphagia and polydipsia d. Swelling of the legs and feet

B b. Left-sided abdominal enlargement

The client complains of constipation while receiving ferrous sulfate (Feosol). What is the best plan by the nurse to assist the client in resolving this common side effect? a. Plan to teach the client about which laxatives are the safest to use. b. Plan to teach the client to increase fluids and high-fiber foods in the diet. c. Plan to teach the client to self-administer Fleets enemas. d. Plan to teach the client to increase exercise.

B b. Plan to teach the client to increase fluids and high-fiber foods in the diet.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

B b. Rarely cause addiction because they are medically indicated

Which symptom reported by a client suggests to the nurse that anemia is a possibility? a. Chronic headaches b. Shortness of breath c. Cold hands and feet d. Difficulty sleeping

B b. Shortness of breath

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is: a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

B b. Sickle cell anemia

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (Select all that apply)? a. Fingersticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen for mild pain control d. Soft toothbrush for dental hygiene e. Administration of PRBCs

B, C, D b. Avoidance of IM injections c. Acetaminophen for mild pain control d. Soft toothbrush for dental hygiene

The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.) a. Increased hematocrit b. Decreased red blood cell count c. Decreased serum iron d. Decreased hemoglobin e. Increased platelet count f. Decreased white blood cell count

B, C, D b. Decreased red blood cell count c. Decreased serum iron d. Decreased hemoglobin

The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate (Select all that apply)? a. Acute Pain r/t vaso-occlusion b. Risk for Infection r/t inadequate secondary defenses or immunosuppression c. Ineffective Protection r/t thrombocytopenia d. Ineffective Tissue Perfusion r/t anemia e. Ineffective Protection r/t abnormal clotting

B, C, D b. Risk for Infection r/t inadequate secondary defenses or immunosuppression c. Ineffective Protection r/t thrombocytopenia d. Ineffective Tissue Perfusion r/t anemia

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease (Select all that apply)? a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

B, C, E b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. e. Notify the health care provider if your child begins to develop symptoms of a cold.

A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis? a. Infant b. <10 years of age c. >25% abnormal cells in bone marrow aspirate d. White count 4,200/mm3 e. White count 25,000/mm3

B, D b. <10 years of age d. White count 4,200/mm3

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend (Select all that apply)? a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

B, D, E b. Swimming d. Golf e. Bowling

Which changes in ADLs are most appropriate for the nurse to suggest to a client newly diagnosed anemia about conserving energy? Which instructions would the nurse give to the client? (Select all that apply.) a. "Cluster your care together to get through them more quickly." b. "Accept help from others when you feel especially tired." c. "Take a complete bath or shower daily to promote relaxation." d. "Stop activity when you feel short of breath or palpitations are present." e. "Try eating four to six small, easy-to-eat meals daily instead of three larger ones." f. "Sit instead of standing for some tasks such as cutting vegetables."

B, D, E, F b. "Accept help from others when you feel especially tired." d. "Stop activity when you feel short of breath or palpitations are present." e. "Try eating four to six small, easy-to-eat meals daily instead of three larger ones." f. "Sit instead of standing for some tasks such as cutting vegetables."

A client is to receive darbepoetin alfa (Aranesp) adjunctive medication during chemotherapy. The client says, "Not another drug. Why do I need this one?" How should the nurse respond? Select all that apply. a. "I know you are tired of drugs, but this is just one more." b. "This drug will help you grow red blood cells." c. "This drug will help keep you from getting infections." d. "This is an erythropoiesis-stimulating factor." e. "This drug will help you get more oxygen around to your tissues so you feel better."

B, E b. "This drug will help you grow red blood cells." e. "This drug will help you get more oxygen around to your tissues so you feel better."

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: a. Aplastic anemia. b. Thalassemia major. c. Disseminated intravascular coagulation. d. Idiopathic thrombocytopenia purpura

D d. Idiopathic thrombocytopenia purpura

The nurse is examining a woman's breast and notes multiple small mobile lumps. Which question would be most appropriate for the nurse to ask? a. "When was your last mammogram at the clinic?" b. "How many cans of caffeinated soda do you drink in a day?" c. "Do the small lumps seem to change with your menstrual period?" d. "Do you have a first-degree relative who has breast cancer?"

C c. "Do the small lumps seem to change with your menstrual period?"

A nurse has taught a female client about the modifiable risk factors for breast cancer. Which statement made by the client indicates that more teaching is needed? a. "I am fortunate that I breast-fed each of my three children for 12 months." b. "It looks as though I need to start working out at the gym more often." c. "I am glad that we can still have wine with every evening meal." d. "When I have menopausal symptoms, I must avoid hormone replacement therapy."

C c. "I am glad that we can still have wine with every evening meal."

A client has thrombocytopenia. What statement indicates that the client understands self-management of this condition? a. "I brush and use dental floss every day." b. "I chew hard candy for my dry mouth." c. "I usually put ice on bumps or bruises." d. "Nonslip socks are best when I walk."

C c. "I usually put ice on bumps or bruises."

A client asks the nurse why he is receiving several chemotherapeutic agents as treatment for cancer. Which response should the nurse provide the client? a. "Using multiple drugs means a shorter treatment time." b. "Using multiple drugs decreases the incidence of side effects." c. "Using multiple drugs will help kill more of the cancer." d. "Using multiple drugs is more cost effective in treating cancer."

C c. "Using multiple drugs will help kill more of the cancer."

Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dl b. 3-year-old child with a hemoglobin of 12 g/dl c. 14-year-old child with a hemoglobin of 10 g/dl d. 1-year-old child with a hemoglobin of 13 g/dl

C c. 14-year-old child with a hemoglobin of 10 g/dl

Which patient is most at risk for fibroadenoma of the breast? а. A 38-year-old woman b. A 16-year-old girl c. A 50-year-old woman d. A 27-year-old woman

C c. A 50-year-old woman

When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.

C c. Adequate dosage will turn the stools a tarry green color.

A school age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: a. Encourage drinking large amounts of favorite fluids b. Encourage child to remain NPO until nausea and vomiting subside c. Administer an antiemetic before chemotherapy begins d. Administer an antiemetic as soon as child has nausea

C c. Administer an antiemetic before chemotherapy begins

Which precaution is most important for the nurse to teach a patient with leukemia to prevent an infection by cross-contamination? a. Reporting any burning on urination immediately b. Taking antibiotics exactly as prescribed c. Avoiding crowds and people who are ill d. Performing mouth care three times daily

C c. Avoiding crowds and people who are ill

Which condition or event within the past 24 hours will the nurse identify as a possible cause of the current crisis episode in a client with sickle cell disease (SCD)? a. Participating in an archery tournament b. Spraining a wrist while stopping a fall c. Binge-drinking wine at a party d. Engaging in sexual intercourse

C c. Binge-drinking wine at a party

A 48-year-old woman with the BRCA genetic mutation requests information about early detection for her daughter due to genetic risk. Which information will the nurse convey? a. Breast self-examination (BSE) beginning at 20 years of age is the best way to detect breast cancer. b. Hormone replacement therapy (HRT) combining estrogen and progesterone may be recommended by your daughter's primary health care provider. c. Cancer screening for the daughter would begin at age 38. d. The health care provider will discuss prophylactic mastectomy as the definitive option for prevention.

C c. Cancer screening for the daughter would begin at age 38.

What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy? a. Teach the client to avoid activity for 24 to 48 hours to prevent infection. b. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort. c. Check the pressure dressing frequently for signs of excessive or active bleeding. d. Report the laboratory results to the primary health care provider.

C c. Check the pressure dressing frequently for signs of excessive or active bleeding.

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? a. Antibiotic administration b. Bone marrow transplant c. Chemotherapy d. Liver transplant

C c. Chemotherapy

Which client being cared for on the medical-surgical unit is appropriate for the nurse to assign to a nurse who has floated from the intensive care unit (ICU)? a. Recent radical mastectomy client requiring chemotherapy administration b. Modified radical mastectomy client needing discharge teaching c. Client with a Jackson-Pratt drain who had a mastectomy yesterday d. Stage III breast cancer client requesting information about radiation and chemotherapy

C c. Client with a Jackson-Pratt drain who had a mastectomy yesterday

The nurse is working with a male client who has gynecomastia. What action by the nurse is most appropriate? a. Teach the client to perform self-breast examination. b. Review the plan for chemotherapy after surgery. c. Educate him on the side effects of tamoxifen. d. Assess his usual daily alcohol intake.

C c. Educate him on the side effects of tamoxifen.

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Fine-needle aspiration (FNA) d. CA 15.3

C c. Fine-needle aspiration (FNA)

A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best? a. Arrange a visitation schedule among friends and family. b. Explain that this process is difficult but must be endured. c. Help the client find things to hope for each day of recovery. d. Provide plenty of diversionary activities for this time.

C c. Help the client find things to hope for each day of recovery.

Which statement most accurately described the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen b. Sickle-shaped cells decreased blood viscosity c. Increased red blood cell destruction occurs d. Decreased red blood cell destruction occurs

C c. Increased red blood cell destruction occurs

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a. Administer with meals. b. Administer between meals. c. Inject deeply into a large muscle. d. Massage injection site for 5 minutes after administration of drug.

C c. Inject deeply into a large muscle.

A client is starting hormonal therapy with tamoxifen to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? a. It blocks the release of luteinizing hormone. b. It interferes with cancer cell division. c. It selectively blocks estrogen in the breast. d. It inhibits DNA synthesis in rapidly dividing cells.

C c. It selectively blocks estrogen in the breast.

A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. b. Intraductal papilloma. c. Lipoma. d. Mammary duct ectasia.

C c. Lipoma.

The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

C c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles.

Which finding in a female client by the nurse would receive the highest priority for further diagnostics? a. Tender moveable masses throughout the breast tissue b. Nipple discharge without a palpable mass c. Nontender fixed mass in the upper outer quadrant of the breast d. Small, painful mass under warm reddened skin and nipple discharge

C c. Nontender fixed mass in the upper outer quadrant of the breast

Which assessment finding of a newly admitted client with thrombocytopenia requires immediate action by the nurse? a. Elevated temperature b. Pain rating of 8 on a 0 to 10 scale c. Nosebleed d. Decreased urine output

C c. Nosebleed

The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect? a. Infection b. Pallor c. Pain d. Fatigue

C c. Pain

Which nursing action is most effective in reducing the potential for sepsis while caring for a client who has sickle cell disease (SCD)? a. Monitoring for abnormal laboratory values b. Checking vital signs every 4 hours c. Performing frequent and thorough handwashing d. Administering prophylactic drug therapy

C c. Performing frequent and thorough handwashing

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately? a. Loss of appetite b. Low WBC count c. Peripheral edema d. Temperature of 100.6F (38.1C), once

C c. Peripheral edema

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of hide and seek in the children's outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the child's room d. A walk down the hospital lobby

C c. Puppet play in the child's room

Which foods will the nurse help the client with vitamin B12 deficiency to increase in the diet? a. Grains b. Unsaturated fats c. Red meat d. Starchy vegetables

C c. Red meat

A client has just returned from a right radical mastectomy. Which action by the assistive personnel (AP) would require the nurse consider to intervene? a. Checking the amount of urine in the catheter collection bag b. Elevating the right arm on a pillow c. Taking the blood pressure on the right arm d. Encouraging the client to squeeze a rolled washcloth

C c. Taking the blood pressure on the right arm

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: a. Venipuncture discomfort is very brief. b. Only one venipuncture will be needed. c. Topical application of local anesthetic can eliminate venipuncture pain. d. Most blood tests on children require only a finger puncture because a small amount of blood is needed.

C c. Topical application of local anesthetic can eliminate venipuncture pain.

What is the most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs b. Thrombocytopenia (excessive destruction of platelets) occurs c. Unrestricted proliferation of immature WBCs occurs d. The first stage of coagulation process is abnormally stimulated

C c. Unrestricted proliferation of immature WBCs occurs

For which adverse effect should the nurse monitor the client prescribed tamoxifen? a. Fatigue b. Cough c. Vaginal discharge d. Signs of dehydration

C c. Vaginal discharge

After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

C c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.

As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

C c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient

Per classification of anemias, the morphology for pernicious anemia or folate-deficiency anemia results in: a. hematocytic-hematochromic erythrocytes. b. microcytic-hypochromic erythrocytes. c. macrocytic-normochromic erythrocytes. d. normocytic-normochromic erythrocytes.

C c. macrocytic-normochromic erythrocytes.

A nurse is preparing to administer ferrous sulfate IM to a client with anemia. What should the nurse consider when giving this injection? Select all that apply. a. Give the injection in the deltoid muscle. b. Iron is best absorbed if given subcutaneously. c. Iron is irritating to the tissues. d. The z-track method should be used. e. Iron preparations should be administered through a needle gauge 16 or larger.

C, D c. Iron is irritating to the tissues. d. The z-track method should be used.

The nurse is teaching a client how to perform breast self-examination (BSE). Which of these techniques does the nurse include in the teaching session? (Select all that apply.) a. Perform the self-examination 1 week before a menstrual period. b. Teach to keep her arm by her side while performing the examination. c. Remind that a clinical breast examination and mammography are still recommended. d. Use light, medium, and then firm pressure to feel the tissue. e. A bra can be left in place during the self-examination.

C, D c. Remind that a clinical breast examination and mammography are still recommended. d. Use light, medium, and then firm pressure to feel the tissue.

A client has received a bone marrow transplant and is waiting for engraftment. What action(s) by the nurse are most appropriate? (Select all that apply.) a. Not allowing any visitors until engraftment b. Limiting the protein in the client's diet c. Placing the client in protective precautions d. Teaching visitors appropriate hand hygiene e. Telling visitors not to bring live flowers or plants

C, D, E c. Placing the client in protective precautions d. Teaching visitors appropriate hand hygiene e. Telling visitors not to bring live flowers or plants

Which statement by a client with leukemia indicates a need for further teaching by the nurse? a. "I will use a soft-bristled toothbrush and avoid flossing." b. "I will not take aspirin or any aspirin product." c. "I will use an electric shaver instead of my manual one." d. "I will take a daily laxative to prevent constipation."

D d. "I will take a daily laxative to prevent constipation."

The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse? a. "No, but it works with your chemotherapy to make it more effective." b. "No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy." c. "No, it will stimulate your immune system to help you battle the cancer." d. "No, this drug will help prevent anemia that can be caused by your chemotherapy."

D d. "No, this drug will help prevent anemia that can be caused by your chemotherapy."

The nurse is discussing treatment options with a client newly diagnosed with breast cancer. Which client statement indicates a need for further teaching? a. "If I get radiation, I am not radioactive to others." b. "I might have chemotherapy before surgery." c. "Hormonal therapy is used to prevent cancer growth." d. "Radiation will remove the cancer, so I might not need surgery."

D d. "Radiation will remove the cancer, so I might not need surgery."

A client asks about the process of graft-versus-host disease. What explanation by the nurse is correct? a. "Because of immunosuppression, the donor cells take over." b. "It's like a transfusion reaction because no perfect matches exist." c. "The patient's cells are fighting donor cells for dominance." d. "The donor's cells are actually attacking the patient's cells."

D d. "The donor's cells are actually attacking the patient's cells."

An assistive personnel is caring for a client with leukemia and asks why the client is still at risk for infection when the white blood cell count (WBC) is high. What response by the nurse is correct? a. "If the WBCs are high, there already is an infection present." b. "The client is in a blast crisis and has too many WBCs." c. "There must be a mistake; the WBCs should be very low." d. "Those WBCs are abnormal and don't provide protection."

D d. "Those WBCs are abnormal and don't provide protection."

The nurse has just received report on a group of clients. Which client is the nurse's first priority? a. 32 year old with pernicious anemia who needs a vitamin B12injection b. 40 year old with iron deficiency anemia who needs an iron dextran infusion c. 67 year old with acute myelocytic leukemia with petechiae on both legs d. 81 year old with thrombocytopenia and an increase in abdominal girth

D d. 81 year old with thrombocytopenia and an increase in abdominal girth

Which observation by the home care nurse when visiting a client who had a stem cell transplant 2 months ago requires immediate action? a. The spouse is preparing a lettuce salad for lunch. b. The client's platelet count remains below 100,000 cells/mm3. c. A dog is the household pet. d. A grandchild is visiting after receiving a measles, mumps, and rubella vaccine.

D d. A grandchild is visiting after receiving a measles, mumps, and rubella vaccine.

A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

D d. A single lump in one breast that can be expected to shrink as the woman ages.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? a. Explain that this occurs in some clients and is usually permanent. b. Inform the client that a small glass of wine may help her relax. c. Protect the client from infection. d. Allow the client an opportunity to express her feelings.

D d. Allow the client an opportunity to express her feelings.

Which action should the nurse take after discontinuing an intravenous infusion of doxorubicin (Adriamycin) that has extravasated? a. Inspect the area for irritation. b. A warm, wet compress should be placed on the site. c. Wash the area thoroughly with soap and water. d. Apply ice packs to the area immediately.

D d. Apply ice packs to the area immediately.

A client who has undergone breast surgery is struggling her sexuality. How will the nurse address the client's concerns? a. Remind the client the she needs to avoid sexual intercourse at this time. b. Ask the client if she is using her surgery as an excuse not to avoid intercourse. c. Give the client a business card for a local counselor. d. Ask the client about satisfaction with sexual relations with her partner.

D d. Ask the client about satisfaction with sexual relations with her partner.

What is the appropriate action for the nurse to take when a client's leukocyte count is 8200/mm3 (8.2 × 109/L) 8 weeks after hematopoietic stem cell transplantation for leukemia? a. Notifying the hematologic health care provider immediately b. Reminding the client to avoid crowds and people who are ill c. Documenting the report as the only action d. Assessing the client for other symptoms of infection

D d. Assessing the client for other symptoms of infection

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. Infection. b. Brain tumor. c. Drug side effects. d. Central nervous system (CNS) disease.

D d. Central nervous system (CNS) disease.

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a(n): a. Decrease in leukocytes. b. Increase in lymphocytes. c. Vitamin C deficiency. d. Decrease in blood platelets.

D d. Decrease in blood platelets.

An accurate description of anemia is: a. Increased blood viscosity. b. Depressed hematopoietic system. c. Presence of abnormal hemoglobin. d. Decreased oxygen-carrying capacity of blood.

D d. Decreased oxygen-carrying capacity of blood.

Which action will the nurse perform first when caring for a client with neutropenia who has a suspected infection? a. Administering prescribed antibiotics b. Administering IV normal saline for hydration c. Placing the client on Contact Precautions d. Drawing blood for cultures

D d. Drawing blood for cultures

During dressing changes, the nurse assesses a client who had breast reconstruction. Which finding would cause the nurse to take immediate action? a. Slightly reddened incisional area b. Blood pressure of 128/75 mm Hg c. Temperature of 99° F (37.2° C) d. Dusky color of the breast flap

D d. Dusky color of the breast flap

A client tells the nurse in the gynecology clinic that she doesn't get a yearly mammogram because she is afraid of what might be found. Which teaching will the nurse provide? a. People with low breast cancer risk can obtain an MRI instead. b. Detection of breast cancer before or after axillary node invasion yields the same outcome. c. Mammography is needed only if the client has a first-degree relative with breast cancer. d. Early detection is important, as localized breast cancer has a 99% 5-year survival rate

D d. Early detection is important, as localized breast cancer has a 99% 5-year survival rate

The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about the side effects of doxorubicin. Which teaching will the nurse provide? a. Report any symptoms of fatigue, cough, or edema to the oncologist. b. There are very few side effects associated with this agent. c. Doxorubicin is a type of selective estrogen receptor modulator (SERM). d. If side effects arise, they begin within 2 days of chemotherapy administration.

D d. If side effects arise, they begin within 2 days of chemotherapy administration.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

D d. Iron-fortified infant cereal by age 4 to 6 months

Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumps

D d. Measles, rubella, mumps

The nurse at the gynecology clinic is examining a woman's breasts. Which assessment finding requires immediate notification of the primary health care provider? a. Backache and breast fungal infection b. Ill-defined painful rubbery lump in the outer breast quadrant c. A 1-cm freely mobile rubbery mass discovered by the client d. Nipple discharge and dimpling

D d. Nipple discharge and dimpling

A younger woman from an unfamiliar culture is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? a. Discourage this surgery since the woman is still of childbearing age. b. Reassure the client that reconstructive surgery is as easy as breast augmentation. c. Inform the client that this surgery removes all mammary tissue and cancer risk. d. Offer to include support people, such as the male partner, in the decision making.

D d. Offer to include support people, such as the male partner, in the decision making.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet, painful joints

D d. Painful swelling of hands and feet, painful joints

The nurse is caring for a client experiencing sickle cell disease crisis. Which priority action would help prevent infection? a. Administering prophylactic antibiotics b. Monitoring the client's temperature c. Checking the client's white blood cell count d. Performing frequent handwashing

D d. Performing frequent handwashing

3. A hospitalized client has a platelet count of 58,000/mm3. What action by the nurse is most appropriate? a. Encourage high-protein foods. b. Institute neutropenic precautions. c. Limit visitors to healthy adults. d. Place the client on safety precautions.

D d. Place the client on safety precautions.

The client receives cyclophosphamide (Cytoxan). The nurse evaluates the clients laboratory work. Which laboratory finding would support canceling the clients next treatment with this drug? a. Hemoglobin of 14 g/dl b. Blood urea nitrogen of 12 mg/dl c. WBC count of 8,000 cells/mcl d. Platelet count of 8,000/mm

D d. Platelet count of 8,000/mm

Which action will the nurse to perform first when caring for a female client who is in sickle cell crisis? a. Asking the client about possible triggers b. Teaching the client about barrier forms of contraception c. Ensuring adequate oral and IV fluid intake d. Providing pain medication

D d. Providing pain medication

A nurse is preparing to administer a blood transfusion. Which action is most important? a. Document the transfusion. b. Place the client on NPO status. c. Place the client in isolation. d. Put on a pair of gloves.

D d. Put on a pair of gloves.

The nurse is caring for a client undergoing mastectomy who asks the nurse about breast reconstruction. Which of these will the nurse include in the discussion? a. Reconstruction of the nipple-areola complex is the first stage in reconstruction. b. Prostheses are not recommended because of the nature of the surgery. c. Reconstruction cannot take place until several months after a mastectomy. d. Some women want breast reconstruction using their own tissue.

D d. Some women want breast reconstruction using their own tissue.

Which action is the first priority for the nurse to take when a client who is receiving a blood transfusion suddenly says, "I don't feel right!"? a. Applying oxygen b. Obtaining vital signs and monitoring for changes c. Initiating the Rapid Response Team d. Stopping the transfusion

D d. Stopping the transfusion

A patient has been prescribed ferrous sulfate (Feosol). What should the nurse teach the patient about taking this medication? a. Take this medication with milk. b. It is okay to take this medication along with your other medications, such as calcium. c. Take this medication with orange juice. d. Take this medication with water.

D d. Take this medication with water.

The nurse assesses a client's oral cavity as seen in the photo below. What action by the nurse is most appropriate? a. Encourage the client to have genetic testing. b. Instruct the client on high-fiber foods. c. Place the client in protective precautions. d. Teach the client about cobalamin therapy.

D d. Teach the client about cobalamin therapy.

The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

D d. The exact cause of breast cancer is unknown.

The client receives methotrexate (Rheumatrex). The nurse assesses for side effects of this drug. Which side effects are a primary concern for the nurse? a. Hyperglycemia and fatigue b. Nausea and vomiting c. Hypertension and seizures d. Ulcerative stomatitis and diarrhea

D d. Ulcerative stomatitis and diarrhea

A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement by the nurse to the parents is most appropriate? a. Radiation therapy is the standard treatment b. The prognosis for this disease is extremely poor c. There are lots of good medications for nausea d. We need to test siblings for a bone marrow match

D d. We need to test siblings for a bone marrow match

A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. Do you have transportation to the teaching hospital so that you can get your mammogram? b. Im concerned that you missed your appointment; let me make another one for you. c. It's very dangerous to skip your mammograms; your breasts need to be checked. d. Would you like me to make an appointment for you to have your mammogram here?

D d. Would you like me to make an appointment for you to have your mammogram here?

Which lab values would the nurse expect to see for a client with sickle cell disease? (Select all that apply.) a. Decreased total bilirubin b. Increased hematocrit c. Decreased iron levels d. Increased reticulocyte count e. Elevated total white blood cell count f. 80% hemoglobin S

D, E, F d. Increased reticulocyte count e. Elevated total white blood cell count f. 80% hemoglobin S

Which actions are priorities for the nurse to perform to prevent harm after a client has a bone marrow biopsy performed? (Select all that apply.) a. Sending the specimen to the laboratory b. Measuring temperature c. Advising the client to not drive for 24 hours d. Inspecting the site for ecchymosis e. Applying pressure to the biopsy site f. Instructing the client to avoid vigorous activity

D, E, F d. Inspecting the site for ecchymosis e. Applying pressure to the biopsy site f. Instructing the client to avoid vigorous activity