MS EXAM 2 EMPHASIZED INFO (Jeopardy, Quizzes, PP Questions, Evolve, Critical Thinking)

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest?

"Ask her how she is feeling." "Ask her if she needs anything." "Talk to her as you normally would when you haven't seen her for a long time."

A hematology unit is staffed by registered nurse's (RNs), licensed practical nurses (LPNs)/licensed vocational nurse (LVNs), and unlicensed assistive personnel (UAP). When the nurse manager is reviewing staff documentation, which entry indicates the need for staff education for his or her appropriate level of responsibility and client care?

"Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP"

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information?

"Do you feel more tired after you get up and go to the bathroom?"

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated?

"Does anyone in your family bleed a lot?"

A 52-year-old client tells the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic?

"Finding a cancer in the early stages increases the chance for cure."

The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary?

"Getting an annual 'flu shot' would be dangerous for me."

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client?

"How is your energy level compared with last year?"

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult male client indicates understanding of the nurse's instructions?

"I need to report the pain going down my legs to my health care provider."

Which client statement indicates in-home stem cell transplantation is not a viable option?

"I was a nurse, so I can take care of myself."

Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment?

"I will have a radioactive device in my body for a short time."

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action?

"It should prevent my blood from clotting."

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is most important to communicate to the health care provider?

"My legs are numb and weak."

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions?

"My mother and grandmother had breast cancer, so I am at risk."

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client?

"Place an ice pack over the site to reduce the bruising."

The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client?

"Provide yourself with four to six small, easy-to-eat meals daily." "Stop activity when shortness of breath or palpitations is present." "Allow others to perform your care during periods of extreme fatigue." "Drink small quantities of protein shakes and nutritional supplements daily."

Which information must the organ transplant nurse emphasize before a client is discharged?

"Taking immunosuppressant medications increases your risk for cancer and the need for screenings.

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means?

"The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis."

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response?

"The clotting process begins with your platelets."

A client with leukemia is being discharged from the hospital. The nurse's discharge instructions say to keep regularly scheduled follow-up primary health care provider appointments. The client says, "I don't have transportation." Which is the most appropriate nursing response?

"The local American Cancer Society may be able to help."

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client?

"The number varies with gender, age, and general health."

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information would the nurse explain to the parents about the risk of a child having sickle cell disease?

"The sickle cell trait will be inherited by your children."

A client with thrombocytopenia is being discharged. Which instruction would the nurse include in a teaching plan for this client?

"Use a soft-bristled toothbrush."

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. What is the most appropriate response by the nurse?

"Would you like to try some relaxation techniques?"

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure?

"You may experience a crunching sound or a scraping sensation as the needle punctures your bone."

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response?

"Your cells are delivering less oxygen than you need."

A patient who is not a candidate for thrombolytic therapy following a cerebral thrombolytic event would be:

1) a patient who was admitted with a stroke and a MVA with head trauma 2) if the thrombolytic event happened 10 hours ago 3) if the patient has a history of a hemorrhagic stroke.

What are normal values for a platelet count?

150,000-450,000/mm3

If both parents have the sickle cell trait there is a _____ % chance they will pass it to their children.

25

Maintaining an oral fluid intake of at least ________ ml/day is important for prevention of vascular occlusion.

3000-4500

A patient opens eyes to pain, withdraws to pain, and does not verbally respond. What is their GCS?

7 (2+4+1)

Which client does the nurse assign as a roommate for a client with aplastic anemia?

A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol)

Which client is at greatest risk for experiencing a hemolytic transfusion reaction?

A 34-year-old client with type O blood

A pediatric nurse is floated to a medical-surgical unit. Which client is assigned to the float nurse?

A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate?

A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit)

After reviewing the laboratory test results, the nurse calls the primary care provider about which client?

A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L)

The nurse is starting the shift by making rounds. Which client would the nurse assess first?

A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis?

A client who had an emergency splenectomy

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)?

A client with chronic microcytic anemia associated with alcohol use

You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below: •A. Recent upper respiratory infection •B. Patient's age: 3 years old •C. Positive stool culture Campylobacter Jejuni •D. Hyperthermia •E. Epstein-Barr •F. Diabetes •G. Myasthenia Gravis

A, C, E

what is the priority in a spinal cord injury?

ABC

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?

Abdominal cavity

MS Drugs can often cause flu like symptoms. What can the patient do?

Acetaminophen or ibuprofen

The nurse is evaluating the collaborative care of a client with traumatic brain injury (TBI). What is the most important goal for this client?

Achieving the highest level of functioning

The nurse is transfusing a unit of whole blood to a client when the primary health care provider prescribes "Furosemide (Lasix) 20 mg IV push." Which intervention would the nurse perform?

Administer the furosemide after completion of the transfusion.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?

Advancing age

Sickle cell anemia is the most common in...

African Americans along with Middle Eastern, Asian, Caribbean and eastern Mediterranean. According to the CDC one in 12 African Americans have the sickle cell trait so it can easily be passed to their offspring. Remember if both parents have the sickle cell trait there is a 25% chance, they will pass it to their children. REMEMBER!!

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education?

After this therapy, I will not need to have any more."

The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect?

Allergy

The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered?

Allopurinol

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?

Allow the client an opportunity to express her feelings.

The nurse assess the client with which hematologic condition first?

An 81-year-old with thrombocytopenia and an increase in abdominal girth

An elderly client with thrombocytopenia and increase in abdominal girth needs immediate assessment. Why?

An increase in abdominal girth in a client with thrombocytopenia indicates possible hemorrhage and warrants further assessment immediately!! REMEMBER!!

Most clients with multiple myeloma have local or generalized bone pain. What is used to treat the pain?

Analgesics, and alternative approach for pain management, such as relaxation techniques are used for pain relief. Even if it is too soon to give additional medication, telling that to the patient is not helpful because it dismisses the clients pain concerns....so don't use that reason. REMEMBER!!

You note that Mr. White is warm to touch, his temp is 103.6°F. You palpate his abdomen, which is soft and nondistended throughout. His bladder is also nondistended. He tells you he's starting to feel very anxious You ask the CNA to help you turn Mr. White and you find a washcloth had been left under his back. What is going on with Mr. White physiologically?

Answer: Mr. White has autonomic dysreflexia caused by the washcloth being left under his back. This irritation in his skin caused his sympathetic nervous system (fight or flight) to overreact because of the impaired signals. This overreaction causes elevated BP, elevated temp, reflex bradycardia, anxiety/restlessness, and warm, flushed skin.

What should you assess to determine autonomic dysreflexia?

Answer: Would need to assess him closer, get a temperature and ask him about symptoms Assess bowels, bladder, and skin to see if there is a specific irritating source.

A nurse interviews an older female patient who reports progressive fatigue, shortness of breath, and headaches. What question should the nurse ask first to collect more data surrounding the possible cause of the patient's symptoms? A."Do you have a history of cardiovascular disease?" B."Can you tell me about your diet?" C."Have you been feeling depressed lately?" D."What medications do you routinely take?"

Answer: B Rationale: All are possible questions to ask a patient regarding symptoms of fatigue, shortness of breath, and headaches. However, older patients are more likely to experience signs and symptoms of anemia (fatigue, shortness of breath, headaches) related to diet and chronically bleeding GI lesions (peptic ulcer disease).

A patient is reporting increased fatigue, malaise, bleeding gums, and frequent "chills." What is the most appropriate initial nursing intervention? A.Notify the physician of the patient's symptoms. B.Review the laboratory analysis for signs and symptoms of bone marrow suppression. C.Review the laboratory analysis for signs and symptoms of infection. D.Obtain vital signs and blood cultures and administer antipyretic medications.

Answer: B The nurse should initially review the patient's laboratory analysis for collective signs of pancytopenia related to the patient's reports of fatigue (anemia), bleeding gums (thrombocytopenia), and chills (neutropenia). Laboratory data are needed before informing the physician and deciding whether to administer an antibiotic. Obtaining blood cultures prior to antibiotic administration is an important intervention. Antipyretic medications may be prescribed to treat the patient's symptoms ("chills").

A patient is transitioning from IV heparin therapy to oral warfarin. Therapeutic anticoagulation of the patient is best assessed by: A.Partial thromboplastin time of 24.3 seconds B.Prothrombin time of 18 seconds C.International normalized ratio of 2.5 D.Bleeding time of 5 minutes

Answer: C Rationale: International normalized ratio (INR) is a more accurate measure of anticoagulation therapy because of variations in prothrombin time (PT) values across different laboratories. The goal of warfarin therapy is usually to maintain the patient's INR between 2.0 and 3.0 regardless of the actual PT in seconds.

The CNA reports to you that the bath has been completed, there was no BM or incontinence of urine. However, Mr. White's blood pressure has risen to 189/100 with a heart rate of 56. You immediately go to the room to check on Mr. White. What could be going on with Mr. White?

Answer: He may be developing Autonomic Dysreflexia

Mr. White is a 17 year old male who was injured in a snowboarding accident 3 weeks ago. He sustained a vertebral fracture and complete spinal cord injury at T7. His fracture has been stabilized with rods and screws. The plan is for him to be discharged home in 3 days with home health and family care. Considering the level of the spinal cord injury, do you anticipate any concern for respiratory failure?

Answer: No, not typically. The diaphragm is innervated by C3-C5, which is when we would have the most concern. At T7, there MIGHT be some weakness of the intercostal muscles, but the majority of the intercostal muscle movement will still be intact, as well as the diaphragm.

The first dose of antiemetics should be given prior to commencing chemotherapy.... 60 minutes prior to first dose of chemotherapy (optimal time is 60 minutes prior to commencing chemotherapy)!! Why?

Antiemetic treatments should be initiated prior to the first dose of chemotherapy for best control of nausea and vomiting, as it can often become difficult to control nausea once the patient is actually vomiting.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action?

Apply pressure to the biopsy site

why would a nurse apply oxygen 2 liters per minute via nasal cannula to a sickle cell anemia patient in crisis?

Applying oxygen decreases the work of breathing and increases the oxygen saturation.

Patients with low platelet counts should not take any medication that contains aspirin. Why is this important to teach the patient about not taking medication with aspirin? Look on page 827...be familiar with chart 40-11.

Aspirin is known as a platelet aggregate, which has the property of making the blood thinner. REMEMBER!!

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement?

Assess for fever. Administer pegfilgrastim (Neulasta). Teach the client to omit raw fruits and vegetables from the diet.

The nurse is assessing a client with a traumatic brain injury after a skateboarding accident. Which sign/symptom is the nurse most concerned about?

Asymmetric pupils

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?

Atropine

Patient with SCI is suddenly hypertensive, bradycardia, sweating, and flushing. What do you suspect?

Autonomic dysreflexia caused be a noxious stimuli (check the foley)

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all that apply. Limit sodium intake. Avoid beef and processed meats. Increase consumption of whole grains. Eat "colorful fruits and vegetables," including greens. Avoid gas-producing vegetables such as cabbage.

Avoid beef and processed meats. Increase consumption of whole grains. Eat "colorful fruits and vegetables," including greens.

A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action? •A. The patient reports a headache. •B. The patient has a weak cough. •C. The patient has absent reflexes in the lower extremities. •D. The patient reports paresthesia in the upper extremities.

B because of respiratory compromise

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom?

Back pain

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?

Behind the sternum, in between the lungs

Name an abortive drug to treat seizures

Benzos: lorazepam diazepam midazolam clonazepam

The nurse performs an assessment on a newly admitted client with thrombocytopenia. Which assessment finding requires immediate intervention by the nurse?

Bleeding from the nose

A client admitted with a diagnosis of acute myelogenous leukemia is prescribed intravenous (IV) cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this drug therapy?

Bone marrow suppression

At what level SPI is bowel and bladder impaired?

Bowel and bladder can be impaired at any level

A client has a glioblastoma. The nurse begins to plan care for this client with which type of cancer?

Brain

The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion?

Breast tenderness and DVT

At what level SPI is breathing impaired?

Breathing is affected at C2-C5

When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider?

Bruises Petechiae Epistaxis

You're about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome. Before sending the patient you will have the patient? •A. Clean the back with antiseptic •B. Drink contrast dye •C. Void •D. Wash their hair

C

Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select all that apply: •A. Edrophonium Test •B. Sweat Test •C. Lumbar puncture •D. Electromyography •E. Nerve Conduction Studies

C, D, E

7 warning signs of cancer (CAUTION)

C-changes in bowel and bladder A-a sore that doesn't heal U-unusual bleeding or discharge T-thickening or lump I-indigestion or difficulty swallowing O-obvious change in wart or mole N-nagging cough or hoarseness

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3 (17 × 109/L)?

Change in mental status

A client with a traumatic brain injury from a motor vehicle crash is monitored for signs/symptoms of increased intracranial pressure (ICP). Which sign/symptoms does the nurse monitor for?

Changes in breathing pattern

When a patient has thrombocytopenia, it is important to do best practices for the patient's safety and quality care. Look on page 825 ....be familiar with chart 40- 7.REMEMBER!!

Chart 40-7 Best Practice for Patient Safety & Quality Care The Patient With Thrombocytopenia Handle the patient gently. • Use a lift sheet when moving and positioning in bed. • Avoid IM injections and venipunctures. • When injections or venipunctures are necessary, use the smallest-gauge needle for the task. • Apply firm pressure to the needlestick site for 10 minutes or until the site no longer oozes blood. • Apply ice to areas of trauma. • Test all urine and stool for the presence of occult blood. • Observe IV sites every 2 hours for bleeding. • Avoid trauma to rectal tissues: • Do not give enemas. • Administer well-lubricated suppositories with caution. • Advise patient not to have anal intercourse. • Measure abdominal girth daily. • Advise the patient to use an electric shaver. • Teach the patient to avoid mouth trauma: • Use soft-bristled toothbrush or tooth sponges. • Do not floss between teeth. • Avoid dental work, especially extractions. • Avoid hard foods. • Make sure that dentures fit and do not rub. • Encourage the patient not to blow the nose or insert objects into the nose. • Advise the patient to avoid contact sports. • Instruct the patient to wear shoes with firm soles when ambulating.

A 56-year-oldclient admitted with a diagnosis of acute myelogenous leukemia (AML) has been prescribed intravenous (IV) cytosine arabinoside and an IV infusion of daunorubicin. The client develops an infection. Which action would the nurse take to determine that the appropriate antibiotic has been prescribed to treat this condition?

Check the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?

Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy

Consume a diet high in fiber.

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia?

Count the respiratory rate before and after ambulating 20 feet (6 m)

During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with: •A. signs and symptoms that are unilateral and descending that start in the lower extremities •B. signs and symptoms that are symmetrical and ascending that start in the upper extremities •C. signs and symptoms that are asymmetrical and ascending that start in the upper extremities •D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

D

Which patient below is MOST at risk for developing a cholinergic crisis? •A. A patient with myasthenia gravis is who is not receiving sufficient amountsof their anticholinesterase medication. •B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. •C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. •D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

D

In assessment findings that are unsafe for the nurse to continue a blood transfusion for a client are hypotension, hypertension, and rapid, bounding pulse. In an older adult receiving a transfusion, low blood pressure is a sign of a transfusion reaction and hypertension is a sign of overload , and a rapid and bounding pulse is a sign of fluid overload. Increased pallor and cyanosis are signs of a transfusion reaction, while swollen superficial veins are present in fluid overload in older adults receiving transfusions. What do you do?

DISCONTINUE THE TRANSFUSION!

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat?

Dairy products

Demonstrate decerebrate & decorticate posturing

Decerebrate: external rotation, extension, arms out Decorticate: internal rotation, flexion, arms in

The nurse is monitoring a client after supratentorial surgery. Which sign/symptom does the nurse report immediately to the provider?

Decorticate posturing

What is an example of a parasympathetic function?

Digestion, bowel movements, salivation, tear production, sexual arousal

What is the drug of choice for pain with a patient who is having a sickle cell crisis?

Dilaudid

The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention?

Do not smoke cigarettes.

What are the risk factors for the development of leukemia?

Down Syndrome Chemical Exposure Ionizing Radiation Bone Marrow hypoplasia

When transfusing a unit of whole blood to a client and an order for drugs is prescribed completing the transfusion before the drugs are administered is indicated. This is the best course of action. Why?

Drugs are not to be administered with infusing blood products, because they can interact with the blood, causing risk for the client. REMEMBER!!

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding?

Dyspnea.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?

Edema of arms and hands

What diagnostic tool can confirm seizure activity?

Electroencephalogram (EEG)

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function?

Encourage the client to participate in changing the ostomy. Offer to have a person who is coping with a colostomy visit with the client. Encourage the client and family members to express their feelings and concerns.

Which nursing intervention most effectively protects a client with thrombocytopenia?

Encourage the use of an electric shaver

T/F: Corticosteroids are used to prevent MS exacerbations

FALSE- Corticosteroids are given during acute exacerbations to shorten the duration and lessen the severity

T/F: Permanent remission can be achieved in MS

FALSE-We can only reduce the frequency and severity of exacerbations

T/F Cholinergic crisis results from too little acetylcholine

False- it is too much acetylcholine

T/F A patient can stop taking their AED once their seizures stop reoccurring

False- seizures will return

True or False: Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system.

False: It effects the PNS, not CNS

Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer?

Fatigue Change in taste Changes in skin of the neck Difficulty swallowing

•A patient with cranial nerve 9 impairment will have difficulty with what?

Gag, cough

What's the best way to prevent infection during a plasmapheresis session?

Good hand hygiene before and after

Name risk factors for a hemorrhagic stroke

HTN, AVM, Aneurysm

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet?

Has the client write down everything he or she has eaten for the past week

the abnormal cells known as ______ are sickle shapes, leading to vasoocclusion and pain

Hemoglobin S

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?

Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client?

Hemolytic anemia

What is Hgb S?

Hgb S is an abnormal type of hemoglobin and be inherited from parents. Sickle cell trait is caused by abnormal hemoglobin S. Hgb S causes red blood cells to become stiff and abnormally shaped. Instead of having a normal roundish shape these red blood cells become sickle shape and stick together. REMEMBER!!

Stroke patients with dysphasia should be fed in which position?

High Fowler's

A 32-year-oldclient is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge?

Hydroxyurea (Droxia)

The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What electrolyte imbalance would the nurse monitor for after the blood transfusion?

Hyperkalemia

When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? Episodes of confusion, Pulse 88 and regular, Weakness and tremors, Labs: Na: 115 mEq/L (115 mmol/L) K: 4.2 mEq/L (4.2 mmol/L) Creatinine: 0.8 mg/dL (70.8 mcmol/L). Meds: Ondansetron (Zofran)Cyclophosphamide (Cytoxan)

Hyponatremia Mental Status Changes Weakness

An 82-year-oldclient with anemia is prescribed 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client?

Hypotension Hypertension Rapid, bounding pulse

A client is considering treatments for a malignant brain tumor. Which statement by the client indicates a need for further instruction by the nurse?

I can go home the day of my craniotomy

What is the biggest risk with most MS drug treatments?

Immunocompromised- risk of infection

What is a simple tool patient's can use at home to prevent respiratory problems?

Incentive Spirometry

Cells with sickle cell hemoglobin are stiff and sticky. When they lose their oxygen, they form into the shape of a sickle or a crescent, like the letter C. These cells stick together and can't easily move through the blood vessels. This can block small blood vessels and the movement of healthy, normal oxygen carrying blood. The blockage can cause pain. How do you prevent and treat?

Increasing the fluids is a way to prevent and treat pain in sickle cell crisis. Encourage patients to maintain an oral intake of at least 3000 to 4500 ml a day of fluids. IV fluids may be required to prevent vascular occlusion. REMEMBER!!

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan?

Infection

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?

Infection

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma?

Infection with hepatitis B virus.

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow for administering this blood product?

Infuse the transfusion over a 15- to 30-minute period.

A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer?

Intravenous (IV) hydromorphone (Dilaudid)

List the 3 components of Cushing's Triad

Irregular Breathing Bradycardia Widening Pulse Pressure

At what level SPI are legs paralyzed?

Legs are involved at L1-T11

Which type of cancer has been associated with Down syndrome?

Leukemia

What are the common cancers related to tobacco use? Select all that apply.

Lung cancer Cancer of the tongue Cancer of the larynx

A client has had a traumatic brain injury and is mechanically ventilated. Which technique does the nurse use to prevent increasing intracranial pressure (ICP)?

Maintaining neutral head position

The nurse is monitoring a postoperative craniotomy client with increased intracranial pressure (ICP). Which pharmacologic agent does the nurse expect to be requested to maintain the ICP within a specified range?

Mannitol

What medications might be ordered for autonomic dysreflexia? What other nursing interventions should be included?

Medications - nitroglycerin, calcium channel blockers (nifedipine, nicardipine) Passive cooling (ice or cool cloths) Remove the source - fix sheets, reposition, catheter to empty bladder, digital rectal disimpaction or enema or suppository for constipation

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?

Morning

What education should be required to prevent complications of autonomic dysreflexia?

Mr. White's family needs to know s/s autonomic dysreflexia to look for as well as the instructions and methods for treatment, including the use of sublingual nitroglycerin or chewable nifedipine. His family should also be taught how to monitor his vital signs and how to prevent the development of Autonomic Dysreflexia His family should also be taught how to perform range of motion exercises and proper turning and positioning to prevent contractures or pressure ulcers. They should also know what to report to the provider, including signs of pneumonia, DVT, or pressure ulcers.

What neurological disorder is known to be the most treatable?

Myasthenia gravis

Metastatic cancer can increase calcium levels.. know the normal ranges... hypercalcemia can cause:

Normal Calcium Range: 8.5-10 tiredness, weakness, or muscle pain an increase falls in patients

Which statement about the process of malignant transformation is correct?

Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first?

Obtain prescribed blood cultures

Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) working on a medical-surgical unit?

Obtain vital signs on a client receiving a blood transfusion

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?

Ondansetron

What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia?

Ototoxicity Nephrotoxicity

What can pass the blood brain barrier?

Oxygen, glucose, CO2, ETOH, anesthetics, and H2O

What's the treatment of choice to prevent cerebral vasospasm following hemorrhagic stroke?

PO Nimodipine 96 hours after bleed (not IV)

Contraindications to MRI

Pacemaker

List some interventions included in seizure precautions

Padded side rails Oxygen Equipment Suction Equipment

The nurse is performing an assessment on a client with anemia. What are the typical clinical manifestations of anemia?

Pallor Fatigue Tachycardia Dyspnea on exertion

The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team?

Palpable lump in the client's axilla

A client recovering from a sickle cell crisis is to be discharged. The nurse says to the client, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the primary health care provider (PHCP) will prescribe?

Penicillin V (Pen-V K)

The nurse is caring for a client with sickle cell disease. Which nursing action is most effective in reducing the potential for sepsis in this client?

Perform frequent and thorough handwashing

The nurse includes which factors in teaching regarding the typical warning signs of cancer? (Select All That Apply)

Persistent constipation Scab present for 6 months Axillary swelling

A client presents to the Emergency Department from an assisted living facility after a ground level fall with a head strike. The client has a Glasgow Coma Score (GCS) of 12, which is decreased for this client, and has projectile vomiting. What is the priority intervention for this client?

Positioning the client to prevent aspiration

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?

Potential for injury related to sensory and motor deficits

The nurse is caring for a client who is in sickle cell crisis. What action would the nurse perform first?

Provide pain medications as needed.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?

Providing oral care with a disposable mouth swab

Name a contraindication for a LP

Rash over the site, Lumbar surgery coagulopathies, Degenerative disc disease, High ICP

A cancer patient has a nursing diagnosis of body image disturbance related to effects of chemotherapy secondary to hair loss. What would you recommend?

Recommendations to the client to increase their body image due to the loss of hair possibly could be use of wigs or scarves. This most likely should be recommended before the hair loss begins. REMEMBER!!

An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?

Reducing all direct and indirect sources of light

Which task does the nurse delegate to unlicensed assistive personnel (UAP)?

Report any bleeding noted when catheter care is given to a client with a history of hemophilia

What is the priority in a spinal cord injury?

Respiratory Status

The nurse is assessing several clients who are receiving transfusions of blood components. Which assessment finding requires immediate action by the nurse?

Respiratory rate of 36 breaths/min in a client receiving red blood cells

What's an early sign of hypoxia/desaturation?

Restlessness, apprehension

The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification?

Review all information with another registered nurse (RN)

Your client is being discharged after a mild brain injury. What symptoms will you tell the client or family require coming back to the emergency department? (Select all that apply)

Severe vomiting Increase weakness Unequal pupil size Drainage from the ear or nose

Name some contraindications for a Lumbar puncture

Skin infection at site, cerebral herniation/high ICPs, coagulopathy, lumbar spine surgery, DGD

What is the most important environmental risk for developing leukemia?

Smoking cigarettes

What's the difference between the autonomic and somatic nervous systems?

Somatic is voluntary, autonomic is involuntary

Patient with a new SCI has sudden flaccid paralysis. What do you suspect?

Spinal Shock

A client who is receiving a blood transfusion suddenly tells the nurse, "I don't feel right!" What is the nurse's first action?

Stop the transfusion

In GBS, muscle weakness presents in what manner?

Symmetrical, ascending

Which activity performed by the community health nurse best reflects primary prevention of cancer?

Teaching a class on cancer prevention.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility?

Testing of stool specimens for occult blood.

Patients on chemotherapy may have gastric distress. Why?

The cells of the GI are particularly sensitive to the effects of chemotherapy. These cells proliferate at a very rapid rate. GI cells proliferation plays an important role in the maintenance of the integrity of the GI system. REMEMBER!

A client with sickle cell disease needs IV pain relief, and it needs to be administered on a routine schedule ...such as before the client has to request it. NSAIDS may be used for clients with sickle cell disease for pain relief once their pain is under control. However, in a crisis, this choice of analgesics is not strong enough. Moderate pain may be treated with opioids, but a client in sickle cell crisis that choice is not considered appropriate. IV analgesics would be used until the client's condition stabilizes. Morphine is not to be administered IM to clients with sickle cell disease. In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin. What is the drug of choice?

The drug of choice is usually Dilaudid. REMEMBER!!

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis?

The patients muscle weakness improves

The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?

The student teaches the client that symptoms of neutropenia include fatigue and weakness.

Patients who have any kind of cancer should continue to do cancer screening. Why?

They are at an increased risk for other cancers

What is SIADH?

This is when the body makes too much ADH which helps kidneys control the amount of water of the body loss through urine. So, a patient who develops SIADH will be on fluid restrictions.

A nurse is counseling a 60-year-old African-American male client about risk factors for lung cancer. Teaching should focus most on what risk factor?

Tobacco use.

Pain in the back of the legs could indicate prostate cancer in an older adult male. True or False? Should it be reported?

True and Yes. This pain is resulted from the sciatic nerve.

What is the priority intervention in a seizure?

Turn patient on their side to protect their airway

A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. Brain Bone Lymph nodes Kidneys Liver

Typical sites of metastasis of lung cancer include the brain, bone, lymph nodes, liver, and pancreas. Kidneys are not a typical site of lung cancer metastasis.

The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)?

Using strict aseptic technique to prevent infection

What's an example of a sympathetic function?

Vasoconstriction, increased HR, bronchial dilation, pupillary dilation, perspiration

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed?

Verify that the client has given informed consent.

The nurse is mentoring a recent graduate registered nurse (RN) about administering blood and blood products. What action does the nurse perform before starting the transfusion?

Verify with another RN all of the data on blood products.

Name a possible trigger for GBS

Viral or bacterial infection, flu shot

•A patient with cranial nerve 2 impairment will have difficulty with what?

Vision

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?

Wait until 1100, so it is at peak during meal time

Give an example of how to test a patient's recent memory?

What did you eat for breakfast? Know the difference between recent memory and recall (immediate memory)

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that the client has an infection or an infection needs to be ruled out?

Wheezes or crackles

Is the loss of consciousness from an epidural or subdural hematoma considered a neurosurgical emergency?

Yes

Name a nursing intervention to lower/maintain ICP

a. Dark, quiet, calm room b. HOB elevated c. Hyperventilation d. Mannitol/23% Saline e. EVD

List 2 signs of late/severe stage alzheimers

a. Hallucinations b. Loss of verbal skills c. Incontinence d. Difficulty eating e. Agnosia f. Bedridden g. Dependent

Name risk factors for an ischemic stroke

a. Obesity b. Smoking c. HLD d. HTN e. Atherosclerosis

Name contraindications for fibrinolytic therapy (tPA) for an ischemic stroke

a. Onset >4.5 hours b. >80 y/o c. Hx stroke, diabetes d. >1/3 of brain involvement e. Anticoagulated f. Recent surgery g. MVA h. Trauma

Myasthenia Gravis occurs when antibodies attack the ______________ receptors at the neuromuscular junction leading to ___________________.

acetylcholine, muscle weakness

A nurse caring for a sickle cell patient in a crisis would establish peripheral IV and...

administer IV fluids and pain medications.

What cannot pass the blood brain barrier?

albumin, antibiotics, bound molecules, large molecules

What is the antidote for edrophonium?

atropine

•A patient's LP showed high opening pressure, low glucose, and cloudy CSF. What do you suspect?

bacterial meningitis

Know that there is a possibility that dyes, preservatives, and preparation methods of foods may be risk factors for getting....

cancer

Hemoglobin S

causes red blood cells to become stiff and abnormally shaped and can be inherited from parents

What does a cerebral angiography show?

cerebral circulation/vessels

Extravasation occurs when medicines leak from the compartment where they are intended to be, such as a vein, into the surrounding tissues.... can cause serious injury such as loss of function or tissue damage requiring grafting or, in extreme cases, amputation. So, with this knowledge remember when a patient is receiving chemotherapy through a peripheral IV line be sure to...

check the IV site every hour

Low___ is the root cause of most Parkinson's symptoms

dopamine

When administering packed red blood cells to a client be sure to...

ensure proper client identification. With another registered nurse all information must be reviewed. This process includes verifying the client by name and number, checking blood compatibility, and noting the expiration date and time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses.

Before administering a blood transfusion, it is important to...

ensure that an informed consent has been obtained.

__________ will help prevent vasoocclusion of the sickled cells

fluids

On page 814 review the of folic acid deficiency anemia versus B12 deficiency anemia. What characteristic feature differentiates the two anemias?

folic acid deficiency anemia: Dietary deficiency Malabsorption syndromes Drugs: • Oral contraceptives • Anticonvulsants • Methotrexate B12 deficiency anemia: Dietary deficiency Failure to absorb vitamin B12 from intestinal tract as a result of: • Partial gastrectomy • Pernicious anemia • Malabsorption syndromes Main takeaway: difference between folic acid deficiency anemia and VitB12 deficiency anemia is that pernicious(VitB12) experiences paresthesia of the hands and feet, while folic acid does not.

A patient who is on a continuous heparin infusion for a blood clot needs to have their platelets and activated partial thromboplastin ( aPTT) time monitored....WHY?

heparin can cause thrombocytopenia and prolong the aPTT

Aranesp (darbepoetin alfa)

is a prescription drug used to treat a lower-than-normal number of red blood cells (anemia), especially chronic anemia. Epogen(epoetin alfa) belongs to a class of drugs called colony-stimulating factors. Their ability to stimulate cells in the bone marrow to multiply and form colonies of identical cells. These drugs are used in the regimen for patients who have chronic anemia and have had many blood transfusions. REMEMBER !!

Induction therapy treatment

is also called remission induction therapy. The goal of induction treatment for leukemia is to clear the blood and bone marrow of immature blood cells like blast cells. Induction therapy is not a cure for leukemia, it is a treatment. The leukemia client needs education to understand this . Because of infection risk, clients with leukemia must avoid people with a cold or the flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission. REMEMBER!

Pernicious anemia

is caused by the patient lacking intrinsic factor, which helps with the absorption of vitamin B12. The patient can consume supplements or food with vitamin B12, but they will not absorb B12 because they lack the intrinsic factor. The typical regimen for injections of B12 will be weekly, then monthly as a maintenance, and usually it is a lifelong treatment. REMEMBER!!

Methotrexate (Mexate)

is used for acute lymphocytic leukemia. The patient is at risk for developing toxic effects of this drug. The nurse might administer Leucovorin, which is often called "leucovorin rescue". The drug essentially saves the body from toxicity by providing another source of folic acid to those healthy cells in need. It is required to be administered over a 2-3 day period of multiple doses. REMEMBER!

_______ is usually one of the first signs of a sickle cell crisis

joint pain

Name a contraindication for a MRI?

metal objects, impacts, pacemaker

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?

monitor weight

Sickle cell patients require ______ for severe pain that is a result of crisis

opioids

Headache, tachycardia, chills and a sense of impending doom would alert a nurse to a hemolytic transfusion reaction in a patient who is receiving a blood transfusion. Remember...

patients who are receiving a blood transfusion and display an increased respiratory rate require immediate attention an action by the nurse.

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related?

platelet (thrombocyte) count

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery?

relief of symptoms or improved quality of life

Patients who have a low platelet count should be placed on safety precautions. Why?

risk for bleeding

You have a patient who has concerns over fertility with a new diagnosis of cancer in the abdominal pelvic region and is aware they will undergo radiation therapy. What would you suggest?

sperm storage

Patients who were on neutropenic precautions should have...

strict hand washing before patient contact. Remove any fresh flowers or plants from the room. Use sterile techniques for all invasive procedures and place a mask on the patient if the patient leaves their hospital room.

When a patient is having a bone marrow aspiration be sure that...

the client has an informed consent on file.

Plasmapheresis is a process where plasma is separated from the blood cells. Plasma is replaced with normal Saline or albumen. The best way to prevent infection in a client who is receiving this procedure is...

very simple wash your hands!! REMEMBER!

Bacterial or viral meningitis: protein elevated, glucose normal, clear

viral

What is cranial nerve 2 responsible for?

vision

When preparing chemotherapy for a patient it is important to remember

wear PPE even for oral medications

Patients with pernicious anemia do not absorb vitamin B12 through the GI system due to lacking in strategic factor which helps with the absorption of vitamin B12. How would you give it?

you would not give this supplement orally. The best route for administering vitamin B12 is in the muscle or IM.

Chart 40-11 Patient and Family Education: Preparing for Self-Management The Patient at Risk for Bleeding

• Use an electric shaver. • Use a soft-bristled toothbrush and do not floss. • Do not have dental work done without consulting your primary health care provider. • Do not take aspirin or any aspirin-containing products. Read the label to be sure that the products do not contain aspirin or salicylates. • Wear shoes or slippers with a sole to avoid foot injury. • Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. • If you are bumped, apply ice to the site for at least 1 hour. • Notify your primary health care provider if you: • Experience an injury and persistent bleeding results • Have excessive menstrual bleeding • See blood in your urine or bowel movement • Have a headache that does not respond to acetaminophen • Avoid anal intercourse. • Take a stool softener to prevent straining during a bowel movement. • Do not use enemas or rectal suppositories. • Avoid bending over at the waist. • Do not wear clothing or shoes that are tight or that rub. • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage.

What are the possible complications of a spinal cord injury?

•Autonomic Instability •Breathing problems •Clots or other circulatory issues (i.e. neurogenic shock) •Discomfort or neuropathic pain •Elimination problems •Functional ability is decreased - they need help with ADL's •Grief - this is a huge alteration in life and can cause grief and possible even depression

Together with the CNA, you remove the cloth, straighten Mr. White's sheets, and make him comfortable. You provide a cool cloth for his forehead, and place a small ice pack under each armpit. You administer Nitroglycerin 0.4 mg SL as ordered. In 5 minutes you recheck and his BP has come down to 142/90, and his HR is 70. He reports his anxiety is decreasing and his temperature has come down to 100.6°F. What would you discuss with the CNA to prevent this from recurring in the future?

•I would first determine if the CNA understands why Mr. White's body reacted the way it did. Then I would help them understand possible causes of Autonomic Dysreflexia. •I would encourage the CNA to help keep Mr. White safe not only by ensuring that sheets are free of wrinkles and that nothing is left under him, but also continuing to report abnormal vital signs or any anxiety in the patient.