Nur 242 Final (thyroid, cancer)

The client is prescribed potassium iodide solution before surgery for a subtotal thyroidectomy. Which explanation will the nurse give as to why this medication should be taken?

"It will reduce the risk of hemorrhage during surgery."

Which response would the nurse offer when a client undergoing brachytherapy for breast cancer asks what precautions need to be observed?

"Visitors should be limited, particularly pregnant women and children."

A client who is hospitalized with severe abdominal pain and vomiting states, "I know I am very sick. Do you think I have cancer?" How would the nurse respond?

"What are your feelings about the diagnosis of cancer?"

Which action by a client who has had a radical neck surgery for laryngeal cancer is the best indicator that the client is reaching acceptance of the laryngectomy?

Attempts self-care of the tracheal stoma (self-care)

A client with cancer receives the plant alkaloid vincristine. Which common side effect of vincristine will the nurse address in the client's care plan?

Constipation. Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Polyuria, not anuria, is common. Visual changes may occur, but color-blindness is not one of them. Hyperuricemia may occur, but hyperphosphatemia is not associated with this medication.

Which intervention would the nurse teach a client scheduled for a subtotal gastrectomy for stomach cancer to minimize postoperative dumping syndrome?

Eat 5 or 6 small meals per day. Eating smaller meals 5 to 6 times per day reduces the chance of a large amount of food emptying too quickly into the duodenum. Ambulating after meals speeds gastric emptying and should be avoided. A diet low in fat speeds gastric emptying and should be avoided. Clients should avoid increasing fluid intake when eating food, because the fluids speed gastric emptying.

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. Which response by the nurse is accurate?

Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium."

Which clinical finding would the nurse expect to increase in a client with Cushing syndrome?

Glucose level

Which vaccine would the nurse administer to provide protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women?

HPV vaccine

Which result will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate?

High levels of 17-ketosteroids in a 24-hour urine test

Which clinical findings can the nurse expect to identify when assessing a female client with Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Hirsutism, Buffalo bump

A nurse is caring for a client who had an adrenalectomy. Which clinical response would the nurse monitor while steroid therapy is being regulated?

Hypotension. After an adrenalectomy, adrenal insufficiency causes hypotension because of fluid and electrolyte alterations. Hypoglycemia, not hyperglycemia, may be a problem stemming from the loss of glucocorticoids. Hyponatremia may occur because of the lack of mineralocorticoid production. Potassium, not sodium, ions may be retained because of the lack of mineralocortico

A mother with newly diagnosed ovarian cancer asks the nurse how she should answer if her child asks, "Are you going to die?" Which would the nurse advise the mother to answer?

I don't know, but I'm going to try very hard to stay alive.

A client with cancer of the bladder and pending surgical intervention asks, "If they remove my bladder, how will I be able to urinate?" Which response would the nurse use?

I know you're upset, but there are alternatives to removing your bladder."

A client who is to undergo a mastectomy for breast cancer says, "I am worried about what I'll look like after surgery." Which response would the nurse use?

I understand that you'd be concerned about appearance."

The nurse is teaching a community health class about the risk factors for cancer of the larynx. Which factor has the least influence in predisposing an individual to this type of cancer?

Inadequate dental hygiene

A client who is receiving radiation therapy for bone cancer lives alone and works full time. Which client action would the nurse encourage?

Include rest periods during the day while receiving radiation

Which actions will the nurse take when caring for a client with possible lung cancer who has just had a thoracentesis? Select all that apply. One, some, or all responses may be correct.

Listen to breath sounds. Encourage deep breaths. Send pleural fluid to the laboratory. Ensure that a chest x-ray is performed.

Which skin growth would require health care provider follow-up to evaluate for possible skin cancer? Select all that apply. One, some, or all responses may be correct.

Mole that is 12 mm wide. Melanomas are detected using the "ABCDE" method: asymmetry, border irregularity, color, diameter, and evolving. A mole that is 12 mm wide would need further assessment by the health care provider. Moles greater than 6 mm in diameter can indicate a melanoma. Moles that are solid black, have equal borders, are symmetrical, and have not changed would not be suspicious for melanoma and can be monitored.

Which signs and symptoms will a client admitted to the hospital with a diagnosis of Cushing syndrome exhibit?

Muscle weakness and frequent urination

The adolescent children are having difficulty talking with their mother, who is in the terminal stage of cancer. Which rationale best supports initiating a family meeting?

Open communication increases ability to work through reactions to the terminal illness.

Which is the priority teaching point at discharge of a child who just completed a cycle of chemotherapy?

Performing thorough hand washing

The nurse is developing a plan of care for a client who underwent extensive oral surgery for head and neck cancer. Which interventions would the nurse include in the plan to prevent infection? Select all that apply. One, some, or all responses may be correct.

Protect incision site. Remove thick secretions. Provide oral care at least every 4 hours. The nurse must take care to protect the incision site, remove thick secretions, and provide oral care at least every 4 hours to prevent infection. Elevating the head of the bed prevents aspiration. When the client can initiate oral intake, small, frequent feedings prevent aspiration.

Which instruction would the nurse provide to a client receiving brachytherapy for prostate cancer to prevent injury?

Refrain from close contact with others."

The nurse is providing immediate postoperative care to a client who had a thyroidectomy. The nurse would monitor a client for which clinical manifestation?

Signs of respiratory obstruction

Which body mechanism related to infectious processes is impaired as a result of Addison disease?

Stress response

The nurse is caring for a client who underwent a total thyroidectomy. Which assessment finding would lead the nurse to notify the rapid response team?

Stridor. Stridor is an indication of respiratory distress, which would require immediate intervention from the rapid response team. Hoarseness is a normal postoperative finding. Tachycardia, not bradycardia, is a sign of respiratory distress. Hypocalcemia can be corrected with intravenous (IV) calcium gluconate or calcium chloride.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." Which intervention is appropriate for the nurse to take?

Test for Chvostek and Trousseau signs and notify the primary health care provider of the complaints.

The nurse reviews the medical record of a client with terminal cancer and notes the presence of a do-not-resuscitate (DNR) order. The order was written with the client's admission orders. The nurse recalls that which factor is relevant to the legal aspects of the DNR order?

The policies of the agency establish the status of DNR orders

Which clinical findings would the nurse expect to see when assessing a client with a primary brain tumor who has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? Select all that apply. One, some, or all responses may be correct.

Vomiting, Increased weight, Decreased serum sodium, Decreased level of consciousness

The nurse manager in a cancer care facility finds that the nursing care team is lacking motivation as a result of consecutive deaths of 2 terminally ill clients. Which action of the nurse manager would help renew the team's energy?

Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team

A client with advanced bone cancer is experiencing cachexia. The nurse reviews the nutritional components of palliative care with the client's family members. The nurse recognizes that the teaching is designed to achieve which outcome?

Enhance the quality of the client's life

Which symptom would the nurse expect a client diagnosed with Cushing syndrome to exhibit?

Lability of mood

Which finding would indicate that the prescribed enteral feeding has been effective in a malnourished client who had head and neck surgery for pharyngeal cancer?

Well-healed incisions

Which response will the nurse give to a client who has terminal cancer and says, "My husband is avoiding me. He doesn't love me anymore because of this awful tumor"

You seem upset. Tell me about what your husband is doing."

Which medication can cause diabetes insipidus?

Demeclocycline (Prolonged administration of demeclocycline may cause diabetes insipidus, because this medication decreases the production of antidiuretic hormone by the kidneys. Cabergoline inhibits the release of growth hormone and prolactin by stimulating dopamine receptors in the brain. Metyrapone and aminoglutethimide decrease cortisol production.)

After a cholecystectomy to remove a cancerous gallbladder, a client has a T-tube in place. The T-tube drains 300 mL of bile-colored fluid during the first 24 hours after surgery. Which action would the nurse take?

Consider this an expected response after surgery and record the results

A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve?

Diminishing toxicity of folic acid antagonists. Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

The family members of a client who has terminal cancer are concerned because she appears to be accepting less and less responsibility for her own care. Which intervention would the nurse use?

Encourage them to accept her regression until she can cope more effectively. Regression to a more immature, helpless developmental level is not unusual and should be supported at this time. The client is not demonstrating anger, denial, or the need for more control.

Which condition would the nurse expect to see in the laboratory reports of a client who has Cushing syndrome?

Hypokalemia. With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

Which carcinoma is the most common type of thyroid cancer and is most often found in younger women?

Papillary carcinoma. Papillary carcinoma is the most common type of thyroid cancer; it is most often seen in younger women. Follicular carcinoma occurs most often in older adults. Medullary carcinoma is seen mostly in clients older than 50 years. Anaplastic carcinoma is a rapid-growing, aggressive tumor.

The client asks the nurse how long she will have to take tamoxifen for breast cancer treatment. Which response by the nurse is appropriate?

"You'll need to take it for 5 years, after which it will be discontinued. Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the medication is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the medication's effectiveness. Medication is given to manage the pain and the tamoxifen is continued.

A client is scheduled for an adrenalectomy. Which action would the nurse expect in the plan of care?

Administer parenteral corticosteroids. Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Corticosteroids must be administered preoperatively to prevent adrenal insufficiency during surgery, so withholding all medications for 48 hours before surgery is contraindicated.

A 26-year-old woman whose sister recently had a lumpectomy for breast cancer calls the local women's health center and asks for an appointment for a mammogram. Which guidance would the nurse provide the client?

An appointment should be given for history, assessment, and indicated imaging

The health care team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse (RN)?

Assessing the respirations

Which nursing intervention is appropriate during the first 24 hours after a thyroidectomy when the nurse is concerned about thyroid storm?

Check vital signs every 2 hours after they stabilize

Which of these positions is most likely to be filled by the nurse for the intensive care of cancer clients?

Clinical nurse specialist

The primary health care provider prescribed tolvaptan to a client whose laboratory reports reveal low plasma osmolarity and continued secretion of vasopressin from syndrome of inappropriate antidiuretic hormone (SIADH). During follow-up care, which finding in the client indicates a side effect of medication?

Increased demyelination of brain neurons ( when sodium levels increase)

The nurse is performing a skin assessment of a client. Which findings may indicate a risk of skin cancer? Select all that apply. One, some, or all responses may be correct.

Lesion, lumps, rashes. Lesions on the skin that take a long time to heal may indicate skin cancer. Lumps and rashes on the skin are characteristics of skin cancer. Bruising may indicate a bleeding disorder or injury. Dryness of the skin may be due to excessive bathing and use of harsh soaps.

Which intervention would the nurse do postoperatively to reduce the risk of thyroid storm after a client has undergone subtotal thyroidectomy?

Prevent infection at the surgical site. Conditions such as trauma and infection can precipitate thyroid storm (thyroid crisis, thyrotoxic crisis

Which outcome is the main focus of treatment for a client with Addison disease?

Restoration of electrolyte balance. Addison disease is the lack of mineralocorticoids, which causes hyponatremia, hypovolemia, and hyperkalemia. Dietary modification and administration of cortical hormones are aimed at correcting these electrolyte imbalances, which can be life threatening.

An adolescent is admitted to the unit with a tentative diagnosis of a bone tumor of the left femur. During the admission procedure the adolescent casually asks, "Do they ever have to cut off a leg if someone has bone cancer?" How would the nurse respond?

Sometimes it's necessary. What do you think about that treatment?"

Which aspect of the client's life is most important for the nurse to explore when obtaining a health history from a client newly diagnosed with cervical cancer?

Support system

The nurse is performing physical assessment of four female clients who came for a general checkup. Which client is most at risk of developing breast cancer?

Women over 40 years of age with a personal or family history of breast cancer, late-age menopause (after age 50), who have not had children or who conceived after the age of 30 years, or women with excessive oral contraceptives use are at risk of developing breast cancer. Client B has all the criteria that increase the risk of developing breast cancer, such as age over 60 years, positive family history, no children, and menopause at a later age. She is at the highest risk of developing breast cancer compared with clients A, C, and D. Client A has children and has a relatively lower risk of developing breast cancer. Client C has negative family history and has a relatively lower risk of developing breast cancer. Client D has children and also has a negative family history, and has a relatively lower risk of developing breast cancer.

When the nurse is assessing a client with laryngeal cancer who has had radical neck surgery, which finding requires the most rapid action?

Rapid oozing of blood at neck incision

A primary health care provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation would the nurse provide to the client about the need to follow this diet?

"Excessive aldosterone and cortisone cause retention of sodium and loss of potassium

Which percentage of all cervical cancers occurs during pregnancy?

3%

A client with cancer experiences severe nausea and vomiting from chemotherapy. The client wants to know if it is true that smoking marijuana will help. How will the nurse respond?

"There are some tetrahydrocannabinol (THC)-based medications that contain marijuana control chemotherapy-induced nausea and vomiting in some people."

A client with untreatable metastasized cancer tells the nurse, "I think they made a mistake. I don't think I have cancer. I feel too good to be dying." Which stage of grief is the client experiencing?

Denial

The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate?

Epistaxis. Nosebleeds (epistaxis) are expected in a child with leukemia who is undergoing chemotherapy because the bone marrow is depressed and the number of platelets decreases substantially. Tachycardia is not expected unless there is severe anemia. Usually children with leukemia have pale skin. An increased temperature occurs only if there is an infection resulting from the leukemia.

Which statement by the client indicates the need for further learning about skin cancer prevention?

I should limit sun exposure to between 7 AM and 12 PM. In prevention of skin cancer, the client should not be out in the sun at midday. This is the time when the sunlight is strongest. Using sunscreen protects a client's skin from the sun's rays. The client should wear a hat and opaque clothing when going out. Going for monthly examination of cancerous and precancerous lesions is recommended.

Which interventions would the nurse include in the plan of care during the first 4 hours after a thyroidectomy? Select all that apply. One, some, or all responses may be correct.

Monitor for stridor or dyspnea, Correct5 Assess the sides and back of the client's neck for evidence of bleeding. Correct5 Assess the sides and back of the client's neck for evidence of bleeding.

The nurse tries several different ways to communicate with a client after thyroid surgery. Which critical thinking attitude is the nurse demonstrating?

Perseverance

Which clinical manifestations would the nurse expect to identify in a client with a diagnosis of Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Truncal obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome.

When laboratory results of a client's bloodwork after chemotherapy indicate bone marrow depression, which activities would the nurse reinforce? Select all that apply. One, some, or all responses may be correct.

Use a soft toothbrush, Read the ingredients in over-the-counter medications before taking them. The gums are vascular tissue and prone to bleed easily if the platelet count is low. Medications such as ibuprofen and salicylates in any analgesic or cold medicine should be avoided because they increase the risk of bleeding by inhibiting platelet function. Raising the head of the bed will not improve bone marrow function. With bone marrow depression, red blood cell number and the oxygen-carrying capacity of the blood is decreased. This client is likely to need more rest, rather than an increase in activity level. Citrus fruits and juices will not change the bone marrow depression and should be avoided because they are acidic and aggravate stomatitis.

The nurse assesses a male client with a preliminary diagnosis of cancer of the urinary bladder. Which clinical manifestation would indicate the cancer is in an early stage?

Hematuria is the most common early sign of cancer of the urinary system, probably because of the urinary system's rich vascular network. Dysuria is not specific for bladder cancer. Retention and hesitancy are not specific for bladder cancer; usually they are associated with an enlarged prostate in the male.

A client is scheduled to have a thyroidectomy. Which medication is indicated for decreasing the size and vascularity of the thyroid gland before surgery?

Potassium iodide. Potassium iodide adds iodine to the body fluids, exerting negative feedback on the thyroid tissue and decreasing its metabolism and vascularity

The laboratory values of a client with a new esophageal cancer diagnosis include a hemoglobin of 7 g/dL (70 mmol/L), hematocrit of 25%, and red blood cell (RBC) count of 2.5 million/mm 3 (2.5 × 10 12/L). Which priority goal would the nurse add to the plan of care?

The client will demonstrate improved nutrition. Based on the presented data, improving nutritional status is the priority at this time. The decreased hemoglobin and hematocrit levels and RBC count may be a result of malnutrition; also, cancer of the esophagus can cause dysphagia and anorexia. Although maintaining the client's safety is a goal, it is not as high a priority as another concern based on the data provided in the question. The data given do not relate to the presence of pain. The data given do not relate to airway obstruction.

The nurse is teaching a client about the prescribed diet after a Whipple procedure for cancer of the pancreas. Which statement should the nurse include in the dietary teaching?

"Low-fat meals should be eaten to prevent interference with your fat digestion mechanism." A Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine and interruption of glucose metabolism; interference with fat digestion may occur. The client requires small, frequent, low-fat, high-protein, moderate-carbohydrate meals and supplemental feedings. The response "There are no dietary restrictions because the tumor has been removed" is false reassurance. High-calorie meals are needed to provide energy and promote the use of protein for tissue repair. High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless metastasis occurs by direct extension.

The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parents ask why the child needs prednisone. Which response by the nurse would be correct?

It decreases inflammation. Prednisone is a synthetic glucocorticoid that exerts an active anti-inflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

A female client is diagnosed as having cancer of the breast and is admitted to the hospital for a lumpectomy to be followed by radiation. While being admitted to ambulatory surgery by the nurse, the client has tears in her eyes and her chin is quivering. In a shaky voice the client says, "I can't believe this is happening." Which is the best response by the nurse?

This must be a very scary time for you."

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose?

To stimulate peristalsis of the upper gastrointestinal (GI) tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents.

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na + (sodium) 149 mEq/L (149 mmol/L); K + (potassium) 3.2 mEq/L (3.2 mmol/L); Hb (hemoglobin) 17 g/dL (170 mmol/L); and glucose 90 mg/dL (5 mmol/L). Based on these lab results, which instructions would the nurse include in the teaching plan for this client? Select all that apply. One, some, or all responses may be correct.

Avoid foods high in salt, Eat foods high in potassium. Based on the laboratory results and not directly related to the client's chronic medical condition, dietary recommendations are as follows: A sodium level of more than 145 mEq (145 mmol/L) is considered hypernatremia; the client should be taught to avoid foods high in sodium (e.g., processed foods, specific condiments). A potassium level less than 3.5 mEq/L (3.5 mmol/L) is considered hypokalemia. The client should be encouraged to eat foods high in potassium. Restricting fluid intake will increase the serum sodium level and is contraindicated. A glucose level of 90 mg/dL (5 mmol/L) is within the expected range of less than 110 mg/dL (6 mmol/L) and is not a concern. The laboratory results for serum sodium and serum potassium are not within the expected values, and the client should be taught how to alter the diet

Which color does the stool of a client have when experiencing cancer of the pancreas head, weight loss, severe epigastric pain, and jaundice?

Clay-colored. Tumors of the head of the pancreas usually obstruct the common bile duct where stool passes through the head of the pancreas to join the pancreatic duct and empty at the ampulla of Vater into the duodenum. The feces will be clay-colored when the tumors prevent bile from entering the duodenum. Green stools may occur with prolonged diarrhea associated with gastrointestinal inflammation. The feces are brown when there is unobstructed bile flow into the duodenum. Inflammation or ulceration of the lower intestinal mucosa results in blood-tinged stools.

Carbamazepine helps decrease thirst associated with central diabetes insipidus (DI). Although carbamazepine is an antiseizure medication, when given to clients with central DI, it decreases thirst. Urine output is decreased by hormone replacement therapy. Carbamazepine does not affect serum calcium levels.

Desmopressin acetate, orally, subQ (of administration of the medication should be changed to oral or subcutaneous. It will help reduce the complications in the client. Lithium carbonate should not be prescribed to a client with diabetic insipidus because it causes medication-related diabetes insipidus as it decreases the levels of antidiuretic hormone by interfering with the response of the kidneys. Administration of antidiuretic hormone does not relieve such symptoms as chest pain. It should be given to the clients during severe dehydration either intravenously or intramuscularly.

An older adult client undergoing cancer therapy reports diffused redness and large blisters on the skin with evident systemic toxicity. Which intervention would be a priority to include in the plan of care for this client?

Discontinue the medication. Toxic epidermal necrolysis (TEN) is a rare acute medication reaction that manifests as diffused redness and large blisters on the skin. Older adult clients on chemotherapy are at greater risk for TEN. The medication should be immediately discontinued to reduce further damage to the skin. Monitoring the body temperature is not a priority intervention in this client. The client should be monitored for hypothermia and fluid and electrolyte balance to provide systemic support and prevent secondary infections. Topical antibacterial medications are administered to suppress the bacterial growth until healing occurs.

Which clinical indicators are consistent with the diagnosis of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Emotional lability, Dyspnea on exertion, Hyperactive deep tendon reflexes (Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurological manifestation related to excessive production of thyroid hormones. Abdominal distention is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism)

When a client with laryngeal cancer has a laryngectomy scheduled, which action will the nurse include in the postoperative teaching plan?

Importance of cleanliness around the site of the stoma. The procedure should be explained so the client understands that the tracheostomy can serve as an entrance for bacteria and that cleanliness is imperative. After laryngectomy, the client's airway ends at the stoma, which cannot be blocked. Clients with a laryngectomy do not swim because of the high risk for water entering the airway. Suctioning must be performed only as needed; a pattern is not necessary. Sterile technique is not required; medical aseptic technique is adequate and realistic.

Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply. One, some, or all responses may be correct.

Intolerance to cold, Decreased body temperature (Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neuromuscular manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in the client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in the client with hypothyroidism.)

The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication?

Pain with urination. Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy.

Which consideration is most important when formulating a plan of care for a child undergoing chemotherapy?

Preventing infection. Chemotherapy suppresses the immune system; the child is in danger of contracting an overwhelming infection. Although increasing caloric intake is important, it is not the priority. Although nausea and vomiting are side effects of chemotherapy, they can be minimized with appropriate pharmacological therapy. Although it is important to check for hematomas, it is not as important as preventing infection; gentle handling helps prevent hematomas.

The nurse shares the discharge instructions with a client who has prostate cancer. The client asks, "How much more blood will they need? Don't they have enough?" Which laboratory test would the nurse discuss the need to monitor throughout the course of the disease?

Prostate-specific antigen (PSA)

Client A is recovering from heart surgery and needs to adapt to his or her environment. Client B is at the last stage of cancer. Which of these theories may the nurse use for better health maintenance of both clients?

Roy's theory for client A and Henderson's theory for client B. The nurse may use Roy's theory for client A and Henderson's theory for client B. Roy's theory emphasizes adaptation to the surroundings. For example, a client who just had heart surgery would be told to take the prescribed medication, follow a proper diet, and exercise daily for a fast recovery. Henderson's theory describes the role of the nurse in assisting the client in performing daily activities that will contribute to recovery or a peaceful death. For example, the nurse may try to improve the morbid condition of a client with end-stage cancer to facilitate an inevitable peaceful death. Peplau's theory focuses on the therapeutic relationship that develops between the nurse and the client. Orem's theory focuses on self-care, self-care deficit, and nursing systems.

A client who has cancer of the sigmoid colon is scheduled to have an abdominoperineal resection with a permanent colostomy. Before surgery, a low-residue diet is prescribed. Which is the nurse's explanation for the necessity of this diet?

To reduce the amount of stool in the large bowel. This diet is low in fiber; after digestion and absorption, there is only a small amount of residue to be eliminated. This diet does not promote peristalsis; the products of digestion remain in the intestine longer, and flatus increases. Although a low-residue diet is less irritating, this is not the primary reason for its use before surgery. Antimicrobials such as neomycin are given to lower the bacterial count in the gastrointestinal tract.

An older adult client is diagnosed with cancer and fears death. Which nursing intervention would demonstrate caring?

Touch. Touch is a therapeutic tool that helps induce relaxation, provides physical and emotional comfort, and shows caring to an older adult. Reminiscence helps bring meaning and understanding to the client's present situation and resolves current conflicts by recollecting the past. Reality orientation involves making an older adult more aware of time, place, and person. Therapeutic communication helps perceive and respect the older adult's health care expectations.

Which risk factor for head and neck cancer would the nurse assess for in a client with a persistent, nagging cough? Select all that apply. One, some, or all responses may be correct.

Type of employment, ear pain, smoking, alcohol, oral hygiene practices. There are several risk factors for head and neck cancers. The nurse would obtain information about the client's employment to determine possible chemical or environmental exposures that can increase the risk for head and neck cancers. The symptom of ear pain along with a nagging cough can indicate head or neck cancer. The use of tobacco and alcohol is a major risk factor for head and neck cancer. Poor oral hygiene is another risk factor the nurse can assess for.

The health care team is caring for a client with diabetes insipidus. According to the functional model, which health care personnel would the nurse state is qualified to perform all hygienic tasks?

Unlicensed assistive personnel (UAP) UAP perform all the hygiene tasks. Per the functional model, intravenous (IV) medication administration is provided by the RN. The LPN and an LVN may be permitted to give IV administration of medications, but they may be limited to giving oral medications.

A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client's teaching?

Use a soft toothbrush for oral hygiene. Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression

A client in the final stage of cancer is very anxious about his or her disease. The client is showing aggressive behavior toward family members. The nurse comforts and offers compassion and empathy to the client and the family members. Which theory principle is the nurse following in this situation?

Watson's theory. Watson's theory involves assisting clients in attaining health, maintaining health, or dying peacefully. Per Watson's theory, the nurse would comfort and offer compassion and empathy to clients and their families. Roy's theory identifies the types of demands placed on the client and helps the client adapt to changes in his or her physiological needs. Leininger's theory is about transcultural care theory, which explains that caring is the central and unifying domain for nursing knowledge and practice. Henderson's theory illustrates that nurses working interdependently with other health care workers can best assist the client.

A client is admitted for a biopsy of a tumor in her left breast. The client states, "I know it can't be cancer, because it doesn't hurt." Which response by the nurse is most therapeutic?

What do you know about breast cancer?" Asking what the client knows about breast cancer allows the nurse to assess the client's understanding of breast cancer and to clarify any misconceptions. Saying that they should hope that the growth isn't malignant avoids an opportunity to teach, and it is a type of false reassurance. The statement may actually increase feelings of hopelessness if the lesion is determined to be malignant. Although correct, stating that most lesions are not malignant provides a false sense of security and avoids an opportunity to teach. Asking whether the primary health care provider has told the client that it wasn't cancer focuses on what the primary health care provider said rather than on what the client knows and may limit further communication of feelings and beliefs.

A client who was admitted to the hospital with metastatic cancer has a temperature of 100.4°F (38°C), a distended abdomen, and abdominal pain. The client asks the nurse, "Do you think that I will need to have surgery?" How would the nurse respond?

You seem concerned about having surgery. The correct statement ("You seem concerned about having surgery.") is open-ended and encourages the client to verbalize concerns. Nothing in the situation indicates that surgery is planned; this response may increase anxiety. The statements, "I'll find out for you. Your record will show if surgery is scheduled" and "I don't know about any surgery. You'll have to ask your health care provider" cut off communication.

After a surgical thyroidectomy a client exhibits carpopedal spasm and tremors. The client reports tingling in the fingers and around the mouth. The nurse suspects a deficiency in which mineral?

Calcium. The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia

A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which types of care will now be removed from the treatment plan? Select all that apply. One, some, or all responses may be correct.

Chemo, blood transfusion, radiation therapy

An adolescent who is undergoing chemotherapy for the treatment of bone cancer has stomatitis as a result of chemotherapy. Which would the nurse include when teaching the child about self-care? Select all that apply. One, some, or all responses may be correct.

Clean the teeth with a swab, Drink fluids through a straw, Avoid foods served at extremes of temperature

The nurse says, "I got depressed too when I was diagnosed with cancer several years ago." Which outcome would the nurse hope to achieve with this brief self-disclosure of personal information?

Client realizes that such feelings are experienced by others

A client experiences melena, and gastric cancer is discovered. A partial gastrectomy is performed, a jejunostomy tube is surgically implanted, and a nasogastric (NG) tube for suctioning is placed. What would the nurse expect regarding NG drainage during the first 24 hours after surgery?

Contains some blood and clots. Drainage containing some blood and clots is an expected response during the first 24 hours after a gastric resection because oozing blood and blood coagulation. There will be a moderate amount of drainage, not minimal or no drainage. Green and viscid are normal characteristics of gastric contents, which are unexpected after gastric surgery. Drainage containing large amounts of frank blood indicates hemorrhage, which is unexpected. Material that appears similar to coffee grounds results from blood that has been digested by the gastric acid; gastric bleeding with a nasogastric tube in place will be red because gastric acids will not have time to act on the blood.

Among which group of women are breast cancer death rates the lowest?

Among these groups of women, Asian American women have the lowest rates of death from breast cancer. Samoan, Hawaiian, Puerto Rican, and African American women have the highest breast cancer death rates.

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How would the nurse respond to complaints of pain?

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How would the nurse respond to complaints of pain?

A client who had a gastric resection for cancer of the stomach is admitted to a postanesthesia care unit with a nasogastric (NG) tube in place. Which symptom would the nurse expect to observe?

Bright red, bloody drainage in the suction container

A client with an inoperable cancer of the head of the pancreas involving the common bile duct has a T-tube inserted. During the first 48 hours after insertion of the tube, which is an appropriate nursing intervention?

Maintain T-tube patency via gravity drainage. A T-tube drains by gravity into a small collection bag; the right side-lying or the semi-Fowler position enhances gravity drainage. A T-tube is not irrigated; it drains by gravity. A T-tube drains by gravity, not intermittent suction. The right side-lying position facilitates drainage and should be encouraged.

A client undergoes surgical implantation of radon seeds for oral cancer. The nurse would observe the client for which side effects?

Nausea or vomiting. The mucosa of the mouth and the vomiting center in the brain stem may be affected, producing nausea and vomiting. Hematuria, occult blood, hypotension, and bradycardia are not side effects of radiation therapy related to the oral cavity. Neither abdominal cramping nor diarrhea is an expected response because of the distance between the radon seeds and the intestines.

A client is diagnosed with hyperthyroidism and is treated with I-131. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms would be included in the teaching? Select all that apply. One, some, or all responses may be correct.

Fatigue, dry skin, Progressive weight gain (Fatigue is caused by a decreased metabolic rate associated with hypothyroidism. Dry skin most likely is caused by decreased glandular function associated with hypothyroidism. Progressive weight gain is associated with hypothyroidism in response to a decrease in the metabolic rate because of insufficient thyroid hormone. Insomnia is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone. Intolerance to heat is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone)

Why would the nurse monitor a client with a diagnosis of Cushing syndrome for symptoms of diabetes mellitus?

Glucocorticoids accelerate the process of gluconeogenesis. Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop. ACTH is increased in Cushing syndrome, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.

The parents of a young man suspected of having Cushing syndrome express anxiety about their son's condition. Which would the nurse tell the parents to help them better understand the illness?

He may have mood swings or depression as a result of his illness.

Which physical symptoms would a client diagnosed with Cushing syndrome exhibit?

Hypertension and moon face

Which signs would the nurse expect to observe in a client with small cell carcinoma of the lung who develops syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. One, some, or all responses may be correct.

Oliguria, Seizures, Vomiting. Cancerous cells of small cell lung cancer can produce antidiuretic hormone, which causes fluid retention, resulting in increased blood volume and decreased urine volume. Fluid retention associated with SIADH can cause cerebral edema, resulting in confusion and seizures. Fluid retention resulting in hyponatremia causes nausea and vomiting. The client will have nausea and vomiting, resulting in a decreased oral fluid and food intake.

The nurse administers erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response demonstrates a therapeutic effect?

Elevated hematocrit. Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. Erythropoietin increases red blood cells (RBCs), not WBCs, not platelets, and not immature neutrophils (band cells).

The nurse is caring for a client who is terminally ill with cancer. The health care team meets and agrees to provide the client with information to help the client make decisions regarding treatment. Which ethical principles are applied in this situation? Select all that apply. One, some, or all responses may be correct.

Justice, Fidelity, Veracity, Autonomy

Which action would the nurse include in the plan for care of a client on the first postoperative day after a radical neck dissection for laryngeal cancer?

Keep the client in semi-Fowler position when in bed

A client with cancer of the cervix has an intracavity radioactive sealed implant in place. Which precaution would the nurse take to protect against excessive exposure to radiation?

Leaving used linens in the room until cleared by the Radiation Safety team

A 5-year-old girl is undergoing a course of chemotherapy. One day the nurse sees the child crying. The child tells the nurse, "All my hair is gone, and everyone stares at me." Which is the best response by the nurse?

Let's ask your mother to bring in a hat for you to wear until your hair grows back." Having the child wear a hat until her hair regrows meets her current needs while assuring her that her hair loss is temporary. Removing the doll's hair demeans the child's feelings. Denying the child's feelings by stating that she just thinks that everyone is staring at her is not the best response. Taking the mirror out of the room demeans the child's feelings and implies that the hair loss is unsightly.

Which is the etiological factor of nephrogenic diabetes insipidus (DI)?

Lithium therapy (Lithium therapy is the etiological factor of nephrogenic DI. Central nervous system infections such as meningitis are etiological factors of central DI. Goiter, an enlarged thyroid gland, is commonly seen in clients with Graves disease. Sulfonamide is a goitrogen that can cause goiter)

A client who has undergone a mastectomy because of breast cancer is now undergoing chemotherapy, which has caused hair loss. The client states, "I feel like I've lost my sense of power." Which response would the nurse give?

Losing power seems important to you."

Which intervention would the nurse include in the plan of care for a client with Addison disease?

Protect from exertion. Exertion, either physical or emotional, places additional stress on the adrenal glands. This stress may precipitate an addisonian crisis because increased metabolic demands decrease levels of adrenocortical hormones, causing fatigue. Restricting fluid intake is contraindicated because of the risk for hypovolemia. The nurse would assess for hyperkalemia and hyponatremia.

Which interventions would the nurse implement when caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH)?

Provide frequent oral care, Institute fall risk precautions, Monitor for and report neurological changes. Fluids are restricted to no more than 1000 mL and to no more than 500 mL for the client with severe hyponatremia. Treatment of SIADH includes placing the bed flat or elevating the head of the bed no more than 10 degrees. This position promotes venous return to the heart, which increases left ventricular filling pressure.

Which nursing interventions would the nurse use to communicate effectively with the client who has undergone surgical treatment for laryngeal cancer? Select all that apply. One, some, or all responses may be correct.

Providing the client with praise and encouragement, Collaborating with a speech and language pathologist, Asking the client to make noise when immediate attention is required

The nurse is caring for several adolescent clients. Which are at increased risk for testicular cancer? Select all that apply. One, some, or all responses may be correct.

Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, and infertility. The client with liver disease may be at increased risk of gynecomastia. Hemophilia, a hematologic disorder, is not a risk factor for testicular cancer.

Which assessment findings are associated with Cushing disease? Select all that apply. One, some, or all responses may be correct

Round face, dependent edema on feet and ankles, thin translucent skin with bruising, increased fatty deposition in neck and back

A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, which advice will the nurse emphasize?

Salt intake may have to be restricted. Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited. Because pancreatic function is unimpaired, insulin therapy is not indicated. Dosages will likely need to be adjusted over time. The dosage will need to be increased for surgery and severe infections; not doing this can cause a life-threatening crisis

A client with Addison's disease is receiving cortisone therapy. Which complications would the nurse expect if the client abruptly stops the medication? Select all that apply. One, some, or all responses may be correct.

Shock, circulatory collapse

The nurse manager oversees an organization that provides secondary care for clients with cancer. Which service would be provided by this type of organization?

Teaching the client about prevention of infection. Secondary care involves the prevention of disease complications. Teaching clients about the prevention of infection would help prevent complications, because cancer clients are at high risk for infection. Long-term care for fatigue would be included as primary or tertiary care, not secondary care. Treatment for chronic care such as pain management in cancer clients is a type of primary care provided to a client. Primary care involves health maintenance measures such as teaching the client about adverse effects of the therapy.

A client who has bone cancer is being prepared for the first radiation treatment. The client starts crying, stating, "I'm so discouraged." Which response would the nurse make?

Tell the client, "It's difficult to deal with your diagnosis and treatment." The correct response focuses on the client's feelings of despair and provides the opportunity to talk about them. Leaving the client alone abandons the client and leaves the client with no support. Avoiding a pressing problem misses an opportunity for discussion of feelings. Explaining the therapy and saying it will only cause a little discomfort focuses on the nurse's interpretation of the problem, not the client's.

Which complication would the nurse be concerned about if there is removal of the parathyroid glands during a thyroidectomy?

Tetany

Which condition would the nurse expect the client to develop if their parathyroid glands have become damaged during a thyroidectomy?

Tetany

A primary health care provider recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. Which would the nurse suggest they discuss?

The amputation and information about chemotherapy

Which clinical manifestations would the nurse expect a client to exhibit with a diagnosis of Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Weakness, Hypertension, Truncal obesity

A complete blood count is prescribed before each round of a client's cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse?

White blood cells (WBCs). Antineoplastic medications depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life-threatening. RBCs diminish slowly and can be replaced with a transfusion of packed RBCs. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.

A client admitted for diagnostic testing to determine the extent of his or her bladder cancer asks, "If they remove my bladder, how will I be able to urinate?" Which response would the nurse use?

When removing a client's bladder, a surgical opening or urostomy allows urine to drain into a collection bag."

Which alternative therapy may be beneficial for the nurse to discuss with a client who has terminal bone cancer?

biofeedback. Biofeedback provides information about changes in body function; clients can learn to use this to control a variety of body responses, including pain. Radiotherapy is a part of standard medical regimens. Bariatrics is a type of therapy that focuses on the correction of obesity; it encompasses prevention, control, and treatment of the problem, which involves medications and surgery. Placement of radioactive sources into or in contact with tissues (brachytherapy) is part of standard medical treatment for cancer.

A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" Which response by the nurse is most appropriate?

"I don't know if you do; let's talk about it.. The nurse has demonstrated recognition of the verbalized concern and a willingness to listen. The client did not state cancer as the diagnosis; this response puts the client on the defensive. Avoiding the question indicates that the nurse is unwilling to listen. Saying the client shouldn't worry cuts off communication and denies feelings.

The father of a child who is dying of cancer asks the nurse whether he should tell his 7-year-old son that his sister is dying. What is the most appropriate response by the nurse?

"Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's possible death."

Which physical assessment findings would the nurse document on a client who is experiencing Cushing triad? Select all that apply. One, some, or all responses may be correct.

-bradycardia -irregular respirations -systolic hypertension -widening pulse pressure. A client experiencing Cushing triad presents with bradycardia (with a full and bounding pulse), irregular respirations, systolic hypertension, and a widening pulse pressure. These clients do not experience tachycardia or diastolic hypertension

After an above-the-knee amputation for bone cancer, an adolescent boy is returned to his room. He is monitored closely because of the potential for hemorrhage from the residual limb. Which would the nurse plan to keep at the bedside?

A pressure dressing will control hemorrhage until surgical intervention can be instituted. A hemostat is not practical because bleeding may be internal. Vitamin K is the antidote for warfarin. There is no indication that the client is taking warfarin. Protamine sulfate is the antidote for an excessive amount of heparin; the client is not receiving heparin.

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which medication will the nurse expect the health care provider to prescribe?

Calcium

While caring for a middle-aged adult client after emergent placement of a colostomy as a result of colorectal cancer, the nurse encourages the client's family members to have a colonoscopy done before age 50 years and annually depending on health care provider recommendations. Which is the basis for the nurse's recommendations to the client's family?

Genomics

A client is diagnosed with cancer of the rectum and has surgery for an abdominoperineal resection and colostomy. Which nursing care would be implemented during the postoperative period?

Keeping the client's skin around the stoma clean

Which findings in a client may indicate potential thyrotoxic crisis?

Rapid heartbeat and tremors

A client with cancer of the prostate requests the urinal frequently but either does not void or voids in very small amounts. Which factor is the likely cause?

Retention

Which signs of Cushing syndrome would the nurse identify in a client with a pituitary tumor?

Retention of sodium and water

A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client?

Thyroxine replacement therapy will be required indefinitely. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism

Allopurinol is prescribed for a child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" Which response by the nurse is most appropriate?

With the other medicines, it helps you get rid of the things that are making you sick.

A client has a permanent sigmoid colostomy as a result of cancer of the rectum. The primary health care provider prescribes daily colostomy irrigations. Which would the nurse explain is the primary purpose of these irrigations?

Establish a regular elimination schedule. Irrigations regulate the bowel to function at a specific time for the convenience of the client. Although irrigations will prevent straining, this is not the purpose of the irrigation. Irrigations will facilitate expulsion of flatus but will not decrease the amount; avoidance of gas-forming foods will accomplish this. Bowel irrigations do not limit the amount of fluid lost from the intestine; most ingested fluid already is absorbed in the large intestine by the time it reaches the sigmoid colon.

After a bronchoscopy because of suspected cancer of the lung, a client develops pleural effusion. The nurse concludes that which condition is the most likely cause of the pleural effusion?

Extension of cancerous lesions. Cancerous lesions in the pleural space increase the osmotic pressure, causing a shift of fluid to that space. Excessive fluid intake is usually balanced by increased urine output. Inadequate chest expansion results from pleural effusion and is not the cause of it. A bronchoscopy does not involve the pleural space.

After a gastrojejunostomy (Billroth II) for cancer of the stomach, a client returns to a regular diet. After eating lunch, the client becomes diaphoretic and experiences palpitations. Which would the nurse conclude is the probable cause of these clinical manifestations?

Extra cellular fluids shift into the bowel

A client progresses to a regular diet after a gastrectomy for gastric cancer. After eating lunch, the client becomes diaphoretic and experiences palpitations. Which probable cause of this response would the nurse recognize?

Extracellular fluid shift into the bowel

The nurse is caring for a client who has had surgery for cancer of the pancreas. The postoperative plan of care will include limiting which type of dietary intake?

Fats and carbohydrates

A client is diagnosed with cancer of the stomach and is scheduled for a partial gastrectomy. Which topic would the nurse include in the postoperative care teaching?

Gastric suction. After gastric surgery a nasogastric tube is in place for drainage of blood and gastric secretions that allow healing at the site of anastomosis. Oxygen is not required unless the client experiences a complication necessitating its administration. An intravenous (IV) line to meet fluid needs and replace gastric losses is given to the average client. A urinary catheter may or may not be necessary.

Which situation in a client with hyperthyroidism may precipitate thyroid crisis (thyroid storm)?

High levels of the hormone triiodothyronine (Thyroid trauma, thyroid surgery, or physiological stress in a client with hyperthyroidism may lead to a release of abnormally high levels of thyroid hormones. High levels of the hormone triiodothyronine (T 3) intensify all the signs and symptoms of hyperthyroidism (thyroid storm or crisis), such as increased temperature, pulse, and respirations, restlessness, vomiting, and often death. Iodine binds with thyroxine, thus decreasing the potential for crisis. Tetany, not thyroid crisis, occurs from surgical excision of the parathyroid glands. Anesthesia will depress metabolism, not increase it)

After a surgical procedure for cancer of the pancreas with removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, which symptom exhibited by the client requires immediate attention by the nurse?

Hyperglycemia. When the head of the pancreas is removed, the client has a greatly reduced number of insulin-producing cells, and hyperglycemia will occur; immediate treatment is necessary. Jaundice, indigestion, and weight loss are not immediately life threatening and will take time to develop.

Which responses would the nurse expect a client to exhibit who is in addisonian crisis? Select all that apply. One, some, or all responses may be correct.

Hyperkalemia, hyponatremia, postural hypotension

Which electrolyte imbalance response would the nurse assess for in a client with a diagnosis of Cushing syndrome?

Hypernatremia

Which classic sign will a nurse find in a client with Addison disease?

Hyperpigmentation

During discharge, the nurse is teaching a client who underwent bilateral adrenalectomy about self-management. Which statements given by the client indicate effective learning? Select all that apply. One, some, or all responses may be correct.

I will procure an influenza vaccination yearly.I will visit the hospital frequently for my lifelong hormonal therapy."I will immediately notify my primary health care provider if I have fever

A client with the diagnosis of breast cancer is scheduled to receive radiation therapy to the affected area. The nurse teaches the client about how to care for the area that will be irradiated. Which client statement indicates the nurse needs to follow up?

I will use an oatmeal-based lotion after each treatment."

The nurse is educating adolescents on using sunscreen to reduce skin cancer risk. Which statement by an adolescent requires correction by the nurse?

I will use sunscreen with a sun protective factor (SPF) of 10. he nurse will recommend using sunscreen with an SPF of at least 15, not 10. Adolescents using sunscreen without lanolin, with an alcohol-free base, and applying it every 2 hours do not need correction by the nurse.

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching?

If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased."Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery

The health care provider prescribes cisplatin for a client with metastatic cancer. Which action will the nurse take to prevent toxic effects?

Increase hydration to promote diuresis. Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concer

Which symptom would a client exhibit if having a thyrotoxic crisis?

Increased T and HR

Which response after radium insertion in a client with cervical cancer would indicate an adverse reaction to the radium?

Increased temperature. nfection, indicated by increased temperature, may develop as a result of sloughing of tissue beyond what is expected in response to the administration of internal radiation. Vomiting is an expected side effect of internal radiotherapy. Back pain is expected because the client must remain flat in bed and it is difficult to relieve back pressure. Vaginal discharge is an expected side effect of internal radiotherapy.

A client had a pancreaticoduodenectomy for cancer of the pancreas. The nurse provides education about long-term complications related to this type of surgery, including information about hypoinsulinism. The nurse would instruct the client to report which symptom that may be indicative of the complication?

Increased thirst. Increased thirst

A hysterectomy is scheduled for a client with endometrial cancer. Before the surgery proceeds, which intervention would the nurse prepare the client to expect?

Indwelling urinary catheter. A catheter decompresses the bladder and limits trauma to the surgical site; it eliminates the need for repeated straight catheterizations after surgery. The gastrointestinal tract does not need to be decompressed for this type of surgery. Packing is usually not necessary; if it is used after a hysterectomy, 10 days is an excessively long time. Drains are usually not necessary after a hysterectomy.

Laboratory results for a client with small cell lung cancer reflect urine with a high specific gravity and a serum sodium level of 127 mEq/L. The client has gained 7 pounds in 3 days, has decreased urine output, and no edema is noted. Which nursing interventions are appropriate for this client? Select all that apply. One, some, or all responses may be correct.

Initiate furosemide (Lasix), Institute a fluid restriction of 800 to 1000 mL/day. This client is experiencing syndrome of inappropriate antidiuretic hormone (SIADH), which is most often caused by cancer, and especially small cell lung cancer. It is appropriate to initiate furosemide to promote diuresis. Instituting a fluid restriction of 800 to 1000 mL/day will encourage weight reduction and a gradual increase in serum sodium concentration and osmolality. Hypertonic saline solution is generally not necessary unless the hyponatremia is severe.

A client who has a history of emphysema is transported back to the nursing unit after a radical neck dissection for cancer of the tongue. The client is receiving oxygen and an intravenous infusion. Within the first hour, the client has 50 mL of sanguineous drainage in the portable wound drainage system. Which initial action would the nurse take?

Inspect the dressing

The nurse is reviewing the electronic health record of a client admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication order would the nurse question?

Intravenous (IV) 0.9% sodium chloride (IV 0.9% sodium chloride should be administered cautiously in clients with SIADH, as it can further potentiate fluid volume overload. Instead, a 3% sodium chloride is hypertonic and can be used to treat severe hyponatremia related to SIADH. Diuretics such as furosemide (Lasix) can be used to treat heart failure if the sodium level is normal. Tolvaptan (Aquaretic) and demeclocycline (Declomycin) are both medications used to treat SIADH)

After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The client asks the nurse, "What does that mean?" How would the nurse explain dumping syndrome?

It is the rapid passage of concentrated fluid into the small intestine.

A client is to receive intraarterial chemotherapy for cancer of the liver. Which benefit would this method provide?

It reduces systemic toxicity. Higher concentrations of the medication can be delivered to the specific site of the tumor, with reduced systemic toxicity. Providing for rapid dilution of chemotherapy is the purpose of central vascular access devices. The ability to pass the blood-brain barrier is the purpose of intrathecal or intraventricular access devices. Delivering chemotherapy to the peritoneal cavity is the purpose of intraperitoneal chemotherapy.

Which is a nursing responsibility during a 24-hour urine collection for a client with the diagnosis of Addison disease?

Keep the client quiet and reduce stress

Which factor identified in a client's history places her at increased risk for breast cancer?

Late beginning of childbearing. Advanced age at the time of a first child's birth is one of the risk factors for malignancy of the breast. This is the result of prolonged exposure to unopposed estrogen. Active lifestyle, low-income background, and delayed menarche are not considered risk factors. Hereditary mutations and family history of breast cancer are considered key risk factors for the development of breast cancer.

A client tells the nurse that her mother died of endometrial cancer 1 year ago and that she is afraid she will also develop this same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed?

Late-onset menarche. Early-onset, not late-onset, menarche is a risk factor for endometrial cancer. Smoking, hypertension, and obesity are all risk factors for endometrial cancer.

A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. Which would the nurse consider when formulating a response?

Less thyroid tissue is available to supply thyroid hormone after surgery (After a thyroidectomy, thyroxine output usually is inadequate to maintain an appropriate metabolic rate. Hypothyroidism is decreased thyroid functioning, not a slowing of functions of the entire body. With hypothyroidism, the level of TSH from the pituitary usually is increased. Thyroid tissue remaining after surgery does not atrophy)

When providing care for a client who had a nephrectomy secondary to renal cancer, which factor affects the client's ability to perform his or her postoperative deep breathing and coughing requirements?

Location of the client's surgical incision

The nurse is caring for a client who underwent surgical resection of an oral cancerous tumor. Which client problem is of highest priority to guide care?

Maintain airway

Which clinical manifestation is indicative of the fluid and electrolyte imbalance associated with a parathyroidectomy?

Muscle spasms. Removal of the parathyroids causes hypocalcemia and associated neuromuscular irritability. Constipation is a sign of hypercalcemia. Hypoactive reflexes are signs of hypercalcemia. Increased specific gravity is a sign of fluid volume deficit.

The nurse is performing a breast assessment. Which statement made by the client indicates a risk of breast cancer? Select all that apply. One, some, or all responses may be correct.

My first child was born when I was 32, I noticed a slight discharge from a nipple, I consume two to four glasses of alcohol a day . Clients who gave birth to a first child after the age of 30 are at a risk of breast cancer. Discharge from the nipple may indicate an early symptom of breast cancer. Consuming two to four glasses of alcohol daily may also increase the risk of breast cancer. An early onset of menarche is a risk factor for breast cancer. Performing breast self-examinations frequently may help identify the early stages of breast cancer.

After numerous diagnostic tests, a client with jaundice receives the diagnosis of pancreatic cancer. Which rational explains the cause of the client's jaundice?

Obstruction of the common bile duct by the pancreatic neoplasm. The common bile duct passes through the head of the pancreas; the neoplasm often constricts or obstructs the duct, causing jaundice. Necrosis of the pancreatic parenchyma caused by the neoplasm will not cause jaundice. Excessive serum bilirubin caused by red blood cell destruction is the prehepatic cause of jaundice. Impaired liver function, resulting in incomplete bilirubin metabolism, is a hepatic cause of jaundice.

The nurse obtains the history of a client with early colon cancer. Which clinical finding does the nurse consider consistent with a diagnosis of cancer of the descending, rather than the ascending, colon?

Obstruction. Signs and symptoms of obstruction occur earlier with cancer in the descending colon because the consistency of the stool is formed rather than liquid. Pain, a late symptom of colon cancer, may occur regardless of the location of the primary lesion. Fatigue occurs in colon cancer regardless of the primary site; it is related to anorexia, weight loss, and anemia. Bleeding, which results in anemia, occurs in colon cancer regardless of the primary site because the lesions extend into the intestinal mucosa

28-year-old woman is diagnosed as having cancer of the left breast. A simple mastectomy is performed. Which action would be included in the plan of care immediately after surgery?

Placing the client in the semi-Fowler position with the left arm elevated. The semi-Fowler position and elevation of the arm on the affected side minimize edema related to the inflammatory process.

The client with a suprapubic prostatectomy for cancer of the prostate has continuous bladder irrigations (CBI) in place after surgery. Which primary goal is the nurse trying to achieve with the CBI?

Prevent the development of clots in the bladder.

Which interventions would the nurse implement in caring for a client with diabetes insipidus (DI) after a head injury? Select all that apply. One, some, or all responses may be correct.

Provide adequate fluids within easy reach, Assess for and report changes in neurological status, Monitor for constipation, weight loss, hypotension, and tachycardia (Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore, erythromycin would not be prescribed. The primary pharmacological treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).

In an ongoing research study, the nurse asks participants, who are breast cancer survivors, to briefly share information about their lives after surviving cancer. The nurse then compiles the views to determine the cancer survivors' quality of life. Which type of study is being conducted?

Qualitative research

A client is diagnosed with testicular cancer. Which treatment would be first?

Radical inguinal orchiectomy. Treatment for testicular cancer may include a radial inguinal orchiectomy (a surgical removal of the diseased testicle). Radiotherapy and chemotherapy are usually implemented after an orchiectomy based on the stage of the tumor. A testicular biopsy is no longer recommended because it may cause the spread of malignant cells.

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. Which action will the hospice nurse take regarding the patch in use at the time of death?

Remove and dispose of the patch in an appropriate receptacle.

Which parameter monitoring would be the nurse's priority while caring for a client with hypothyroidism?

Respiratory rate

Which discharge instruction would the nurse teach a client who receives a radium implant for uterine cervical cancer?

Return for follow-up care

Which explanation would the nurse give to the family when an older widow, who is in the terminal stages of lung cancer, exhibits mood changes and anger toward the family?

She is trying to cope with her impending death.

A client diagnosed with invasive cancer of the bladder has brachytherapy scheduled. Which successful therapy outcome would the nurse expect with this client?

Shrinkage of the tumor when scanned. Brachytherapy involves implanting isotope seeds in, or next to, the tumor. The isotope seeds interfere with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary output will increase with successful therapy. With brachytherapy of the bladder, an increase in pulse strength is not a sign of success. The radioactive isotope seeds may affect the client's bone marrow sites, resulting in a reduction of WBCs.

Which client response is most important for the nurse in the postanesthesia care unit to monitor when caring for a client who had a thyroidectomy?

Signs of respiratory obstruction

A client has terminal cancer after 7 years of chemotherapy and surgeries. The nurse enters the client's room and finds the client crying. Which is the correct intervention by the nurse?

Sit down quietly next to the bed and allow her or him to cry

When evaluating for nerve injury after a thyroidectomy, which action would the client be asked to do?

Speak . The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland

The nurse is caring for a client after a thyroidectomy. With concerns of nerve injury, which functional ability would the client be assessed for?

Speaking

The nurse is providing postoperative care to a client with cancer of the lung who had a lobectomy. The client has a chest tube attached to suction. Which assessment finding indicates a complication?

Subcutaneous emphysema on the second postoperative day. Subcutaneous emphysema on the second postoperative day should not occur; it is evidence of a leak from the chest tube or the lung into the subcutaneous tissue. Clots are expected initially after surgery. Bloody drainage is expected immediately after surgery. Decreased bubbling in the water-seal chamber on the third postoperative day occurs as the lung is reexpanding or if there is an obstruction in the chest tube; bubbling stops completely when the lung is expanded fully.

A client is admitted to the hospital with a diagnosis of cancer of the larynx, and a laryngectomy is scheduled. Postoperatively, which is the most important piece of equipment that the nurse would place at the client's bedside?

Suction equipment

A client who had a laryngectomy for cancer of the larynx is being transferred from the postanesthesia care unit to a surgical unit. Which is the most important equipment that the nurse would place in the client's room?

Suction supplies

During preoperative teaching for a thyroidectomy, which specific instruction about postoperative care would the nurse provide the client?

Support the head with the hands when changing position

The primary health care provider instructs the nurse to manage fluid replacement therapy in a client with cancer. Which type of care is the client receiving?

Supportive care. In oncology departments, medical professionals use supportive care to improve the client's quality of life. Supportive care is based mainly on the use of medical interventions to support client health. Medical interventions during supportive care include managing fluid replacement therapy, providing blood transfusions, and administering bone marrow-stimulating agents.

Hydrocortisone is prescribed for a client with Addison's disease. Which response is a therapeutic effect of this medication?

Supports a better response to stress

A client newly diagnosed with cancer of the pancreas is scheduled for surgery. The client asks the nurse, "Don't you think that some other treatment would be better than surgery?" How would the nurse respond?

Surgery is the recommended approach. Perhaps you should discuss this further with the health care provider."

A client is diagnosed with cancer and feels weak. The delegator has assigned health care team members to care for the client. Which aspects of care are most appropriate for the registered nurse (RN)? Select all that apply. One, some, or all responses may be correct.

Teaching the client to be hopeful about the treatment, Providing emotional support to the client's family members. Providing emotional support to the client's family members

Which finding by the home health nurse who is visiting a client who has had laryngeal cancer surgery indicates a need for further intervention?

The client smokes 4 cigarettes per day

A client with hyperthyroidism asks the nurse about the tests that will be ordered. Which diagnostic tests would the nurse include in a discussion with this client?

Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T 3) A decreased TSH assay together with an elevated T 3 level may indicate hyperthyroidism. X-ray films will not indicate thyroid disease, and elevation of T 4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. Po 2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

Which skin conditions would the nurse expect when performing a physical assessment on a client with a new diagnosis of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Warm, moist, smooth

The nurse provides postoperative teaching about colostomy care to a client who underwent surgery for cancer of the colon. The education would include which instruction related to skin care around the stoma?

Wash the area with soap and water and then apply a protective ointment.

After a craniotomy to remove a brain tumor, the client develops the syndrome of inappropriate antidiuretic hormone (SIADH). For which clinical indicators would the nurse monitor the client? Select all that apply. One, some, or all responses may be correct.

increased weight, Decreased serum sodium, Decreased level of consciousness. As fluid is retained, the body weight will increase. One liter of fluid weighs 2.2 pounds (1 kilogram). Excess antidiuretic hormone (ADH) causes water retention, which leads to dilutional hyponatremia. Dilution of blood and hyponatremia cause a decreased level of consciousness. Water retention and decreased urinary output occur because of ADH excess. Urine output decreases to less than 20 mL/hour. This client will be lethargic, confused, or comatose, depending on the degree of hyponatremia. Tachycardia, not bradycardia, occurs in response to fluid volume excess associated with increased ADH.

Which question would the nurse ask a client when assessing her or his needs related to a recent diagnosis of cancerous lesions?

"Have you noticed any change in your appetite?" Problems involving the oral cavity often result in nutritional problems and weight loss requiring nursing intervention. The question, "Have you noticed any change in your appetite?" will elicit more information. The nurse needs to determine a client's past and current appetite and nutritional status. Difficulty sleeping is not usually a characteristic symptom of cancer of the oral cavity, although it may occur after the diagnosis because of anxiety. Gum infections are not typically an early problem after an oral cancer diagnosis. Although a dentist may be the first to identify oral cancer, the need for medical treatment exists.

Immediately after a bilateral adrenalectomy, a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed?

"I am glad that I only have to take the medication once a day."Usually a larger dose is given at 8:00 AM and the second dose is given before 4:00 PM to mimic expected hormonal secretion and prevent insomnia.

A client with colon cancer had surgery for resection of the tumor and creation of a colostomy. During the 6-week postoperative checkup, the nurse teaches the client about nutrition. Which response by the client indicates learning has taken place?

"I should follow a diet that is as close to normal as possible. Although foods that produce gas generally are avoided, the diet should be as close to normal as possible for optimal physiological and psychological adaptation. A high-protein diet is important until healing occurs, but this is at the 6-week checkup; a balanced diet generally meets nutritional needs for protein. There is no need to limit sodium. Absorption of nutrients is unaffected; there is no need to increase caloric intake.

When teaching the client about when to call the primary health care provider if they are showing signs of hypothyroidism after a thyroidectomy, which statement made by the client shows that teaching was effective?

"I will call if I get dry hair and can't tolerate the cold. (Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine. Muscle cramping is associated with hypocalcemia. Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate. Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia.)

A client experiencing thyrotoxic crisis tells the nurse, "I know I'm going to die. I'm very sick." Which is the best response by the nurse?

-"You must feel very sick and frightened."

Which complication is the nurse's main priority during the early postoperative period after a subtotal thyroidectomy?

Airway obstruction. Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life. Although important, hemorrhage, thyrotoxic crisis, and hypocalcemic tetany do not exceed patency of the airway in priority.

A client with metastatic breast cancer is started on docetaxel. The nurse will assess the client for which nontherapeutic effects? Select all that apply. One, some, or all responses may be correct.

Alopecia, Febrile neutropenia, Hypersensitivity reaction. Alopecia is a nontherapeutic response to docetaxel. Docetaxel affects interphase and mitosis of the cell cycle. Febrile neutropenia is a common nontherapeutic effect. Hypersensitivity reactions (e.g., flushing, rash, local eruption) are common nontherapeutic reactions, particularly within the first few minutes of the infusion. Nausea, vomiting, and diarrhea, not constipation, are nontherapeutic effects of docetaxel. Hypotension, not hypertension, is a nontherapeutic effect of docetax

Which question made by the nurse will help determine diabetes insipidus in a client who reports frequent urination?

Are you on lithium carbonate therapy? (Lithium carbonate is known to interfere with normal kidney response to antidiuretic hormone. Enquiring about lithium carbonate therapy can help assess for diabetes insipidus, which has a clinical manifestation of frequent urination. Inquiry about history of cancer helps in assessing syndrome of inappropriate antidiuretic hormone (SIADH) because some cancer therapy medications result in SIADH. Treatment with fluoroquinolone antibiotics also can result in SIADH. Hodgkin and non-Hodgkin lymphoma are causes of SIADH)

Which interventions would the nurse implement when providing care to a client after a subtotal thyroidectomy? Select all that apply. One, some, or all responses may be correct.

Assess for frequent swallowing.Ambulate the client the evening of surgery. Correct3 Assess for facial spasms, apprehension, or tingling of the lips, fingers, or toes.Ensure that oxygen, suction equipment, and a tracheostomy tray are at the bedside.

Which intervention would the nurse implement during the first 6 to 8 hours when caring for a client after a thyroidectomy?

Assess the sides and back of the client's neck for evidence of bleeding

A client with terminal cancer says to the nurse, "If I could just be free of pain for a few days, I might be able to eat more and regain strength." Which stage of grieving would the nurse conclude the client is experiencing?

Bargaining

The nurse understands which medication places a client's offspring at risk for vaginal cancer?

Diethylstilbestrol is a synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. When it is consumed during pregnancy, it may show the delayed teratogenic effect of vaginal cancer in female offspring by the age of 18 years. Danazol is an androgen that may cause masculinization of the female fetus. Estrogen causes congenital defects of the female reproductive organs. Valproic acid, a medication used to control seizures, may cause neural tube defects.

Levothyroxine 25 mcg daily is prescribed for a client with hypothyroidism. The pharmacy dispensed levothyroxine 12.5 mcg per tablet. How many tablets will the nurse instruct the client to take daily?_____ tablets

2

Which finding in a client who has syndrome of inappropriate antidiuretic hormone (SIADH) is an expected finding?

Retention of water. SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules. There is hyponatremia and dilution of serum sodium in SIADH. Decreased vasopressin is seen in diabetes insipidus. Generally, pedal (dependent) edema is not seen in SIADH despite the water retention.

A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. Which behaviors indicate the client is emotionally accepting the impending death?

Revising the client's will and planning a visit to a friend. Revising the will and planning a visit to a friend are realistic, productive, and constructive ways of using this time. Crying and talking openly about death are signs of depression. Going from health care provider to health care provider demonstrates disbelief, denial, or desperation. Refusing to follow treatments and stating that the client is going to die anyway indicates anger and hopelessness, not acceptance.

A client who is to receive external radiation for cancer says to the nurse, "My family and friends say that I will get a radiation burn." Which response by the nurse is most appropriate ?

A localized skin reaction usually occurs

A client with a small nodule of the thyroid gland is to have a subtotal thyroidectomy and asks the nurse for clarification about what this surgery involves. Which information would the nurse include in a response to the question?

A small part of the gland is left intact.

Which emergency equipment is most important for the inpatient unit nurse to have available for a client who underwent a subtotal thyroidectomy?

A tracheostomy tray

The nurse provides education to a client with the diagnosis of bone cancer that has a metastasis to the lung. Which client statement indicates the need for further teaching related to the concept of metastasis?

Because my cancer has metastasized, my diagnosis now is lung cancer."

When a client with cancer reaches an incurable last stage, the nurse explains the situation to the client and calls the client's family members to provide support. Which need of the client would the nurse prioritize here?

Belonging need. The client at an incurable stage of cancer might need loved ones to provide emotional support. The belonging need is fulfilled through this action. Safety needs may not be the top priority of the client at this stage. Self-esteem needs may be fulfilled through recognition and personal growth. Self-actualization needs may not be a priority for the client.

The client undergoing cancer chemotherapy develops bone marrow suppression and stomatitis. Which instruction will the nurse provide to the client?

Use an electric razor when shaving. Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets. Clients with stomatitis should avoid citrus juices. With bone marrow suppression, there is a decrease in red blood cells to meet cellular oxygen needs; rest should be encouraged, if needed. Sleeping with the head of the bed slightly elevated does not offer any specific advantage; the client should sleep in the position of comfort.

Which medical condition could most probably result in clients developing primary diabetes insipidus (DI)?

defect in hypothalamus (A defect in the hypothalamus (thirst center) could be the most probable cause of primary DI. Meningitis or a brain tumor could interfere with the synthesis, transport, or release of antidiuretic hormone (ADH) and cause central DI. Lithium therapy affects the renal response to ADH and results in nephrogenic DI or medication-related DI)

Which outcome would be expected after a client received treatment for Cushing disease?

Decreased blood glucose level

Which signs would the nurse expect a client to exhibit with Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Hirsutism, Round face, Buffalo hump

The nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

T4

A client with a newly formed colostomy, secondary to cancer of the rectum, received instructions regarding ostomy care and management. Which client statement indicates understanding of colostomy care?

"I will call the clinic and report if I have difficulty inserting the irrigating tube into the stoma." Difficulty inserting the irrigating tube into the stoma occurs with stenosis of the stoma; forcing insertion of the tube may cause injury. Loss of sensation to touch in the stomal tissue is expected; there is no need to call the clinic. Mucus exiting the stoma between irrigations is expected; there is no need to call the clinic. Expulsion of flatus while irrigating fluid is running out is expected; feces and flatus accompany fluid expulsion.

The nurse is caring for a client with Addison disease. Which dietary instruction would the nurse provide?

Add extra salt to food. Because of diminished mineralocorticoid secretion, clients with Addison disease are prone to developing hyponatremia. The addition of salt to the diet is advised. Clients with Addison disease are prone to hyperkalemia. High-potassium foods can be restricted. Protein is not omitted from the diet; ingestion of essential amino acids is necessary for optimum metabolism and healing. Fluids are not restricted for clients with Addison disease.

A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. Which intervention would the nurse anticipate the health care provider will prescribe to prepare the client for surgery?

Administration of an antibiotic. Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit. Intravesical chemotherapy is unnecessary because the urinary bladder is removed with this surgery. Instillation of a urinary antiseptic is not necessary. There is no evidence of a urinary tract infection. The urinary bladder will be removed, so there is no need for an indwelling urinary catheter. No data indicate that the client is experiencing urinary retention before surgery.

A primary health care provider tells a client about the diagnosis of inoperable cancer and that the client does not have long to live. After the primary health care provider leaves, the client says to the nurse, "I feel fine. I probably only have the flu." Which would the nurse do to help meet the client's emotional needs?

Allow the denial and be available to discuss the situation with the client

The nurse reviews the medical records of four male clients. Which client would the nurse note as having the highest risk for development of clinical manifestations related to prostate cancer?

Cancer of the prostate is rare before age 50 years but increases with age. African American men develop cancer of the prostate more often and at an earlier age than white men do. African American men develop prostate cancer more often than any other ethnic group. Asian American men have a lower incidence than white men do.

A 30-year-old woman is scheduled for a total abdominal hysterectomy because of noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. Which concern would be the cause of this anticipated difficulty?

Change in femininity. Removal of the uterus may produce changes in how some women view themselves sexually because it is a reproductive organ. The young age of this client may contribute to heightened feelings of loss of femininity and reproductive potential. Although body image changes are possible, they are more likely to occur with surgery that involves obvious external changes. The libido of a premenopausal woman will probably not be altered unless she has concerns about sexuality. An otherwise healthy 30-year-old woman should have an uneventful recovery.

Which clinical manifestations would the nurse anticipate when assessing a client with hypothyroidism? Select all that apply. One, some, or all responses may be correct.

Dry skin, brittle hair. Dry skin results from a decrease in the metabolic rate, which is associated with hypothyroidism. Dry, brittle hair results from a decrease in the metabolic rate, which is associated with hypothyroidism. Weight loss is associated with hyperthyroidism because of an increase in body metabolism. Resting tremors are not associated with hypothyroidism; they are associated with Parkinson's disease. Heat intolerance is associated with hyperthyroidism, not hypothyroidism, because of the increase in body metabolism.

An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, which action is most therapeutic?

Encouraging her peers to visit

When assessing a client with diabetes insipidus, which signs would the nurse anticipate finding? Select all that apply. One, some, or all responses may be correct.

Excessive thirst, Dry mucous membranes, Decreased urine specific gravity (As excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity (less than 1.005). Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases)

A farmer seeks medical care for a large crusty patch of skin on the cheek. The client states that even after using different remedies, it still bleeds easily and has not gotten better. From the client's history, the nurse suspects skin cancer. Which factor in the client's history helped the nurse form this conclusion?

Exposure to radiation. The major cause of skin cancer is exposure to the sun's ultraviolet light, a form of radiation. Farmers are susceptible to this type of cancer. The location of the lesion is not a causative factor of skin cancer. Self-treatment of a lesion is not a causative factor of skin cancer. Although environmental pollutants may have some bearing, they are not considered the major cause of skin cancer.

Which manifestations of surgically induced hypothyroidism might the client exhibit after a thyroidectomy? Select all that apply. One, some, or all responses may be correct.

Fatigue, dry skin. Fatigue results from the decreased metabolic rate associated with hypothyroidism. Dry skin is caused by decreased glandular function. Insomnia is associated with hyperthyroidism (not hypothyroidism) because of the increased metabolic rate. Lethargy, not excitability, is associated with hypothyroidism because of the decreased metabolic rate. Weight gain, not loss, is associated with hypothyroidism because of the decreased metabolic rate. Intolerance to heat is associated with hyperthyroidism, not hypothyroidism.

Which clinical manifestations does the nurse expect the client to report when admitted for surgical resection of a rectosigmoid colon cancer? Select all that apply. One, some, or all responses may be correct.

Feeling tired, rectal bleeding, changes in the shape of stool, feeling of abdominal bloating

The client has had 2 weeks of radiation therapy for breast cancer and is experiencing some erythema over the area being irradiated and notes the area to be sensitive but not painful. The client states that she has been using tepid water and a soft washcloth when cleansing the area and applying an ice pack three times a day. Which conclusion would the nurse reach based on this information?

Further teaching on skin care is necessary. Further teaching is needed because extremes of temperature should be avoided; ice constricts blood vessels, interfering with circulation. Continued application of cold is contraindicated because it may cause tissue damage. Erythema is an expected reaction; however, pain, vesicle formation, or sloughing of tissue requires intervention. The knowledge deficit is related to skin care, not the side effects of radiation therapy.

A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period?

Hoarseness and airway obstruction may result from laryngeal nerve damage.

What information from a client's history would the nurse identify as risk factors for the development of colon cancer? Select all that apply. One, some, or all responses may be correct.

Increased age, Ulcerative colitis

A client with hyperthyroidism is to receive methimazole. Which information would the nurse provide?

Initial improvement will take several weeks (Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy)

Which signs and symptoms might the nurse identify when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Menstrual irregularities, Flushed appearance, Short attention span (Menstrual irregularities are due to hypothalamic or pituitary disturbances associated with both hyperthyroidism and hyperthyroidism. The skin is warm and flushed because of a hyperdynamic circulatory state. A short attention span is related to altered cerebral metabolism from excess thyroid hormones. Hypertension is associated with hyperthyroidism; hypotension is associated with hypothyroidism. Facial edema is not related to hyperthyroidism. Hypothyroidism is associated with decreased renal blood flow that results in fluid retention (e.g., peripheral and facial edema).

A client undergoing chemotherapy for cancer gave birth to a newborn with limb malformations. Which medication may have caused limb malformations in the neonate?

Methotrexate. When taken during pregnancy, methotrexate may cause limb malformations. Nitrofurantoin is not an immunosuppressant; it may cause abnormally small eyes or absent eyes in fetuses. Carbamazepine is an antiepileptic medication that may cause neural tube defects. Cyclophosphamide may cause central nervous system malformations and secondary cancers.

A health care team is caring for a client with diabetes insipidus. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply. One, some, or all responses may be correct.

Monitoring urine output, Administering oral rehydration medication

The health care team is caring for a 68-year-old client with diabetes insipidus. Which task is most suitable to be delegated to the licensed practical nurse (LPN) for effective client care? Select all that apply. One, some, or all responses may be correct

Monitoring urine output, Administering oral rehydration medication (The LPN's scope of practice includes monitoring urine output. Administration of any type of oral medication can be performed by the LPN. Activities related to a client's hygiene, such as emptying drainage, usually are performed by unlicensed assistive personnel (UAP). Feeding the client usually is performed by UAP. Administration of intravenous fluids is the responsibility of the registered nurse)

After recovery from a modified neck dissection for oropharyngeal cancer, the client receives external radiation to the operative site. Which side effect of radiation would the nurse expect to find?

Mucosal edema. The mucosal lining of the oral cavity, oropharynx, and esophagus is sensitive to the effects of radiation therapy; the inflammatory response causes mucosal edema that may progress to an airway obstruction. A decrease in salivary secretions resulting in dry mouth may interfere with nutritional intake, but it is not life threatening. Erythema of the skin may cause dry or wet desquamation, but it is not life threatening. Radiation to the neck area should not produce as significant bone marrow suppression as radiation to the other sites

A client with cancer of the pancreas has a pancreaticoduodenectomy (Whipple procedure). The nurse expects that the client will have which type of tube after surgery?

Nasogastric. Nasogastric surgery involves the stomach, duodenum, pancreas, and common bile duct; a nasogastric tube removes gastric secretions and prevents distention of the gastrointestinal tract. A chest tube is used to remove air or blood from the chest cavity; the chest is not entered in the Whipple procedure. Intestinal tubes are used for small bowel obstructions; except for the duodenum, the small bowel is not included in the Whipple procedure. A gastrostomy tube is used to deliver nutrients into the stomach of a client who cannot ingest food via the oral route.

A client with hyperthyroidism is treated initially with propylthiouracil (PTU). Which instruction will the nurse include when teaching the client about this medication?

Symptoms may not subside until the client has taken the medication for several weeks (This medication does not interfere with thyroxine already stored in the gland; symptoms remain until the hormone is depleted. Duration of therapy varies depending on the severity of the disease and the client's response to therapy. Milk does not need to be taken because this medication is not irritating to mucosal tissue, and no special precautions are necessary. Absorption is not affected by the presence of food in the stomach)

While providing nursing care for an adolescent undergoing chemotherapy for leukemia, the nurse notes blood on the child's pillowcase and several bloody tissues. Which of the child's laboratory test results would the nurse review?

Platelet count. The platelet count is reduced as a result of bone marrow depression associated with leukemia and the side effects of chemotherapeutic agents. A low hematocrit level might indicate anemia, but it does not establish its cause. Prothrombin time is influenced by vitamin K factors, not by lack of platelets. The red blood cell count does not affect this type of bleeding.

A client, admitted with a diagnosis of Addison disease, is emaciated and reports muscular weakness and fatigue. Which disturbed body process would the nurse determine is the root cause of the client's clinical manifestations?

Protein catabolism. Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein, decreased fat stores, and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this di

When working with palliative care clients, which objective data is most helpful to monitor in the debilitated client with terminal liver cancer?

Record of daily weights. Weight is objective information that aids in determining the extent of ascites; 1 L of retained fluid equals approximately 2.2 lb (1 kg). Ascites can develop in the late stages of liver cancer, and the effects of cancer and dying cause weight loss. The client's description of pain, hunger, and bowel patterns are helpful but not objective.

Which activities would the nurse include when teaching adults about activities that increase the risk of developing bladder cancer? Select all that apply. One, some, or all responses may be correct.

Smoking two packs of cigarettes a day, Working with dyes used in rubber every day. The occurrence of bladder cancer is related to smoking. Dyes in rubber and hair dyes are environmental carcinogens; working with them daily increases an individual's risk of bladder cancer. Jogging is unrelated to the development of cancer of the bladder. Ingestion of cola has not been linked to cancer of the bladder. Vibrations may result in musculoskeletal or kidney problems but are unrelated to cancer of the bladder.

Which clinical findings would the nurse expect to find when caring for a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Tachycardia, Exophthalmos (Tachycardia is associated with hyperthyroidism and is caused by the increase in the basal metabolic rate. Exophthalmos is associated with hyperthyroidism and results from accumulation of fluid behind the eyeball. Lethargy is associated with hypothyroidism; hyperactivity occurs with hyperthyroidism. Weight gain occurs with hypothyroidism; weight loss occurs with hyperthyroidism because of the high metabolic rate. Constipation is associated with hypothyroidism; frequent loose stools occur with hyperthyroidism)

A client with stage 4 ovarian cancer is admitted for dehydration. The client is to receive an intravenous (IV) bolus of 500 mL D 5W (5% dextrose in water) for 1 hour, after which the rate is to be changed to 150 mL/h. The drop factor is 15 gtt/mL. At which rate, in drops per minute, would the nurse regulate the IV after delivery of the 500-mL bolus?

The nurse would administer 38 gtt/min. Solve the problem with the following formula:

Which neurological manifestation is associated with hyperthyroidism?

Tremors (Tremors is a neurological manifestation in a client associated with hyperthyroidism. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism)

A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. One, some, or all responses may be correct.

Truncal obesity, thin extremities. An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

A client with cancer of the tongue has radon seeds implanted. The plan of care states that the client is to receive meticulous oral hygiene. How would the nurse implement the plan?

Using a gentle spray of normal saline. Gentle sprays are effective in cleaning the mouth and teeth without disturbing the sensitive tissues or radon seeds. Offering a firm-bristled toothbrush can dislodge the radon seeds and be traumatic to the compromised oral mucosa. An antiseptic mouthwash is an astringent that is too harsh for the sensitive oral mucosa. Swabbing the mouth with a moistened gauze square can dislodge the radon seeds and be traumatic to the compromised oral mucosa.

When a newly admitted client tells the nurse, "The doctor told me I have lung cancer. My father died from cancer. I wish I had never smoked," which response by the nurse is best?

You have been thinking about your diagnosis

A client who was admitted to the hospital with metastatic cancer has a temperature of 100.4°F (38°C), a distended abdomen, and abdominal pain. The client asks the nurse, "Do you think that I will need to have surgery?" How would the nurse respond?

You seem concerned about having surgery

A client is being treated for pituitary Cushing syndrome. The nurse anticipates that which medication will be prescribed?

Cyproheptadine. Cyproheptadine is effective for the treatment of pituitary Cushing syndrome. Mitotane is prescribed for the treatment of adrenal Cushing syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.

The home health nurse provides education for a client with cancer of the tongue who will begin gastrostomy feedings at home. Which client statement indicates effective teaching?

"Before I start the procedure, I will measure the residual volume." Measuring the residual volume establishes the absorption amount of the previous feeding. If a residual exceeds the parameter identified by the health care provider or is over 200 mL, a feeding may be held. This safety measure prevents adding excess feeding solution that may lead to abdominal distention, nausea, vomiting, and aspiration. Clean, not sterile, gloves are necessary to protect the client from contamination with gastric secretions. The client obtains and reports weekly or monthly weights, depending on the client's condition and clinical goals. If the tube becomes clogged, the client may instill 30 mL of a carbonated beverage; this action is not used routinely.

A child is undergoing chemotherapy to treat a neuroblastoma, stage IV, and had his first chemotherapy session last week. He arrives with his mother for this week's session. How would the nurse greet the child?

"How did you feel after your last treatment?". Asking how the child felt allows the child to volunteer information first and thus feel in control; the nurse can ask validating questions later. "It's time for your next dose" is a flippant, insensitive statement. Stating that there are three more sessions is unfeeling because it reminds the child and mother that there are more sessions in the future. "Did you get sick to your stomach?" focuses the assessment on vomiting, thereby predisposing the child to think about vomiting during this treatment.

The nurse teaches a teenager who is undergoing chemotherapy about the need for special mouth care. Which statement by the teenager leads the nurse to conclude that the instructions have been understood

"I'll use a soft-bristled toothbrush to clean my teeth." Soft bristles are less irritating to the oral mucosa and less likely to cause trauma than irritating substances are. Baking soda, mouthwash, and hydrogen peroxide are all caustic substances that may irritate the mucosa.

Which symptom would the nurse assess in a client with a diagnosis of Addison disease?

Hypoglycemia

A client has a colostomy because of surgery for cancer of the colon. Which nursing statement will most effectively minimize the client's stress the first time self-irrigation is done?

"I'll close the curtain and assemble all the equipment. Would you like me to stay, or do you prefer to try it yourself and call if you need help?". Drawing the curtain protects the client's privacy, and the client can make decisions about care; independence is encouraged, and nursing assistance is offered. Raising the issue of nervousness may increase anxiety and promote dependence. Although learning self-care begins in the hospital, teaching will continue in the client's home or extended care facility. While the client is in the hospital, the nurse should assemble the equipment. Having the client ask for the curtain drawn places the client in the position of asking for privacy. The client should be encouraged to attempt self-care rather than be offered an opportunity to continue to be dependent

Which response would the nurse use when a client, who receives radiation therapy for cancer, states, "My family said I will get a radiation burn today."

A localized skin reaction usually occurs about 3 to 6 weeks after beginning treatment. Radiodermatitis occurs 3 to 6 weeks after the start of treatment. Avoid the use of the word "burn" because it may increase anxiety. Emollients are contraindicated; they may alter the calculated x-ray route and injure healthy tissue. The response about the client's family does not address the client's personal concerns.

A client has a basal cell carcinoma that is scheduled to be removed. The client expresses concerns that the cancer has metastasized. Which is the best response by the nurse?

Basal cell tumors usually do not spread. Basal cell tumors usually do not spread, so the statement is accurate. The response "You are a low surgical risk" does not speak to the client's concern. The response "I can understand how you must feel" may provide reassurance but does not permit further exploration of concern. The response "The primary health care provider probably caught it just in time" reinforces the client's fears instead of pointing out reality.

A client with central diabetes insipidus has a serum osmolarity of 600 mOsm (mmol)/kg. Carbamazepine is prescribed. Which is an effective outcome of the medication?

Decreased thirst (Carbamazepine helps decrease thirst associated with central diabetes insipidus (DI). Although carbamazepine is an antiseizure medication, when given to clients with central DI, it decreases thirst. Urine output is decreased by hormone replacement therapy. Carbamazepine does not affect serum calcium levels)

On the first postoperative day after a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. Which intervention would the nurse take for this client?

Administer analgesics as prescribed before meals.Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity. Analgesics as prescribed will reduce soreness during meals

Which nursing intervention would be provided to a client who has undergone unilateral adrenalectomy?

Administer temporary glucocorticoid replacement therapy. Temporary glucocorticoid replacement therapy is needed for a client who has undergone a unilateral adrenalectomy. Spironolactone therapy is used when surgery cannot be performed. A client on spironolactone therapy is advised to increase sodium intake to reduce the risk of hyponatremia. Spironolactone therapy can cause a side effect of dry mouth that can be managed by saliva-inducing agents. A client who has undergone bilateral adrenal gland removal will require lifelong replacement of glucocorticoids and should wear a medical alert bracelet as an indicatio

The nurse administers desmopressin acetate (DDAVP) to a client with diabetes insipidus. Which would the nurse monitor to evaluate the effectiveness of the medication?

Intake and output (DDAVP replaces antidiuretic hormone, facilitating the reabsorption of water and the consequent return of balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although the correction of tachycardia is consistent with the correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected)

A client diagnosed with breast cancer is prescribed doxorubicin. Which assessment finding would the nurse recognize as a toxic effect of this medication?

the potential for cardiac toxicity, including changes in heart rhythm. Paralytic ileus is a toxic effect of vincristine, not doxorubicin. Red-tinged urine is a benign side effect, the result of metabolism of the doxorubicin. The magnesium level is not influenced by doxorubicin

The nurse is caring for a client who is admitted to the hospital with severe dyspnea and a diagnosis of cancer of the lung. Which is the probable cause of the severe dyspnea?

Bronchial obstruction or pleural effusion

Which manifestations are associated with syndrome of inappropriate antidiuretic hormone (ADH)? Select all that apply. One, some, or all responses may be correct.

Weight gain, hyponatremia, oliguria, hypertension, increased specific gravity

A 10-year-old child who is about to begin chemotherapy for acute myelogenous leukemia (AML) tells the nurse that he is old enough to refuse treatment. Which is the nurse's most appropriate response?

You seem frightened. Let's talk about it."

Which action by a parent of an adolescent indicates understanding of the vaccination protocol to prevent cervical cancer?

All three vaccinations were received at intervals. The human papillomavirus (HPV) vaccination is administered as a three-dose series. Clients do not need to obtain bloodwork for titers before receiving the HPV vaccine. HPV vaccinations can begin as early as 9 years of age, not 8 years. Boosters are received at 16 years for meningococcal vaccine, not HPV vaccine.

Who would the nurse use as an interpreter to explain a consent form for a foreign-language speaking client who needs to undergo chemotherapy?

An official interpretation

An adolescent with terminal cancer tells the home care nurse, "I'd really like to get my general education development certificate. Do you think that's possible?" Which is the best approach to the adolescent's question?

Arranging a conference with the school and encouraging the adolescent to prepare for the test

The nurse is caring for a client with biliary cancer. The associated jaundice gets progressively worse. The nurse is most concerned about the potential complication of which symptom?

Bleeding. Obstruction of bile flow impairs absorption of phytonadione, a fat-soluble vitamin; prothrombin is not produced, and the clotting process is prolonged. Although deposition of bile salts in the skin may lead to pruritus, this is not life threatening. Although there may be an increase in flatulence with biliary disease, it is not life threatening. Although abdominal bloating may occur with jaundice, it is not life threatening.

A client receiving cancer chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy will the nurse consider when formulating a response?

Bone marrow. Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.

Which intervention would the nurse implement when caring for a client 24 hours after thyroidectomy?

Check the sides of the operative site dressing and the back of neck

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery?

Chemotherapy interferes with cell growth and delays wound healing. Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue

A client was treated with methotrexate for cancer during the sixth month of her pregnancy. Which teratogenic effect that may be seen in the child would the nurse discuss with the client?

Developmental disabilities. The fetus is in its fetal stage of development at 6 months of gestation. Methotrexate exposure in the fetal stage of development may cause developmental disabilities in the baby. Stillbirth may occur if the exposure is during the presomite stage. Holoprosencephaly may occur if the teratogen exposure was in the embryonic stage. Normal development of the child may occur if the exposure occurred during the presomite stage.

Which skin condition would the nurse expect when performing a physical assessment on a client with a history of hypothyroidism?

Dry (Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T 3 and T 4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist, smooth skin occurs with hyperfunction of the thyroid and an increase in the basal metabolic rate)

After reviewing the laboratory hormonal profile for four clients, the nurse anticipates which client will need an evaluation for ovarian cancer?

Estradiol is the primary female sex steroid hormone. Estradiol levels mid-menstrual cycle are 150 to 750 pg/mL. Clients with elevated estradiol levels, such as client B, need to be evaluated for possible ovarian cancer. Progesterone levels of 50 ng/dL in client A indicate normal levels. Higher levels of prolactin, 530 ng/mL, in client C indicate possible galactorrhea (breast discharge), pituitary tumor, disease of the hypothalamus or pituitary gland, or hypothyroidism. A luteinizing hormone of 1.02 IU/L in client D indicates possible infertility and anovulation.

A 75-year-old male who has a history of prostate cancer is admitted for a prostatectomy. The client's prostate specific antigen (PSA) levels have been increasing. Which intervention would the nurse to include in the client's plan of care?

Handle the client gently when turning. Increasingly elevated PSA levels may indicate a worsening of the client's condition with possible metastasis to the bone, increasing the risk of pathological fractures; therefore handling must be gentle. Additional fluids will not improve the PSA level. Seizure precautions are not necessary; a PSA elevation indicates bone, not brain, involvement. Elevated PSA levels do not significantly affect the plasma pH.

A school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. Breakthrough pain occurs and a fentanyl "lollipop" is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs?

Hold it in your cheek only until the pain is relieved

A client is admitted to the hospital for an adrenalectomy. Before the client's replacement steroid therapy is regulated fully, the nurse will monitor the client for which complication?

Hypotension

A client with positive family history of testicular cancer arrives at the hospital and reports testicular pain. The primary health care provider reviews the laboratory reports and makes a diagnosis of testicular cancer. After surgery, the client will undergo chemotherapy. Which conditions might occur in this client after chemotherapy? Select all that apply. One, some, or all responses may be correct.

Infertility, heart disease, metabolic syndrome. A family history of testicular cancer is a risk factor for testicular cancer. The client with testicular cancer may report pain in the testicular region. Radical inguinal orchiectomy, chemotherapy, and radiotherapy would be beneficial for this client. Chemotherapy can cause infertility. It can also cause cardiovascular disease and metabolic syndrome. Varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle, not with chemotherapy for testicular cancer. Penile carcinoma is commonly associated with human papillomavirus type 16 infection.

Which prescribed medication would the nurse anticipate administering to a client who tested positive for human epidermal growth factor (HER) and has a diagnosis of advanced breast cancer

Lapatinib. Clients with advanced breast cancer have an overexpressed HER-2. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Treatment of non-Hodgkin lymphoma includes administration of rituximab and tositumomab.

A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. Which explanation will the nurse provide?

Noncancerous cells also are susceptible to the effects of chemotherapeutic medications." Noncancerous cells also are susceptible to the effects of chemotherapeutic medications."

Which client's laboratory result is consistent with a diagnosis of Cushing syndrome?

Normal salivary cortisol level is lower than 2.0 ng/mL. A client with Cushing syndrome has high levels of salivary cortisol levels; therefore, client D has Cushing syndrome. Thus client A, client B, and client C do not have Cushing syndrome because they have normal levels of cortisol in the saliva.

In anticipation of a client returning to the room after a subtotal thyroidectomy, which intervention would be highest priority for the nurse to perform?

Place a tracheostomy set at the bedside

A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response would alert the nurse that the client is experiencing dumping syndrome?

Reactive hypoglycemia. Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia and dumping syndrome. Diarrhea, not constipation, occurs. Steatorrhea, not clay-colored stools, may occur. Anorexia, not sensations of hunger, occurs.

The nurse is caring for a client who is diagnosed with diabetes insipidus and is on intranasal desmopressin acetate (DDAVP). The client develops an upper respiratory tract infection during a hospital stay. Which alteration would the nurse anticipate in the client's prescription?

Reduced DDAVP dose via subcutaneous route (The client develops an upper respiratory tract infection while on DDAVP therapy for diabetes insipidus. The best alternative is to administer the DDAVP via oral or subcutaneous routes. The subcutaneous (parenteral) form of DDAVP is almost 10 times more potent than intranasal and oral forms. If opting for the subcutaneous route, the dose of DDAVP should be reduced. The DDAVP cannot be stopped because it can lead to uncontrolled fluid loss. The DDAVP can be continued in the prescribed dose if opting for the oral route, but it does not need to be reduced. The DDAVP cannot be administered via nasal route because the client has developed an upper respiratory tract infection)

A client who is on long-term corticosteroid therapy after an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. Which statement is an important concern for client safety?

Steroid therapy will need to be increased to avert a life-threatening crisis.

A client is scheduled for a bilateral adrenalectomy. Which rationale describes why steroids are administered to the client?

To compensate for sudden lack of these hormones after surgery

Which equipment would the nurse include when setting up emergency equipment at the bedside of a client in the immediate postoperative period after a thyroidectomy?

Tracheostomy set and oxygen

A client receiving chemotherapy develops a temperature of 102.2°F (39°C). The temperature 6 hours ago was 99.2°F (37.3°C). Which nursing intervention is the priority in this case?

Administer the prescribed antipyretic and notify the primary health care provider of this change. Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.

The nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. Which common clinical manifestations would the nurse include in the teaching program? Select all that apply. One, some, or all responses may be correct.

Anemia, rectal bleeding, changes in bowel habits. And abdominal not rectal pain

The spousal caregiver for a client receiving chemotherapy for inoperable bone cancer asks the nurse, "What can I do to help?" Which action best supports the client's spouse?

Assist the couple to maintain open communication. Clients and their families need to maintain honest, open interpersonal communication for sharing and addressing concerns and future problems. Although an understanding of the disease is important, details will not assist the significant other in maintaining an active, caring role. The spouse may want to know about the action of the medications; however, the knowledge will not help meet the needs of both the spouse and the client. Although the nurse may meet privately with the spouse to explore feelings, this does not address the spouse's immediate concern.

Which instructions would be included when teaching a client with hyperthyroidism who just had radioactive iodine to ablate thyroid tissue?

Avoid holding an infant (Infants are particularly sensitive to radioactivity; even the small amount emitted after treatment may affect infants. It is not necessary to avoid leaving the house as long as close proximity to others is avoided. Saving urine in a lead-lined container is not necessary; the same bathroom may be used by all members of the family, but the toilet should be flushed twice after use by the client. Refraining from using a bathroom used by others is not necessary)

Which symptom would the client in a women's health educational session be taught to report as a possible early indication of cervical cancer?

Bloody spotting after intercourse. Bloody spotting after intercourse may indicate cervical pathology and must be investigated. Discomfort and abdominal heaviness are late signs of cervical cancer, because there are few nerve endings in this area. The cancer must be extensive to cause pressure. Discharge becomes foul smelling after there is necrosis and infection; it is not an early sign.

Which are neurological manifestations of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Blurred vision, exophthalmos (Blurred vision and exophthalmos are the neurological manifestations of hyperthyroidism. Fatigue is the metabolic manifestation of hyperthyroidism. Diaphoresis, or excessive sweating, is the skin manifestation of hyperthyroidism. Shallow respirations are the cardiopulmonary manifestation of hyperthyroidism)

To avoid complications in a client who has developed severe bone marrow depression after receiving chemotherapy for cancer, which actions by the nurse are appropriate? Select all that apply. One, some, or all responses may be correct.

Bone marrow depression causes neutropenia; it is essential to prevent infection in this client by thorough hand washing before touching the client or client's belongings. Thrombocytopenia occurs with chemotherapy-induced bone marrow depression; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary health care provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Clients who have neutropenia may eat raw fruits and vegetables after washing off soil that may contain disease-causing microbes.

A client who had a gastric resection for cancer of the stomach is admitted to a postanesthesia care unit with a nasogastric (NG) tube in place. Which symptom would the nurse expect to observe?

Bright red, bloody drainage in the suction container. Drainage is bright red initially and gradually becomes darker red during the first 24 hours. If the nasogastric tube is functioning correctly, secretions will be removed, and vomiting will not occur. Because the bowel was emptied before surgery and the client is now nothing by mouth, intestinal activity is not expected. If the nasogastric tube is functioning correctly, gastric distention will not occur.

A client with terminal pancreatic cancer says, "I am suffering so much because there are evil spirits in my body." Which religion might the nurse expect the client to practice?

Buddhists believe illness is due to the presence of nonhuman spirits, so this client might practice Buddhism. Muslims believe that time of death is fixed and cannot be changed. Jews and Christians do not believe that evil spirits cause suffering.

Which concept is most important to teach a client in relation to why medication cocktails are more effective than a single medication in cancer therapy?

Cellular growth cycle. Different medications destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one medication may be destroyed by another medication during a different stage of cell replication

Which common response do clients with cancer experience, regardless of the site of the cancer, that accounts for their cachexia?

Changes in taste and food aversions. This problem may occur even when nutritional intake appears adequate. Changes in taste resulting from the cancer or the treatment can reduce appetite and cause food aversions. Some clients experience early satiety or a sense of fullness and inability to eat even though they have eaten only a small volume of food. Depression would not occur in all clients with cancer, and when it does, it does not necessarily cause anorexia. Decreased saliva impeding chewing and swallowing is not a commonality associated with all clients with cancer; it may occur in clients who receive treatment to the head and neck. Nutrients not being absorbed through the gastrointestinal mucosa is not a commonality associated with all clients with cancer; it may occur in clients who receive treatment that affects the gastrointestinal tract.

A client has cancer and reports weakness related to treatment of the cancer. The delegator has delegated the health care team members to care for the client. Which aspects of the care are most appropriate for the registered nurse (RN)? Select all that apply. One, some, or all responses may be correct.

Teaching the client to be hopeful about the treatment, Providing emotional support to the client's family members

Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells?

Combining with DNA strands and interfering with cell replication. Alkylating agents such as nitrogen mustard combine with DNA strands and interfere with cell replication. Some chemotherapeutic medications are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites. Antibiotics, not nitrogen mustard, used in cancer chemotherapy are believed to act by binding with DNA to interfere with RNA production.

The nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. Which risk factor commonly associated with this type of cancer should the nurse assess when collecting the client's history?

Consuming a large amount of alcohol

The nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun to care for the client. Which is the best nursing intervention in preparing for the client's discharge?

Contact the client's health care provider to discuss use of transdermal medications for pain control.

A client with a history of hemoptysis and cough for the past 6 months is suspected of having lung cancer. A bronchoscopy is performed. Two hours after the procedure the nurse identifies an increase in the amount of bloody sputum. Which is the nurse's priority?

Contact the primary health care provide

Which discharge instruction would the nurse emphasize when preparing a client with Addison disease for discharge?

Continue steroid replacement therapy

Which clinical manifestations would the nurse expect a client with hypothyroidism to exhibit? Select all that apply. One, some, or all responses may be correct.

Cool skin, Constipation, Periorbital edema, Decreased appetite. Cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edemas are caused by changes that cause myxedema and third-space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and gastrointestinal manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.

Which clinical manifestation would the nurse expect a client with diabetes insipidus to exhibit?

Decreased urine osmolarity (Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity. Diabetes insipidus does not affect glucose levels; diabetes mellitus affects glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine)

A client with cancer of the colon is admitted to the hospital for a hemicolectomy. Which would the nurse expect the preoperative plan of care to include?

Administering cleansing enemas and then neomycin. After the bowel is cleansed, neomycin is given to decrease gram-negative bacteria in the colon, which should limit postoperative infection. Oil-retention enemas are used to alleviate constipation; oil-retention enemas are not prescribed before surgery because they contaminate the bowel with oil. A Sengstaken-Blakemore tube is used for a client with ruptured esophageal varices, not for a client having a hemicolectomy. A diet to decrease bulk and empty the colon generally is prescribed; usually it is a clear, liquid diet.

Which describes the role of the nurse in the situation where the nurse informs the client's family that the client does not wish to proceed with chemotherapy?

Advocate. The nurse acts as the client's advocate by communicating the client's concern to the family. As an advocate, the nurse protects the client's human and legal rights. The nurse manager coordinates the activities of health care personnel in delivering quality health care. The nurse acts as an educator while explaining concepts and facts about health or demonstrating procedures for self-care activities. The nurse also acts as a caregiver by providing measures to restore a client's physical, emotional, spiritual, and social well-being.

Which hormonal deficiency causes diabetes insipidus in a client?

Antidiuretic hormone (ADH) (ADH deficiency causes diabetes insipidus. Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. Luteinizing hormone deficiency causes menstrual abnormalities, decreased libido, and breast atrophy)

A client has a colostomy after surgery for cancer of the colon. Which postoperative nursing intervention maximizes skin integrity?

Apply stoma adhesive around the stoma and then attach the appliance. Stoma adhesive protects the skin and helps keep the appliance attached to the skin. The appliance should be emptied when it is one-third to one-half full. Allowing one-half inch between the stoma and the appliance is too much space; the enzymes in feces can erode the skin. Initially the nurse should change the appliance; self-care usually is instituted more gradually, depending on the client's physical and emotional response to the surgery.

Which intervention would be included in the plan of care for a client diagnosed with hyperthyroidism?

Arrange for sufficient rest periods (Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite)

female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. Which response by the nurse is appropriate

As long as medication is continued, ovulation will occur

When a client who has seemed cheerful after a diagnosis of lung cancer and pneumonectomy becomes withdrawn after being discharged home, which action by the home health nurse will be best?

Ask the client to describe the current emotional state

An older adult client who is receiving chemotherapy for cancer has severe nausea and vomiting and becomes dehydrated. The client is admitted to the hospital for rehydration therapy. Which nursing actions have specific gerontological implications the nurse must consider? Select all that apply. One, some, or all responses may be correct.

Assessment of skin turgor, Administration of antiemetic medications, Replacement of fluid and electrolytes

While caring for a female client, the nursing student feels a lump in the client's breast. The nursing student tells the registered nurse (RN), "I think this client has breast cancer." Which statements of the RN would be appropriate in accordance with the knowing element of Swanson's theory? Select all that apply. One, some, or all responses may be correct.

Avoid making assumptions., Assess the client thoroughly, Check for other signs of breast cancer." The knowing element of the caring process involves understanding an event. Avoiding assumptions, performing a thorough assessment of the client, and checking for other signs of breast cancer and are related to the knowing element of Swanson's theory of caring. The doing for element includes comforting the client. The caring process of being with involves the nurse providing emotional support.

Which would the nurse teach a client with newly diagnosed pancytopenia caused by chemotherapy?

Avoid traumatic injury and exposure to infection. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase the susceptibility to infection. Although careful oral care may help decrease infection risk, mouth care should be done gently to avoid bleeding. Although fluids may be increased to flush out the toxic byproducts of chemotherapy, this will have no effect on pancytopenia. Unusual tingling sensations in the extremities are not a complication of pancytopenia.

Which finding indicates that a client is at an increased risk for colorectal cancer (CRC)? Select all that apply. One, some, or all responses may be correct.

Dark, tarry stools; a family history of polyposis; a 20-year history of ulcerative colitis; unintentional weight loss of 20 pounds; and a change in bowel patterns lasting 3 months are all findings that would warrant further evaluation for CRC. All of these clients are at higher risk for CRC. Dark, tarry stools occur from occult blood loss. A client who reports a longstanding change in bowel pattern should be tested for CRC. Familial polyposis is a precursor to CRC. Ulcerative colitis is an inflammatory bowel disease that increases the client's risk for CRC. Any client who experiences an unexplained and unintentional weight loss should be evaluated for cancer.

An adolescent child is in the terminal stage of cancer. The parents ask how they will know when death is imminent. The nurse discusses the physical manifestations with the parents. Which are the signs and symptoms of approaching death? Select all that apply. One, some, or all responses may be correct.

Decreased thirst, weak pulse, difficulty swallowing, loss of bladder control. As the flow of blood through the body decreases, the vital centers in the brain, including the centers for thirst and appetite, become dulled; as a result, the child loses the desire for fluid and food. As circulation slows, oxygenation and muscle tone decrease; the heart loses its contractile force, and the pulse becomes weaker and slower. As nerve impulses become weaker, the entire digestive tract is slowed and the child has difficulty controlling the act of swallowing (deglutition), resulting in dysphagia; also, the gag reflex is lost. The loss of sensation and control starts in the lower extremities and progresses upward; control of the bladder and bowel is lost as loss of control reaches the trunk. Bradycardia, not tachycardia, occurs as the heart fails.

The spouse of a 22-year-old client who is being tested for Hodgkin lymphoma tells the nurse, "Don't you think it is unlikely for someone like my spouse to have cancer?" Which information about Hodgkin lymphoma will the nurse use when responding?

Diagnosed during adolescence and young adulthood. Hodgkin lymphoma incidence peaks between the ages of 15 and 35 years and again at age 55 and above. Hodgkin lymphoma is twice as prevalent in men as in women. The incidence of Hodgkin lymphoma is not limited to people in older age groups. Ethnic background is not a risk factor for Hodgkin lymphoma.

client is taking thyroxine to manage hypothyroidism. Which developments indicate to the nurse that the dosage should be reduced? Select all that apply. One, some, or all responses may be correct.

Diaphoresis, tachycardia, nervousness . Diaphoresis, tachycardia, and nervousness are signs of hyperthyroidism, which indicate that too much medication is being taken. Weight gain and cold intolerance indicate that the medication has not yet been effective.

For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be correct.

Diarrhea, bleeding tendencies. Most chemotherapeutic agents interfere with mitosis. The rapidly dividing cells of the mucous membranes of the gastrointestinal tract are affected, causing stomatitis and diarrhea. Bone marrow depression often causes thrombocytopenia, resulting in bleeding tendencies. The bone marrow consists of rapidly dividing cells, and its activity is depressed. Leukopenia, not leukocytosis, can occur. The erythrocyte sedimentation rate generally increases in the presence of tissue inflammation or necrosis. Hemoglobin and hematocrit levels may decrease because of an inadequate number of red blood cells related to bone marrow depression.

A client receiving radiation therapy for neck cancer reports, "I feel a lump while swallowing, and foods get stuck." Which term would the nurse document in the client's medical history?

Dysphagia is having difficulty while swallowing. This characterizes pharyngeal and esophageal involvement, which further impedes eating. In this condition, the client may report a feeling of having a "lump" when swallowing and feeling that "foods get stuck." Dysgeusia is the loss of taste; clients will report that all food has lost its flavor. Although xerostomia may contribute to difficulty swallowing, it is not the term used; xerostomia is used to indicate dry mouth. Odynophagia is painful swallowing; clients will report severe pain while swallowing.

When teaching the actions of cetuximab to a client with colorectal cancer, which process would the nurse explain that cetuximab inhibits?

Epidermal growth factor receptors (EGFRs)

After surgery for cancer of the pancreas, the client's nutrition and fluid regimen are influenced by the remaining amount of functioning pancreatic tissue. The nurse considers both the exocrine and the endocrine functions of the pancreas and expects that, postoperatively, the client's dietary regimen will be focused on the management of which substances?

Fats and carbohydrates. Formation of lipase necessary for digestion of fats is an exocrine function; the endocrine function is to secrete insulin, which is a hormone essential in carbohydrate metabolism. Although it is necessary to avoid alcohol, this is not related to pancreatic exocrine functions; caffeine is unrelated to pancreatic function. Fluid and electrolyte problems are not related specifically to exocrine or endocrine pancreatic functioning. Deficiencies of vitamins and minerals may occur because of inadequate intake, but these deficiencies are not specifically related to exocrine or endocrine pancreatic functioning.

A client is admitted with a diagnosis of stage 0 cervical cancer (carcinoma in situ). Which information about this diagnosis would the nurse emphasize while helping the client understand her diagnosis and prognosis?

Five-year survival rates for this cancer are about 93%. With carcinoma in situ the epithelium is eroded and replaced by rapidly dividing neoplastic cells. There is no distinct tumor; with treatment the prognosis is excellent. Many clients would want information about survival rates, but some would not. The nurse would need to explore the client's preferences for information before discussing survival rates. Preinvasive lesions of the cervix are treated with cryotherapy, laser therapy, or loop electrosurgical excision procedure (the last also known as LEEP). Radiation therapy is used for invasive cervical cancer. Stage II involves the vaginal wall; stage 0 is preinvasive. Stages I to IV are considered invasive by increasing degrees; stage 0 is preinvasive. Treatment is based on the staging.

A client suffering from cancer is near the end of life. Which action(s) would be performed by the nurse to support the client's family members? Select all that apply. One, some, or all responses may be correct.

Helping the family set up hospice, Giving the family information about the dying process, Making sure that the family knows what to do at the time of death. When the client is at the last stage of life, the nurse would help the family set up hospice and other appropriate resources, including grief support. The family members should be informed about the dying process. Make sure that the family knows what to do at the time of death. When the client is hospitalized, take time to make sure that the family is comfortable, and stay with the client in the absence of their family members.

The nurse is caring for a client who is receiving internal radiation for cancer of the cervix. For which adverse reactions to the radiotherapy would the client be monitored? Select all that apply. One, some, or all responses may be correct.

Hemorrhaging, increased temperature. Excessive sloughing of tissue may cause hemorrhage and is considered an adverse reaction. Infection, marked by an increase in temperature, may also develop from excessive sloughing of tissue. Nausea is an expected side effect of internal radiotherapy. Restlessness is not a sign of an adverse reaction; it is associated with a need to maintain a set position to prevent the applicator from being dislodged. Vaginal discharge is an expected side effect of internal radiotherapy.

Which questions would the nurse ask to elicit psychosocial issues in a client with cancer? Select all that apply. One, some, or all responses may be correct.

How is your family dealing with your condition?". How do you rate your distress on a scale of 0 to 10?"

The nurse is performing an assessment of the client's reproductive system. Which finding in the past medical history indicates the client is at risk of cervical cancer?

Human papilloma virus infection

The nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication would the nurse expect to be prescribed for this client?

Hydrocortisone is a glucocorticoid

A client is diagnosed with Cushing syndrome. The nurse would monitor the client for which cardiovascular complication?

Hypertension

The nurse is providing postoperative care for a client 1 hour after an adrenalectomy. Maintenance steroid therapy has not begun yet. The nurse would monitor the client for which complication?

Hypotension. Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension often occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy is performed, adrenal hormones are lowered until replacement therapy is regulated.

Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct.

Institute neutropenic precautions. Doxorubicin and cyclophosphamide can lower the client's blood cell counts. Clients with low WBC counts need interventions to prevent infection, which include instituting neutropenic precautions. The nurse would instruct the client to use an electric razor if the platelet count was less than 50,000 cells/µL. Airborne precautions would be indicated if the client was ill with an infectious disease. The nurse would transfuse RBCs for a client with anemia (if prescribed by the health care provider). Nursing staff would wear dosimeter badges when caring for a client receiving internal radiation (brachytherapy).

A client is admitted to the hospital with a diagnosis of a large, cancerous tumor of the sigmoid colon, and surgery for a colon resection is scheduled. Which clinical finding would the nurse expect when completing the client's nursing admission history and physical?

Rectal bleeding. Tumors of the sigmoid colon are associated with rectal bleeding. Diarrhea alternating with constipation frequently occurs. Dehydration usually does not occur unless there is severe vomiting or severe prolonged diarrhea. A change in the shape of stool occurs with tumors in the descending colon and sigmoid colon.

A client from China is referred to the National Cancer Institute in the United States for the treatment of a brain tumor. Which type of health information technology oversees the exchange of the client's health information among the client's health care providers and between the two countries?

Regional Health Information Organization (RHIO). An RHIO is an essential element of the health information technology infrastructure. It supervises the exchange of a client's information among health care providers and across geographic areas

A primary health care provider prescribes total parenteral nutrition (TPN) for a client with cancer of the pancreas. A central venous access device is inserted. Which reason would the nurse identify as the purpose for using this type of access?

The amount of blood in a major vein helps dilute the solution. Unless diluted, the highly concentrated solution can cause vein irritation or occlusion. Although it permits free use of the hands, this is not the primary reason for a central line. Infection can occur at any invasive site and requires diligent care to avoid this complication. The chance of the infusion infiltration decreasing is not the primary reason, although the infusion at this site is more secure than a peripheral site and promotes free use of the hands.

A client has a surgical creation of a colostomy for cancer of the rectum. The client asks, "What's the difference between irrigating a colostomy and having an enema?" The nurse should differentiate between the two procedures by explaining that the colostomy irrigation procedure involves which step?

Using a cone-shaped tip catheter. A cone-shaped tip controls the depth of insertion of the catheter, which prevents perforation of the bowel and limits leakage of water from the stoma during fluid insertion. In both procedures, the catheter tip should be lubricated with a water-soluble jelly, which limits trauma to the intestinal mucosa. In both procedures, the tubing should be clear of air to facilitate the tolerance of a larger volume of irrigating solution. In both procedures, cramping can occur.

How would the nurse assess for unilateral injury of the laryngeal nerve when caring for a client immediately after a subtotal thyroidectomy?

Ask the client to say what the current time is

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which is the most appropriate initial nursing response?

Encouraging expression of concerns. Open communication helps decrease anxiety. An important initial step is to allow the client to express concerns. This is beneficial to the client as well as the nurse, who can identify needs that the client has. Identifying the client's support systems, teaching stress reduction techniques, and explaining that there are many effective cancer treatments can be included in the client's plan of care; these interventions can take place later.

A client who has been told she needs a hysterectomy for cervical cancer reports being upset about being unable to have a third child. Which action would the nurse take?

Ensure that other treatment options for her are explored

A client with stage I seminoma underwent chemotherapy. Which adverse effects of chemotherapy would the nurse inform the client about? Select all that apply. One, some, or all responses may be correct.

Metabolic syndrome, cardiovascular disease. Clients who receive chemotherapy are at a future risk of metabolic syndrome and cardiovascular disease. Obese clients are at risk of developing asthma. Females with amenorrhea and eating disorders are at a risk of developing osteoporosis. Genital warts are commonly associated with the human papilloma virus.

After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, which information will the nurse share about alopecia characteristics?

Not permanent. Once the medications that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the medications are being received; once the medications are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.

The nurse observes vaginal packing protruding from the client's vaginal vault after radium implants for cervical cancer were inserted. Which rationale supports the need for the nurse to contact the client's primary health care provider immediately?

The radioactive packing will injure healthy tissue. During the procedure, vaginal packing maintains the radium implant in the correct location; correct placement minimizes the effect on healthy tissue. There should not be active bleeding with a radium implant; there is an expectation of cellular sloughing. Although exposure to the radioactive packing damages healthy tissue, it is not life threatening.

A client is worried about what to expect after having a pancreatoduodenectomy (Whipple procedure) for cancer of the pancreas. In helping this client plan for the future, which concept would the nurse need to understand?

The stage and grade of the client's cancer

Which assessment finding differentiates central and nephrogenic diabetes insipidus?

Urine osmolarity (Polydipsia and polyuria are signs of diabetes insipidus. When a water deprivation test is performed, urine osmolarity is increased dramatically from 100 to 600 mOsm (mmol)/kg in clients with central diabetes insipidus. But in nephrogenic diabetes insipidus, the urine osmolarity may not be greater than 300 mOsm (mmol)/kg. The urine output is 2 to 20 L/day in all types of diabetes insipidus. The specific gravity is less than 1.005 in all types of diabetes insipidus and the serum osmolarity is also greater than 295 mOsm (mmol)/kg in all types of diabetes insipidus)

A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy?

white blood cell count. Antineoplastic medications depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (PRBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of PRBCs.

Which clinical findings would the nurse expect when assessing a client with Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Lability of mood, Slow wound healing

Which client activities warrant the highest priority for education about health promotion to prevent head and neck cancer? Select all that apply. One, some, or all responses may be correct.

Tabasco, multiple sex partners, hx of alcohol abuse. Which client activities warrant the highest priority for education about health promotion to prevent head and neck cancer? Select all that apply. One, some, or all responses may be correct.

The nurse teaches an adolescent who has completed chemotherapy for acute lymphocytic leukemia (ALL) about the administration of mercaptopurine. Which statement by the adolescent indicates teaching has been effective?

This will help prevent a relapse. Mercaptopurine is given as maintenance therapy to prevent relapses. Mercaptopurine is an oral medication. Oral chemotherapy is an adjunct to other therapies in childhood leukemia, not an alternative for other therapies. The prime site of metastasis of ALL is the central nervous system.

The nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone can be impaired in its production because of this disease?

Aldosterone. Aldosterone can be impaired in its production because of Addison disease, although Addison disease itself is caused by a cortisol deficiency. Aldosterone causes the kidneys to retain sodium ions. Increased sodium promotes water retention, which elevates blood pressure. The absence of aldosterone causes hypotension. The major effect of cortisol is on glucose metabolism and not on sodium and water concentrations, so the absence of this hormone will not cause significant hypotension. Estrogen and androgens are sex hormones and do not affect blood pressure.

A client with cancer is scheduled for a bone scan. Which comment by the client indicates to the nurse that the teaching before the scan is effective?

"A low radioactivity substance will be injected into my vein and a machine will detect where it goes." A bone scan maps the uptake of a bone-seeking radioactive isotope; an increased uptake is seen in metastatic bone disease, osteosarcoma, osteomyelitis, and certain fractures. A bone scan measures the uptake of radioactive material, not the absence of calcium, which is seen in an x-ray examination of bone. The response "Portions of my bone marrow will be removed and examined for cell composition" refers to a bone marrow aspiration, when a small amount of marrow is examined to determine the presence of abnormal cells in diseases such as leukemia. A bone scan involves a small diagnostic dosage of a radioactive substance; it is not therapeutic.

A client admitted with a diagnosis of cervical cancer tells the nurse "I haven't had a Papanicolaou (Pap) smear for more than 8 years. I probably wouldn't be in the hospital today if I'd had those tests more often." Which response would the nurse provide?

"You feel as though you've neglected your health

After a cholecystectomy to remove a cancerous gallbladder, a client has a T-tube in place. The T-tube drains 300 mL of bile-colored fluid during the first 24 hours after surgery. Which action would the nurse take?

Consider this an expected response after surgery and record the results. The T-tube provides an outlet for bile produced by the liver and is expected to drain 300 to 500 mL in the first day. Clamping the tube during the early postoperative period may cause a buildup of pressure and leakage of bile into the peritoneum. The health care provider prescribes the rate of fluid administration. Drainage from the T-tube is by gravity; negative pressure is not applied.

Which instruction would be included in the discharge plan for a client status post-total thyroidectomy?

Take thyroid replacement medications as prescribed.

After head and neck surgery for cancer, the client reports that the neck dressing is tight. Which action would the nurse take?

Assess for signs of constriction. If the dressing is too tight, impaired cerebral circulation may result. Also, the client must be assessed for the presence of edema or a hematoma that may be compressing structures in the neck, which may compromise the airway. Bleeding will not cause the client to report feelings of tightness. The dressing may be loosened or removed only if prescribed by the primary health care provider. A pressure dressing is not necessary after this type of surgery.

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing?

Denial

Which condition would the nurse document to describe a client presenting with the loss of the ability to taste after cancer treatment has affected the client's ability to eat food?

Dysgeusia. Dysgeusia is the loss of the ability to taste, which can occur after treatment for cancer. Mucositis is the inflammation and irritation of the mucosa in the mouth or throat. Dysphagia is difficulty in swallowing or an inability to swallow. Xerostomia is dry mouth. All four of these complaints are common side effects of chemotherapy or radiation treatment.

Which discharge instructions would the nurse include for a woman who has undergone breast-conserving surgery (lumpectomy) for breast cancer?

Emphasizing the importance of breast self-examination

The nurse teaches a client who is scheduled to receive intravenous chemotherapy for ovarian cancer about the use of imagery to maximize the effects of the chemotherapy and reduce the side effects. Which statement would the nurse use regarding this alternative therapy?

Focus on the droplets of chemotherapy attacking the cancer cells. Imagery is the application of the conscious use of the power of imagination with the intention of activating biological, psychological, and spiritual healing. The individual creates mental pictures of the desired outcome from memories, dreams, fantasies, and hopes. Meditation, not imagery, quiets the mind and focuses on the present to release fears, worries, anxieties, and doubts concerning the past and the future. Music therapy, not imagery, aligns the body, mind, and spirit with its own fundamental frequency, which brings about changes in emotions and functioning. Aromatherapy, not imagery, uses essential oils to stimulate the olfactory receptors and ultimately the brain, where many believe the products influence emotions, memory, and a variety of bodily functions such as heart rate, blood pressure, breathing, and immune responses.

A client has a hysterectomy, salpingo-oophorectomy, tumor removal, and multiple abdominal biopsies for ovarian cancer. For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus would the nurse assess the client? Select all that apply. One, some, or all responses may be correct.

Increased temperature, Decreased oxygen saturation level, Sudden onset of shortness of breath

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Which action of PTU will the nurse include in teaching?

Interferes with the synthesis of thyroid hormone (PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil)

Which mechanism of action explains how propylthiouracil (PTU) manages hyperthyroidism?

It decreases production of thyroid hormones. (PTU is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.)

The nurse is obtaining a history and performing a physical assessment of a client who has cancer of the tongue. Which clinical findings would the nurse expect to identify? Select all that apply. One, some, or all responses may be correct.

Leukoplakia, Alterations in taste, Enlarged cervical lymph nodes. Leukoplakia are white, thickened patches that tend to fissure and become malignant; ulcerations in the mouth or on the tongue may indicate cancer. Taste buds in the tongue may be impaired, resulting in alterations in taste. Regional lymph nodes enlarge as cancer cells begin to metastasize. Halitosis is not an early sign of or specific to cancer of the mouth. Bleeding gums occur in gingival diseases, not cancer of the tongue. Pain associated with cancer of the tongue does not radiate to the substernal area.

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. Which is the nurse's priority action immediately postoperative?

Monitor the trachea for deviation to the right or left

A client with stomach cancer expresses a lack of interest in food and consumes only small amounts. Which nursing intervention is best for meeting the dietary needs for this client?

Nutritional supplements between meals. Nutritional problems, especially weight loss, develop in clients with stomach cancer. Nutritional supplements provide more adequate calories and nutrients. Although smaller food portions given more frequently may be helpful, adding nutritional supplements between meals is important to ensure the client receives adequate daily nutritional requirements. Vitamins do not stimulate appetite. Offering only food the client likes in small portions at mealtimes would not ensure adequate nutrition; if reducing the portion size, meal frequency must be increased.

The nurse is caring for a client who has cancer of the rectum and is scheduled for an abdominoperineal resection with creation of a colostomy. For which type of surgery would the nurse prepare the client?

Permanent sigmoid colostomy. When intestinal continuity cannot be restored after removal of the anus, rectum, and adjacent colon (abdominoperineal resection), a permanent colostomy is formed. The ascending segment of the colon lies on the right side of the abdomen and has no anatomical proximity to the rectum. Temporary double-barrel colostomy is performed to allow a segment of colon to heal; intestinal continuity is restored eventually. Temporary transverse loop colostomy commonly is performed for inflammation of the colon when intestinal continuity eventually can be restored.

Three days before surgery for a permanent colostomy because of cancer of the colon, a client is receptive to all procedures, responds pleasantly when approached, and does not question staff about interventions or care being received. Which conclusion should the nurse make based on these behaviors?

The client is not verbalizing feelings about concerns. Both a diagnosis of cancer and a colostomy drastically alter self-image and body image. People react differently to this stress, often finding it difficult to express their concerns verbally; however, their actions may demonstrate awareness of the situation. There is not enough information available to support the conclusions that the client is fully informed about expectations, is not accepting of the illness and the need for surgery, or is feeling reassured by health care members.

A client who is to undergo dilation and curettage and conization of the cervix for cancer appears tense and anxious. Which approach would the nurse use to support the client emotionally?

Asking whether something is troubling the client and whether she'd like to talk about it

Which nursing intervention would be recommended for a client after a radiation implant is inserted as part of internal radiation therapy for cervical cancer?

Ensuring that the client's diet is low residue. Clients with internal radiation for cervical cancer are given a low-residue diet and often medications to suppress peristalsis and prevent pressure from bowel movements. The necessity for this altered diet should be explained to the client. If the head of the bed is elevated, the implant may be dislodged by gravity. A catheter is inserted routinely before loading to prevent bladder distention and possible radiation damage or alteration of implant position. Because the client is the source of radiation, the nurse must limit the time spent with the client to prevent excessive exposure.

Which action would the nurse include in the plan of care to prevent oral infections in a client preparing to undergo surgical resection for esophageal cancer? Select all that apply. One, some, or all responses may be correct.

Good oral care is essential for clients undergoing esophageal cancer resection to prevent infections of the oral cavity. The nurse would ensure that the client soaks the dentures every night to prevent food particles from causing irritation and infection. Yankauer suctioning helps the client remove excess secretions. Chlorhexidine is frequently used to decrease the incidence of oral infections. IV fluids promote good hydration, which lubricates the oral cavity. Sugar-free candy can also be used to keep the mouth moist.

A client who is admitted to the hospital with liver cancer and ascites is scheduled for a paracentesis. Which nursing intervention would be included in the client's plan of care?

Having the client void before the procedure

Which cause of Cushing syndrome would the nurse consider before assessing a client for physiological responses?

Hyperplasia of the adrenal cortex

Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication would the nurse suspect the client is experiencing?

Hypocalcemia

A client reports irregularity of menses and weight loss and is diagnosed with hypothyroidism. Which type of menstrual disorder does this client have?

Hypogonadotropic amenorrhea. <meta charset='utf-8'><span style="color: rgb(68, 68, 68); font-family: Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(246, 195, 195); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Hypogonadotropic amenorrhea may be due to an interruption in the hypothalamic pituitary axis; this disruption results in endocrine disorders such as hypothyroidism and absence of menstruation. Primary amenorrhea is the absence of menses by 16.5 years regardless of normal growth and development. Dysmenorrhea, primary or secondary, is pain before or during menstruation.</span>

Neomycin is prescribed preoperatively for a client with colon cancer. The client asks why this is necessary. Which response would the nurse provide?

It kills intestinal bacteria to decrease the risk for infection. Neomycin is an aminoglycoside antibacterial medication that provides preoperative intestinal antisepsis. Neomycin is not a cancer chemotherapeutic medication; therefore, it does not kill cancer cells. It is not an anti-inflammatory medication; therefore it is not given for that purpose. Antibiotic alteration of body flora increases the risk for superinfections, rather than preventing them.

A client with cervical cancer is undergoing a course of internal radiation. She has an indwelling urinary catheter and a vaginal applicator in place. Once the primary health care provider has loaded the applicator with the radiation source, which actions would the nursing care plan include?

Leaving the urinary catheter undisturbed Preventing the occurrence of complications is a major goal during internal radiation treatment. If the source of radiation is disturbed, injury to the client, as well as to the personnel caring for her, may result. The area surrounding the urinary catheter is not touched or cleansed. Linens are changed only when necessary; they are kept in the client's room until therapy is complete. As a means of preventing dislodgement of the radiation applicator, the area surrounding the source of internal radiation is not touched or cleansed. Displacement may result in unnecessary tissue damage or exposure of the nurse to radiation. Equipment is usually kept in the client's room until the source of radiation is removed.

A client with hyperthyroidism has been treated with radioactive iodine ( 131I) to destroy overactive thyroid gland cells. To reduce radiation exposure, which would the nurse consider when providing care?

Limiting time with and increasing distance from the client (When caring for clients who are radioactive, the three most important concepts for reducing radiation exposure are to limit exposure time, increase distance, and use shielding. In this situation, time and distance provide the best reduction in radiation exposure. Wearing a lead-shield apron will help prevent radiation exposure, but time and distance are the first priorities. A radiation meter measures exposure, but does nothing to protect caretakers. Remaining at least 6 feet (1.8 m) away from the client at all times is not a practical approach)

A 55-year-old client has been diagnosed with endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. One, some, or all responses may be correct.

Obesity, smoking, family hx, previous hormone replacement therapy. Obesity is a risk factor for endometrial cancer because adipose cells store estrogen; the extent of exposure to estrogen is the most significant risk factor. Nulliparity, not multiparity, is a risk factor for endometrial cancer because of the increased exposure to estrogen. Cigarette smoking has been identified as a risk factor for endometrial cancer. Late, not early, onset of menopause is a risk factor for endometrial cancer because of the increased exposure to estrogen. Although endometrial cancer has not been proven to have a genetic predisposition, it is more common in families who have gene mutations for hereditary nonpolyposis colon cancer.

Which action is appropriate to include in the plan of care for a client who just had a subtotal thyroidectomy?

Observe for signs of tetany. The parathyroid glands may be excised accidentally during surgery; because they regulate calcium, lowered blood levels of calcium may induce tetany

Which position would the nurse maintain a client in after a thyroidectomy?

The semi-Fowler position. Limits edema in the operative area via gravity and promotes respirations by facilitating thoracic expansion. The prone, supine, and Sims position will promote edema in the operative area, which can compromise respirations.

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. Which concern about the client would prompt the nurse to notify the primary health care provider?

There is a decreased ability to handle stress despite steroid therapy. Clients with adrenocortical insufficiency who are receiving steroid therapy usually require increased amounts of medication during periods of stress because they are unable to produce the increased levels of glucocorticoids needed by the body at this time

A client is scheduled for skin cancer surgery and has not signed the consent form. Which situation will cause the nurse to legally delay signing the operative consent?

A sedative type of medication has been given recently. Sedation may interfere with the client's knowledge of the consent form. Many clients face contradictory feelings regarding their impending surgery, but their consent is legal unless they withdraw the consent. A complete history and physical examination are needed before surgery, but they do not affect the legality of consent. A second opinion is not required for a consent to be legal.

The nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan?

Consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium

A client with early-stage cancer of the esophagus is treated with laser therapy. When oral intake is permitted, which type of dietary selection should the nurse recommend to the client?

Liquids. Liquid foods are less irritating to the esophageal mucosa. Cold food is not as "easy" as liquids. High-protein foods are desirable because they promote tissue repair. High-calorie foods are desirable for maintaining weight, promoting anabolism, and preventing negative nitrogen balance.

Which finding would the nurse expect in the urinalysis report of a client with diabetes insipidus?

Specific gravity of urine: 0.4 (The normal specific gravity of urine lies between 1.003 and 1.030. The specific gravity of urine of clients with diabetes insipidus is low due to the impaired functioning of antidiuretic hormone. The pH of normal urine ranges from 6.5 to 7.0. A pH higher than 8 indicates a urinary tract infection (UTI). Normal urine contains between 0 and 4 hpf of RBCs. A count greater than 4 hpf indicates tuberculosis, cystitis, neoplasm, and glomerulonephritis. In a normal urine sample, WBCs lie in the range of 0 to 5 hpf. Any increase in the number of WBCs indicates a urinary tract inflammation.)

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse expect to be prescribed for the client?

Vitamin B 12 injections. A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200-835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia because of a vitamin B 12 deficiency and should be given vitamin B 12 injections. Vitamin B 12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb vitamin B 12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron-deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.

Before major abdominal surgery for cancer, a client says to the nurse, "I really don't think this is cancer at all. I'll bet they won't find anything." Which is the most appropriate initial response by the nurse?

"I can understand why you'd like to believe that is true." The response, "I can understand why you'd like to believe that," indicates recognition of the client's need to use denial and opens the way for a discussion of feelings. Some texts, like Comprehensive Review for the NCLEX-RN Examination, 4th edition, labels this response "acknowledgment," which means recognizing the client's opinions and statements without imposing your own values and judgment. The response, "I hope you're right, although tests indicate cancer," forces reality on the client and blocks a discussion of feelings. The reply, "It must be difficult to be facing such serious surgery," focuses on the surgery, which is not the concern expressed by the client. The reply, "You think the health care provider may have made a wrong diagnosis?" focuses on the health care provider rather than on the client's feelings.

Which finding would the nurse expect for a client who has just developed the syndrome of inappropriate secretion of antidiuretic hormone (ADH)?

Decreased urine volume (ADH causes water retention, resulting in decreased urine output. Blood volume may increase, causing dilution of nitrogenous wastes in the blood. The client is overhydrated so that serum sodium is decreased, producing a dilutional hyponatremia. ADH acts on nephrons to cause water to be reabsorbed from glomerular filtrate, leading to an increased specific gravity of urine)

Propylthiouracil and potassium iodide are prescribed for the client with hyperthyroidism. Which statement would the nurse include in the client's plan of care?

Assess the client for signs of infection and bleeding every shift (Propylthiouracil can cause depression of leukocytes and platelets. This creates an increased bleeding risk. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Medication therapy decreases the risk of postoperative hemorrhage because this medication regimen decreases the size and vascularity of the thyroid gland. Medication therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range)

A client is admitted to the hospital for a needle biopsy of the liver. A diagnosis of liver cancer is suspected. Which would the nurse include in the client's preoperative teaching plan?

Bed rest must be maintained after the procedure. Bed rest in the right side-lying position for 2 hours after the procedure applies pressure to the insertion site and reduces the risk of bleeding. A needle biopsy requires a puncture wound over the liver, not an abdominal incision. A liver biopsy is done with local anesthesia. The supine position is contraindicated. The client should be positioned in the right side-lying position for 2 hours after the procedure; this applies pressure to the insertion site and reduces the risk of bleeding

A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, which symptom does the nurse expect the client to report?

Pruritus. Itching associated with jaundice is believed to be caused by accumulating bile salts in the skin. Diarrhea, blurred vision, and bleeding gums are not related to jaundice.

The nurse is assessing a client who is undergoing chemotherapy. The nurse notes that the client is using a scarf to cover the head. The nurse asks the client about coping with the altered body image. Which functional pattern would the assessment include?

Self-perception-self-tolerance pattern. The nurse is applying Gordon's self-perception-self-tolerance pattern to assess the client. This functional pattern describes the client's self-worth, emotional patterns, and body image. The value-belief pattern describes patterns of values, beliefs, spiritual practices, and goals that guide the client's choices or decisions. The role-relationship pattern describes patterns of role engagements and relationships. The cognitive-perceptual pattern describes sensory-perceptual patterns, language adequacy, memory, and decision-making ability.

Which is the correct response to a parent whose child is undergoing chemotherapy and is not up to date on required immunizations for school?

This isn't the best time to finish the immunizations, because your child's immune system is suppressed." Chemotherapy compromises the immune system. The vaccines may be administered after the completion of the chemotherapy protocol, once the immune system has returned to its previous state. The child has not developed sufficient antibodies; booster immunizations are needed, but not at this time. Administering immunizations at this time could prove fatal.

A client with hyperthyroidism is being treated with propylthiouracil (PTU). Which instruction will the nurse include in the teaching plan regarding this medication? Select all that apply. One, some, or all responses may be correct.

Avoid abrupt discontinuation of the medication, Monitor your weight, pulse, and mood routinely., Report side effects, such as sore throat, fever, joint pain, or oral lesions." (Abrupt discontinuation of the medication may result in thyroid crisis. PTU blocks the synthesis of T 3 (triiodothyronine) and T 4 (thyroxine). The therapeutic effect of the medication should result in increased weight, decreased pulse, and stability of mood. Sore throat, joint pain, fever, or oral lesions may indicate infection caused by medication-induced blood dyscrasias, such as leukopenia and agranulocytosis. The response to this medication may take up to 3 weeks. Over-the-counter medications and seafood containing iodine should be avoided)

The nurse is admitting a client with severe myxedema coma. Which interventions would the nurse include in the plan of care? Select all that apply. One, some, or all responses may be correct.

- Administer intravenous (IV) levothyroxine. - Giving IV normal saline Myxedema coma is a major complication of poorly treated hypothyroidism. Interventions include administering IV levothyroxine. This promotes the return to normal thyroid hormone levels. IV normal saline corrects dehydration. Corticosteroids are administered as part of the treatment. Levothyroxine is initiated before obtaining laboratory results because waiting can cause death. The blood pressure should be monitored hourly.

Which physiological responses would the nurse expect when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Blurred vision, Increased appetite, Widened pulse pressure (Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate)

The nurse identifies which clinical manifestations as being characteristic of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Diaphoresis, weight loss, protruding eyes

Which clinical findings would the nurse expect when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct

Diarrhea, weight loss

The nurse is caring for a client hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which action performed by the nurse may result in a positive outcome of the treatment?

Changing the position of the client frequently (Changing the position of the client frequently helps in maintaining skin integrity and joint mobility. The head of the bed should not be elevated more than 10 degrees to enhance venous return to the heart. The client's weight should be obtained daily to help assess fluid retention. In acute care settings, the client's fluid intake should be no more than 800 to 1000 mL/day. Fluid intake is restricted to 500 mL/day in severe hyponatremia cases)

Which long-term effect is associated with untreated congenital hypothyroidism?

Cognitive impairment. Congenital hypothyroidism is the result of insufficient secretion by the thyroid gland because of an embryonic defect. A decreased level of thyroid hormone affects the fetus before birth during cerebral development, so it is likely that there will be some cognitive impairments at birth. Treatment before 3 months of age will prevent further damage. Congenital hypothyroidism does not become myxedema. Thyrotoxicosis is another term for hyperthyroidism. Although it is not expected, it may occur with an overdose of exogenous thyroid hormone, but it is too soon to discuss this possibility with the parents. Spastic paralysis occurs only if the infant has cerebral palsy.

Which finding would be expected in a client with a history of hypothyroidism? Select all that apply. One, some, or all responses may be correct.

Cold intolerance, lethargy, fatigue, hemoglobin 11.2, 15 lbs weight gain, HR 59 (A client with hypothyroidism would report feeling cold all the time, lethargy, and fatigue. These symptoms occur as a result of decreased metabolism from low thyroid hormone levels. Clients with hypothyroidism may also be anemic (as evidenced by a hemoglobin of 11.2 g/dL), report weight gain, and have bradycardia (heart rate 59 beats/min).

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. Which purpose would the nurse include when explaining why this medication is prescribed?

Decreases the size and vascularity of the thyroid gland (Potassium iodide aids in decreasing the size and vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed; it should be given no longer than 10 to 14 days before surgery because its effect is temporary. Thyroid hormone substitutes regulate the body's metabolism. Maintaining the function of the parathyroids is not the therapeutic action of potassium iodine. The parathyroid glands help regulate adequate levels of calcium in the blood. When hypocalcemia occurs, the parathyroid glands increase the absorption of calcium from urine and the intestine and stimulate the breakdown of bone matrix, increasing the release of calcium from bone. Antithyroid medications, not iodine, prevent the formation of thyroxine)

The nurse is teaching a client who had a thyroidectomy to observe for symptoms of surgically induced hypothyroidism. Which symptoms would be included in the teaching plan? Select all that apply. One, some, or all responses may be correct.

Dry skin, Lethargy, Sensitivity to cold. Dry skin is a response to hypothyroidism that is related to the associated decreased metabolic rate. Lethargy and sensitivity to cold are symptoms related to hypothyroidism that are associated with a decreased metabolic rate. Insomnia and tachycardia are related to hyperthyroidism, not hypothyroidism.

A client is diagnosed with hyperthyroidism, and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, which instruction would the nurse teach the client?

Eliminate coffee, tea, and cola from the diet(Coffee, tea, and cola contain caffeine, which may increase thyroid activity. Hyperactivity is a physiological response; it is not under conscious control. The increased metabolic rate associated with hyperthyroidism will make the client feel warm; a cool environment is needed. Hyperactivity is a problem, and the client should be encouraged to rest)

After treatment with propylthiouracil for hyperthyroidism, a client has the thyroid ablated with 131I. On a visit to the endocrine clinic, the client exhibits signs and symptoms of thyrotoxic crisis (thyroid storm). Which alteration is the likely cause of thyrotoxic crisis?

Excessive hormone replacement (Thyrotoxic crisis (thyroid storm) is the body's response to excessive circulating thyroid hormones. A deficiency of iodine results in a deficiency in thyroid hormone production. A decreased serum calcium causes tetany. Sodium retention is unrelated to thyrotoxic crisis; thyrotoxic crisis is caused by excessive circulating thyroid hormones)

Which symptom might the nurse identify when assessing a client with hyperthyroidism?

Fatigue (Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism)

Which manifestations are exhibited with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)?

Hyponatremia and decreased urine output. Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

Which symptoms indicating thyroid storm would the nurse monitor a client for? Select all that apply. One, some, or all responses may be correct.

Increased T, HR, BP. Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby causing an increased heart rate (tachycardia). Because of the increased metabolic rate associated with thyroid storm, body temperature will increase. Because of the increased metabolic rate associated with thyroid storm, the respiratory rate increases (tachypnea) to meet the body's oxygen needs. Pulse deficit, the difference between apical and peripheral pulse rates, is not indicative of thyroid storm. The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.

The nurse is caring for a client with nephrogenic diabetes insipidus who is prescribed a low-sodium diet and chlorothiazide therapy. Which alternative treatment would the nurse be prepared to administer if the client fails to respond to the therapy?

Indomethacin (When a low-sodium diet and thiazide medications such as chlorothiazide are ineffective in a client with nephrogenic diabetes insipidus (DI), indomethacin is prescribed. This medication helps increase the renal responsiveness to antidiuretic hormone. Furosemide is not recommended for nephrogenic DI. Chlorpropamide helps decrease thirst seen in clients with central DI. Lysine vasopressin is also prescribed to clients with central DI. Because the kidney is unable to respond to antidiuretic hormone in nephrogenic DI, hormone therapy has little effect)

Which medication might have caused hypothyroidism in a neonate?

Methimazole (Methimazole is used to treat hyperthyroidism and is contraindicated during pregnancy because its use may cause hypothyroidism in the neonate. Lithium may cause cardiac defects in a neonate. Androgens may cause masculinization of a female fetus. Used to treat hypothyroidism, levothyroxine is a safe medication to be taken during pregnancy)

The nurse is caring for a client. Which statement would the nurse consider when administering opioids to a client with myxedema who has undergone abdominal surgery?

One-third to one-half the usual dose should be prescribed. Because of a decreased metabolism, the usual adult dose of an opioid may result in an overdose. A decreased basal metabolic rate prolongs the time for medication detoxification and elimination. Hypothyroidism does not alter tolerance. Opioids do not alter the thyroid hormone; opioids will cause excessive sedation, not hyperactivity.

Which clinical findings would the nurse expect to identify when completing a nursing admission history and physical on a client with suspected hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Palpitations, Tachycardia, Missed menstrual periods (Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema)

One week after beginning antithyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis. Which intervention is appropriate to implement for this client?

Reduce body temperature and heart rate (Immediate treatment in this emergency focuses on reduction of oxygen demands and thus cardiac workload to prevent cardiac decompensation. The need is for an increase, not decrease, in fluid intake to compensate for that loss because of the high metabolic rate. A response to sedatives is not likely because medications are metabolized more rapidly with thyrotoxic crisis; there is a danger of exaggerated effects of the medication with hypothyroidism. Clients with thyrotoxic crisis are more apt to develop hypoglycemia from the high metabolic rate)

The nurse is planning care for a client with diabetes insipidus (DI). Which intervention made by the nurse requires correction?

Restricting fluids at night (A client with DI is at risk for severe fluid volume deficit due to increased urination. Therefore the nurse would never restrict fluids for longer than 4 hours, because it can lead to severe dehydration. The nurse would assess sodium levels, measure urine output, and have the client change positions slowly)

A primary health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the medication, the client calls the nurse and complains of feeling tired and looking pale. Which action would the nurse take for this client?

Schedule the client for an appointment (The client should be examined by the primary health care provider, and blood tests should be prescribed; anemia may result from the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a primary health care provider's prescription; advising the client to alter the dosage of a medication is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a primary health care provider's prescription; advising the client to alter the dosage of a medication is not within the legal role of the nurse)

Which assessment findings would indicate the need for atenolol in a client diagnosed with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Tachycardia, Atrial fibrillation, Systolic hypertension (In hyperthyroidism, atenolol is prescribed to reduce cardiac manifestations. Tachycardia, atrial fibrillation, and systolic hypertension are cardiac manifestations associated with hyperthyroidism. Distant heart sounds are associated with hypothyroidism. The cardiac output is increased in hyperthyroidism)

The nurse is educating a client with hypothyroidism about the use of levothyroxine. Which information would the nurse provide? Select all that apply. One, some, or all responses may be correct.

Take dose same time each day, Refrain from switching brands, Have regular bloodwork drawn. Clients taking levothyroxine should take the same dose the same time each day and should not switch medication brands. The client should have regular thyroid levels drawn to ensure accurate dosage. The medication should be held if the client is experiencing tachycardia, or a heart rate greater than 100 beats per minute. The client with hypothyroidism will begin to lose weight with medication as thyroid levels stabilize.

An infant with congenital hypothyroidism receives levothyroxine for 3 months. Which finding would indicate to the nurse that the medication is effective?

The infant is alert and interactive. Infants with congenital hypothyroidism are lethargic, and may even need to be awakened and stimulated to nurse; therefore an infant who is alert and interacts appropriately for its age would demonstrate improvement. Cool skin is a clinical sign of hypothyroidism related to a slow basal metabolic rate. Fine hand tremor is related to hyperthyroidism and is not present in an infant with hypothyroidism, even one whose condition is being stabilized with levothyroxine. An increased thyroid stimulating hormone level would indicate inadequate treatment.

When a female client becomes hypothyroid, levothyroxine is prescribed. The client asks whether she can become pregnant while taking levothyroxine. How will the nurse respond?

This medicine will not interfere with your ability to become pregnant. Hormone replacement should stabilize the metabolic rate and should not interfere with the client's becoming pregnant. If thyroid function remains controlled, there is no reason why the client should not become pregnant. Because thyroid function will be normalized, the fetus will not be negatively affected, and pregnancy risk will not be increased.

A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. One, some, or all responses may be correct.

Tremors, Heat intolerance (Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine)

Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct.

Tremors, diaphoresis, nervousness, temp 101, HR 116 ( Clients with hypothyroidism can develop thyrotoxicosis from an acute overdose of thyroid hormone. Tremors, diaphoresis, and nervousness are all signs of thyrotoxicosis. Clients may also be hyperthermic and tachycardic.)

Which measures would the nurse include when teaching a client with hyperthyroidism how to manage the discomfort associated with exophthalmia? Select all that apply. One, some, or all responses may be correct.

Use tinted glasses, elevate HOB 45 degrees, Tape eyelids shut at night if they do not close (Tinted glasses decrease light on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly)

Which clinical findings would the nurse expect to see when assessing a client with hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Weight loss, tachycardia, restlessness, exophthalmos (Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism)