NURA 1500 Exam 4

You're caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to: A. Empty her bladder B. Lie supine in bed C. Remain NPO for 4 hours D. Clean her bowels with an enema

Answer: A Explanation: A full bladder can interfere with paracentesis and be punctured inadvertently.

A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-cell lung cancer. A pneumonectomy involves removal of: A. An entire lung field B. A small, wedge-shaped lung surface C. One lobe of a lung D. One or more segments of a lung lobe

Answer: A Explanation: A pneumonectomy is the removal of an entire lung field. A wedge resection refers to removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of one lobe. Removal of one or more segments of a lung lobe is called a partial lobectomy.

You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? A. Administering a lactulose enema as ordered B. Encouraging a protein-rich diet C. Administering sedatives, as necessary D. Encouraging ambulation at least four times a day

Answer: A Explanation: You may administer the laxative lactulose to reduce ammonia levels in the colon.

Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? A. Pain at the incisional site B. Arm edema on the operative side C. Sanguineous drainage in the Jackson-Pratt drain D. Complaints of decreased sensation near the operative site

Answer: B Explanation: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.

The nurse would assess the client experiencing an acute episode of cholecysitis for pain that is located in the right A. Upper quadrant and radiates to the left scapula and shoulder B. Upper quadrant and radiates to the right scapula and shoulder C. Lower quadrant and radiates to the umbilicus D. Lower quadrant and radiates to the back

Answer: B Explanation: During an acute "gallbladder attack," the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatomes in the body.

The nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer? A. Alcohol abuse B. Cigarette smoking C. Use of chewing tobacco D. Exposure to air pollutants

Answer: B Explanation: The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of tobacco increase the risk. Another risk factor is exposure to environmental pollutants.

The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for? A. Actinic B. Asymmetry C. Arcus D. Assessment

Answer: B Explanation: When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter."

Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? A. 24 hours B. 2 to 4 days C. 7 to 14 days D. 21 to 28 days

Answer: C Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days

Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He's jaundiced and reports weakness. Which intervention will you include in his care? A. Regular exercise B. A low-protein diet. C. Allow patient to select his meals. D. Rest period after small, frequent meals.

Answer: D Explanation: Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.

A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? A. Biopsy of the tumor B. Abdominal ultrasound C. Magnetic resonance imaging D. Computerized tomography scan

Answer: A Explanation: A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy.

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? A. Assess level of consciousness B. Assess temperature C. Assess bowel sounds D. Assess skin turgor

Answer: A Explanation: A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.

A patient has an acute upper GI hemorrhage. Your interventions include: A. Treating hypovolemia B. Treating hypervolemia C. Controlling the bleeding source D. Treating shock and diagnosing the bleeding source

Answer: A Explanation: A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can't diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment

Vanessa, a community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? A. Alopecia B. Back pain C. Painless testicular swelling D. Heavy sensation in the scrotum

Answer: A Explanation: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

Hepatic encephalopathy develops when the blood level of which substance increases? A. Ammonia B. Amylase C. Calcium D. Potassium

Answer: A Explanation: Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic circulation, which carries it to the brain.

Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation? A. "It empties the stomach of fluids and gas." B. "It prevents spasms at the sphincter of Oddi." C. "It prevents air from forming in the small intestine and large intestine." D. "It removes bile from the gallbladder."

Answer: A Explanation: An NG tube is inserted into the patients stomach to drain fluid and gas.

A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client? A. Anticipatory grieving B. Impaired swallowing C. Disturbed body image D. Chronic low self-esteem

Answer: A Explanation: Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.

Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? A. 30 minutes before the initiation of therapy. B. With the administration of therapy. C. Immediately after nausea begins. D. When therapy is completed.

Answer: A Explanation: Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.

You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? A. Asterixis B. Chvostek's sign C. Trousseau's sign D. Hepatojugular reflex

Answer: A Explanation: Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure? A. Hypoalbuminemia B. Increased capillary permeability C. Abnormal peripheral vasodilation D. Excess rennin release from the kidneys

Answer: A Explanation: Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidneys aren't direct ramifications of liver failure.

The nurse is teaching a 17-year old client and the client's family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? A. Fever B. Chills C. Tachycardia D. Dyspnea

Answer: A Explanation: Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

Nurse Bea is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? A. Increased calcium B. Increased white blood cells C. Decreased blood urea nitrogen level D. Decreased number of plasma cells in the bone marrow

Answer: A Explanation: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? A. Give tepid baths B. Avoid lotions and creams C. Use hot water to increase vasodilation D. Use cold water to decrease the itching

Answer: A Explanation: For pruritus, care should include tepid sponge baths and use of emollient creams and lotions

In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client? A. Acute lymphocytic leukemia B. Chronic myeloid leukemia C. Severe aplastic anemia D. Severe combined immunodeficiency

Answer: A Explanation: For the first episode of acute lymphocytic anemia, conventional therapy is superior to bone marrow transplantation. In severe combined immunodeficiency and in severe aplastic anemia, bone marrow transplantation has been employed to replace abnormal stem cells with healthy cells from the donor's marrow. In myeloid leukemia, bone marrow transplantation is done after chemotherapy to infuse healthy marrow and to replace marrow stem cells ablated during chemotherapy.

The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient's diet? A. Meats and beans B. Butter and gravies C. Potatoes and pastas D. Cakes and pastries

Answer: A Explanation: Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted

Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? A. Restrict fluids B. Encourage ambulation C. Increase sodium in the diet D. Give antacids as prescribed

Answer: A Explanation: Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space.

Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax? A. Dyspnea and reduced or absent breath sounds over the right lung B. Tachycardia, hypotension, and cool, clammy skin C. Fever, rebound tenderness, and abdominal rigidity D. Redness, warmth, and drainage at the biopsy site

Answer: A Explanation: Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds over the affected lung (right lung).

What information is correct about stomach cancer? A. Stomach pain is often a late symptom B. Surgery is often a successful treatment C. Chemotherapy and radiation are often successful treatments D. The patient can survive for an extended time with TPN

Answer: A Explanation: Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when the cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects. TPN may enhance the growth of the cancer

You're caring for a 28 y.o. woman with hepatitis B. She's concerned about the duration of her recovery. Which response isn't appropriate? A. Encourage her to not worry about the future. B. Encourage her to express her feelings about the illness. C. Discuss the effects of hepatitis B on future health problems. D. Provide avenues for financial counseling if she expresses the need.

Answer: A Explanation: Telling her not to worry minimizes her feelings.

Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make? A. Testicular cancer is a highly curable type of cancer. B. Testicular cancer is very difficult to diagnose. C. Testicular cancer is the number one cause of cancer deaths in males. D. Testicular cancer is more common in older men. men.

Answer: A Explanation: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger men

Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms: A. yearly after age 40. B. after the birth of the first child and every 2 years thereafter. C. after the first menstrual period and annually thereafter. D. every 3 years between ages 20 and 40 and annually thereafter.

Answer: A Explanation: The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It's recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.

Nurse Cindy is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client? A. Elevating the knee gatch on the bed B. Assisting with range-of-motion leg exercises C. Removal of antiembolism stockings twice daily D. Checking placement of pneumatic compression boots

Answer: A Explanation: The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.

Nurse Melinda is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client's diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? A. Bowel sounds B. Ability to ambulate C. Incision appearance D. Urine specific gravity

Answer: A Explanation: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options B, C, and D are unrelated to the subject of the question.

Jenny, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately? A. Vision changes B. Hearing loss C. Headache D. Anorexia

Answer: A Explanation: The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn't associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don't warrant a change in therapy.

A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? A. Bed rest B. Out of bed ad lib C. Out of bed in a chair only D. Ambulation to the bathroom only

Answer: A Explanation: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.

The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client's pain would include which of the following? A. The client's pain rating B. Nonverbal cues from the client C. The nurse's impression of the client's pain D. Pain relief after appropriate nursing intervention

Answer: A Explanation: The client's self-report is a critical component of pain assessment. The nurse should ask the client about the description of the pain and listen carefully to the client's words used to describe the pain. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question.

Glenda has cholelithiasis (gallstones). You expect her to complain of: A. Pain in the right upper quadrant, radiating to the shoulder B. Pain in the right lower quadrant, with rebound tenderness C. Pain in the left upper quadrant, with shortness of breath D. Pain in the left lower quadrant, with mild cramping

Answer: A Explanation: The gallbladder is located in the RUQ and a frequent sign of gallstones is pain radiating to the shoulder.

What should a male client over age 52 do to help ensure early identification of prostate cancer? A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B. Have a transrectal ultrasound every 5 years. C. Perform monthly testicular self-examinations, especially after age 50. D. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

Answer: A Explanation: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases

A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? A. Liver B. Colon C. Reproductive tract D. White blood cells (WBCs)

Answer: A Explanation: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia? A. Bactrim B. Oral nystatin suspension C. Prednisone D. Vincristine (Oncovin)

Answer: A Explanation: The most frequent cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn't an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent.

A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? A. "Chemotherapy affects all rapidly dividing cells." B. "The molecular structure of the DNA is altered." C. "Cancer cells are susceptible to drug toxins." D. "Chemotherapy encourages cancer cells to divide."

Answer: A Explanation: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins.

Gail is scheduled for a cholecystectomy. After completion of preoperative teaching, Gail states,"If I lie still and avoid turning after the operation, I'll avoid pain. Do you think this is a good idea?" What is the best response? A. "You'll need to turn from side to side every 2 hours." B. "It's always a good idea to rest quietly after surgery." C. "The doctor will probably order you to lie flat for 24 hours." D. "Why don't you decide about activity after you return from the recovery room?

Answer: A Explanation: To prevent venous stasis and improve muscle tone, circulation, and respiratory function, encourage her to move after surgery.

Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as: A. sarcoma. B. lymphoma. C. carcinoma. D. melanoma.

Answer: A Explanation: Tumors that originate from bone, muscle, and other connective tissue are called sarcomas.

For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? A. "Client verbalizes feelings of anxiety." B. "Client doesn't guess at prognosis." C. "Client uses any effective method to reduce tension." D. "Client stops seeking information."

Answer: A Explanation: Verbalizing feelings is the client's first step in coping with the situational crisis. It also helps the health care team gain insight into the client's feelings, helping guide psychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn't appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.

When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. A. Verify patency of the line by the presence of a blood return at regular intervals. B. Inspect the insertion site for swelling, erythema, or drainage. C. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present. D. If unable to aspirate blood, reposition the client and encourage the client to cough. E. Contact the health care provider about verifying placement if the status is questionable.

Answer: A, B, D, E Explanation: A major concern with intravenous administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent evaluation of blood return when administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is questionable and may require a declotting regimen.

A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client? A. She should have had a baseline mammogram before age 30. B. She should eat a low-fat diet to further decrease her risk of breast cancer. C. She should perform breast self-examination during the first 5 days of each menstrual cycle. D. When she begins having yearly mammograms, breast self-examinations will no longer be necessary.

Answer: B Explanation: A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman's risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.

The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: A. Rupture of the bladder B. The development of a vesicovaginal fistula C. Extreme stress caused by the diagnosis of cancer D. Altered perineal sensation as a side effect of radiation therapy

Answer: B Explanation: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options A, C, and D.

When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: A. increased intracranial pressure B. decreased urine output C. bradycardia D. hypertension

Answer: B Explanation: Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

Which of the following tests is most commonly used to diagnose cholecystitis? A. Abdominal CT scan B. Abdominal ultrasound C. Barium swallow D. Endoscopy

Answer: B Explanation: An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn't necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.

George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage? A. "If there is any drainage, notify the surgeon immediately." B. "The drainage will decrease daily until the bile duct heals." C. "First, the drainage is dark green; then it becomes dark yellow." D. "If the drainage stops, milk the tube toward the puncture wound."

Answer: B Explanation: As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? A. Pruritus B. Dyspnea C. Jaundice D. Peripheral Neuropathy

Answer: B Explanation: Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing. The others are signs of cirrhosis that aren't relieved by paracentesis

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care? A. Administering aspirin if the temperature exceeds 102° F (38.8° C) B. Inspecting the skin for petechiae once every shift C. Providing for frequent rest periods D. Placing the client in strict isolation

Answer: B Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750ml of green-brown drainage. Which nursing intervention is most appropriate? A. Notify the physician B. Document the findings C. Irrigate the T-tube D. Clamp the T-tube

Answer: B Explanation: Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.

Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? A. Calcium B. Glucose C. Magnesium D. Potassium

Answer: B Explanation: Glucose level increases and diabetes mellitus may result d/t the pancreatic damage to the islets of Langerhans

The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care? A. Coughing and deep breathing B. Encouraging fluids C. Monitoring red blood cell count D. Providing frequent oral care

Answer: B Explanation: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options 1, 3, and 4 may be components in the plan of care but are not the priority in this client.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Gastric ulcer

Answer: B Explanation: Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.

A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first? A. Stand as far away from the implant as possible and call for help. B. Pick up the implant with long-handled forceps and place it in a lead-lined container. C. Leave the room and notify the radiation therapy department immediately. D. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

Answer: B Explanation: If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.

Which of the following tests is performed on a client with leukemia before initiation of therapy to evaluate the child's ability to metabolize chemotherapeutic agents? A. Lumbar puncture B. Liver function studies C. Complete blood count (CBC) D. Peripheral blood smear

Answer: B Explanation: Liver and kidney function studies are done before initiation of chemotherapy to evaluate the child's ability to metabolize the chemotherapeutic agents. A CBC is performed to assess for anemia and white blood cell count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells. A lumbar puncture is performed to assess for central nervous system infiltration.

A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present? A. Flushing, decreased oxygen saturation, mild hypotension B. Low-grade fever, chills, tachycardia C. Elevated temperature, oliguria, hypotension D. High-grade fever, normal blood pressure, increased respirations

Answer: B Explanation: Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.

When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess: A. short-term memory impairment. B. tactile agnosia. C. seizures. D. contralateral homonymous hemianopia.

Answer: B Explanation: Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobe tumor.

Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women: A. perform breast self-examination annually. B. have a mammogram annually. C. have a hormonal receptor assay annually. D. have a physician conduct a clinical examination every 2 years.

Answer: B Explanation: The American Cancer Society guidelines state, "Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years]; all women should perform breast self-examination monthly [not annually]." The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.

The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client: A. To examine the testicles while lying down B. That the best time for the examination is after a shower C. To gently feel the testicle with one finger to feel for a growth D. That testicular self-examination should be done at least every 6 months

Answer: B Explanation: The testicular self-examination is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.

The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: A. To examine the testicles while lying down. B. The best time for the examination is after a shower C. To gently feel the testicle with one finger to feel for a growth D. That testicular examination should be done at least every 6 months.

Answer: B Explanation: The testicular self-examination is recommended monthly after a warm shower or bath when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps.

Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? A. Limit the time with the client to 1 hour per shift B. Do not allow pregnant women into the client's room C. Remove the dosimeter badge when entering the client's room D. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client

Answer: B Explanation: The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room.

During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? A. Recommending that the client discontinue chemotherapy B. Providing a solution of hydrogen peroxide and water for use as a mouth rinse C. Monitoring the client's platelet and leukocyte counts D. Checking regularly for signs and symptoms of stomatitis

Answer: B Explanation: To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? A. Related to visual field deficits B. Related to difficulty swallowing C. Related to impaired balance D. Related to psychomotor seizures

Answer: C Explanation: A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A. Dyspnea and fatigue B. Ascites and orthopnea C. Purpura and petechiae D. Gynecomastia and testicular atrophy

Answer: C Explanation: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

The most important pathophysiologic factor contributing to the formation of esophageal varices is: A. Decreased prothrombin formation B. Decreased albumin formation by the liver C. Portal hypertension D. Increased central venous pressure

Answer: C Explanation: As the liver cells become fatty and degenerate, they are no longer able to accommodate the large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.

Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur? A. Immediately B. 1 week C. 2 to 3 weeks D. 1 month

Answer: C Explanation: Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.

Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that "If I can just live long enough to attend my daughter's graduation, I'll be ready to die." Which phrase of coping is this client experiencing? A. Anger B. Denial C. Bargaining D. Depression

Answer: C Explanation: Denial, bargaining, anger, depression, and acceptance are recognized stages that a person facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change prognosis or fate. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn. Anger also may be a first response to upsetting news and the predominant theme is "why me?" or the blaming of others.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? A. Decreased number of plasma cells in the bone marrow. B. Increased WBC's C. Increased calcium levels D. Decreased blood urea nitrogen

Answer: C Explanation: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: A. breast self-examination. B. mammography. C. fine needle aspiration. D. chest X-ray.

Answer: C Explanation: Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.

Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient? A. Teaching the client diaphragmatic breathing techniques B. Administering cough suppressants as ordered C. Teaching and encouraging pursed-lip breathing D. Placing the client in a low semi-Fowlers position

Answer: C Explanation: For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion. Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder. Administering cough suppressants will not help respiratory effort. A low semi-Fowlers position does not encourage lung expansion. Lung expansion is enhanced in the upright position.

The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states that which of the following is characteristic of the disease? A. Presence of Reed-Sternberg cells B. Involvement of lymph nodes, spleen, and liver C. Occurs most often in the older client D. Prognosis depends on the stage of the disease

Answer: C Explanation: Hodgkin's disease is a disorder of young adults. Options 1, 2, and 4 are characteristics of this disease.

The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: A. Dyspnea B. Diarrhea C. Sore throat D. Constipation

Answer: C Explanation: In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Options B and D may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.

The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: A. Restrict all visitors B. Restrict fluid intake C. Teach the client and family about the need for hand hygiene D. Insert an indwelling urinary catheter to prevent skin breakdown

Answer: C Explanation: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.

A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? A. Persistent nausea B. Rash C. Indigestion D. Chronic ache or pain

Answer: C Explanation: Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

Which of the following symptoms best describes Murphy's sign? A. Periumbilical ecchymosis exists B. On deep palpitation and release, pain in elicited C. On deep inspiration, pain is elicited and breathing stops D. Abdominal muscles are tightened in anticipation of palpation

Answer: C Explanation: Murphy's sign is elicited when the client reacts to pain and stops breathing. It's a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen's sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.

Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient? A. Serum creatinine and BUN B. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) C. Serum amylase and lipase D. Cardiac enzymes

Answer: C Explanation: Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.

Parents of pediatric clients who undergo irradiation involving the central nervous system should be warned about postirradiation somnolence. When does this neurologic syndrome usually occur? A. Immediately B. Within 1 to 2 weeks C. Within 5 to 8 weeks D. Within 3 to 6 months

Answer: C Explanation: Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3 to 15 days. It's characterized by somnolence with or without fever, anorexia, nausea, and vomiting. Although the syndrome isn't thought to be clinically significant, parents should be prepared to expect such symptoms and encourage the child needed rest.

A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: A. a decreased serum creatinine level. B. hypocalcemia. C. Bence Jones protein in the urine. D. a low serum protein level.

Answer: C Explanation: Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn't rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.

A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: A. hair loss. B. stomatitis. C. fatigue. D. vomiting.

Answer: C Explanation: Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing: A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis

Answer: C Explanation: The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29 mEq/L.

The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. Check that the hemostat is on the bedside B. Monitor IV fluids for the shift C. Regularly assess respiratory status D. Check that the balloon is deflated on a regular basis

Answer: C Explanation: The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)? A. White, cottage cheese-like patches on the tongue B. Yellow tooth discoloration C. Red, open sores on the oral mucosa D. Rust-colored sputum

Answer: C Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

A male client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? A. It interferes with deoxyribonucleic acid (DNA) replication only. B. It interferes with ribonucleic acid (RNA) transcription only. C. It interferes with DNA replication and RNA transcription. D. It destroys the cell membrane, causing lysis.

Answer: C Explanation: Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane.

The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? A. Ambulation three times a day B. Monitoring temperature C. Monitoring the platelet count D. Monitoring for pathological factors

Answer: C Explanation: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if leukopenia is present. Options 1 and 4, although important in the plan of care are not related directly to thrombocytopenia.

A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? A. Monitoring temperature B. Ambulation three times daily C. Monitoring the platelet count D. Monitoring for pathological fractures

Answer: C Explanation: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia.

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions? A. Viral factors B. Stress C. Low-fat and high-fiber diets D. Exposure to radiation

Answer: C Explanation: Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer.

Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes: A. Continuous peritoneal lavage B. Regular diet with increased fat C. Nutritional support with TPN D. Insertion of a T tube to drain the pancreas

Answer: C Explanation: With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support.

Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover: A. cancerous lumps. B. areas of thickness or fullness. C. changes from previous self-examinations. D. fibrocystic masses.

Answer: C Explanation: Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.

A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: A. Call the physician B. Reinsert the implant into the vagina immediately C. Pick up the implant with gloved hands and flush it down the toilet D. Pick up the implant with long-handled forceps and place it in a lead container.

Answer: D Explanation: A lead container and long-handled forceps should be kept in the client's room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it in the lead container. Options A, B, and C are inaccurate interventions.

Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client? A. Eat a light breakfast only B. Maintain an NPO status before the procedure C. Wear comfortable clothing and shoes for the procedure D. Drink six to eight glasses of water without voiding before the test

Answer: D Explanation: A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure.

Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia? A. To rule out meningitis B. To decrease intracranial pressure C. To aid in classification of the leukemia D. To assess for central nervous system infiltration

Answer: D Explanation: A spinal tap is performed to assess for central nervous system infiltration. It wouldn't be done to decrease ICP nor does it aid in the classification of the leukemia. Spinal taps can result in brain stem herniation in cases of ICP. A spinal tap can be done to rule out meningitis but this isn't the indication for the test on a leukemic client.

A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? A. Apply sunscreen only after going in the water. B. Avoid peak exposure hours from 9am to 1pm C. Wear loosely woven clothing for added ventilation D. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

Answer: D Explanation: A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided

The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent: A. Nausea B. Alopecia C. Vomiting D. Hyperuricemia

Answer: D Explanation: Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs from the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting

The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery? A. Sanguineous drainage in the Jackson-Pratt drain B. Pain at the incisional site C. Complaints of decreased sensation near the operative site D. Arm edema on the operative side

Answer: D Explanation: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. The other options are expected occurrences.

One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is: A. Underlying liver disease B. Brain metastasis C. Intravenous heparin therapy D. Sepsis

Answer: D Explanation: Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinical DIC; however, sepsis is the most common cause.

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? A. Urine output of 400 ml in 8 hours B. Serum potassium level of 3.6 mEq/L C. Blood pressure of 120/64 to 130/72 mm Hg D. Dry oral mucous membranes and cracked lips

Answer: D Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L

During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? A. Diarrhea B. Hypermenorrhea C. Abdominal bleeding D. Abdominal distention

Answer: D Explanation: Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. Duodenal ulcers B. Hemorrhoids C. Weight gain D. Polyps

Answer: D Explanation: Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

Nurse Kate is reviewing the complications of colonization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching? A. Infection B. Hemorrhage C. Cervical stenosis D. Ovarian perforation

Answer: D Explanation: Conization procedure involves removal of a cone-shaped area of the cervix. Complications of the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is not a complication.

A client being treated for chronic cholecystitis should be given which of the following instructions? A. Increase rest B. Avoid antacids C. Increase protein in diet D. Use anticholinergics as prescribed

Answer: D Explanation: Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.

A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is most likely responsible for her symptoms? A. Hiatal hernia B. Stomatitis C. Radiation enteritis D. Esophagitis

Answer: D Explanation: Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall

The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client? A. The client lies still. B. The client asks questions. C. The client hears thumping sounds. D. The client wears a watch and wedding band.

Answer: D Explanation: During an MRI, the client should wear no metal objects, such as jewelry, because the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The client must lie still during the MRI but can talk to those performing the test by way of the microphone inside the scanner tunnel. The client should hear thumping sounds, which are caused by the sound waves thumping on the magnetic field.

A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide? A. Presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin B. Increase in the number of normal cells in a normal arrangement in a tissue or an organ C. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found D. Alteration in the size, shape, and organization of differentiated cells

Answer: D Explanation: Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found is called metaplasia.

You're discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? A. "Now I can never get hepatitis again." B. "I can safely give blood after 3 months." C. "I'll never have a problem with my liver again, even if I drink alcohol." D. "My family knows that if I get tired and start vomiting, I may be getting sick again."

Answer: D Explanation: Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B

A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client? A. Fatigue B. Weakness C. Weight gain D. Enlarged lymph nodes

Answer: D Explanation: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells? A. probenecid (Benemid) B. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) C. thioguanine (6-thioguanine, 6-TG) D. leucovorin (citrovorum factor or folinic acid [Wellcovorin])

Answer: D Explanation: Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren't used to treat osteogenic carcinoma.

A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? A. Onset of sporadic sexual activity at age 17 B. Spontaneous abortion at age 19 C. Pregnancy complicated with eclampsia at age 27 D. Human papillomavirus infection at age 32

Answer: D Explanation: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.

Nina, an oncology nurse educator, is speaking to a women's group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate? A. Mammography is the most reliable method for detecting breast cancer. B. Breast cancer is the leading killer of women of childbearing age. C. Breast cancer requires a mastectomy. D. Men can develop breast cancer.

Answer: D Explanation: Men can develop breast cancer, although they seldom do. The most reliable method for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small, confined, and in an early stage.

A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder? A. Malignant exacerbation in the number of leukocytes. B. Altered red blood cell production. C. Altered production of lymph nodes D. Malignant proliferation of plasma cells and tumors within the bone.

Answer: D Explanation: Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Option 1 describes the leukemic process. Options 2 and 3 are not characteristics of multiple myeloma.

A female client diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? A. Altered red blood cell production B. Altered production of lymph nodes C. Malignant exacerbation in the number of leukocytes D. Malignant proliferation of plasma cells within the bone

Answer: D Explanation: Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options A and B are not characteristics of multiple myeloma. Option C describes the leukemic process.

Which of the following clients is most at risk for developing multiple myeloma? A. A 20-year-old Asian woman B. A 30-year-old White man C. A 50-year-old Hispanic woman D. A 60-year-old Black man

Answer: D Explanation: Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often in Black men.

Which of the following represents the most appropriate nursing intervention for a client with pruritis caused by cancer or the treatments? A. Administration of antihistamines B. Steroids C. Silk sheets D. Medicated cool baths

Answer: D Explanation: Nursing interventions to decrease the discomfort of pruitus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicyclic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for the hospitalized client with pruritis.

Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia? A. Diphtheria and tetanus and pertussis (DPT) vaccine. B. Hepatitis B vaccine C. Haemophilus influenzae type b vaccines (Hib) D. Oral poliovirus vaccine (OPV)

Answer: D Explanation: OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be indicated because it isn't a live virus and wouldn't pose the threat of infection. DTP, Hib, and hepatitis B vaccines can be given accordingly to the recommended schedule.

When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important? A. Eat a low-protein diet B. Eat a low-fat, low-cholesterol diet C. Limit exercise to 10 minutes/day D. Keep weight proportionate to height

Answer: D Explanation: Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn't implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may also indirectly decrease the chances of developing cholecystitis.

Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective? A. There is no skin breakdown B. Her appetite improves C. She loses more than 10 lbs D. Stools are less fatty and decreased in frequency

Answer: D Explanation: Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance.

Nurse Mary is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: A. at the end of her menstrual cycle. B. on the same day each month. C. on the 1st day of the menstrual cycle. D. immediately after her menstrual period.

Answer: D Explanation: Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman's breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.

Gio, a community health nurse, is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination: A. At the onset of menstruation B. Every month during ovulation C. Weekly at the same time of day D. 1 week after menstruation begins

Answer: D Explanation: The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

A 32-year-old woman meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesn't go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client's current needs? A. Call the physician to discuss allowing the client to return to work earlier. B. Suggest that the client learn relaxation techniques to help with her insomnia C. Perform a nutritional assessment to assess for anorexia D. Ask open-ended questions about sexuality issues related to her mastectomy

Answer: D Explanation: The content of the client's comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first address the psychosocial and sexual issues that are contributing to her sleeping difficulties. A nutritional assessment may be useful, but there is no indication that she has anorexia.

A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction? A. "Keep the stoma uncovered." B. "Keep the stoma dry." C. "Have a family member perform stoma care initially until you get used to the procedure." D. "Keep the stoma moist."

Answer: D Explanation: The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine? A. Assisting with a naloxone challenge test before therapy begins B. Discontinuing the drug immediately if signs of dependence appear C. Changing the administration route to P.O. if the client can tolerate fluids D. Obtaining baseline vital signs before administering the first dose

Answer: D Explanation: The nurse should obtain the client's baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn't discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

Which of the following treatment measures should be implemented for a child with leukemia who has been exposed to the chickenpox? A. No treatment is indicated. B. Acyclovir (Zovirax) should be started on exposure C. Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of disease D. VZIG should be given within 72 hours of exposure.

Answer: D Explanation: Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the course of the disease. Giving the vaccine at the onset of symptoms wouldn't likely decrease the severity of the illness. Acyclovir may be given if the child develops the disease but not if the child has been exposed.

Which of the following types of leukemia carries the best prognosis? a. Acute lymphoblastic leukemia b. Acute myelogenous leukemia c. Basophilic leukemia d. Eosinophilic leukemia

Answer: a Explanation: Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children. Basophilic and eosinophilic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis.

Which of the following assessment findings in a client with leukemia would indicate that the cancer has invaded the brain? a. Headache and vomiting. b. Restlessness and tachycardia c. Hypervigilant and anxious behavior d. Increased heart rate and decreased blood pressure.

Answer: a Explanation: The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain. The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache, vomiting, irritability, lethargy, increased blood pressure, decreased heart rate, and eventually, coma. Often children with a variety of illnesses are hypervigilant and anxious when hospitalized.

Which of the following complications are three main consequences of leukemia? a. Bone deformities, spherocytosis, and infection. b. Anemia, infection, and bleeding tendencies c. Lymphocytopoiesis, growth delays, and hirsutism d. Polycythemia, decreased clotting time, and infection.

Answer: b Explanation: The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone deformities don't occur with leukemia although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn't a feature in leukemia. Mature cells aren't produced in adequate numbers. Hirsutism and growth delay can be a result of large doses of steroids but isn't common in leukemia. Anemia, not polycythemia, occurs. Clotting times would be prolonged.

What are the three most important prognostic factors in determining long-term survival for children with acute leukemia? a. Histologic type of disease, initial platelet count, and type of treatment b. Type of treatment and client's sex c. Histologic type of disease, initial WBC count, and client's age at diagnosis d. Progression of illness, WBC at the time of diagnosis, and client's age at the time of diagnosis.

Answer: c Explanation: The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a better prognosis because age 2 or after 10.

A child is seen in the pediatrician's office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia? a. Abdominal pain b. Increased activity level c. Increased appetite d. Petechiae

Answer: d Explanation: The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Increased appetite can occur but it usually isn't a presenting symptom. Abdominal pain may be caused by areas of inflammation from normal flora within the GI tract or any number of other causes