Malignant Intentions
Provide 4 risk factors for breast cancer in women.
1.) Jewish ancestry
2.) Age >65
3.) Family history
4.) Alcohol consumption
5.) No children or did not have first child until after age 30
6.) Obesity
7.) BRCA gene mutation
A clinic nurse is performing a physical assessment on a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?
A.) A grey colored, non-purpuric papular rash.
B.) A dry, red rash across the bridge of the nose and on the cheeks.
C.) Pitting edema of the hands and fingers.
D.) Subcutaneous nodules on the ulnar side of the arm.
B.) A dry, red rash across the bridge of the nose and on the cheeks (butterfly rash)
A group of nurses are discussing risk factors for transmission of human immunodeficiency virus (HIV) from clients. Which of the following individuals should the nurse identify as being at the greatest risk for contracting HIV?
A.) An occupational therapist who works with a client who has HIV
B.) A personal trainer who works with a client who has HIV
C.) A phlebotomist who collects blood from clients who have HIV
D.) A nurse who works for an insurance company and collects urine samples from clients who have HIV
C - Phlebotomist - The greatest risk for exposure to HIV is from a needle stick; therefore, the phlebotomist who collects blood is at greatest risk.
How long after a tick bite do you need to wait for Lyme's disease testing?
4-6 weeks
Earlier testing may be false negative as there needs to be time for antibodies to develop.
When triaging during a disaster situation, state what each color tag means and what order you would triage.
Red - Emergent: immediate threat to life
Yellow - Urgent: major injuries that require treatment within 20 minutes to 2 hours
Green - Non-urgent: minor injuries that do not require immediate treatment
Black - Expectant: expected and allowed to die
A nurse is assessing a client who reports a new lump in their breast. Which of the following findings should the nurse recognize as a potential indication of breast cancer?
A.)The lump is hard and irregularly shaped.
B.) The lump is tender and painful.
C.) The lump is soft and movable.
D.) The lump decreases in size with menstrual cycles.
A - The lump is hard and irregularly shaped.
The nurse should identify hard and irregularly shaped lumps as potential indications of breast cancer and warrant further evaluation. These lumps are more likely to be malignant.
A nurse is assessing a client who has systemic lupus erythematosus and is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately?
A.) Diarrhea
B.) Blurred Vision
C.) Pruitis
D.) Fatigue
B.) Blurred vision - When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of hydroxychloroquine toxicity and can be an indication of retinal damage.
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?
A.) Positive western blot test
B.) CD4 T cell count 180
C.) Platelets 150,000
D.) WBCs 5,000
B.) CD4 T cell count 180 - A CD4-T-cell count of less than 180 cells/mm3 indicates that the client is severely immunocompromised and is at high risk for infection. Therefore, this value is the priority for the nurse to report to the provider.
Name 3 medications used for Lyme's Disease treatment?
1.) Doxycycline
2.) Amoxicillin
3.) Cefuroxime
A nurse leader is giving a presentation about bioterrorism to a group of staff. Which of the following statements should the nurse include?
A.) "Biological agents cause manifestations immediately after exposure."
B.) "Biological agents cannot spread from person to person."
C.) "Biological agents can include anthrax, smallpox, and Ebola."
D.) "Biological agents include sarin and chlorine gas.
C.) "Biological agents can include anthrax, smallpox, and Ebola."
Anthrax, smallpox, and Ebola are examples of biological agents used in bioterrorism. Biological agents are living organisms or toxins—such as bacteria, viruses, or biological toxins—that, when intentionally introduced into the body, can cause serious illness or death.
A nurse is reviewing the CBC findings for a female client who is receiving combination chemotherapy for breast cancer. Which of the following findings should the nurse report to the provider?
A.) WBC 2300
B.) RBC 5 million
C.) Hemoglobin 12
D.) Platelets 155,000
A.) WBC 2300
This WBC finding is below the expected reference range. Chemotherapy treatment can cause leukopenia; the nurse should report this finding to the provider and implement precautions to protect the client from infection.
A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE?
A.) Sunlight
B.) Pregnancy
C.) Infection
D.) Exercise
D.) Exercise - Deconditioning and muscle atrophy occurs as a result of lack of mobility. The nurse should encourage client to engage in conditioning exercises alternated with periods of rest.
Exposure to sunlight and artificial ultraviolet light can cause for an exacerbation of SLE manifestations, especially the characteristic skin manifestations of lesions and butterfly rash.
Pregnancy can cause an exacerbation of SLE, probably due to hormonal changes. The client should be advised of the risks and must be monitored closely for effects on the renal and cardiovascular systems if she decides to get pregnant.
Infection is a major stressor on the body and can trigger an exacerbation of the SLE disease process. In addition, many clients who have SLE take steroid medications that place them at higher risk for infection.
A nurse is presenting a community-based program about HIV and AIDS. A client asks the nurse to describe the initial symptoms experienced with HIV infection. Which of the following manifestations should the nurse include in the explanation of initial symptoms?
A.) Flu-like symptoms and night sweats
B.) Pneumocystis lung infection
C.) Kaposi's sarcoma
D.) Fungal and bacterial infections
A.) Flu like symptoms and night sweats
The rest are later stage symptoms.
A nurse is teaching a group of clients about tick-borne illnesses. Which of the following information should the nurse include in the teaching regarding ticks?
A.) Grasp the tick as close to the skin as possible.
B.) Use a twisting motion when removing the tick.
C.) Apply a pediculicide lotion to the area surrounding the tick.
D.) Use the hot ember from the tip of a match to remove the tick.
A.) Grab the tick as close to the skin as possible
A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the following clients should the nurse plan to care for first?
A.) A client with a tension pneumothorax
B.) A client with a closed upper extremity fracture
C.) A client with full thickness burns to 80% of their body
D.) A client with agonal respirations
A.) A client with a tension pneumothorax
__________________ occurs when a tumor is destroyed and release large amounts of potassium and uric acid into the bloodstream. Symptoms of this include ________________________ (name 3).
Tumor lysis syndrome
Signs/symptoms: lethargy, muscle weakness, EKG changes, N/V, diarrhea, flank pain, twitching
A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings is the highest priority for the nurse to report to the provider?
A.) Client reports feelings of depression
B.) Dry raised rash on the face
C.) Peripheral edema
D.) Joint pain in hands and knees
C.) Peripheral edema - The client who has SLE is at greatest risk for death from lupus nephritis. Therefore, according to the safety and risk reduction priority setting framework, findings that indicate an impairment of renal function are the highest priority to report.
A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions?
A.) Talking to the client at bedside
B.) Administering an IM injection
C.) Administering an IV push medication
D.) Performing a dressing change
D.) Performing a dressing change - Standard precautions require personal protective equipment when there is a risk of contact with body fluids. A dressing change does present a risk for coming into contact with body fluids.
If your going to be irrigating a wound, wear eye protection too.
A patient who removed an embedded tick 4 days ago presents with a classic erythema migrans rash. The primary health care provider orders an enzyme immunoassay (EIA/ELISA) for Borrelia burgdorferi antibodies, which returns negative. The patient is distressed. Which explanation should the nurse provide?
A.) A negative ELISA test definitively rules out Lymes Disease
B.) Serological blood testing is only valid if performed within the first 48 hours of a tick bite
C.) The test must be completed every 24 hours until a positive result is seen
D.) Antibodies take several weeks to reach a detectable level. Treatment is guided by clinical presentation rather than negative serology
D.) Antibodies take several weeks to reach a detectable level. Treatment is guided by clinical presentation rather than negative serology.
Early clinical manifestations can be treated based on symptoms
A is nurse assisting with field triage following a motor-vehicle crash involving a bus with multiple victims. The nurse assesses a child who has an open fracture of the femur. Which of the following actions should the nurse take?
A.) Locate the child's parents to obtain consent for treatment.
B.) Notify the emergency department of the child's imminent arrival.
C.) Place a yellow triage tag on the child.
D.) Perform a complete head-to-toe assessment.
C.) Place a yellow tag on the child - The child's Condition indicates the need for treatment within 20 min to 2 hr. Therefore, the nurse should triage the child with a yellow tag.
A nurse is assessing a client receiving chemotherapy and has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?
A.) Excessive thrombosis and bleeding
B.) Progressive increase in platelet production
C.) Immediate sodium and fluid retention
D.) Increased clotting factors
A.) Excessive thrombosis and bleeding.
The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.
You would see DECREASED platelet production, volume loss (not retention). Expect a decrease, in clotting factors because the formation of multiple small clots consumes clotting factors and fibrinogen faster than the body can produce them.
A nurse is caring for a client who has a new diagnosis of systemic lupus erythematosus (SLE) and asks where this disease originates within the body. The nurse should tell the client that SLE originates in which of the following locations in the body?
A.) Muscle tissue
B.) Lymphatic system
C.) Peripheral vascular system
D.) Connective tissue
D. ) Connective tissue
A nurse is talking with a client who has to come to the clinic for HIV testing. The nurse should explain that, after the laboratory has the enzyme-linked immunosorbent assay (ELISA) results, it will use which of the following tests to confirm the diagnosis?
A.) CD4+T-Cell Count
B.) Western blot test
C.) Quantitative RNA Assay
D.) Viral load test
B.) Western blot - The Western blot analysis is used to confirm seropositivity when the ELISA test has a positive result. ELISA is inexpensive and accurate with few false-positives. Western blot is expensive, so is done only for confirmation.
A.) Lyme's Carditis
B.) Chronic neuroborreliosis
C.) Late stage Lymes arthritis
D.) Acute rheumatic fever
A.) Lymes carditis - stage 2 disseminated lymes can cause cardiac manifestations
A nurse is the triage officer in the emergency department when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first?
A.) A conscious adult client who reports shortness of breath, has a respiratory rate of 24/min, and capillary refill of < 2 seconds
B.) A conscious adult client who has a dislocated right shoulder, respiratory rate of 18/min, and capillary refill of < 2 seconds
C.) An unconscious adult client who has no respirations, capillary refill is > 2 seconds, and paramedics have already tried to reposition airway without results
D.) An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of < 2 seconds
D.) An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of < 2 seconds
Any adult who has a respiratory rate of over 30/min requires immediate attention. Additionally, this patient is unconscious, which constitutes altered mental status. This client is the client he nurse should care for first.