Cancer
The nurse is teaching a client about prostate cancer. Which point(s) should be included in the instruction? Select all that apply.
A. Prostate cancer is usually multifocal and slow growing.
B. Most prostate cancers are adenocarcinoma.
C. The incidence of prostate cancer is higher in males of African descent, and the onset is earlier.
D. A prostate-specific antigen (PSA) lab test result higher than 4 ng/mg will require another test and further monitoring.
E. Cancer cells are detectable in the urine.
ABCD
Cancer of the prostate gland is the second leading cause of cancer death among American and Canadian males and is the most common carcinoma in clients older than age 65. The incidence of prostate cancer is higher in males of African descent, and the onset is earlier. Most prostate cancers are adenocarcinoma. Prostate cancer is usually multifocal and slow growing and can spread by local extension, by lymphatics, or through the bloodstream. If the client has a PSA test result higher than 4 ng/mg, the health care provider will recommend a repeat test and further monitoring. Additional examinations may include a skeletal x-ray, a bone scan, and computed tomography or magnetic resonance imaging to detect local extension and bone and lymph node involvement. Urine does not have prostate cancer cells.
A 25-year-old female is about to deliver a baby. The patient is HIV-positive and has been taking antiretroviral therapy during the pregnancy. What steps can be taken to help prevent transmitting the virus to the baby after birth?
A. Substitute formula for breastfeeding.
B. Administer antiretroviral treatment to the newborn for 2 weeks after birth.
C. Avoid kissing and hugging the newborn.
D. Stop taking antiretroviral therapy for 2 months postpartum.
The answer is A.
Breastmilk can transmit the HIV virus. The patient should avoid breastfeeding but use formula instead. Option B is wrong because the newborn should receive antiretroviral treatment for 4-6 weeks after birth (NOT 2 weeks). The mother can kiss and hug her newborn (this does NOT transmit the virus), and the patient should not quit taking antiretroviral therapy during the postpartum period.
How are the systemic type I IgE-mediated responses initiated?
A. With contact of the allergen and IgE in the conjunctival tissues.
B. by contact of the allergen with IgE in the bronchial tree
C. the allergen makes contact with the IgE in the circulatory system
D. Allergens are absorbed in the GI mucosa
D. Allergens are absorbed in the GI mucosa
Systemic IgE responses can occur when the GI mucosa is altered by a local allergic response, then the allergen may be absorbed, and the resulting reaction may be systemic. IgE is produced by plasma cells located in lymph. IgE attach to mast cells in body tissues. Contact of allergens with IgE in the bronchial and conjunctival tissues results in a localized response
The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement?
a. "I will make an appointment to see the doctor every year."
b. "I will stop taking the prednisone if I experience a dry cough."
c. "I will not worry if I feel a little short of breath with exercise."
d. "I will call the health care provider right away if I develop a fever."
ANS: D
Low-grade fever may indicate infection or acute rejection so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team. Annual health care provider visits would not be sufficient. Home oxygen use is not an expectation after lung transplant. Shortness of breath should be reported. Low-grade fever, fatigue, dyspnea, dry cough, and oxygen desaturation are signs of rejection. Immunosuppressive therapy, including prednisone, needs to be continued to prevent rejection
A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing?
a. Abbreviated
b. Anticipatory
c. Dysfunctional
d. Inhibited
C
Dysfunctional grieving is a term used to describe a type of grief that deviates from the normal grieving process and can lead to social, emotional, and psychological dysfunction:
A nurse is caring for a client who has undergone a total laryngectomy for laryngeal cancer. The client has a history of smoking. What information is important to include in discharge teaching? Select all that apply.
A. Provide humidity at home.
B. Follow a bland diet.
C. Learn how to suction
D. Have communication rehabilitation with a speech pathologist.
E. Attend a smoking cessation program.
A. C. D. E.
Home care for a client with a total laryngectomy should include a high-humidity environment, laryngectomy tube care and suctioning, speech rehabilitation, and smoking cessation. The client is not restricted to a bland diet.
Which type of opportunistic infection occurs from inhaling a parasitic organism that can be found in cat and bird feces?
A. Histoplasmosis
B. Crytococcosis
C. Mycobacterium Avium complex
D. Toxoplasmosis
The answer is D. Toxoplasmosis is a protozoal parasitic infection that is found in cat and bird feces along with undercook meat, such as pork and red meat.
Which is the nurse's PRIORITY action when managing a client experiencing a type I hypersensitivity?
A. Management of arthralgia
B. Airway management
C. Stopping the blood transfusion
D. Decreasing a fever
B. airway management
Airway management is a priority with a client experiencing a type I hypersensitivity.
A fever is a symptom of a type II, III, and IV hypersensitivity. Arthralgia is symptom associated with serum sickness, a type III hypersensitivity. A blood transfusion is the result of a type II hypersensitivity.
A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate
a. administration of immunosuppressant medications.
b. insertion of an arteriovenous graft for hemodialysis.
c. placement of the patient on the transplant waiting list.
d. drawing blood for human leukocyte antigen (HLA) and ABO compatibility matching.
a. administration of immunosuppressant medications
ANS: A Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.
A nurse is caring for a client who has hearing loss. Which of the following actions should the nurse use to enhance communication with the client? (Select All That Apply).
a) Provide the client with large print materials.
b) Ensure the clients wears their hearing aids.
c) Use a sign language interpreter
d) Communicate using paper and pen.
e) Face the client when speaking.
BCDE
If a patient has hearing loss, the nurse should make sure that patients wear hearing aids, use a sign language interpreter, have them use paper and pen, and lastly face the patient directly when speaking so the nurse can communicate better with the patient.
Interprofessional management of ovarian cancer includes which measure(s)? Select all that apply.
A. combination chemotherapy to cure the cancer
B. bilateral salpingo-oophorectomy to remove diseased organs
C. radiation therapy to eliminate all cancer cells
D. referral to social services for supportive care
E. nutrition therapy for parenteral lipids
B. D.
Ovarian cancer is a malignant tumor of the ovary. Ovarian cancer is the fourth most common gynecologic cancer, and it is the most lethal. It is usually found in advanced stages because clients are often without symptoms in the early stages of the disease. Interdisciplinary management may involve chemotherapy, radiation therapy, surgery, and supportive services. Chemotherapy may be used to achieve remission of the disease; it is not, however, curative. Surgery is the treatment of choice, usually involving total hysterectomy with bilateral salpingo-oophorectomy and removal of the omentum. Radiation therapy may be performed for palliative purposes only. The nurse should provide a referral to home health services, financial assistance, psychological counseling, clergy, and other social services, as appropriate. Nutrition therapy for parenteral lipids is not part of the management of ovarian cancer.
Which patient below is a candidate for PEP (Post-exposure Prophylaxis)?
A. A 32-year-old patient who reports sharing IV drug injection devices with a person who is HIV-positive 5 days ago.
B. A 28-year-old patient who engages in high risk activities on a regular basis that could lead to an HIV infection.
C. A 55-year-old who is HIV-positive.
D. A 30-year-old who was sexually assaulted two days ago.
The answer is D. PEP (post-exposure prophylaxis) is medication that is taken AFTER an encounter with an HIV infected person. These medications can help prevent becoming infected with HIV, if started within 72 HOURS of the exposure (option A is not a candidate). These medications are NOT for routine usage but for emergencies (sexual assault, needle stick etc.). If a patient is at high risk (as with the patient in option B), they should consider PrEP (pre-exposure prophylaxis). PEP is taken for 28 days.
Which nursing interventions address the immediate priority of care for a client experiencing a severe hypersensitivity reaction? (select all that apply)
A. Assess respiratory status continuously
B. Administer subcutaneous epinephrine as prescribed
C. Monitor urine output
D. Teach the client when and how to use an anaphylactic kit
E. Administer oxygen via nasal cannula at the prescribed rate
A. Assess respiratory status continuously
B. Administer subcutaneous epinephrine as prescribed
E. Administer oxygen via nasal cannula at the prescribed rate
Administering epinephrine is a component of emergency management and will interrupt the anaphylactic response.
Assessing respiratory status and administering oxygen to preserve ventilation and perfusion are acute priorities.
Monitoring urine output in the setting of hypotension is important, as is client teaching, these are not priorities over emergency management, ventilation, and perfusion
A client was admitted to the emergency department (ED) following a workplace accident and has just experienced brainstem death. The nurse recognizes that the client is likely an appropriate donor for tissue and organs. What actions related to organ donation should the (ED) nurse perform?
A. Present the family with literature that provides an overview of the organ donation process.
B. Ensure that the family has a quiet, private place to discuss their decision around tissue donation.
C. Describe the potential benefits of organ donation for individuals who are awaiting an organ.
D. Support and validate the decision that the client's family makes.
E. Ask if the family if the client ever expressed an interest in organ donation.
B. D.
In most cases, it is not the role or responsibility of the nurse to initiate the first dialogue about organ or tissue donation following brainstem death. The nurse should answer any questions posed by the family, but the primary responsibilities include supporting and validating the family.
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?
a) Placing ID tags on the shroud and ankle
b) Washing the body to remove blood and excretions
c) Placing the body in normal anatomic position
d) Removing tubes and soiled dressings
A
All of the answers are correct, but legally, we are supposed to tag our patients.
The nurse is teaching a client about ovarian cancer. Which information should the nurse include in the teaching plan? Select all that apply
A. details about the prognosis
B. staging and grading of ovarian cancer
C. need for routine colonoscopy beginning at age 30
D. procedures for diagnosis if there is a pelvic mass
E. symptoms occurring early in the disease process
B. D.
Client teaching emphasizes the importance of regular gynecologic examinations. If a pelvic mass is found, the nurse should completely explain the procedures for diagnosis, presurgical and postsurgical instructions, and the terminology particular to staging and grading of cancer, when appropriate. The nurse should refer all questions about the prognosis to the health care provider. Routine colonoscopies are typically begun at age 50 unless family history warrants otherwise. Ovarian tumors are commonly occult until symptoms of advanced disease are present.
A client is to have a transfusion of packed red blood cells from a designated donor. The client asks if any diseases can be transmitted by this donor. The nurse should inform the client that which disease(s) can be transmitted by a designated donor? Select all that apply.
A. Epstein-Barr virus
B. human immunodeficiency virus (HIV)
C. cytomegalovirus (CMV)
D. hepatitis A
E. malaria
ABC
Using designated donors does not decrease the risk for contracting infectious diseases, such as the Epstein-Barr virus, HIV, or CMV. Hepatitis A is transmitted by the oral-fecal route, not the blood route; however, hepatitis B and C can be contracted from a designated donor. Malaria is transmitted by mosquitoes.
13. You’re providing education to a Systemic Lupus Erythematosus support group about preventing flares. Which statement by a participant requires re-education about this topic?
A. “Emotional stress and illness are triggers for a flare-up.”
B.”I always wear large-brimmed hats and long sleeves when I’m outside.”
C. “Exercise should be avoided due to the physical stress it causes on the body.”
D. “I will make it priority to receive my yearly influenza vaccine.
The answer is C. Exercise is a very important step in preventing lupus flares. It helps maintain joint stability and manages weight. Exercise should not be limited but encouraged to as much as the patient can tolerate. Remember LESS for less flares: Lower stress (avoid overworking, emotional, illness, and use techniques to have prevent stress), Exercise (helps joints and manages weight), Sleep (need more than 8 hours to prevent the body from getting too exhausted), Sun Protection (sunscreen and large-brimmed hats…sunlight can activate a flare).
The nurse assesses the flap created after a laryngectomy to remove cancer of the larynx and the immediate post-operative period appears dusky in color. What is the nurse's first action?
A. Apply moist heat over the flap site.
B. Massage the flap site vigorously.
C. Place a tight dressing over the flap.
D. Assess flow to the area using a Doppler device.
D. Assess flow to the area using a Doppler device. First 24 hours post, assess every hour
A client diagnosed with terminal cancer is making plans to take flying lessons because that has always been her personal goal, and it will allow her to visit older adult parents. What stage of death and dying, according to Kübler-Ross, is best illustrated in this description?
a. Anger
b. Depression
c. Acceptance
d. Bargaining
Answer:
d. Bargaining
Rationale:
This example demonstrates characteristics of bargaining, such as a desire to fulfill wished, make a will, visit relatives, and putt affairs in order. This stage is unlike the acceptance stage, during which the client feels tranquil and is prepared to die with all arrangements in order. During the anger stage, the client expresses rage and hostility. In the depression stage, the client goes through a period of grief before death.
A client is undergoing a bone marrow aspiration and biopsy. The client is very worried about the procedure. What should the nurse do to prepare the client for the procedure?
A. Allow the client's family to stay as long as possible
B. Listen as the client expresses concerns.
C. Encourage the client to take slow, deep breaths to relax.
D. Suggest the client request the health care provider prescribe a sedative.
D. Administering a sedative prior to a bone marrow aspiration and biopsy is common preparation for the procedure, and the nurse can suggest that the client request a sedative if it has not been prescribed. Encouraging the client to take slow, deep breaths may be helpful, but a sedative may be more helpful during the uncomfortable parts of the procedure to decrease the stress response of tightening and tensing the muscles. Allowing the client's family to stay may be appropriate if the family has a calming effect on the client prior to the procedure, but they will not be able to be present during the procedure. The nurse should listen while the client expresses concerns, but this may not be sufficient for calming the client during the procedure.
The nurse in the emergency department reports there is a possibility of having had direct contact with the blood of a client who is suspected of having human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The nurse requests that the client have a blood test. Which circumstance(s) would indicate that the client does not need to give consent for HIV testing? Select all that apply.
A. An emergency medical provider has been exposed to the client's blood or body fluids.
B. Testing is prescribed by a health care provider (HCP) under emergency circumstances.
C. Testing is ordered by a court, based on evidence that the client poses a threat to others.
D. Testing is done on blood collected anonymously in an epidemiologic survey.
E. An HCP who is taking care of a client suspected of having HIV/AIDS requests a blood test.
ABC
Upon an HCP's written prescription requesting an HIV test for a client, consent for HIV testing must be obtained. Consent exceptions include the following: testing is prescribed by a HCP under emergency circumstances, and the test is medically necessary to diagnose or treat the client's condition; testing is prescribed by a court, based on clear and convincing evidence of a serious and present health threat to others posed by an individual; testing is done on blood collected or tested anonymously as part of an epidemiologic survey; or an emergency medical provider has been exposed to the client's blood or body fluids.
FILL IN THE BLANK.
The Second Stage of Lyme Disease is aka _______________________ ________________. It occurs ______________ to ______________ weeks after tick bite. It tends to have symptoms involving the ________________ and _______________. S/s consist of things such as; _______________________ which is an inflamed heart, a decrease in respiratory rate and heart rate leading to __________________ and ____________________________. One may feel off balance or ______________ and experience heart __________________. CNS disorder may occur such as ____________________, _______________________, and _________________.
-Early disseminated
-2 to 12 weeks
-Heart and CNS
-Carditis
-Bradycardia and Bradypnea
-Dizzy
-Palpitations
-Meningitis
-Facial Paralysis
-Peripheral Neuropathy
Which finding is most important for the nurse to communicate to the healthcare provider about a patient who received a liver transplant 1 week ago?
a. Dry palpebral and oral mucosa
b. Crackles at bilateral lung bases
c. Temperature 100.8° F (38.2° C)
d. No bowel movement for 4 days
ANS: C
The risk of infection is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions and might be communicated to the health care provider, but they do not indicate a need for urgent action
A nurse is performing postmortem care for a client who has just died. The client's medical record states that they are a member of the Russian Orthodox Church and wish their body to be prepared according to those common practices and customs. When preparing the body, the nurse would perform which action(s)? Select all that apply.
A. Maintain the arms at the client's sides
B. Place the fingers in a cross formation.
C. Apply holy oil brought in by the family.
D. Allow only family members to participate in body preparation.
E. Use natural fibers to wrap the body.
B.E.
Common practices associated with death and members of the Russian Orthodox Church include the following: the arms are crossed after death, fingers are set in a cross, and the unembalmed body is clothed in natural fiber. The other options mentioned may be customary for some members of other religions but would not be performed for this client.