Q2 25-30, Q3 1
A 6-year-old child is brought to the clinic for evaluation of short stature, fatigue, and recurrent episodes of morning irritability and sweating. The parent reports the child often “crashes in the morning before breakfast.” Lab results show low growth hormone, low cortisol, and low TSH levels, consistent with panhypopituitarism. What is the priority nursing concern for this child?
Fluid overload due to antidiuretic hormone excess
Delayed cognitive development related to low thyroid hormone
Risk for hypoglycemia related to cortisol and growth hormone deficiency
Risk for hyperactivity due to excess adrenal stimulation
Risk for hypoglycemia related to cortisol and growth hormone deficiency
There are four kinds of leukemia which are categorized based on:
How aggressive they are AND whether they mostly affect adults or children
What cell line is involved AND whether they are slow or fast-growing
Whether they are managed inpatient or outpatient AND whether they are curable or not
What cell line is involved AND whether they are curable or not
What cell line is involved AND whether they are slow or fast-growing
One of the most painful expected effects from chemotherapy used to treat hematologic malignancies is:
Nausea
Dyspnea
Alopecia
Mucositis
Mucositis
The nurse observes that an older adult patient with a diagnosis of end-stage renal failure prefers to have an adult child make all health care decisions. While the family is visiting, the patient explains that this is a cultural practice and is very important to them. Which is the best response(s) by the nurse? Select all that apply.
Privately ask the adult child to allow the patient to make health care decisions.
Explain to the patient they are responsible for their decisions.
Work with the care team to negotiate informed consent.
Avoid divulging information to the adult child.
Acknowledge the patient’s right to receive culturally appropriate care.
Work with the care team to negotiate informed consent.
Acknowledge the patient’s right to receive culturally appropriate care.
The nurse is caring for an older adult hospitalized with pneumonia. Which assessment finding is most consistent with delirium?
Gradual decline in memory over several years
Difficulty recalling recent events
Sudden disorientation and fluctuating alertness
Progressive inability to perform activities of daily living
Sudden disorientation and fluctuating alertness
Maria is a 66-year-old retired caregiver on a fixed income with type 2 diabetes and worsening diabetic retinopathy. She reports that she has been rationing her insulin due to increased medication costs and has not attended an eye specialist appointment in over 3 years because the nearest clinic is far away and she lacks transportation. She lives alone in a small farm town 90 minutes from the nearest city and has recently stopped driving due to vision changes. Which social determinants of health (SDOH) most directly contributed to Maria’s current condition? (Select all that apply.)
Inadequate access to affordable medications leading to nonadherence
Rural setting with a great distance to specialty healthcare
Age-related decline in insulin effectiveness
Limited access to specialty care due to transportation barriers
Financial barriers related to healthcare costs
Inadequate access to affordable medications leading to nonadherence
Rural setting with a great distance to specialty healthcare
Which best explains induction and consolidation chemotherapy?
Induction chemotherapy is given over months to years to ensure long-term remission and consolidation chemotherapy is given before stem cell transplant to prepare the body for the stem cell infusion
Induction chemotherapy is given at diagnosis to attempt to induce remission and consolidation chemotherapy is given in planned cycles to ensure that the remission is durable
Induction chemotherapy is given inpatient and consolidation chemotherapy is given outpatient
Induction chemotherapy is given for leukemias, and consolidation chemotherapy is given for lymphomas and multiple myeloma
Induction chemotherapy is given at diagnosis to attempt to induce remission and consolidation chemotherapy is given in planned cycles to ensure that the remission is durable
Which of the following is NOT the role of the registered nurse in managing central venous access devices?
Teaching patients how to flush their lines at home
Monitoring CVAD sites for s/sx infection
Troubleshooting lines that will not draw blood
All of these are the role of the RN in managing CVADs
All of these are the role of the RN in managing CVADs
A medical nurse is providing end-of-life care for a patient diagnosed with metastatic bone cancer. The nurse notes that the patient has been receiving extended-release oral opiates for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?
Request the analgesics be prescribed by an alternative route.
Crush the medication in order to aid swallowing and absorption.
Administer the patient's medication with the meal tray.
Administer the oral medication rectally.
Request the analgesics be prescribed by an alternative route.
An older adult patient says, “I don’t want to be a burden to my family anymore.” Which response by the nurse is best?
“You shouldn’t feel that way.”
"Your family probably doesn’t mind helping you.”
"Tell me more."
“You need to focus on the positive.”
"Tell me more."
A patient with systemic lupus erythematosus (SLE) has been taking prednisone daily for several weeks to control a disease flare. The patient tells the nurse: “My joint pain is finally better, but the weight gain and mood swings are exhausting. I haven’t slept since I started taking these stupid pills. I’m going to stop taking the prednisone.” Which response by the nurse is most appropriate?
“Stopping prednisone may cause your lupus symptoms to flare again, and they will be worse this time.”
“You should stop prednisone only if your blood pressure becomes elevated, not just for mood swings and insomnia.”
“Prednisone must be tapered gradually to prevent adrenal crisis, even if side effects are difficult to tolerate.”
“Once symptoms improve, long‑term prednisone can usually be stopped abruptly if you have been on the medication for less than one month.”
“Prednisone must be tapered gradually to prevent adrenal crisis, even if side effects are difficult to tolerate.”
The best way to explain the difference between HL and NHL is:
HL only affects young people whereas NHL generally affects people over age 60
HL is curable with stem cell transplant
HL is a certain kind of lymphoma arising from a B-cell mutation that results in a hallmark Reed-Sternberg cell
HL is a more heterogenous disease, with many presentations based on the lymph nodes affected whereas NHL is a more homogenous disease with classic features
HL is a certain kind of lymphoma arising from a B-cell mutation that results in a hallmark Reed-Sternberg cell
Understanding the normal values on a CBC with differential, and knowing the expected alterations in different disease states and with cancer treatments will help the nurse:
Provide a medical diagnosis to the patient
Plan priorities for patient care and education
Understand the patient’s kidney function
Gauge the effectiveness of anti-emetics
Plan priorities for patient care and education
A patient receiving comfort care for osteosarcoma is experiencing severe pain and receiving pain medication regularly and PRN. For the past several hours the level of consciousness has declined, and the patient is now unresponsive. How will the nurse address the patient's pain control regimen? Select all that apply.
The pain control regimen should be continued as prescribed.
The pain control regimen should be placed on hold until the client's level of consciousness improves.
IV analgesics should be withheld and replaced with transdermal analgesics.
The client's analgesic dosages should be reduced by approximately one half.
Pain assessment should be conducted to include nonverbal indicators of pain.
The pain control regimen should be continued as prescribed.
Pain assessment should be conducted to include nonverbal indicators of pain.
A nurse is assessing fall risk in an 88-year-old patient. Which finding increases the patient’s risk for falls?
Use of multiple medications
Daily physical activity
Corrective eyeglasses
Adequate hydration
Use of multiple medications
BOW TIE
PATIENT DATA Dolores is a 47-year-old woman with Type 1 diabetes brought to the emergency department by her co-worker at 1300. The co-worker reports that Dolores has been confused, shaky, and sweating profusely for the past hour. She also states that she has been with Dolores since 0700 today at a work meeting, and she has not seen Dolores eat anything in that timeframe, or drink anything outside of coffee. On arrival, the patient is diaphoretic, anxious, and has slurred speech. Her blood glucose is 42 mg/dL.
What condition is the patient most likely experiencing?
Diabetic ketoacidosis (DKA)
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
Hypoglycemia
What are the TWO actions to take?
Administer lispro insulin
Give oral fast-acting carbohydrate if patient alert enough to swallow safely
Administer acetaminophen
Give IV sodium bicarbonate
Prepare for intubation and mechanical ventilation
Start IV and give IV dextrose if patient not alert enough to swallow safely
What are the TWO parameters to monitor?
Blood glucose
Urine output
Urine ketones
Level of consciousness
Anion gap
Serial potassium levels
Condition: Hypoglycemia
Two Actions: Give oral fast-acting carbohydrate if patient alert enough to swallow safely
Start IV and give IV dextrose if patient not alert enough to swallow safely
Monitor: Blood glucose and level of consciousness
Which of the following would most likely be included in plan for nursing care of the hospitalized patient with multiple myeloma
Monitor intake and output, daily weights, and creatinine
Promote a calcium-rich diet and enforce a fluid restriction
Patient teaching about the risk for falls
Answers 1 and 3
Answers 1 and 3: Monitor intake and output, daily weights, and creatinine and patient teaching about the risk for falls
The nurse is caring for an adolescent receiving chemotherapy for leukemia. Morning laboratory results reveal a significant decrease in hemoglobin and hematocrit levels compared with the previous week. Which assessment finding represents a cardinal symptom of this complication?
increasing fatigue and decreased activity tolerance
generalized rash on arms
an episode of epistaxis after coughing
burning with urination and flank pain
increasing fatigue and decreased activity tolerance
. What priority problems would be considered when planning care for a patient diagnosed with breast cancer who will receive both chemotherapy and radiation? Select all that apply.
Impaired skin integrity
Impaired nutrition
Risk for infection
Disturbed body image
Activity intolerance
Impaired skin integrity
Impaired nutrition
Risk for infection
Disturbed body image
Activity intolerance
A patient comes to the clinic and reports recent heavy menstrual flow. The nurse suggests an increase in daily intake of which substance to offset the effects of this bleeding?
Vitamin E
Vitamin D
Iron
Magnesium
Iron
Which statement best explains why a patient with DIC is bleeding?
The liver stops producing clotting factors
Platelets are destroyed by bacteria
Clotting factors and platelets have been consumed
The immune system attacks blood cells
Clotting factors and platelets have been consumed
The rationale for watchful waiting for a slow-growing hematologic malignancy is based on:
The expense of targeted therapies which causes a burden for many patients
The low risk of the disease causing morbidity and mortality and the risk of toxicities from the available treatments
The need for people to adjust emotionally over time to their cancer before they can fully invest in the treatment regimen
The need to allocate scarce medical resources to more aggressive malignancies
The low risk of the disease causing morbidity and mortality and the risk of toxicities from the available treatments
The parent contacts the health care provider because their preschool-age child has a temperature of 101.5°F (38.6°C). The child received outpatient chemotherapy 1 week ago. Which is the most appropriate response by the nurse?
Instruct the parent to administer acetaminophen every 4 hours until the fever dissipates.
Ask whether any family members or other close associates are ill.
Have the parent bring the child to the pediatric oncology clinic triage station as soon as possible.
Instruct the parent to obtain and give the antibiotic that the oncologist calls in to the pharmacy.
Have the parent bring the child to the pediatric oncology clinic triage station as soon as possible.
The nurse is teaching students about normal aging changes. Which statement by a student indicates understanding?
“All older adults eventually develop dementia.”
“Confusion is a normal part of aging.”
“Older adults may have slower recall, but cognition should remain intact.”
"Depression is expected in older adults due to the rates of chronic illness.”
“Older adults may have slower recall, but cognition should remain intact.”
The nurse is providing care for an older adult diagnosed with a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning?
Bone marrow in older adults produces the same amount of healthy, functional blood cells as younger patients.
Older adults are less able to increase blood cell production when demand suddenly increases.
Stem cells in older adults eventually lose their ability to differentiate.
The ratio of plasma to erythrocytes and lymphocytes increases with age.
Older adults are less able to increase blood cell production when demand suddenly increases.