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Exam 3 end of chapter Practice Questions
Terms in this set (102)
A nurse is planning care for a client who has a new prescription for peripheral parenteral nutrition (PPN). Which of the following actions should the nurse include in the plan of care? (Select all that apply.)
A. Examine trends in weight loss.
B. Review prealbumin finding.
C. Administer an IV solution of 20% dextrose.
D. Add a micron filter to IV tubing.
E. Use an IV infusion pump.
A, B, D, E
(A. CORRECT: Examining trends in weight loss will help to evaluate the outcome of PPN.
B. CORRECT: Reviewing the prealbumin finding will determine nutritional deficiency over a short period of time.
C. An IV solution of 20% dextrose is administered only as TPN using a central vein.
D. CORRECT: A micron filter is always used when infusing PN solution.
E. CORRECT: An IV infusion pump is always used to regulate the flow and provide accurate delivery of the PN solution.)
A charge nurse is providing information about fat emulsion added to total parenteral nutrition (TPN) to a group of nurses. Which of the following statements by the charge nurse are appropriate? (Select all that apply.)
A. "Concentration of lipid emulsion can be up to 30%."
B. "Adding lipid emulsion gives the solution a milky appearance."
C. "Check for allergies to soybean oil."
D. "Lipid emulsion prevents essential fatty acid deficiency."
E. "Lipids provide calories by increasing the osmolality of the PN solution."
A, B, C, D
(A. CORRECT: Lipid emulsion is available in 10%, 20%, and 30% concentrations depending upon the client's carbohydrate and caloric needs.
B. CORRECT: The lipid emulsion is formulated from safflower and/or soybean oils and egg phospholipid, making the solution appear milky.
C. CORRECT: Lipid emulsion is formulated from safflower and/or soybean oil and egg phospholipid. The nurse should check for allergies to these ingredients.
D. CORRECT: Lipid emulsion is used for additional calories as concentrated energy and to prevent essential fatty acid deficiency.
E. Lipids provide the calories needed without increasing osmolality of the PN solution)
A charge nurse is teaching a group of nurses about medication compatibility with TPN. Which of the following statements should the charge nurse make?
A. "Use the Y‑port on the TPN IV tubing to administer antibiotics."
B. "Regular insulin can be added to the TPN solution."
C. "Administer heparin through a port on the TPN tubing."
D. "Administer vitamin K IV bolus via a Y‑port on the TPN tubing."
(A. Administering any IV medication through a Y‑port on the TPN line is contraindicated.
B. CORRECT: Regular insulin may be added to the TPN solution to decrease hyperglycemia.
C. Heparin may be added to the TPN solution to decrease clot formation in the cannula, but it is not injected directly into a port on the TPN tubing.
D. Vitamin K can be added to the TPN solution, but it should not be administered IV bolus through the TPN IV line.)
A nurse is preparing to administer lipid emulsion and notes a layer of fat floating in the IV solution bag. Which of the following actions should the nurse take?
A. Shake the bag to mix the fat.
B. Turn the bag upside down one time.
C. Return the bag to the pharmacy.
D. Administer the bag of solution as it is
(A. Shaking the bag is not an appropriate action because "cracking" of the solution has occurred and it should not be administered.
B. Turning the solution upside down does not resolve the problem because cracking of the TPN has occurred and it should not be administered.
C. CORRECT: Returning the solution to the pharmacy is an appropriate action by the nurse because cracking of the solution has occurred and it should not be administered. The pharmacist and provider will need to adjust the formulation of the solution to prevent cracking.
D. Administering the solution as it is would not be an appropriate nursing action because cracking of the solution has occurred. Infusion of a cracked solution can lead to fat or particulate embolisms.)
A nurse is caring for a client who is receiving TPN through a central venous access device, but the next bag of solution is not available for administration at this time. Which of the following is an appropriate action by the nurse?
A. Administer 20% dextrose in water IV until the next bag is available.
B. Slow the infusion rate of the current bag until the solution is available.
C. Monitor for hyperglycemia.
D. Monitor for hyperosmolar diuresis.
(A. CORRECT: Administering 20% dextrose in water IV until the TPN solution is available will prevent hypoglycemia.
B. Decreasing the rate of the TPN solution is not an appropriate action because the decreased rate can cause hypoglycemia.
C. The client should be monitored for hypoglycemia when the TPN solution is not infusing and adequate glucose is not provided.
D. Monitor the client for hyperosmolar diuresis when the TPN solution has infused too fast.)
A nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. The client reports having a cough along with nausea and diarrhea. Their temperature is 38.1° C (100.6° F) orally. The client is concerned about the possibility of having HIV. Which of the following actions should the nurse take? (Select all that apply.)
A. Perform a physical assessment.
B. Determine when manifestations began.
C. Teach the client about HIV transmission.
D. Draw blood for HIV testing.
E. Obtain a sexual history.
A, B, E
(A. CORRECT: Perform a physical assessment to gather data about the client's condition.
B. CORRECT: Gather more data to determine whether the manifestations are acute or chronic.
C. Teaching the client about HIV transmission is not an appropriate action at this time.
D. Drawing blood for HIV testing is not an appropriate action at this time.
E. CORRECT: Obtain a sexual history to determine how the virus was transmitted.)
A nurse is caring for a client who is suspected of having HIV. The nurse should identify that which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select all that apply.)
A. Western blot
B. Indirect immunofluorescence assay
C. CD4+ T‑lymphocyte count
D. HIV RNA quantification test
E. Cerebrospinal fluid (CSF) analysis
(A. CORRECT: Positive results of a Western blot test confirm the presence of HIV infection.
B. CORRECT: Positive results of an indirect immunofluorescence assay confirm the presence of HIV infection.
C. CD4+ T‑lymphocyte count assists with classifying the stage of HIV infection.
D. HIV RNA quantification tests are used to determine vial level and to monitor treatment.
E. A CSF analysis can be used to confirm meningitis.)
A nurse is providing teaching for a client who has stage 3 HIV disease. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?
A. "I will wear gloves while changing the pet litter box."
B. "I will rinse raw fruits with water before eating them."
C. "I will wear a mask when around family members who are ill."
D. "I will cook vegetables before eating them."
(A. A client who has AIDS should avoid changing the litter box to prevent acquiring toxoplasmosis.
B. A client who has AIDS should avoid consuming raw fruits due to the presence of bacteria that can cause opportunistic infections.
C. Due to compromised immune response, a client who has AIDS should avoid contact with family members who are ill.
D. CORRECT: A client who has AIDS should cook vegetables before eating to kill bacteria that cause opportunistic infections.)
A nurse is assessing a client for HIV. The nurse should identify that which of the following are risk factors associated with this virus? (Select all that apply.)
A. Perinatal exposure
C. Monogamous sex partner
D. Older adult woman
E. Occupational exposure
A, D, E
(A. CORRECT: Perinatal exposure is a risk factor associated with HIV. Women who are pregnant should take precautionary measures to prevent HIV exposure.
B. Women who are pregnant should be tested for HIV, but pregnancy is not a risk factor associated with this virus.
C. Having a monogamous sex partner is not a risk factor associated with the HIV virus.
D. CORRECT: Being an older adult woman is a risk factor associated with the HIV virus due to vaginal dryness and the thinning of the vaginal wall.
E. CORRECT: Occupational exposure, such as being a health care worker, is a risk factor associated with the HIV virus.)
A nurse is providing teaching for a client who has stage 2 HIV disease and is having difficulty maintaining a normal weight. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?
A. "I will choose a diet high in fat to help gain weight."
B. "I will be sure to eat three large meals daily."
C. "I will drink up to 1 liter of liquid each day."
D. "I will add high‑protein foods to my diet."
(A. The client should be taught to avoid high‑fat foods to gain weight because fat intolerance—causing flatus, bloating, and diarrhea—is common in clients who have HIV/AIDS .
B. The client should be taught that small frequent meals (such as six meals daily) are better tolerated than three large meals.
C. The client should be taught to drink 2 to 3 L of liquids daily to maintain nutrition status.
D. CORRECT: The client should be taught to add high‑protein, high‑calorie foods to the diet daily as the best way to gain weight and maintain health.)
A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect?
A. Decreased blood lipase level
B. Decreased blood amylase level
C. Increased blood calcium level
D. Increased blood glucose level
(A. The client will experience an elevated blood lipase level due to pancreatic cell injury.
B. The client will experience an elevated blood amylase level due to pancreatic cell injury.
C. The client will experience a decreased blood calcium level due to fat necrosis.
D. CORRECT: The client will experience an increased blood glucose level due to pancreatic cell injury, which results in impaired metabolism of carbohydrates due to a decrease in the release of insulin.)
A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take?
A. Instruct the client to chew the medication before swallowing.
B. Offer a glass of water following medication administration.
C. Administer the medication 30 min before meals.
D. Sprinkle the contents on peanut butter.
(A. Pancrelipase should be swallowed without chewing to reduce irritation and slow the release of the medication.
B. CORRECT: Drink a full glass of water following administration of pancrelipase.
C. Pancrelipase should be administered with every meal and snack.
D. The contents of the pancrelipase capsule can be sprinkled on nonprotein foods, and peanut butter is a protein food.)
A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect?
A. Pain in right upper quadrant radiating to right shoulder
B. Report of pain being worse when sitting upright
C. Pain relieved with defecation
D. Epigastric pain radiating to the left shoulder
(A. A client who has cholecystitis will report pain in the right upper quadrant radiating to the right shoulder.
B. A client who has pancreatitis will report pain being worse when lying down.
C. A client who has pancreatitis will report that pain is relieved by assuming the fetal position.
D. CORRECT: A client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank, or left shoulder)
A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis?
A. Generalized cyanosis
B. Hyperactive bowel sounds
C. Gray-blue discoloration of the skin around the umbilicus
D. Wheezing in the lower lung fields
(A. Expect to find generalized jaundice.
B. Expect to find absent or decreased bowel sounds.
C. CORRECT: A gray-blue discoloration in the periumbilical area is a manifestation of pancreatitis.
D. Expect to find diminished breath sounds as well as dyspnea or orthopnea.)
A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.)
A. "I plan to eat small, frequent meals."
B. "I will eat easy‑to‑digest foods with limited spice."
C. "I will use skim milk when cooking."
D. "I plan to drink regular cola."
E. "I will limit alcohol intake to two drinks per day."
A, B, C
(A. CORRECT: Small, frequent meals are recommended for the client who has pancreatitis.
B. CORRECT: Bland, easy‑to‑digest foods are recommended for the client who has pancreatitis.
C. CORRECT: Low‑fat foods are recommended for the client who has pancreatitis.
D. Caffeine‑free beverages are recommended for the client who has pancreatitis. Regular cola contains caffeine.
E. The client who has pancreatitis should avoid any alcohol intake)
A nurse on a medical‑surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care?
A. Initiate contact precautions.
B. Weigh the client weekly.
C. Measure abdominal girth at the base of the ribcage.
D. Provide a high‑calorie, high‑carbohydrate diet.
(A. Hepatitis B is transmitted via blood. Standard precautions are adequate.
B. Daily weights are obtained to monitor fluid status.
C. The client's abdominal girth is measured over the largest part of the abdomen, which will vary by client.
D. CORRECT: The client who has hepatitis B should have a diet high in calories and carbohydrates)
A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect?
A. Presence of immunoglobulin G antibodies (IgG)
B. Positive EI A test
C. Aspartate aminotransferase (AST) 35 units/L
D. Alanine aminotransferase (ALT) 15 IU/L
(A. The presence of IgG is an expected laboratory finding in a client who has hepatitis A infection.
B. CORRECT: A positive EI A test is an expected laboratory finding in a client who has a new diagnosis of hepatitis C.
C. AST is elevated in clients who have hepatitis C infection; 35 units/L is within the expected reference range.
D. ALT is elevated in clients who have hepatitis C infection; 15 units/L is within the expected reference range.)
A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? (Select all that apply.)
B. Change in orientation
E. Fetor hepaticus
B, C, E
(A. Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy.
B. CORRECT: A change in orientation indicates hepatic encephalopathy in a client who has advanced cirrhosis.
C. CORRECT: Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy.
D. Ascites can be present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy.
E. CORRECT: Fetor hepaticus (a fruity, musty breath odor) is a finding of hepatic encephalopathy in the client who has advanced cirrhosis.)
A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.)
B. Beta‑blocking agent
C. Opioid analgesic
A, B, D
(A. CORRECT: Diuretics facilitate excretion of excess fluid from the body in a client who has cirrhosis.
B. CORRECT: Beta‑blocking agents are prescribed for a client who has cirrhosis to prevent bleeding from varices.
C. Opioid analgesics are metabolized in the liver. They should not be administered to a client who has cirrhosis.
D. CORRECT: Lactulose is prescribed for a client who has cirrhosis to aid in the elimination of ammonia in the stool.
E. Sedatives are metabolized in the liver. They should not be administered to a client who has cirrhosis)
A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
A. Limit physical activity.
B. Avoid alcohol.
C. Take acetaminophen for comfort.
D. Wear a mask when in public places.
E. Eat small frequent meals.
A, B, E
(A. CORRECT: Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B.
B. CORRECT: Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B.
C. Acetaminophen is metabolized in the liver and should be avoided by the client who has hepatitis B.
D. Hepatitis B is a blood‑borne disease. Wearing a mask is not necessary to prevent transmission to others.
E. CORRECT: The client who has hepatitis B should eat small, frequent meals to promote improved nutrition due to the presence of anorexia.)
A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.)
A. Obtain a capillary blood glucose four times daily.
B. Administer prescribed medications through a secondary port on the TPN IV tubing.
C. Monitor vital signs three times during the 12‑hr shift.
D. Change the TPN IV tubing every 24 hr.
E. Ensure a daily aPTT is obtained.
A, C, D
(A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin.
B. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion.
C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection.
D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr.
E. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN)
A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching?
A. Mucus will be present in stool for 5 to 7 days after surgery.
B. Expect 500 to 1,000 mL of semiliquid stool after 2 weeks.
C. Stoma should be moist and pink.
D. Change the ostomy bag when it is ¾ full.
(A. Mucus and blood can be present for 2 to 3 days after surgery.
B. Output should become stool‑like, semi‑formed, or formed within days to weeks.
C. CORRECT: A pink, moist stoma is an expected finding for a colostomy.
D. The ostomy bag should be changed when it is ¼ to ½ full.)
A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take?
A. Remove the current bag and hang a new bag.
B. Infuse the remaining solution at the current rate and then hang a new bag.
C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag.
D. Remove the current bag and hang a bag of lactated Ringer's.
(A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection.
B. A bag of TPN should not infuse for more than 24 hr due to the risk of infection.
C. The rate of TPN infusion should never be increased abruptly due to the risk of hyperglycemia.
D. Administration of TPN should never be discontinued abruptly. If the solution needs replacing and another bag is not available, use dextrose 10% in water to maintain blood glucose levels.)
A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD ). The nurse should expect prescriptions for which of the following medications? (Select all that apply.)
B. Histamine 2 receptor antagonists
C. Opioid analgesics
D. Fiber laxatives
E. Proton pump inhibitors
A, B, E
(A. CORRECT: Antacids neutralize gastric acid which irritates the esophagus during reflux.
B. CORRECT: Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux.
C. Opioid analgesics are not effective in treating GERD .
D. Fiber laxatives are not effective in treating GERD .
E. CORRECT: Proton pump inhibitors decrease gastric acid production, which contributes to reflux.)
A nurse is completing an assessment of a client who has GERD . Which of the following is an expected finding?
A. Absence of saliva
B. Painful swallowing
C. Sweet taste in mouth
D. Absence of eructation
(A. Hypersalivation is an expected finding in a client who has GERD .
B. CORRECT: Painful swallowing is a manifestation of GERD due to esophageal stricture or inflammation.
C. A client who has GERD would report a bitter taste in the mouth.
D. Increased burping is an expected finding in a client who has GERD.)
A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.)
A. Rigid abdomen
C. Elevated blood pressure
D. Circumoral cyanosis
E. Rebound tenderness
A, B, E
(A. CORRECT: Manifestations of perforation include a rigid, board‑like abdomen.
B. CORRECT: Tachycardia occurs due to gastrointestinal bleeding that accompanies a perforation.
C. Hypotension is an expected finding in a client who has a perforation and bleeding.
D. Circumoral cyanosis is not a manifestation of perforation.
E. CORRECT: Rebound tenderness is an expected finding in a client who has a perforation.)
A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching?
A. Eat three moderate‑sized meals a day.
B. Drink at least one glass of water with each meal.
C. Eat a bedtime snack that contains a milk product.
D. Increase protein in the diet.
(A. Consume small, frequent meals rather than moderate‑sized meals.
B. Eliminate liquids with meals and for 1 hr prior to and following meals.
C. Avoid milk products.
D. CORRECT: Eat a high‑protein, high‑fat, low‑fiber, and moderate‑ to low‑carbohydrate diet)
A nurse is completing discharge teaching for a client who has an infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching?
A. "I will continue my prescription for corticosteroids."
B. "I will schedule a CT scan to monitor improvement."
C. "I will take a combination of medications for treatment."
D. "I will have my throat swabbed to recheck for this bacteria."
(A. Corticosteroid use is a contributing factor to an infection caused by H. pylori.
B. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment.
C. CORRECT: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori.
D. H. pylori is evaluated by obtaining gastric samples, not a throat swab.)
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.)
A. Client reports pain relieved by eating.
B. Client states that pain often occurs at night.
C. Client reports a sensation of bloating.
D. Client states that pain occurs 30 min to 1 hr after a meal.
E. Client experiences pain upon palpation of the epigastric region.
C, D, E
(A. A client who has a duodenal ulcer will report that pain is relieved by eating.
B. Pain that rarely occurs at night is an expected finding.
C. CORRECT: A client report of a bloating sensation is an expected finding.
D. CORRECT: A client who has a gastric ulcer will often report pain 30 to 60 min after a meal.
E. CORRECT: Pain in the epigastric region upon palpation is an expected finding.)
A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply.)
A. Take the medication 1 hr before a meal.
B. Limit NSAIDs when taking this medication.
C. Expect skin flushing when taking this medication.
D. Increase fiber intake when taking this medication.
E. Chew the medication thoroughly before swallowing.
(A. CORRECT: Take the medication 1 hr before meals.
B. CORRECT: Limit taking NSAIDs when on this medication.
C. Skin flushing is not an adverse effect of this medication.
D. Fiber intake does not need to be increased when taking this medication.
E. Swallow the capsule whole. It should not be crushed or chewed.)
A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching?
A. Pernicious anemia is caused when the cells producing gastric acid are damaged.
B. Expect a monthly injection of vitamin B12.
C. Plan to take vitamin K supplements.
D. Pernicious anemia is caused by an increased production of intrinsic factor.
(A. Damage to parietal cells has occurred, which leads to pernicious anemia and causes a decrease of the intrinsic factor by the stomach parietal cells.
B. CORRECT: Include in the information that the client will receive a monthly injection of vitamin B12 to treat pernicious anemia due to a decrease of the intrinsic factor by the stomach parietal cells.
C. Vitamin K supplements are given to clients who have a bleeding disorder.
D. Parietal cell damage results in insufficient production of intrinsic factor by the stomach parietal cells.)
A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching?
A. Take the medication with food.
B. Monitor for diarrhea.
C. Wait 1 hr before taking other oral medications.
D. Maintain a low‑fiber diet.
(A. Advise the client to take aluminum hydroxide on an empty stomach.
B. Include in the teaching that aluminum hydroxide can cause constipation.
C. CORRECT: Advise the client not to take oral medications within 1 hr of an antacid.
D. Include in the teaching for the client to increase dietary fiber due to the constipating effect of the medication)
A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (Select all that apply.)
A. Evaluate intake and output.
B. Monitor laboratory reports of electrolytes.
C. Provide three large meals a day.
D. Administer ibuprofen for pain.
E. Observe stool characteristics.
A, B, E
(A. CORRECT: Evaluate the client's intake and output to prevent electrolyte loss and dehydration.
B. CORRECT: Monitor the client's electrolyte laboratory values to prevent fluid loss and dehydration.
C. Instruct the client to eat small, frequent meals.
D. Instruct the client to avoid taking ibuprofen, an NSAID, because of its erosive capabilities.
E. CORRECT: Instruct the client to report to the provider any indication of the presence of blood in the stools, which can indicate gastrointestinal bleeding)
A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching?
A. "The medicine coats the lining of my stomach."
B. "The medication should stop the pain right away."
C. "I will take my pill at bedtime."
D. "I will monitor for bleeding from my nose."
(A. Famotidine decreases gastric acid output. It does not have a protective coating action.
B. The client might need to take famotidine for several days before pain relief occurs when starting this therapy.
C. CORRECT: The client should take famotidine at bedtime, which suppresses nocturnal acid production.
D. Instruct the client to monitor for GI bleeding when taking famotidine.)
A charge nurse is teaching a group of nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements by a unit nurse indicates understanding of the purpose of the procedure?
A. "The client will have increased duodenal gastric emptying."
B. "The client will have a reduction of gastric acid secretions."
C. "The client will have an increase of gastric mucus secretion."
D. "The client will have an increased secretion of hydrogen/potassium ATPase enzymes."
(A. Pyloroplasty will increase gastric emptying, which is performed to widen the opening from the stomach to the duodenum.
B. CORRECT: Selective vagotomy will reduce gastric acid secretions.
C. Prostaglandin analog medication will stimulate mucosal protection and decrease gastric acid secretions.
D. A histamine2 antagonist medication will inhibit gastric secretion by inhibiting the hydrogen/potassium ATPase enzyme system in the gastric parietal cells.)
A nurse is completing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include?
A. Keep a food diary to identify triggers to exacerbation.
B. Consume 15 to 20 g of fiber daily.
C. Plan three moderate to large meals per day.
D. Limit fluid intake to 1 L each day.
(A. CORRECT: The client should keep a food diary to identify foods that trigger exacerbation of manifestations.
B. The client should increase daily fiber intake to 30 to 40 g.
C. The client should eat small frequent meals.
D. The client should drink 2 to 3 L fluids per day to promote a consistent bowel pattern.)
A nurse is reviewing the laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following blood laboratory results should the nurse expect to be elevated? (Select all that apply.)
B. Erythrocyte sedimentation rate
D. Folic acid
(A. Hematocrit is decreased as a result of chronic blood loss.
B. CORRECT: Increased erythrocyte sedimentation rate is a finding in a client who has Crohn's disease as a result of inflammation.
C. CORRECT: Increased WBC is a finding in a client who has Crohn's disease.
D. A decrease in folic acid level is indicative of malabsorption due to Crohn's disease.
E. A decrease in albumin is indicative of malabsorption due to Crohn's disease.)
A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following findings as the priority?
A. Client reports difficulty sleeping.
B. The client's urine is positive for glucose.
C. Client reports having an elevated body temperature.
D. Client reports gaining 4 lb in the last 6 months.
(A. The client is at risk for sleep deprivation because prednisone can cause anxiety and insomnia. However, another finding is the priority.
B. The client is at risk for hyperglycemia because prednisone can cause glucose intolerance. However, another finding is the priority.
C. CORRECT: The greatest risk to the client is infection because prednisone can cause immunosuppression. Therefore, identify manifestations of an infection, such as an elevated body temperature, as the priority finding.
D. The client is at risk for weight gain because prednisone can cause fluid retention. However, another finding is the priority.)
A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching?
A. "Take the medication 2 hours after eating."
B. "Discontinue this medication if your skin turns yellow‑orange."
C. "Notify the provider if you experience a sore throat."
D. "Expect your stools to turn black."
(A. Sulfasalazine should be taken right after meals and with a full glass of water to reduce gastric upset and prevent crystalluria.
B. Yellow‑orange coloring of the skin and urine is a harmless effect of sulfasalazine.
C. CORRECT: Sulfasalazine can cause blood dyscrasias. The client should monitor and report any manifestations of infection, such as a sore throat.
D. Sulfasalazine can cause thrombocytopenia and bleeding. Black stools are a manifestation of gastrointestinal bleeding, and the client should report this to the provider.)
A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching?
A. Decrease intake of calorie‑dense foods.
B. Drink canned protein supplements.
C. Increase intake of high fiber foods.
D. Eat high-residue foods.
(A. A high‑protein diet is recommended for the client who has Crohn's disease.
B. CORRECT: A high‑protein diet is recommended for the client who has Crohn's disease. Canned protein supplements are encouraged.
C. A low‑fiber diet is recommended for the client who has Crohn's disease to reduce inflammation.
D. Instruct the client to eat low-residue foods to reduce inflammation.)
A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching?
A. "I will plan to limit fiber in my diet."
B. "I will restrict fluid intake during meals."
C. "I will switch to black tea instead of drinking coffee."
D. "I will try to eat cold foods rather than warm when my stomach feels upset."
(A. CORRECT: A low‑fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation.
B. A client who has dumping syndrome should avoid fluids with meals.
C. Caffeine can increase diarrhea and cramping. The client should avoid caffeinated beverages, such as black tea.
D. The client should avoid cold foods because these can increase intestinal motility and cause exacerbation of manifestations.)
A nurse is planning care for a client who has a platelet count of 10,000/mm3 . Which of the following interventions should the nurse include in the plan of care?
A. Apply prolonged pressure to puncture site after blood sampling.
B. Administer epoetin alfa as prescribed.
C. Place the client in a private room.
D. Have the client use an oral topical anesthetic before meals.
(A. CORRECT: Implement bleeding precautions for the client who has thrombocytopenia.
B. Epoetin alfa is administered to the client who has anemia.
C. The client who has neutropenia is placed in a private room.
D. A topical oral anesthetic is used for the client who has mucositis.)
A nurse is caring for a client who is receiving chemotherapy and has mucositis. Which of the following actions should the nurse take?
A. Use a glycerin‑soaked swab to clean the client's teeth.
B. Encourage increased intake of citrus fruit juices.
C. Obtain a culture of the lesions.
D. Provide an alcohol‑based mouthwash for oral hygiene.
(A. Glycerin‑based swabs should be avoided when providing oral hygiene to a client who has mucositis.
B. Acidic foods should be discouraged for a client who has oral mucositis.
C. CORRECT: Obtain a culture of the oral lesions to identify pathogens and determine appropriate treatment.
D. Nonalcoholic mouthwashes are recommended for a client who has mucositis.)
A nurse is planning care for a client who is undergoing chemotherapy and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (Select all that apply.)
A. Encourage a high‑fiber diet.
B. Eliminate standing water in the room.
C. Have the client wear a mask when leaving the room.
D. Have client‑specific equipment remain in the room.
E. Eliminate raw foods from the client's diet.
B, C, D, E
(A. There is no benefit to a high‑fiber diet for a client who has neutropenia.
B. CORRECT: Neutropenic precautions include the client not having contact with flowers and plants due to the presence of surface infectious agents in the water and soil.
C. CORRECT: Neutropenic precautions include having the client wear a mask when leaving the room to reduce the incidence of infection.
D. CORRECT: Neutropenic precautions include having equipment available that is only for use in caring for the client to reduce the incidence of infection.
E. CORRECT: A client who has neutropenia should avoid consuming raw foods due to the presence of surface infectious agents on peeling and rind.)
A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements should the nurse make?
A. "Your nausea will lessen with each course of chemotherapy."
B. "Hot food is better tolerated due to the aroma."
C. "Try eating several small meals throughout the day."
D. "Increase your intake of red meat as tolerated."
(A. Nausea usually occurs to the same extent with each session of chemotherapy.
B. Cold foods are better tolerated than warm or hot foods because odors from heated foods can induce nausea.
C. CORRECT: Several small meals a day are usually better tolerated by the client who has nausea.
D. Red meat is not tolerated well by the client undergoing chemotherapy because the taste of meat is frequently altered and unpalatable)
A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? (Select all that apply.)
A. Permit visitors to stay with the client 30 min at a time.
B. Warn pregnant individuals to visit the room only once daily.
C. Wear a dosimeter when in the client's room.
D. Place soiled dressings in a biohazard bag before discarding in the regular trash.
E. Dispose soiled linens in the hamper outside the client's room.
(A. CORRECT: Visitors should remain for no more than 30 min at a time and maintain a distance of at least 6 ft.
B. Pregnant individuals should not enter the room of a client receiving brachytherapy.
C. CORRECT: Healthcare personnel should wear a dosimeter when there is potential exposure to radiation, such as in the radiology department or in the room of a client receiving brachytherapy.
D. Do not discard the client's dressings in the regular trash, because the client's secretions are radioactive.
E. Do not place objects from the client's room in the hallway because they are radioactive, but should dispose of them following facility policy.)
A nurse is reviewing the plan of care for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first?
A. Instruct the client to take rest periods throughout the day.
B. Encourage the client to reposition in bed every 2 hr.
C. Check temperature every 4 hr.
D. Monitor platelet counts.
(A. Offer the client rest periods throughout the day to prevent fatigue. However, another action is the priority.
B. Encourage the client to reposition in bed every 2 hr to prevent skin breakdown. However, another action is the priority.
C. Check the client's temperature every 4 hr to monitor for indicators of infection. However, another action is the priority.
D. CORRECT: The greatest risk to the client who has thrombocytopenia is injury due to bleeding. The priority action for the nurse to take is to monitor the client's platelet level to ensure it does not reach critical level. The nurse should institute bleeding precautions.)
A nurse is reviewing the medical record of a client who has suspected ovarian cancer. Which of the following findings should the nurse identify as a risk factor for ovarian cancer? (Select all that apply.)
A. Previous treatment for endometriosis
B. Family history of colon cancer
C. First pregnancy at age 24
D. Report of first period at age 14
E. Use of oral contraceptives for 10 years
(A. CORRECT: Endometriosis is a risk factor for ovarian cancer.
B. CORRECT: A family history of breast, ovarian, or colon cancer is a risk factor for ovarian cancer.
C. A first pregnancy after 30 years of age or nulliparity is a risk factor for ovarian cancer.
D. Early menarche is a risk factor for ovarian cancer.
E. Birth control pills offer protection against ovarian cancer)
A nurse is caring for a client 24 hr following a liver lobectomy for hepatocellular carcinoma. Which of the following laboratory reports should the nurse monitor?
A. Urine specific gravity
B. Blood glucose
C. Serum amylase
(A. Alterations in urine specific gravity following a liver lobectomy are not expected.
B. CORRECT: Blood glucose should be monitored during the first 24 to 48 hr following a liver lobectomy due to decreased gluconeogenesis and stress to the liver from surgery.
C. Alterations in serum amylase following a liver lobectomy are not expected.
D. Alterations in the D‑dimer following a liver lobectomy are not expected.)
A nurse is providing teaching about colon cancer to a group of females 45 to 65 years of age. Which of the following statements should the nurse include in the teaching?
A. "Colonoscopies for individuals with no family history of cancer should begin at age 40."
B. "A sigmoidoscopy is recommended every 5 years beginning at age 60."
C. "Fecal occult blood tests should be done annually beginning at age 50."
D. "An MRI provides a definitive diagnosis of colon cancer."
(A. A colonoscopy is recommended every 10 years beginning at age 50 for a client who has no family history of cancer.
B. A sigmoidoscopy is recommended every 5 years beginning at age 50.
C. CORRECT: Fecal occult blood tests should be done annually by clients ages starting at age 50 years.
D. A biopsy performed during an endoscopic procedure confirms this diagnosis.)
A nurse is caring for a client who has multiple types of skin lesions. Which of the following skin lesions are indicative of a malignant melanoma? (Select all that apply.)
A. Diffuse vesicles
B. Uniformly colored papule
C. Area with asymmetric borders
D. Rough, scaly patch
E. Irregular colored mole
(A. Diffuse vesicles are consistent with an allergic reaction.
B. A uniformly colored papule is consistent with a birthmark or skin injury.
C. CORRECT: A lesion with asymmetric borders is considered suspicious for a melanoma.
D. A rough, scaly patch is consistent with skin irritation due to friction.
E. CORRECT: A lack of uniformity of pigmentation of a mole is considered suspicious for a melanoma.)
A nurse is reviewing testicular self-examination with a client. Which of the following client statements indicates understanding?
A. "It is best to examine the testicles before bathing."
B. "It is not necessary to report small lumps, unless they are painful."
C. "I will examine one testicle at a time."
D. "I will use my palms to feel for abnormalities."
(A. Examining the testicles after showering or bathing ensures the scrotum is relaxed, and examination is more accurate.
B. The client should report any lump or swelling to the provider as soon as possible.
C. CORRECT: The client should examine one testicle at a time to ensure that an abnormality is not missed.
D. The client should use the thumb and fingers to examine the testes to better detect small changes because the fingertips are more sensitive.)
A nurse is caring for a client who has chronic cancer pain and has a permanent epidural catheter for administration of a fentanyl/bupivacaine solution. The nurse should monitor the client for which of the following findings? (Select all that apply.)
A. Respiratory depression
D. Muscle spasticity
E. Sensory blockage
A, B, C, E
(A. CORRECT: Respiratory depression is an adverse effect of epidural analgesics. Other adverse effects include seizures and dura puncture.
B. CORRECT: Hypotension is an adverse effect of epidural analgesics that can be corrected by administration of fluids. Other adverse effects include hematoma and infection.
C. CORRECT: Sedation is an adverse effect of epidural analgesics. Other adverse effects include anaphylaxis and severe headache.
D. Muscle weakness, not spasticity, is an adverse effect of epidural analgesics.
E. CORRECT: Sensory blockage is an adverse effect of epidural analgesics. Other adverse effects include decreases in bowel and bladder control.)
A nurse is caring for a client who will undergo a neurolytic ablation. The client asks the nurse the reason for this procedure. Which of the following responses should the nurse make?
A. "It should provide permanent pain relief."
B. "It reduces the adverse effects of your pain medication."
C. "It increases your ability to fight infections."
D. "It increases cells that stop bleeding."
(A. CORRECT: Inform the client that neurolytic ablation causes permanent destruction of the nerves that transmit pain from a specific area and is a last resort after other methods have been unsuccessful.
B. Neurolytic ablation should reduce the need for analgesics. However, it does not reduce the adverse effects of pain medication.
C. Neurolytic ablation does not treat myelosuppression (which reduces immunity) or increase the ability to fight infections.
D. Neurolytic ablation does not treat thrombocytopenia. The procedure can cause complications, such as disruption of bladder and bowel function, but it does not affect clotting mechanisms.)
A nurse is caring for a client who has cancer and has a prescription for transcutaneous electrical nerve stimulation (TENS) for pain management. Which of the following actions should the nurse take?
A. Remove hair before applying the electrodes from the TENS unit on the skin.
B. Apply alcohol to the client's skin before attaching the electrodes from the TENS unit.
C. Attach the electrodes from the TENS unit over painful incisions or skin damage.
D. Avoid other pain medications when using the TENS unit.
(A. CORRECT: Remove the client's hair before applying the electrodes from the TENS unit to the skin.
B. The skin should be clean and intact before applying the electrodes, but the skin does not have to be cleansed with alcohol.
C. Apply the electrodes over intact skin that is over or near the site of pain, but not over incisions or areas of damage.
D. Administer pain medication while the client is using the TENS unit.)
A nurse is caring for a client who has a prescription for gabapentin for neuropathic pain. The nurse should monitor the client for which of the following adverse effects of this medication?
B. Urinary retention
(A. Monitor a client who is taking an opioid analgesic for constipation. However, constipation is not an adverse effect of gabapentin.
B. Monitor a client who is taking an opioid analgesic for urinary retention. However, urinary retention is not an adverse effect of gabapentin.
C. Monitor the client for sedation, rather than insomnia.
D. CORRECT: Monitor the client for dizziness. Instruct the client to avoid driving until medication effects are known.)
Emerging and reemerging infections affect health care by (select all that apply)
a. reevaluating vaccine practices.
b. revealing antimicrobial resistance.
c. limiting antibiotics to those with life-threatening infection.
d. challenging researchers to discover new antimicrobial therapies
A, B, D
(An emerging infection is an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future. Reemerging infections are those infections that were previously controlled but have resurfaced. The most common reason for reemerging infectious is low vaccination rates. Ways in which emerging and reemerging infectious have affected the health care system include revising vaccine recommendations for previously controlled infections (e.g., pertussis, measles); discovery of antimicrobial-resistant organisms; and creation of new antiinfective agents to combat new organisms or antimicrobialresistant infections.)
Interventions to prevent health care-associated infections include (select all that apply)
a. following hand-washing protocols.
b. limiting visitors to persons over age 18.
c. placing high-risk patients in private rooms.
d. decontaminating equipment used for patient care.
e. appropriately using personal protective equipment.
A, D, E
(First lines of defense to prevent the spread of HAIs include hand washing (or using an alcohol-based hand sanitizer) before and after patient contact or procedures, appropriate use of personal protective equipment such as gloves, and decontamination of equipment used for patient care.)
Transmission of HIV from an infected person to another most often occurs because of
a. unprotected anal or vaginal sexual intercourse.
b. low levels of virus in the blood and high levels of CD4+ T cells.
c. transmission from mother to infant during labor and delivery and breastfeeding.
d. sharing eating utensils, dry kissing, hugging, using toilet seats, or shaking hands.
(Unprotected sexual contact (semen, vaginal secretions, blood) with a partner infected with human immunodeficiency virus (HIV) is the most common mode of HIV transmission.)
During HIV infection
a. reverse transcriptase helps HIV fuse with the CD4+ T cell.
b. HIV RNA uses the CD4+ T cell's mitochondria to replicate.
c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.
d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.
(Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes))
A diagnosis of AIDS is made when an HIV-infected patient has
a. a CD4+ T cell count below 200/μL.
b. a high level of HIV in the blood and saliva.
c. lipodystrophy with metabolic abnormalities.
d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.
(AIDS is diagnosed when a person with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/uL.)
Screening for HIV infection generally involves
a. detecting CD8+ cytotoxic T cells in saliva.
b. laboratory analysis of saliva to detect CD4+ T cells.
c. analysis of lymph tissues for the presence of HIV RNA.
d. laboratory analysis of blood to detect HIV antigen and/or antibody.
(The most useful screening tests for HIV detect HIV-specific antibodies and/or antigen.)
HIV antiretroviral drugs are used to
a. cure acute HIV infection.
b. decrease viral RNA levels.
c. treat opportunistic diseases.
d. decrease symptoms in terminal disease.
(The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.)
Opportunistic diseases in HIV infection
a. are usually benign.
b. are generally slow to develop and progress.
c. occur in the presence of immunosuppression.
d. are curable with appropriate drug interventions.
(Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates)
Which statements about metabolic side effects of ART are true (select all that apply)?
a. These are annoying symptoms that are ultimately harmless.
b. ART-related body changes include fat redistribution and peripheral wasting.
c. Lipid problems include increases in triglycerides and decreases in high-density cholesterol.
d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol.
e. Compared to uninfected people, insulin resistance and hyperlipidemia are harder to treat in HIV-infected patients.
B, C, D
(Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) from lipodystrophy, hyperlipidemia (i.e., high triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.)
Which strategy can the nurse teach the patient to eliminate the risk for HIV transmission?
a. Using sterile equipment to inject drugs
b. Cleaning equipment used to inject drugs
c. Taking lamivudine (Epivir) during pregnancy
d. Using latex or polyurethane barriers to cover genitalia during sexual contact
(Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment. Lamivudine alone is not appropriate for treatment in pregnancy. Barrier methods reduce but do not eliminate risk.)
What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen?
a. Set up a drug pillbox for the patient every week.
b. Give the patient a video and a brochure to view and read at home.
c. Tell the patient that side effects of ART are bad but that they go away.
d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.
(The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.)
Trends in the incidence and death rates of cancer include the fact that
a. a higher percent of women than men have lung cancer.
b. lung cancer is the most common type of cancer in men.
c. blacks have a higher death rate from cancer than whites.
d. breast cancer is the leading cause of cancer deaths in women.
(Cancer incidence and death rates are disproportionately higher among Blacks than among other minority groups and white people.)
What features of cancer cells distinguish them from normal cells (select all that apply)?
a. Cells lack contact inhibition.
b. Cells undergo rapid proliferation.
c. Cells return to a previous undifferentiated state.
d. Proliferation occurs when there is a need for more cells.
e. New proteins characteristic of embryonic stage emerge on cell membrane.
A, C, E
(Cancer cells proliferate at the same rate as the normal cells of the tissue from which they arise. However, cancer cells respond differently than normal cells to the intracellular signals that regulate cell proliferation and death. The result is that the proliferation of the cancer cells is indiscriminate and continuous. They lack contact inhibition. Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens. Normally the differentiated cell is stable and will not dedifferentiate. Cancer cells can dedifferentiate. Abilities and properties that the cell had in fetal development are again expressed.)
A characteristic of the stage of progression in cancer development is
a. oncogenic viral transformation of target cells.
b. a reversible steady growth facilitated by carcinogens.
c. a period of latency before clinical detection of cancer.
d. proliferation of cancer cells despite host control mechanisms.
(Progression is the last stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (e.g., metastasis). Progression occurs because of rapid proliferation and decreased cell adhesion.)
The primary protective role of the immune system related to malignant cells is
a. surveillance for cells with tumor-associated antigens.
b. binding with free antigens released by all cancer cells.
c. producing blocking factors that immobilize cancer cells.
d. reacting to a new set of antigenic determinants on cancer cells.
(Cancer cells may have altered cell surface antigens because of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.)
The nurse is caring for a 59-year-old woman who had surgery 1 day ago to remove an ovarian cancer mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to
a. motivate change in an unhealthy lifestyle.
b. teach her about the 7 warning signs of cancer.
c. discuss healthy stress relief and coping practices.
d. let her communicate about the meaning of this experience.
(While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns. You should be skilled in techniques that can engage the patient and caregivers in a discussion about their cancer-related fears.)
The goals of cancer treatment are based on the principle that
a. surgery is the single most effective treatment for cancer.
b. initial treatment is always directed toward cure of the cancer.
c. a combination of treatment modalities is effective for controlling many cancers.
d. although cancer cure is rare, quality of life can be increased with treatment modalities.
(The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the cancer being treated and may involve local therapies (e.g., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (e.g., chemotherapy))
The most effective method of administering a chemotherapy agent that is a vesicant is to
a. give it orally.
b. give it intraarterially.
c. use an Ommaya reservoir.
d. use a central venous access device.
(Infusion with central venous access devices reduces the risk of infiltration of chemotherapy agents that are vesicants. If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result.)
The nurse explains to a patient undergoing brachytherapy of the cervix that she
a. must undergo simulation to locate the treatment area.
b. requires the use of radioactive precautions during nursing care.
c. may have desquamation of the skin on the abdomen and upper legs.
d. requires shielding of the ovaries during treatment to prevent ovarian damage.
(Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or next to the tumor. It would not be possible to shield the ovaries during therapy. Caring for the person undergoing brachytherapy requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety. Simulation is a process by which external radiation treatment fields are defined. Desquamation is an effect of external radiation.)
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, what is the most serious clinical finding?
a. Cough, rhinitis, and sore throat
b. Fatigue, nausea, and skin redness at site of radiation
c. Temperature of 101.9° F, fatigue, and shortness of breath
d. Skin redness at site of radiation, headache, and constipation
(Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation. It can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.)
To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with
c. sodium bicarbonate.
d. meperidine (Demerol).
(Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is often premedicated with acetaminophen to try to prevent or decrease the intensity of these symptoms. Large amounts of fluids help decrease symptoms.)
The nurse counsels the patient receiving radiation therapy or chemotherapy that
a. effective birth control methods should be used for the rest of the patient's life.
b. after successful treatment, patients can expect a return to their previous level of function.
c. the cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity.
d. nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other interventions.
(Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other nondrug interventions. Some cancer survivors may continue to have symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. Maintaining activity within tolerable limits is helpful in managing fatigue. Lifelong birth control is not necessary.)
A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority?
a. Discuss with the provider the need for parenteral nutrition.
b. Teach the patient to eat foods that are fatty, fried, or high in calories.
c. Tell the patient to drink a nutritional supplement beverage three times a day.
d. Have the patient try various spices and seasonings to enhance the flavor of food.
(Teach the patient to try different ways to mask the taste changes. Some find stronger seasonings and spices effective. Others find it better to avoid strong flavors and eat more bland foods. Avoiding strong smells, drinking more water with food, oral care before eating, eating smaller amounts more often, and using plastic utensils may help.)
A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and reports nausea and constipation. Which complication of cancer is this most likely caused by?
b. Tumor lysis syndrome
c. Spinal cord compression
d. Superior vena cava syndrome
(Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.)
A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on?
a. Maintaining the patient's hope
b. Preparing a will and advance directives
c. Discussing replacement child care for the patient's children
d. Discussing the patient's past experiences with her grandmother's cancer
(Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.)
A patient is jaundiced, and her stools are clay colored. This is most likely related to
a. decreased bile flow into the intestine.
b. increased production of urobilinogen.
c. increased bile and bilirubin in the blood.
d. increased production of cholecystokinin.
(Bile is made by the hepatocytes and stored and concentrated in the gallbladder. When bile is released from the common bile duct, it enters the duodenum. In the intestines, bacterial action reduces bilirubin to stercobilinogen and urobilinogen. Stercobilinogen accounts for the brown color of stool. Stools may be clay-colored if bile is not released from the common bile duct into the duodenum. Jaundice may result if the bilirubin level in the blood is high.)
The percentage of daily calories for a healthy person consists of
a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids.
b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids.
c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids.
d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.
(The Dietary Guidelines for Americans recommend that 45% to 65% of total calories should come from carbohydrates. Ideally, 10% to 35% of daily caloric needs should come from protein. Persons should limit their fat intake to 20% to 35% of total calories. Fats can be divided into (1) potentially harmful (saturated fat and trans fat) and (2) healthier dietary fat (monounsaturated and polyunsaturated fat). To reduce the risk of obesity, we should consume less than 10% of calories from saturated fatty acids (about 20 g of saturated fat per day in a 2000-calorie diet) and choose foods with no trans-fatty acids.)
A complete nutritional assessment including anthropometric measurements is most important for the patient who
a. has a BMI of 25.5 kg/m2.
b. reports episodes of nightly nocturia.
c. reports a 5-year history of constipation.
d. reports an unintentional weight loss of 10 lb in 2 months.
(A loss of more than 5% of usual body weight over 6 months, whether intentional or unintentional, is a critical indicator for further assessment.)
Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube?
b. Air insertion
c. Observing patient for coughing
d. pH measurement of gastric aspirate
(The nurse should obtain x-ray confirmation to determine whether a blindly placed nasogastric or orogastric tube (small bore or large bore) is properly positioned in the gastrointestinal tract before giving feedings or medications. Air insertion, observing a patient for coughing, and measuring the pH of gastric aspirate are not appropriate ways to confirm whether a blindly placed nasogastric or orogastric tube is properly positioned in the gastrointestinal tract before use.)
A patient is receiving peripheral parenteral nutrition. The solution is completed before the new solution arrives on the unit. The nurse gives
a. 20% intralipids.
b. 5% dextrose solution.
c. 0.45% normal saline solution.
d. 5% lactated Ringer's solution.
(If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) should be given to prevent hypoglycemia.)
M.J. calls the clinic and tells the nurse that her 85-yr-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to
a. administer antiemetic drugs and assess her mother's skin turgor.
b. give her mother sips of water and elevate the head of her bed to prevent aspiration.
c. offer her mother large quantities of Gatorade to decrease the risk for sodium depletion.
d. give her mother a high-protein liquid supplement to drink to maintain her nutritional needs.
(Excessive replacement of fluid and electrolytes may result in adverse consequences for an older person who has heart failure or renal disease. An older adult with a decreased level of consciousness may be at high risk for aspiration of vomitus. Older adults are susceptible to the central nervous system (CNS) side effects of antiemetic drugs and may develop confusion. Dosages should be reduced, and efficacy closely evaluated. Older patients are more likely to have cardiac or renal insufficiency, which increases their risk for life-threatening fluid and electrolyte imbalances. High-protein drinks and high-sodium liquids may be contraindicated.)
The nurse explains to the patient with Vincent's infection that treatment will include
a. tetanus vaccinations.
b. viscous lidocaine rinses.
c. amphotericin B suspension.
d. topical application of antibiotics.
(Vincent's infection is treated with topical applications of antibiotics. Other treatments include rest (physical and mental); avoiding tobacco and alcoholic beverages; soft, nutritious diet; correct oral hygiene habits; and mouth irrigations with hydrogen peroxide and saline solutions.)
The nurse teaching young adults about behaviors that put them at risk for oral cancer includes
a. discouraging use of chewing gum.
b. avoiding use of perfumed lip gloss.
c. avoiding use of smokeless tobacco.
d. discouraging drinking of carbonated beverages.
(Oral cancer has several predisposing risks factors:
• Lip: constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, and immunosuppression
• Tongue: tobacco, alcohol, chronic irritation, and syphilis
• Oral cavity: poor oral hygiene, tobacco use (e.g., pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (e.g., jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, and human papillomavirus [HPV] infection))
Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)?
a. "The best time to take an as-needed antacid is 1 to 3 hours after meals."
b. "A glass of warm milk at bedtime will decrease your discomfort at night."
c. "Do not chew gum; the excess saliva will cause you to secrete more acid."
d. "Limit your intake of foods high in protein because they take longer to digest."
(Patients who use an as-needed antacid should do so 1 to 3 hours after eating. Teach patients that the increased saliva production associated with chewing gum will help with GERD symptoms. The patient should not eat meals within 3 hours of bedtime. Some foods, such as red wine, decrease lower esophageal sphincter pressure and worsen symptoms. Milk increases gastric acid secretion. There is no need for the patient to limit protein intake.)
The pernicious anemia that may accompany gastritis is due to
a. chronic autoimmune destruction of cobalamin stores in the body.
b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss.
c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa.
d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.
(Gastritis may cause a loss of parietal cells because of atrophy. This results in a lack of intrinsic factor, which is essential for the absorption of cobalamin in the terminal ileum, and cobalamin deficiency. Because cobalamin is essential for the growth and maturation of red blood cells, the lack of cobalamin results in pernicious anemia and neurologic complications.)
The nurse is teaching the patient and family that peptic ulcers are
a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori.
b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood.
c. promoted by factors that cause oversecretion of acid, such as excess dietary fats, smoking, and alcohol use.
d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.
(Peptic ulcers develop only in the presence of an acidic environment. However, an excess of hydrochloric acid (HCl) is not necessary for ulcer development. The back diffusion of HCl into the gastric mucosa results in cellular destruction and inflammation. Histamine is released from the damaged mucosa, which results in vasodilation and increased capillary permeability and further secretion of acid and pepsin. A variety of agents (certain infections, medications, lifestyle factors) can damage the mucosal barrier. Helicobacter pylori can alter gastric secretion and produce tissue damage, which leads to peptic ulcer disease. Ulcerogenic drugs, such as aspirin and NSAIDs, inhibit synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. High alcohol intake stimulates acid secretion and is associated with acute mucosal lesions. Coffee (caffeinated and decaffeinated) is a strong stimulant of gastric acid secretion.)
The teaching plan for the patient being discharged after an acute episode of upper GI bleeding includes information about the importance of (select all that apply)
a. limiting alcohol intake to 1 serving per day.
b. only taking aspirin with milk or bread products.
c. avoiding taking aspirin and drugs containing aspirin.
d. only taking drugs prescribed by the health care provider.
e. taking all drugs 1 hour before mealtime to prevent further bleeding.
(Before discharge, teach the patient with upper gastrointestinal (GI) bleeding and the caregiver how to avoid future bleeding episodes. Drug and alcohol use can be a source of irritation and interfere with tissue repair. Their use should be eliminated. Help make the patient and caregiver aware of the consequences of nonadherence with drug therapy. Emphasize not to take any drugs (especially aspirin and nonsteroidal antiinflammatory drugs [NSAIDs]) other than those prescribed by the HCP. Taking drugs with meals may decrease irritation.)
Several patients come to the urgent care center with nausea, vomiting, and diarrhea that began 2 hours ago while attending a large family reunion potluck dinner. You ask the patients specifically about foods they ingested containing
b. meat and milk.
c. poultry and eggs.
d. home-preserved vegetables.
(Staphylococcus aureus toxins provoke onset of symptoms (vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources of these toxins from the skin and respiratory tract of food handlers.)
A 35-yr-old female patient is admitted to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply)
b. Ectopic pregnancy
c. Gastrointestinal bleeding
d. Irritable bowel syndrome
e. Inflammatory bowel disease
f. all of the above
(All these conditions could cause acute abdominal pain.)
The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states
a. "I should only have to change the pouch every 4 to 7 days."
b. "The drainage in the pouch will look like my normal stools."
c. "I may not need to wear a drainage pouch if I irrigate it daily."
d. "Limiting my fluid intake should decrease the amount of output."
(Stage I colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.)
In contrast to diverticulitis, the patient with diverticulosis
a. has rectal bleeding.
b. often has no symptoms.
c. usually develops peritonitis.
d. has localized cramping pain.
(Many people with diverticulosis have no symptoms. Patients with diverticulitis have symptoms of inflammation. Diverticulitis can lead to obstruction or perforation.)
A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that
a. itching is a common problem with jaundice in this phase.
b. the patient is most likely to transmit the disease during this phase.
c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B.
d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.
(The acute phase of jaundice may be icteric or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.)
A patient with acute hepatitis B is being discharged. The discharge teaching plan should include instructions to
a. avoid alcohol for the first 3 weeks.
b. use a condom during sexual intercourse.
c. have family members get an injection of immunoglobulin.
d. follow a low-protein, moderate-carbohydrate, moderate-fat diet.
(Hepatitis B virus may be transmitted by mucosal exposure to infected blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.)
A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include
a. having genetic testing done.
b. recommending a heart-healthy diet.
c. the necessity to reduce weight rapidly.
d. avoiding alcohol until liver enzymes return to normal.
(Nonalcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For patients who are overweight, weight reduction is important. Weight loss improves insulin sensitivity and reduces liver enzyme levels. No specific dietary therapy is recommended. However, a heart healthy diet as recommended by the American Heart Association is appropriate.)
The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that
a. a lack of clotting factors promotes the collection of blood in the abdominal cavity.
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel.
d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.
(Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis. With portal hypertension, proteins shift from the blood vessels through the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, those substances leak through the liver capsule into the peritoneal cavity. Osmotic pressure of the proteins pulls more fluid into the peritoneal cavity. A second mechanism of ascites formation is hypoalbuminemia, which results from the inability of the liver to synthesize albumin. Hypoalbuminemia results in decreased colloidal oncotic pressure. A third mechanism is hyperaldosteronism, which occurs when aldosterone is not metabolized by damaged hepatocytes. The increased aldosterone level causes increases in sodium reabsorption by the renal tubules. Sodium retention and an increase in antidiuretic hormone levels cause further water retention.)
Nursing management of the patient with acute pancreatitis includes (select all that apply)
a. administering pain medication.
b. checking for signs of hypocalcemia.
c. providing a diet low in carbohydrates.
d. giving insulin based on a sliding scale.
e. monitoring for infection, particularly respiratory tract infection.
A, B, E
(During the acute phase, it is important to provide pain relief and monitor vital signs. Hypotension, fever, and tachypnea may compromise hemodynamic stability. Give fluids and monitor the response to therapy. Closely monitor fluid and electrolyte balances. Vomiting and gastric suction may result in decreased chloride, sodium, and potassium levels. Because hypocalcemia can occur, observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early sign of hypocalcemia. Assess the patient for Chvostek's sign or Trousseau's sign. Observe for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, causing the patient to take shallow, guarded abdominal breaths.)
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