advanced med surg quiz
DESCRIPTION
Cancer, diet, infectionsTRANSCRIPT
1. The nurse includes which information about benign tumors when presenting an inservice on cancer?
A.
they do not cause pain
B.
they are smaller than 2cm in size
C.
They are often surrounded by a capsule
D.
They cause the sensation of itching
2. In reviewing the pathophysiology of a particular type of cancer, the nurse correlates the generation time for cancer development with which description?
A.
The rate at which cancer cells are able to migrate anbd metastasize to different sites
B.
How long it t akes for a malignant tumor to double in size by mitotic cell divisions
C.
The period of time necessary for one cell to enter and complete one round of cell division by mitosis
D.
the period of time between when a carcinogen damages for DNA of a cell and when that cell expresses malignant characteristics
3. The nurse reorganizes which biologic characteristic as specific to normal differentiated adult cells but not to cancer cells
A.
Anaplasia
B.
hypertrophy
C.
aneuploidy
D.
loose adherence
4. The client states that a his brain tumor and does not need to be removed. What is the nurse's best response?
A.
Because benign tumors continue to get larger, when they are in a place that could damage normal tissue, then need to be removed
B.
Because benign tumors are composed of completely normal cells, removal is only done for cosmetic purposes
C.
Because benign tumors can easily become malignant, they should be removed before cancer develops
D.
Because benign tumors can migrate, the should be removed before they spread
5. Which comment made by the client with breast cancer indicates a need for clarification regarding cancer causes and prevention.
A.
I will eat a low fat diet from now on
B.
I know that nothing I did or didn't do caused this cancer
C.
I hope my daughter doesn't have this problem when she grows up
D.
I will have regular mammograms on my other breast to prevent cancer.
6. The nurse recognizes malignant cell growth as uncontrolled because of which action?
A.
Cancer cells always divide more rapidly than normal cells.
B.
The mitosis of malignant cells usually produces more that two daughter cells
C.
Malignant cells are able to bypass one or more phases of the cell cycle during cell division
D.
malignant cells re-enter the cell cycle more frequently, making cell division a continuous process
7. The nurse recognizes that the client who is employed as a hairdresser is at increased risk for which type of cancer
A.
Breast cancer
B.
bladder cancer
C.
colorectal cancer
D.
oropharyngeal cancer
8. The nurse assesses the client who's occupation is asbestos removal for which specific type of cancer?
A.
skin cancer
B.
Bladder cancer
C.
lung cancer
D.
Colorectal cancer
9. The nurse correlates "intiation" in cancer development to which action?
A.
Inflicting mutations at specific sites on the exposed cells DNA
B.
Increasing the transformed cells capacity for error free DNA repair
C.
Stimulating or enhancing cell division of cells damages by a carcinogen
D.
Making cancer cells appear more normal to escape immunosurveillance
10. The middle aged cleint with small cell lung cancer asks if his adult children are at increased risk for this cancer. What is the nurse's best answer?
's
A.
This disease is a random event and there is not way to prevent it
B.
Because this disease is inherited as a dominant trait, your children have a 50% risk for developing it
C.
Cigarette smoking is the main cause of this disease, and helping your children not to smile will decrease their risk
D.
Lung cancer can be avoided by decreaseing dietary intake of fats and increasing the amount of regular aerobic exercise
11. An adult cleint who has a supspicious mammogram says that her mother died of bone cancer when she was around the same age. Which is the most important question for the nurse to ask the client?
A.
Have any other members of your family had bone cancer
B.
Did your mother every have any other type of cancer
C.
how old were you when you started to have periods
D.
did your mother have regular mammograms
12. The client with prostate cnacer says that he is now having a lot of pain in his lower back and legs. The nurse correlated this to which condition?
A.
Arthritis
B.
Urinary retention
C.
metastasis to the bone
D.
muscle atrophy from inactivity
13. Based on the higher mortality rates in men from specific types of cancer, which question is most important for the nurse to ask during annual health screenings?
A.
How much time do you spend in the sun
B.
How many servings of fruits and vegetables do you eat every day
C.
How often do you eat smoked meats
D.
Do you smoke cigarettes
14. In reviewing a pathology report on a tumor, the nurse interprets which of the following as a very mailignant, or high grade cancer
A.
undifferentiated; mitotic index =50%
B.
Poorly differentiated; mitotic index=40%
C.
Moderately differentiated; mitotic index=50%
D.
Highly differentiated; mitotic index = 10%
15. The staging of the client's cancer by the TNM classification is T1,N3, M1/ what is the nurses interpretation of this classification?
A.
The client has two tumors that are non-responsive to treatment
B.
The client has leukemia confined tot he bone marrow
C.
the client has a 2cm tumor with one regional lymph node involved and no distant metastasis
D.
The client has a small primary tumor, tumpr extension into three lymph nodes, and one site of distant metastasis
16. The client says that she has heard that the origin of most cancer is genetic, what is the nurse's best response?
A.
The development of most cnacers is predetermined and not affected by environmental factors
B.
Cancers arise in cells that have alterations in the genes
C.
The majority of cancers are inherited
D.
Cancer is more common among males than females
17. In preparing a community teaching program, which information presented by the nurse addresses a type of secondary cancer prevention?
A.
Receiving cancer treatment with chemotherapy
B.
Annual measurement of prostate specific antigen levels
C.
Avoiding know cancer causing substances or conditions
D.
Having genetic engineering to remove or repress oncogenes
18. The nurse correlates the role of suppressor genes in cancer development to which action?
A.
The presence of suppressor genes increases the risk for gene damage by carcinogens
B.
People with more suppressor genes are at an increased risk for cancer development
C.
Suppressor genes increase immune function, suppressing the risk for cancer development
D.
Suppressor genes control the expression of oncogenes, reducing the risk for cancer development
19. The nurse correlates the development of which cancer to a genetic perdisposiotion
A.
Lung cancer
B.
Prostate cancer
C.
Cervical cancer
D.
Bone cancer
20. The nurse calculates that a woman who inherits a pair of BRCA1 gene alleles has what chance for developing breast cancer during her lifetime?
A.
0%
B.
approximately 50%
C.
approximately 100%
D.
same as for the general population
21. In assessing clients' risk for development of any type of cancer, the nurse identifies which as the greatest risk?
A.
Advancing age
B.
Cigarette smoking
C.
Genetic predisposition
D.
Declining immune function
22. The client asks the nurse how taking an aspirin each day may help prevent colorectal cancer. Which is the nurse's best response?
A.
Aspirin is an antioxidant that can prevent the formation of carcinogens during metabolism of food
B.
Aspirin has been found to suppress the activity of known carcinogens ingested as food
C.
The area of the gastrointestinal tract that absorbs aspirin is the same place where carcinogens are absorbed. Aspirin displaces carcinogens from the absorption site
D.
Aspirin increases the rate that food move through the intestinal tract, so there is less time for carcinogens to come into contact with body organs
23. In preparing a cancer risk reduction pamphlet for African-American cleints, it is most important that the nurse include information on prevention and early detection for which
types of cancer?
A.
Lung and prostate
B.
Bone and leukemia
C.
Skin and lymphoma
D.
Stomach and esophageal
24. An adult man who has a mother with breast cancer, a father with smoking-related lung cancer a sister with breast cancer, and a sister with ovarian cancer, aske if he should be concderned for his cancer risk. what is the nurse;s best response?
A.
Your risk is not affected by this family history, because most of the cancers arose in female gender-associated tissues
B.
You have two fist-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer
C.
Your risk for breast cancer is increased. however, your risk for lung cancer is not affected by this history
D.
Your risk for cancer is affected by your parents' cancer development. Your sister' cancers have no bearing on your risk
25. It is most important that the nurse include which cancer screening in the examination of a young adult client with Down syndrome?
A.
Encouraging him to eat more fruit and leafy green vegetables
B.
teaching him how to perform testicular self-examination
C.
assessing his skin for bruises and petechiae
D.
testing his stool for occult blood
26. An older client says that she does not perform breast self-examination because there is no history fo breast cancer in her famiy. What is the nurse's best response?
A.
You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you to develop it.
B.
Breast cancer can be found more frequently in families. However, the risk for general, nonfamilial breast cancer increases with age
C.
Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased
D.
Examining your breast once a year when you have your mammogram is sufficient screening for someone with your history
27. the nurse recognizes that which client is at greatest risk for cancer development?
A.
Young man receiving radiation therapy for a brain tumor
B.
Woman who recently had postpartum hemorrhage
C.
Man diagnosed with AIDS
D.
Middle-aged woman undergoing chemotherapy for bowel cancer
28. The oncology nurse educator is preparing an educational program on cancer and includes which information about the promotion of cancer development? (select all that apply)
A.
Promoters only work on non initiated cells
B.
Insulin and estrogen's are examples of promoters
C.
Ongoing promotion results in greater metastasis
D.
Promoters may revert to normal cells in the absence of carcinogens
E.
promoters shorten the latency period for tumor development
F.
promoters are activated by carcinogens
29. What statement indicates that the client understands teaching about neutropenia and bone marrow suppression?
A.
I need to use a soft toothbrush to prevent gum trauma and bleeding
B.
I have to wear a mask at all times
C.
My grandchildren may get an infection from me because they are so young
D.
I should call my health care provider with any increase in my body temperature
30. The client who is being treated with radiation for cervical cancer asks if she should have a mammogram. what is the nurse's best response?
A.
Although you should delay the mammogram until your therapy is finished, perform a breast self-examination monthly
B.
Being treated for one kind of cancer does not prevent the development of another type of cancer, Have a mammogram
C.
Absolutely do not have the mammogram this year, because you are already over the limit for safe exposure levels to radiation
D.
The radiation therapy you are receiving will protect you against other cancer development, so it okay to skip the mammogram this year
31. The client who has just had a mastectomy is crying. When the nurse asks about her crying, the client responds. I know I shouldnt cry because this surgery may well save my life. What is the nurse's best response.
A.
Its all right to cry. Mourning this loss is important for getting past this
B.
I know this is hard, but your chances of survival are better now
C.
Would you like to talk to someone who also has had a mastectomy
D.
How have you coped with difficult situations in the past
32. In evaluating dietary teaching for the client with chemotherapy-induced neutropenia, the nurse would be concerned if the client made which food choice?
A.
Fruit salad
B.
Applesauce
C.
Steamed broccoli
D.
baked potato
33.What teaching is essential for the client who has received an injection of iodine-131?
A.
Do not share a toilet with anyone else for 3 days
B.
You need to save all your urine or the next week
C.
no special precautions are needed because this type of radiation is weak
D.
Avoid all contact with other people until the radiation device is removed
34. What intervention will the nurse implement to prevent injury in the client with bone cancer?
A.
Using a lift sheet when repositioning the client
B.
positioning clients heels from touching the mattress
C.
providing small, frequent meals that are rich in calcium and phosphorus
D.
Applying pressure for a full 5 minutes ater any intramuscular injections
35. The client with lung cancer is scheduled to have a liver scan and asks why this procedure is being done. What is the nurse's best response?
A.
Cigarette smoking can also cause liver cancer
B.
It is best to test liver function first in case the treatment causes liver damage
C.
Treatment or lung cancer is different if it has spread to the liver.
D.
An enlarged liver can interfere with cancer therapy
36. The client scheduled to undergo radation therapy for breast cancer asks why 6 weeks of daily treatment are necessary. What is the nurse's best response?
A.
Your cancer is widespread and requires more than the usual amount of radiation treatment
B.
the cost of giving larger doses of radiation or a shorter period of time is unjustified by the results
C.
Research has shown that more cancer cells are killed if the radiation is given in smaller doses over a longer time period
D.
It is less likely that your hair will fall out or that you will become anemic i the radiation is given in small doses over a longer time period.
37. A client is recieving brachytherapy with a sealed radiation source for cervical cancer. Which nirse will be assigned to provide personal care to this client while the radiation source is in the client?
A.
The new nurse who has no exposure with radiation from brachytherapy
B.
The pregnant nurse with expertise in oncology
C.
The experienced nurse assigned to care or two other clients receiving brachytherapy
D.
the nurse who is experienced with brachytherapy
38. The cleint's radiation implant has become dislodged overnight, and thenurse finds it in the client's bed. What will the nurse do first?
A.
Assess the client's mental status
B.
Use tongs to place the implant into the radiation container
C.
Notify the physician and move the client to a different room
D.
Don gloves and attempt to reposition the implant and position-holding device
39. The cleint is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurse's first action when the client complains of burning at the site?
A Checks for a blood
. returnB.
slows the rate of infusion
C.
Discontinues the infusion
D.
Applies a cold compress
40. The client receiving intravenous chemotherapy asks the nurse the reason for wearing a mask, gloves, and gown when he or she is giving the drugs to the client. What is the nurse's best response?
A.
These covering protect you from getting an infection from me
B.
I am preventing the spread of infection from you to me or any other client here.
C.
The hospital policy if for any nurse giving these drugs to wear a gown, glove and mask
D.
The clothing protects me from accidentally absorbing these drugs
41. The clients spouse reports that the last time the client received lorazepam (Ativan) before receiving chemotherapy, the client didn't remember the trip home. Which is the nurse's best action?
A.
Holding the dose of lorazepam for this round of chemotherapy
B.
Explaining to the client and spouse that this is a normal response to the drug
C.
Performing a Mini Mental state Examination
D.
Documenting the response as the only action
42. Which intervention is most important to teach the client who develops thrombocytopenia secondary to chemotherapy
A.
Eat low bacteria diet
B.
Take your temperature daily
C.
use a soft bristled toothbrush and do not floss
D.
avoid using mouthwashes that contain alcohol
43. The client with chemotherapy-induced bone marrow suppression has received filgrastim (Neopogen). which laboratory finding indicates that this therapy is effective
A.
The client's hematocrit is 28%
B.
The client's hematocrit is 38%
C.
The client's segmented neutrophil count is 2500/mm3
D.
The client segmented neutrophil count is 3500/mm
44. What is the priority nursing diagnosis for the client experiencing chemotherapy-induced anemia?
A.
Risk for Injury related to poor blood clotting
B.
Fatigue related to decreased cellular oxygenation
C.
Disturbed Body Image related to skin color changes
D.
Imbalanced Nutrition, less than body requirements related to anorexia
45. The clien's chemotherapy had been postponed becasue of a low white blood count. When the cleint expresses concern. Which is the nurse's best response
A.
This extra time will give your hair a chance to grow back in
B.
It is too dangerous to give your hair a chance to grow back in
C.
I will call the physician and request a prescription for something to calm your nerves
D.
Your counts will probably be high enough next week and the chemotherapy will work just as well then.
46. The client who has jsut been diagnosed with breast cancer asks why her treatment plan does not include the new drug. Herceptin, that she has read about. What is the nurse's best response?
A.
Your immune system is too weak to tolerate herceptin
B.
this drug is experimental
C.
your breast cancer does not have the protein that this drug attacks
D.
You are young and can better tolerate the standard therapies for breast cancer
47. The client with prostate cancer is taking estrogen daily to control tumor growth. he reports that his left calf is swollen and painful. which is the nurse's best action.
A.
Instructs the client to keep the leg elevated
B.
measures the calf circumference and compare with right calf
C.
Applies ice to the calf after massaging it
D.
Documents this expected response.
48. Which is the priority nursing diagnosis for the client receiving interleukin-2(IL-2) theraly ffor cancer?
A.
Risk for Injury related to excessive bleeding
B.
Impaired Comfort related to drug side effects
C.
Deficient Fluid Volume related to persistent diarrhea
D.
risk for infection related to drug induced neutropenia
49. The client recieving tamoxifen ask how this therapy helps fight cancer. Which is the nurse's best response?
A.
This agent decreases your circulating levels of estrogen
B.
This agent causes you to secrete testosterone instead of estrogen
C.
this agent kills both the normal estrogen-secreting cells and the cancer cells
D.
The agent blocks the receptors for estrogen, reducing its availability to the cancer cells
50. Which laboratory result in a client with cancer suggests the possibility of syndrome of inappropriate diuretic hormone (SIADH)
A Serum potassium of 5.2 mmol/L
.B.
Serum Sodium of 120 mmol/L
C.
hematocrit of 40%
D.
Blood urea nitrogen (BUN) of 10mg/dl
51. The cleint with hypercalcemia from advanced cancer is being treated with intravenous mithramycin. which clinical manifestation indicates that the treatment is effective?
A.
Bowel sounds are present and active in all four quadrants
B.
the clients serum sodium level is 138 mmol/L
C.
The pulse rate is 68/min and bounding
D.
Urine output has increased
52. In reviewing the laboratory report of white blood cell count with differential for a client receiving chemotherapy for cancer, which finding alerts the nurse to the possibility of sepsis?
A.
The total white blood cell count is 9000/mm
B.
the lymphocytes outnumber the basophils
C.
The bands outnumber the segs
D.
The monocyte count is 1800/mm
53. Which intervention is most important for thenurse to implement to prevent complications from tumor lysis syndrome during chemotherapy
A.
Ensures that the client has a fluid intake of 3000 to 5000 ml/day
B.
Monitors telemetry every hour during therapy
C.
applies pressure to all injection sites for 5 minutes
D.
assists the client in all ambulatory activities
54. The nurse teaches the client with superior vena cava syndrome that improvement is characterized by which clinical manifestation.
A.
The clients hands are less swollen
B.
Breath sounds are clear bilaterally
C.
The clientThe client's back pain is relieved
D.
Pedal edema is present
55. The nurse prioritizes which nursing diagnoses in the client whith late stage colon cancer with metastasis to the spine and bones being treated at home
A.
Imbalanced Nutrition, less than body requirements related to fatigue and increased metabolism
B.
Constipation related to decreased activity and medication regimen
C.
activity intolerance related to dyspnea and fatigue
D Acute Pain related to
. metastasis
56. After recieving their reports, which client will the nurse assess first?
A.
The client with leukemia ordered to receive an antiemetic before receiving chemotherapy
B.
The client with breast cancer scheduled for external beam radiation
C.
The client with xerostomia associated with laryngeal cancer
D.
The client with neutropenia who has just been admitted with a possible infection
57. The nurse questions which activity for the client with thrombocytopenia?
A.
Application of warm compresses to bruises
B.
Cleaning teeth with a soft bristle brush
C.
Taking acetaminophen (Tylenol) for pain
D.
using stool softeners daily for constipation
58. The nurse prioritizes which intervention inthe client with xerostomia secondary to radiation therapy to the neck area?
A.
Applying lotions and oils to affected areas
B.
Wearing a hat to decrease heat loss
C.
Carrying out oral care after every meal and at hour of sleep
D.
Monitoring vital signs every 4 hours
59.Which statement indicates the client needs more teaching about mucositis?
A.
I will rinse my mouth with water after every meal to remove food particles
B.
I will use a soft-bristled toothbrush to prevent trauma to my guns
C.
I should use an alcohol based mouth rinse to kill bacteria
D.
I cannot use floss because it can irritate my gums
60. In planning a teaching session for the client undergoing phototherapy for lung cancer, the nurse includes which statements (select all that apply)
A.
this is a palliative treatment that should decrease your pain
B.
Avoid exposure to sun for 1 to 3 months after treatment
C.
Do not eat or drink anything before your treatments
D.
do not remove skin markings between treatments
E. You need to wear sunglasses to protect your eyes after treatments
F.
drink fluids liberally after treatment to prevent dehydration
61. The nurse is planning care for a client with hypercalcemia secondary to bone metastisis.
Which interventions will be included in the plan (select all that apply)
A.
Increasing oral fluids
B.
placing an oral airway at the bedside
C.
Monitoring for chvostek's sign
D.
Implementing seizure precautions
E. assessing for hyperactive reflexes
F.
observing for muscle weakness
62. The client is undergoing several procedures. Which one will require informed consent?
A.
Bone marrow aspiration
B.
capillary fragility studies
C.
electrophoresis for hemoglobin type
D.
Reticulocyte count
63. The nurse assists the client with anemia to amblate inthe hallway. Which assessment finding indicates that the client is not tolerating the activity?
A.
blood pressure of 120/90 mm hg
B.
heart rate of 110 beats/min
C.
pulse oximetry reading of 95%
D.
Respiratory rate of 20 breaths/min
64. A client is admitted to the clinic with a hematocrit (hct) of 32%. When taking the client's history, which information is most significant
A.
use of acetaminophen (Tylenol)
B.
consumption of alcohol
C.
use of oxygen
D.
Recent infections
65. The nurse is caring for a cleint with liver failure, ,Which nursing action is a high priority for t his client?
A.
Auscultation for bowel sounds
B.
assessing for deep vein thrombosis
C.
monitoring blood pressure hourly
D.
Assessing for signs of bleeding
66. A nurse observes yellow-tinged sclera in a client with dark skin. Based on this assessment finding, what will the nurse do next.
A Assess the client's
. pulsesB.
Examine the soles of the client's feet
C.
Inspect the clients oral mucosa and hard palate
D.
assess lung sounds
67. The nurse assesses a client with numerous areas of bruising. Which question willassist the nurse in determining the cause of this symptom?
A.
Do you take aspirin
B.
Do you take vitamin supplements
C.
Are you a vegetarian
D.
Do you take Tylenol
68. A client is admitted to the hospital with a vitamin B12 deficiency. When taking the client's history, which question will the nurse ask first?
A.
Are you having any pain
B.
are you having blood in your stools
C.
do you notice any changes in your memory
D.
do you bruise easily
69. Which instruction is most important for the nurse to include in the client's discharge plan after a splenectomy?
A.
Avoid crowds
B.
Avoid fruit and raw vegetables
C.
you will be at an increased risk for developing allergies
D.
Do not play contact sports
70. It is most important for the nurse to include which instruction in the health care teaching of a cleint who has undergone a bone marrow biopsy?d
A.
Change the dressing every 8 hours
B.
monitor the site for bruising
C.
Maintain bed rest for 24 hours
D.
Use a heating pad for pain
71. For which purpose will the nurse explain to the client that a radiosotopic imaging assessment is being done
A.
determine platelet function
B.
evaluating bone marrow function
C.
monitoring blood flow to the spleen
D.
monitoring clotting factors
72. A client being discharged with a white blood cell (WBC) count of 2,000/mm3. which instruction is most important for the nurse to include in this client's discharge teaching plan?
A.
Avoid contact sports
B.
Avoid the use of aspirin
C.
Eat a diet high in iron
D.
Use good hand washing technique
73. The nurse is careing for four clients. Which client will the nurse prioritize to see first?
A.
Client with decreased protein levels
B.
Client with increased lymphocytes
C.
client with increased thromboxane level
D.
client with decreased erythropoietin
74. The nurse is planning interventions for four clients, Which intervention has the nurse correctly correlated with the client's laboratory findings?
A.
Client with decreased protein level, administering vitamin K
B.
Client with increased lymphocytes, administering antibiotics
C.
Client with increased thromboxane level, administering Digibind
D.
Client with decreased erythropoietin, administering oxygen
75. A client has a decreased erythrocyte count. What action by the nurse will be most therapeutic?
A.
Administering erythropoietin (Epogen)
B.
Starting an IV of normal saline
C.
Administering a platelet transfusion
D.
Giving a subcutaneous injection of vitamin K
76. Which information relates most directly to a diagnosis of a hamatologic problem in an older adult?
A.
discolored nails
B.
Increased prothrombin time
C.
progressive loss of body hair
D.
sin dryness
77. When assessing an older male client, which blood value indicates that the client is experiencing normal changes assiciated with aging?
A.
Hemoglobin=13.0 g/dl
B.
platelet count=100,000 /mm
C.
Prothrombin time (PT)=14 seconds
D.
White blood cell count=5,000/mm
78. The nurse has completed an admission assessment on an older adult client, which finding requires fruther assessement or intervention.
A.
Absent hair on lower extremities
B.
yellow thickened toenails
C.
petechiae on the arms and trunk
D.
mottled pigmentation on the cheeks and forehead.
79. The client has decreased production of platelets. Which of the client's platelet count is 30,000/mm. Which is the nurse's first action?
A.
Administering oxygen by nasal cannula
B.
instituting bleeding precautions
C.
Instituting isolation precautions
D.
obtaining vital signs
80. The nurse recognizes that which factor in the clients history is most likely to be related to a decreased level of iron (Fe)?
A.
eating a meat free diet
B.
family history of sickle cell disease
C.
history of leukemia
D.
history of bleeding ulcer
81. The client has decreased serum irol level. Which intervention will the nurse implement first?
A.
Dietary consult
B.
Family assessment
C.
Cardiac assessment
D.
Administration of Vitamin K
82. The nurse notices an elevated white blood cell (WBC) count in the client's laboratory finding. Which action will thenurse take first?
A.
Administer antibiotics
B.
Document the findings
C.
Obtain a respiratory rate
D.
Obtain a temperature
83. A reticulocyte count of 7% is most likely caused by which condition?
A.
Autoimmune disorders
B.
Infection
C.
Renal failure
D.
Vomiting large amounts of blood
84. A female client is admitted with the medical diagnosis of iron deficiency anemia. The nurse assesses for which potiental causes?
A.
Diet high in meat and fat
B.
Daily intake of aspirin
C.
heavy menses
D.
smoking history
85. A clients susceptibility to rejecting a transplanted kidney is most likely the result of which finding?
A.
Decreased T-lymphocyte helper or inducer T-cell
B.
Decreased white blood cell count
C.
Increased cytotoxic cytolytic T cell
D.
Increased neutrophil count
86. The client recieving cancer chemotherapy, Which action by the nurse is most therapeutic?
A.
Assessing fibronogen level
B.
Administration of iron
C.
adhering to standard precautions
D.
Continuous monitoring of pulse oximetry
87. The nurse is performing an admission assessment on a client who relates a history of daily alcohol intake. Which laboratory abnormality correlates with this history?
A.
Decreased WBC count
B.
Decreased bleeding time
C.
Elevated PT
D.
Elevated RBC count
88. A clients warfarin (Coumadin) therapy was discontinued 3 weeks ago. Which laboratory test result indicates that warfarin is not longer therapeutic.
A.
International normalized ratio (INR) of 0.9
B.
Reticulocyte count of 1%
C Serum ferritin level of 350
. ng/mlD.
Total WBC count of 9000/mm3
89. The nurse performs the preoperative checklist on a client, The client indicates that he has been taking aspirin every day for a headache. Which is the best action of the nurse?
A.
Calls for a prescribed pain medication
B.
Calls the surgeon and plan to reschedule the surgery
C.
Administers Tylenol preoperatively
D.
Administers vitamin K to prevent bleeding
90. The client is recieving heparin therapy. How will the nurse evaluate the therapeutic effect of the therapy
A.
evaluate platelets
B.
monitor the partial thromboplastin time (PTT)
C.
Assess bleeding time
D.
Monitor fibrin degradation products
91. A fibrinolytic is prescribed for a client who is having a myocardial infarction (MI). For which would the nurse assess the client?
A.
bleeding
B.
Increased PT and INR
C.
Increased RBC count
D.
Nausea and vomiting
92. A client who just has had a bone marrow aspiration begins to have bleeding from the site. Which is the most important action by the nurse?
A.
Applying external pressure to the site
B.
Applying a sandbag to the site
C.
Covering the site with a dressing
D.
Immobilizing the leg
93. A client ask the nurse if a bone biopsy and aspiration are painful. Which response is best?
A.
The procedure is always done under general anesthesia
B.
The biopsy only last for 2 minutes
C.
there is a chance they you may have pain
D.
you can relieve pain with guided imagery
94. The nurse is monitoring a client with liver failure. Which assessment are essential in the care of this client? (select all that apply)
A Gums
.B.
lung sounds
C.
Urine
D.
Stool
E. Hair
95. A client is recieving sodium warfarin (Coumadin). Which teacing interventions does the nurse plan for this client? (select all that apply)
A.
Dietary teaching
B.
Teaching to avoid aspirin
C.
Avoiding contact sports
D.
Dietary exercise
E.
Weight management
96. The nurse assigns a client with leukemia to an LPN. Which instruction is most important for the RN to provide the LPN
A.
Monitor the amount of protein that the client eats
B.
Monitor the roommate for infection
C.
Wash hands frequently
D.
wear a mask when entering the room
97. Which instructions will the nurse include in the discharge teaching plan of a client with sickle cell disease who was admitted for splenomegaly and abdominal pain
A.
Avoid drinking large amount of fluids
B.
Eat six small meals daily
C.
Engage in aerobic exercise three days a week
D.
Receive a yearly influenza vaccination
98. Which discharge teaching is essential to include for the client with acute myelogenic leukemia (AML)
A.
Avoid contact sports
B.
Avoid intercourse
C.
Apply heat to any bruised areas
D.
use aspirin when necessary
99. When providing care for a client with autoimmune thrombocytopenic purpura, which intervention is most important for the nurse to implement
A.
Avoiding IM injections and venipunctures
B.
administering anticoagulants as prescribed
C hydration with IV normal
. salineD.
Monitoring for increase in temperature
100.A client is being discharged from the hospital after allogenic transplantation. When planning this clinets discharge, it is most important for the nurse to coordinate with which member of the health care team?
A.
Home health care aide
B.
Nutritionist
C.
Nurse
D.
Social services
101.Which instruction is most important to include in the discharge teaching plan of a client who has had stem cell transplantation?
A.
Eating a diet high in salads and fruit
B.
Importance of getting a rubella vaccination
C.
Need for a clean home environment
D.
Performing daily physical therapy
102. The home health care nurse notices that the client has peeling skin several weeks after his allogenic transplantation. Why will the nurse notify the physician
A.
The immunosuppressant drugs need to be discontinued
B.
The client may need a prescription for steroid cream
C.
This is the time for a second marrow transfusion
D.
This may be graft versus host disease
103.Before administering transfusion therapy, it is essential for the nurse to take which action?
A.
Check the client's room number on the blood tag
B.
Check the client's ABO and RH types with the blood tag
C.
Place a 22 gauge needle in the clients forearm
D.
Obtain a pulse oximetry reading
104.Which identification means shouls the nurse use to ensure that a blood transfusion is administered to the correct client
A.
Ask the client if his or her name is the one on the blood product tag
B.
ask the clients spouse if the client is the correct person who is to have the transfusion
C.
compare the name and ID on the blood product tag with the name and ID number on the client's ID band
D.
Compare the bed and room number of the client with the bed and room number listed on the blood product tag
105. If a client has a family history of leukemia, what will the nurse teach them to avoid
A.
Alcohol consumption
B.
Exposure to radiation
C.
High cholesterol diet
D.
smoking cigarettes
106.A clients susceptibility to acute leukemia is most likely caused by which factor in her or his history
A.
Daily insulin injections for diabetes
B.
Enzyme replacements for cystic fibrosis
C.
Treatment with cyclophosphamide (cytoxan)
D.
Use of oral contraceptives
107.When assessing a client, which blood values indicates that the client is at risk for an infection?
A.
Fibronogen level 100 mg/dl
B.
Hemoglobin, 14g
C.
Platelet count, 140,000/mm3
D.
White blood cell (WBC) count, 1000/mm3
108.Which symptoms is most characteristic of a factor VIII deficiency?
A.
Excessive bleeding from a cut
B.
Back pain
C.
nausea and vomiting
D.
Temperature of 101 F
109.Which action will the nurse take to prevent fatigue in a clinet with leukemia?
A.
arrange for a family member to be with the client
B.
Plan care for periods when the client has the most energy
C.
Provide for daily physical therapy
D.
Plan all activities in the morning to allow for afternoon naps
110.A client with vitamin B12 dificiency anemia has been taught to eat a diet high in this vitamin.Which meal selected by the client indicates that he or she understands that prescribed diet?
A.
Backed chicken breast, boiled carrots, glass of milk
B.
Eggplant Parmesan, cream style cottage cheese, iced tea
C.
Fried liver and onions, orange juice, spinach salad
D.
Whole grain pasta with cheese, apple sauce, glass of red wine
111.A client with iron deficiency anemia has been taught proper diet. Which food choice indicates understanding of dietary teaching.
A.
Chicken
B.
oranges
C.
steak
D.
Tomatoes
112. e nurse assesses that the client has a smooth, beefy red tongue, Based on this information, which intervention will the nurse include in the client's plan of care?
A.
Administering oral iron supplements
B.
monitoring the daily white blood cell count
C.
Providing for a diet high in green leafy vegetables
D.
Performing more frequent mouth care
113.An anemia form dietary deficiency is most likely related to what condition?
A.
Antacid therapy
B.
Chronic alcoholism
C.
Congestive heart failure
D.
Type 2 diabetes
114. The client being discharged to home after a bone marrow transplantation aske why protection from injury is so important. Which is the nurses best response?
A.
Injured tissue makes you at risk for infection
B.
platelet recovery is slow, which makes you at risk for bleeding
C.
Trauma could result in rejection of the transplant
D.
The medication regimen can make you bruise easy
115. The client is scheduled for surgery and has expressed concern that she might receive blood products, an act prohibited by her religion. Which is the nurse's best response?
A.
there are other ways to replace blood loss besides blood products
B.
your chance of needing a blood transfusion is small
C.
you need to do what is necessary to save your life
D.
You could have family members donate blood for you
116.A client with Hodgkins lymphoma in the abdominopelvic region is about to undergo readiation therapy and expresses concern about becoming infertile. Which response by the nurse is likely to be most helpful in reducing the clients fears?
A Adoption is always an
. optionB.
Infertility is not seen with this type of radiation therapy
C.
Sperm production will be permanently disrupted
D.
You have the option to store sperm in a sperm bank
117.When preparing a client with leukemia for a peripherial stem cell transfusion, the nurse will provide the client with which instruction.
A.
Nausea and vomiting are common after the transfusion
B.
the infusion will take about 6 hours
C.
you may have numbers in your fingers and toes
D.
you may have red urine for a short time.
118.Which question or statement by the client about to undergo allogeneic bone marrow transplantation indicates a need for further discussion regarding the procedure
A.
Which bone will the surgeon insert the marrow in
B.
Until the marrow transplant takes, I should have few visitors
C.
The transplant does not start working immediately
D.
I will need chemotherapy prior to my transplant
119.Which intervention will the nurse plan to implement to reduce a cleint's pain during a sickle cell crisis?
A.
Administer acetaminophen (Tylenol) as needed
B.
Administer intramuscular (IM) morphine around the clock
C.
Keep the room temperature at 80 F
D.
Transfuse red blood cells (RBC)
120.A client is admitted to the hospital with a medical diagnosis of anemia, When assessing the clent, the nurse should expect which symptom?
A.
Difficulty with breathing
B.
Blood pressure of 150/0 mm hg
C.
Heart rate of 45 beats/min
D.
Skin flushed and warm
121. The student nurse asks the nurse why a child has sickle cell disease, Which explanation is best for the nurse to provide?
A.
The child has two hemoglobin S gene alleles, one inherited from each parent
B.
The child has one hemoglobin A allele, and one hemoglobin S allele
C.
The child has two hemoglobin A alleles, both inherited from one parent
D.
The child has two hemoglobin S gene alleles, both inherited from one parent.
122. The finding of which laboratory value indicates that the nurse should iscontinue red blood cell transfusions to a cleint with sickle cell disease
A.
Hematocrit level (HCT) of 32%
B.
Hemoglobin S of 88%
C.
Serum Iron level of 300 ug/dl
D.
total WBC of 12,000/mm
123. The childbearing age client in sickle cell crisis has a pulse oximetry reading of 90% on room air and a respiratory rate of 28/min. Which is the priority nursing diagnosis?
A.
Deficient knowledge related to contraception and pregnancy options
B.
Deficient Knowledge related to prevention of crisis episodes
C.
Risk of Injury related to decreased tissue oxygenation
D.
Risk for infection related to decreased spleen function.
124. The childbearing age client in sickle cell crisis has a pulse oximetry reading of 90% on room air and a respiratory rate of 28/min. Which is the priority nursing diagnosis
A.
Deficient Knowledge related to contraception and pregnancy options
B.
Deficient Knowledge related to prevention of crisis episodes
C.
Risk for Injury related to decreased tissue oxygenation
D.
Risk for infection related to decreased spleen function
125.A client whi is newly diagnosed with sickle cell anemia is being discharged from the hospital. Which information is most impportant for the nurse to provide the client prior to discharge?
A.
Diet high in iron
B.
how to take hydroxyurea (Droxia)
C.
Recognizing signs of crisis
D.
Use of oral contraceptives
126.A client with sickle cell anemia is admitted to the hospital complaining of severe pain. Which action will the nurse take first?
A.
Administer one unit of packed red blood cells
B.
Administer hydroxyurea (Droxia)
C.
Begin dextrose 5% in water at 250ml/hr
D.
Prepare for bone marrow transplantation
127.A client with sickle cell disease is admitted to the hospital. Which question indicates that the nurse understands the major symptoms associated with this disease
A.
are you more fatigued than usual
B are you taking your daily iron
. supplementC.
do you bruise more easily
D.
do you notice any blood in your stools
128.Which information is most important for the nurse to provide to the cleint to prevent sickle cell crisis?
A.
avoid exercising
B.
avoid planes with pressurized cabins
C.
maintain a diet high in iron
D.
Maintain an oral fluid intake of at least 4500 ml/day
129.A clients susceptibility to leukemia is most related to which factor?
A.
diet lacking vitamin b12
B.
diet lacking iron
C.
treatment of previous cancer
D.
treatment of previous thrombocytopenia
130.A client is admitted to the emergency room complaining of increased fatigue, decreased appetite, and white blood cell count of 30,000 /mm3. A bone marrow biopsy performed 2 days ago s hows blast phase cells.Which nursing intervention is most essential to include in the client's plan of care?
A.
Assess client for the presence of infection
B.
Assess circulation at the site of the biopsy
C.
Contact physical therapy for an exercise program
D.
Increase client's intake of raw fruits and vegetables
131.Which instruction should the nurse include in the discharge teaching plan of a client w ho was recently diagnosed with AML and underwent stem cell transplantation?
A.
Avoid large crowds
B.
Eat food that is high in vitamin B12
C.
Group all activities to allow for naps
D.
Receive the measles immunizations
132.which instruction will the nurse include in the discharge teaching plan of a client who was recently diagnosed with thrombocytopenia?
A.
drink at least 3 liters of fluid each day
B.
use a soft bristled toothbrush
C.
avoid blowing your nose
D.
use only aspirin when having pain
133.Which intervention will the nurse implement immediately for a cleint with a platelet count of 5,000 /mm3
A.
assessing the client for petechiae
B.
Administer epoetin alfa (Epogen, Procrit)
C.
monitoring for client's temperature
D.
Determining the white blood cell count
134.Which instruction will the nurse include for the client with myelodysplastic syndrome?
A.
exercise slowly
B.
drink at least 3 liters of liquids per day
C.
wear gloves and socks outdoors in cool weather
D.
use a soft bristled toothbrush
135.A nurse observes that the cleints wh os blood type is AB negative is receiving a transfusion with type o negative packed red blood cells. Which is the nurses best first action?
A.
calls the blood bank
B.
takes and records the client's vital signs
C.
stops the transfusion and keeps the IV open
D.
Administers diphenhydramine (Benadryl)
136. The client is prescribed to recieve a unit of packed red blood cells, When the blood products arrive, a nurse notes that the client's current IV is infusion Ringer's lactate solution. Which is the nurse's first best action
A.
change the intravenous solution to dextrose 5% in water
B.
Change the intravenous solution to normal saline
C.
hang the blood with the currently infusing solution
D.
Start an additional intravenous infusion site
137.A client with a history of heart failure is receiving a unit of packed red blood cells, His respiratory rate is 33/min and blood pressure is 140/90 mm hg. Which will the nurse do first?
A.
Administer diphenhydramine (Benadryl)
B.
continue to monitor vital signs
C.
stop the infusion
D.
Slow the rate of the infusion
138.A client who is receiving a unit of red blood cells begins to complain of chest and lower back pain. Which action will the nurse take first?
A.
Administer morphine sulfate 1 mg IV
B.
Assess the level of the pain
C.
Stop the transfusion
D.
slow the rate of the transfusion
139.When preparing for the third transfusion of red blood cells, The nurse would be most concerned with w hich laboratory findings
A.
Fibronogen level less than 100 mg/dl
B.
hematocrit of 30%
C.
Potassium level of 5.5 mg/dl
D.
serum ferritin level of 250 ng/ml
140. The following four transfusions are to be given. Which type of transfusion presents the greatest risk for a client to develope itching, chills, shortness of breath, and hives?
A.
Cryoprecipitate transfusion
B.
platelet transfusion
C.
red blood cell transfusion
D.
White blood cell transfusion