ONCOLOGY,HEMATOLOGY,COMMUNICABLE DISEASES

Question 1

Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:
A.yearly after age 40.
B after the birth of the first child and every 2 years thereafter.
C after the first menstrual period and annually thereafter.
D. every 3 years between ages 20 and 40 and annually thereafter.

Answer 1

A. The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It’s recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.

Question 2

Breast Cancer is most likely to spread to your ____________area.
A Face
B Stomach
C. Underarm
D Leg

Answer 2

C. Underarm

Question 3

A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:
A.Elevate the client’s right arm on pillows
B Place the client’s right arm in a dependent sling
C Keep the client’s right arm on the bed beside her
D Place the client’s right arm across her body

Answer 3

A. A total mastectomy involves removal of the entire breast and some or all of the axillary lymph nodes. Following surgery, the client’s right arm should be elevated on pillows, to facilitate lymph drainage. Other options are incorrect because they would not help facilitate lymph drainage and would create increased edema in the affected extremity.

Question 4

Nina, an oncology nurse educator is speaking to a women’s group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate?
A Mammography is the most reliable method for detecting breast cancer.
B Breast cancer is the leading killer of women of childbearing age.
C Breast cancer requires a mastectomy.
D Men can develop breast cancer.

Answer 4

D. Men can develop breast cancer, although they seldom do. The most reliable method for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small, confined, and in an early stage.

Question 5

What is Breast Cancer?
A A tumor that developes in the breast area
B A very common disease among women
C A deadly disease
D. All of the above

Answer 5

D. All of the above

Question 6

Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
A.Vision changes
B Hearing loss
C Headache
D Anorexia

Answer 6

A.Vision changes
The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don’t warrant a change in therapy.

Question 7

What is a symptom of Breast Cancer?
A Itchy throat
B. Lump in underarm or breast area.
C Pain in the arm

Answer 7

B. Lump in underarm or breast area.

Question 8

A 37-year-old client with uterine cancer asks the nurse, “Which is the most common type of cancer in women?” The nurse replies that it’s breast cancer. Which type of cancer causes the most deaths in women?
A.Breast cancer
B. Lung cancer
C Brain cancer
D Colon and rectal cancer

Answer 8

B. Lung Cancer
Lung cancer is the most deadly type of cancer in both women and men. Breast cancer ranks second in women, followed (in descending order) by colon and rectal cancer, pancreatic cancer, ovarian cancer, uterine cancer, lymphoma, leukemia, liver cancer, brain cancer, stomach cancer, and multiple myeloma.

Question 9

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
A Urine output of 400 ml in 8 hours
B Serum potassium level of 3.6 mEq/L
C Blood pressure of 120/64 to 130/72 mm Hg
D.Dry oral mucous membranes and cracked lips

Answer 9

D.Dry oral mucous membranes and cracked lips
Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.

Question 10

The nurse is teaching the client about breast self-examination. Which observation should the client be taught to recognize when doing the examination for detection of breast cancer?
A.tender, movable lump
B pain on breast self-examination
C round, well-defined lump
D. dimpling of the breast tissue

Answer 10

D. dimpling of the breast tissue
The tumor infiltrates nearby tissue, it can cause retraction of the overlying skin and create a dimpling appearance.

Question 11

Ductal lavage is used for

A women at higher risk for benign proliferative breast disease.
B women at low risk for breast cancer.
C screening women over age 65.
D women with breast implants.

Answer 11

A. Women at higher risk for benign proliferative breast disease
Performed in the doctor’s office, a microcatheter is inserted through the nipple while instilling saline and retrieving the fluid for analysis. It has been shown to identify atypical cells in this population and has been found to be adept at detecting cellular changes within the breast tissue.

Question 12

A 52 yr-old female tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?
A eversion of the right nipple and a mobile mass
B nonmobile mass with irregular edges
C mobile mass that is oft and easily delineated
D nonpalpable right axillary lymph nodes

Answer 12

B. nonmobile mass with irregular edges
Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. Nipple retraction —not eversion—may be a sign of cancer. A mobile mass that is soft and easily delineated is most often a fluid-filled benigned cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass.

Question 13

A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) 8mg PO to be given 30 minutes before induction of the chemotherapy. The purpose of the medication is to:
A Prevent anemia
B Promote relaxation
C.Prevent nausea
D Increase neutrophil counts

Answer 13

C. Zofran is given before chemotherapy to prevent nausea. Answers A, B, and D are not associated with the medication; therefore, they are incorrect.

Question 14

Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:
A.cancerous lumps.
B areas of thickness or fullness.
C.changes from previous self-examinations.
D fibrocystic masses.

Answer 14

C. Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.

Question 15

A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
A Persistent nausea
B Rash
C Indigestion
D Chronic ache or pain

Answer 15

C. Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn’t one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

Question 16

During a breast examination, which finding most strongly suggests that the Luz has breast cancer?
A Slight asymmetry of the breasts.
B. A fixed nodular mass with dimpling of the overlying skin
C Bloody discharge from the nipple
D Multiple firm, round, freely movable masses that change with the menstrual cycle

Answer 16

B. A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition.

Question 17

Hormonal agents are used to treat some cancers. An example would be:

A Thyroxine to treat thyroid cancer.
B ACTH to treat adrenal carcinoma.
C Estrogen antagonists to treat breast cancer.
D Glucagon to treat pancreatic carcinoma

Answer 17

C. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. A well-known estrogen antagonist used in breast cancer therapy is tamoxifen (Nolvadex). This drug, in combination with surgery and other chemotherapeutic drugs reduces breast cancer recurrence by 30 percent. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history of the disease. Thyroxine is a natural thyroid hormone. It does not treat thyroid cancer. ACTH is an anterior pituitary hormone, which stimulates the adrenal glands to release glucocorticoids. It does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone, which stimulates glycogenolysis and gluconeogenesis. It does not treat pancreatic cancer.

Question 18

Which of the following are used in diagnosing breast cancer?
A Mammogram
B Ultrasound
C MRI
D Biopsy
E All of the above

Answer 18

E

Question 19

Is early detection of breast cancer your best chance of survival?
A No
B Yes
C Sometimes
D I Don’t Know

Answer 19

B

Question 20

What does regional refer to in relation to breast cancer?
A Metastases
Lymph nodes
C A tumor within the breast
D A tumor is within both breasts

Answer 20

Lymph nodes

Question 21

Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:
A at the end of her menstrual cycle.
B on the same day each month.
C.on the 1st day of the menstrual cycle.
D. immediately after her menstrual period.

Answer 21

D. Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman’s breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.

Question 22

The community health nurse implemented a new program about effective breast cancer screening technique for the female personnel of the health department of Valenzuela. Which of the following technique should the nurse consider to be of the lowest priority?
A Yearly breast exam by a trained professional
B. Detailed health history to identify women at risk
C Screening mammogram every year for women over age 50
D Screening mammogram every 1-2 years for women over age of 40

Answer 22

B.Because of the high incidence of breast cancer, all women are considered to be at risk regardless of health history.

Question 23

The nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (ACS) guidelines, the nurse should recommend that the women:
A perform breast self-examination annually
B. have a mammogram annually
C have a hormonal receptor assay annually
D have a physician conduct a clinical evaluation every 2 years

Answer 23

B. According to the ACS guidelines, “Women older than age 40 should perform breast selfexamination monthly (not annually).” The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.

Question 24

Noninvasive Breast Cancer is when..
the cancer cells have stayed from their A.origin and have not spread
B the cancer cells have spread to other parts of your body

Answer 24

A

Question 25

Maria Sison, 40 years old, single, was admitted to the hospital with a diagnosis of Breast Cancer. She was scheduled for radical mastectomy. Nursing care during the preoperative period should consist of
A assuring Maria that she will be cured of cancer
B.assessing Maria’s expectations and doubts
C. maintaining a cheerful and optimistic environment
D keeping Maria’s visitors to a minimum so she can have time for herself

Answer 25

B. Assessing the client’s expectations and doubts will help lessen her fears and anxieties. The nurse needs to encourage the client to verbalize and to listen and correctly provide explanations when needed.

Question 26

What is the purpose of using hormonal therapy for patients with breast cancer cells?
A To replace the hormones and add testosterone.
B.To produce more hormones by adding testosterone along with estrogen and progesterone.
C. To block the supply of estrogen or pregesterone to the cells.

Answer 26

C

Question 27

Breast reconstruction is done aftersurgery.
A.Lumpectomy
B.Mastectomy

Answer 27

B

Question 28

Maria refuses to acknowledge that her breast was removed. She believes that her breast is intact under the dressing. The nurse should
A call the MD to change the dressing so Kathy can see the incision
B recognize that Kathy is experiencing denial, a normal stage of the grieving process
C reinforce Kathy’s belief for several days until her body can adjust to stress of surgery.
D remind Kathy that she needs to accept her diagnosis so that she can begin rehabilitation exercises.

Answer 28

B.A person grieves to a loss of a significant object. The initial stage in the grieving process is denial, then anger, followed by bargaining, depression and last acceptance. The nurse should show acceptance of the patient’s feelings and encourage verbalization.

Question 29

A 34-year-old female client is requesting information about mammograms and breast cancer. She isn’t considered at high risk for breast cancer. What should the nurse tell this client?
A.She should have had a baseline mammogram before age 30.
B.She should eat a low-fat diet to further decrease her risk of breast cancer.
C She should perform breast self-examination during the first 5 days of each menstrual cycle.
D When she begins having yearly mammograms, breast self-examinations will no longer be necessary.

Answer 29

B.A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman’s risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.

Question 30

What is the percentage of breast tissue that can be removed and rearranged to have the breast still looking like a breast?
A 60%
B 15%
C 30%
D 45%

Answer 30

C

Question 31

Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
A breast self-examination.
B mammography.
C fine needle aspiration.
D chest X-ray

Answer 31

C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.

Question 32

Which of the following terms is used to describe removal of the breast tissue and an axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer?
A Modified radical mastectomy
B Segmental mastectomy
C Total mastectomy
D Radical mastectomy

Answer 32

A. modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.

Question 33

The primary purpose of the Schilling test is to measure the client’s ability to:
A Digest vitamin B12
B Absorb vitamin B12
C Store vitamin B12
D Produce vitamin B12

Answer 33

B. Pernicious anemia is caused by the body’s inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling’s test helps diagnose pernicious anemia by determining the client’s ability to absorb vitamin B12.

Question 34

A 22-year-old with stage I Hodgkin’s disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the client tells you, “Sometimes I am afraid of dying.” Which response is most appropriate at this time?
A “Most people with stage I Hodgkin’s disease survive.”
B “Perhaps you should ask the doctor about medication.”
C “Tell me a little bit more about your fear of dying.”
D “Many individuals with this diagnosis have some fears.”

Answer 34

C. Most assessment about what the client means is needed before any interventions can be planned or implemented. All of the other statements indicate a conclusion that the client is afraid of dying of Hodgkin’s disease. Focus: Prioritization

Question 35

Which of the following disorders results from a deficiency of factor VIII?
A Hemophilia A
B Hemophilia B
C Sickle cell disease
D Christmas disease

Answer 35

A. Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.

Question 36

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection?
A Prothrombin time
B Hemoglobin concentration
C Hematocrit
D Partial thromboplastin time

Answer 36

C. Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

Question 37

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?
A Trauma
B Fluid overload
C Infection
D Stress

Answer 37

B. Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.

Question 38

A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately?
A The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion.
B The new RN tells the client that the PRBCs may cause a serious transfusion reaction.
C The new RN primes the transfusion set using 5% dextrose in lactated Ringer’s solution.
D The new RN starts an intravenous line for the transfusion using a 22-gauge catheter.

Answer 38

C. Normal saline, an isotonic solution, should be used when priming the IV line to avoid causing hemolysis of RBCs. Ideally, blood products should be infused as soon as possible after they are obtained; however, a 20-minute delay would not be unsafe. Large-gauge IV catheters are preferable for blood administration; if a smaller catheter must be used, normal saline may be used to dilute the RBCs. Although it is appropriate to instruct clients to notify the nurse if symptoms of a transfusion reaction such as shortness of breath or chest pain occur, it will cause unnecessary anxiety to indicate that a serious reaction is likely to occur. Focus: Prioritization

Question 39

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia?
A An elevated RBC count
B A decreased reticulocyte count
C Red blood cells that are microcytic and hypochromic
D An elevated hemoglobin level

Answer 39

C. The results of a CBC in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

Question 40

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions?
A Intake and output
B Bowel function
C Bleeding tendencies
D Peripheral sensation

Answer 40

C. Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.

Question 41

After receiving change-of-shift report about all of these clients, which one will you assess first?
A A 26-year-old with thalassemia major who has a short-stay admission for a blood transfusion
B A 44-year-old who was admitted 3 days previously with a sickle cell crisis and has orders for a CT scan
C A 50-year-old with newly diagnosed stage IV non-Hodgskin’s lymphoma who is crying and stating “I’m not ready to die.”
D A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature

Answer 41

D Any temperature elevation in a neutropenic client may indicate the presence of a life-threatening infection, so actions such as blood cultures and antibiotic administration should be initiated quickly. The other clients need to e assessed as soon as possible, but are not critically ill. Focus: Prioritization

Question 42

You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation for a client with Hodgkin’s lymphoma who is receiving radiation to the groin area. Which nursing activity is best delegated to a nursing assistant caring for the client?
A Explain good skin care to the client and family.
B Clean the skin over daily with a mild soap.
C Check the skin for signs of redness or peeling.
D Apply alcohol-free lotion to the area after cleaning.

Answer 42

B Skin care is included in nursing assistant education and job description. Assessment and client teaching are more complex tasks that should be delegated to registered nurses. Use of lotions to the irradiated area is usually avoided during radiation therapy. Focus: Delegation

Question 43

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
A Elevated serum bilirubin concentration.
Autoimmune reaction complicated by hypoxia
C Obstruction to circulation
D Lack of oxygen in the red blood cells

Answer 43

C. Characteristic sickle cells tend to cause “log jams” in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease

Question 44

Which of the following diagnostic findings are most likely for a client with aplastic anemia?
A Decreased levels of white blood cells, red blood cells, and platelets
B Reed-Sternberg cells and lymph node enlargement
C Increased levels of WBCs, RBCs, and platelets
D Decreased production of T-helper cells

Answer 44

A. In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn’t decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin’s disease.

Question 45

Which of the following blood components is decreased in anemia?
A Leukocytes
B Granulocytes
C Platelets
D Erythrocytes

Answer 45

D. Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells).

Question 46

A mother asks the nurse if her child’s iron deficiency anemia is related to the child’s frequent infections. The nurse responds based on the understanding of which of the following?
A Children with iron-deficient anemia are equally as susceptible to infection as are other children.
B Children with iron deficiency anemia are more susceptible to infection than are other children.
C Little is known about iron-deficiency anemia and its relationship to infection in children.
D Children with iron-deficiency anemia are less susceptible to infection than are other children.

Answer 46

B. Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.

Question 47

Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply.
A “I can’t keep enough apple juice in the house; he must drink over 10 ounces per day.”
B “He doesn’t like meat, but he will eat small amounts of it.”
C “He sleeps 12 hours every night and take a 2-hour nap.”
D “He drinks over 3 cups of milk per day.”
E “He refuses to eat more than 2 different kinds of vegetables.”

Answer 47

A&D Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.

Question 48

After receiving the change-of-shift report, which client will you assess first?
A A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit
B A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge
C A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of bed
D A 60-year-old with non-Hodgkin’s lymphoma who is refusing the ordered chemotherapy regimen

Answer 48

A. A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit

Question 49

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate?
A Continue to monitor vital signs
B Check the dressing and drains for frank bleeding
C Call the physician
D Start oxygen at 2L/min per NC

Answer 49

A. The nurse should continue to monitor the client, because this value reflects a normal physiologic response.

Question 50

A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern?
A “I take one aspirin every morning because of my history of angina.”
B “I’ve noticed that I bruise more easily since the chemotherapy started.”
C “My bowel movements are soft and dark brown in color.”
D “My appetite has decreased since the chemotherapy strated.”

Answer 50

A) Because aspiring will decrease platelet aggregation, clients with thrombocytopenia should not use aspirin routinely. Client teaching about his should be included in the care plan. Bruising is consistent with the client’s admission problem of thrombocytopenia. Soft, dark brown stools indicate that there is no frank blood in the bowel movements. A decrease in appetite is common with chemotherapy, and more assessment is indicated. Focus: Prioritization

Question 51

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vasoocclusive sickle cell crisis?
A Pain related to tissue anoxia
B Excess fluid volume related to infection
C Ineffective coping related to the presence of a life-threatening disease
D Decreased cardiac output related to abnormal hemoglobin formation

Answer 51

A. For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusive and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

Question 52

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan?
A “Take the medication with an antacid.”
B “Take the medication on an empty stomach.”
C “Take the medication with cereal.”
D “Take the medication with a glass of milk.”

Answer 52

B. Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconae should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

Question 53

A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion?
A Hemophilia is a Y linked hereditary disorder
B Hemophilia A results from a deficiency of factor VIII
C Males inherit hemophilia from their fathers
D Females inherit hemophilia from their mothers

Answer 53

B) Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.

Question 54

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?
A Sedimentation rate, 16 mm/hour
B Schilling’s test, elevated
C RBCs 5.0 million
D Intrinsic factor, absent

Answer 54

D) The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs

Question 55

A client admitted to the hospital with a sickle cell crisis complains of severe abdominal, hip, and knee pain. You observe an LPN accomplishing these client care tasks. Which one requires that you, as charge nurse, intervene immediately?
A The LPN checks the client’s temperature every 2 hours.
B.The LPN encourages the client to use the ordered PCA.
C The LPN positions cold packs on the client’s knees.
D The LPN places a “No Visitors” sign on the client’s door.

Answer 55

C) The joint pain that occurs in sickle cell crisis is caused by obstruction to blood flow by the sickled red blood cells. The appropriate therapy for this client would be application of moist heat to the joints to cause vasodilation and improve circulation. Because control of pain is a priority during sickle cell crisis, there is no need to restrict all visitors or to check the temperature every 2 hours. Focus: Prioritization

Question 56

*

A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse’s first response?
A Assess for potential abuse
B Check for diminished sensations
C Document the findings
D Clean and dress the area

Answer 56

B) Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings.

Question 57

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?
A Get 8 hours of sleep at night and take naps during the day
B Eat animal protein and dark leafy vegetables each day
C Avoid exposure to others with acute infection
D Practice yoga and meditation to decrease stress and anxiety

Answer 57

C) Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia.

PRIORITIZATION