Quiz 1 PrepU Flashcards
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?
Monitor daily platelet counts.
Perform a cardiovascular assessment every 4 hours.
Closely observe the client’s skin for petechiae and bruising.
Check the client’s history for a congenital link to thrombocytopenia.
Closely observe the client’s skin for petechiae and bruising.
The nurse should closely observe the client’s skin for petechiae and bruising. Daily laboratory testing may not reflect the client’s condition as quickly as subtle changes in the client’s skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don’t help detect early signs and symptoms of thrombocytopenia.
In which phase of the cell cycle does cell division occur?
Mitosis
S phase
G2 phase
G1 phase
Mitosis
Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the health care provider to report that the client has symptoms of
acute leukopenia.
graft-versus-host disease.
nadir. metastasis.
graft-versus-host disease.
Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Bone pain
Stomatitis
Extravasation
ausea and vomiting
Extravasation
The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
The nurse at the clinic explains to the client that the surgeon will be removing a mole on the client’s back that has the potential to develop into cancer. The nurse informs the client that this is what type of procedure?
Reconstructive
Palliative
Prophylactic
Diagnostic
Prophylactic
Explanation:
Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the client as comfortable as possible, and promote quality of life as defined by the client and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant.
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client’s care plan?
Wearing a lead apron during direct contact with the client
Avoiding using soap on the irradiated areas
Remove skin markings
Avoiding using soap on the irradiated areas
Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client’s body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?
Repeat biopsy is needed before treatment begins.
Adjuvant therapy is likely.
Palliative care is likely.
No further treatment is indicated.
Adjuvant therapy is likely.
Explanation:
T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
A client had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The client takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this client at risk for?
Sickle cell anemia
Iron deficiency anemia
Aplastic anemia
Pernicious anemia
Pernicious anemia
Explanation:
A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn’s disease, or after ileal resection or gastrectomy.
The nurse is preparing the client for a test to determine the cause of vitamin B12 deficiency. The client will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the client being prepared for?
Magnetic resonance imaging (MRI) study Bone marrow aspiration
Schilling test
Bone marrow biopsy
Schilling test
Explanation:
The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the client receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
A nurse should expect to administer which vaccine to the client after a splenectomy?
Tetanus toxoid
Recombivax HB
Pneumovax 23
Attenuvax
A client at the clinic has just been diagnosed with iron deficiency anemia. What would the nurse recommend the client consume to promote the absorption of iron?
Sources of vitamin B12 Meat, egg yolks, oysters, and shellfish Rich sources of vitamin C Vitamin E
Pneumovax 23
Explanation:
Pneumovax 23, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy. Recombivax HB is a vaccine for hepatitis B. Attenuvax is a live, attenuated virus vaccine for immunization against measles (rubeola). Tetanus toxoid is administered to prevent tetanus resulting from impaired skin integrity caused by traumatic injury.
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?
Develop a therapeutic regimen recommendation for the client.
Assist the client to incorporate the therapeutic regimen into daily activities.
Assist the client to use a medication reminder system for the therapeutic regimen.
Develop a therapeutic regimen based on the client’s understanding of the medication.
Assist the client to incorporate the therapeutic regimen into daily activities.
Explanation:
The best way for the nurse to promote adherence to the therapeutic regimen is to assist the client to incorporate the therapeutic regimen into daily activities. This action is the only answer choice that is a collaborative effort with the client and is the reason it is correct.
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse
Questions the health care provider about the use of both medications
Instructs the client not to lift more than 20 pounds
Checks the client’s BUN and creatinine
Teaches the client to bend at the back when lifting objects
Checks the client’s BUN and creatinine
Explanation:
Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.
Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand’s disease?
amount and quality of factor IX
amount and quality of factor VIII
quality of factor IX
quality of factor VIII
amount and quality of factor VIII
Explanation:
In a less serious form of hemophilia A, von Willebrand’s disease, the amount and quality of factor VIII is diminished.
