Unit 8 - Class Activities Flashcards
While being educate by the nurse about breast self-examination, a client asks what the rationale is for moving her arms in different positions while standing in front of a mirror. The nurse explains that these positions are use to.
A.Increase the examiner’s comfort during procedure
B.More easily diagnose any masses
C.Determine whether there is any nipple discharge with movement
D.Emphasize any change in shape or contour of the breast
D.Emphasize any change in shape or contour of the breast
*All arm positions except when the arms are relaxed by the sides, will accentuate skin changes. When the arms are raised over the head, visualization of the underside of the breasts is easier. When the hands are placed on the hips and arms are pressed forward, the breast tissue is pushed outward, which accentuates dimpling and puckering. Breast self examination is not an uncomfortable procedure. Although masses may be seen on inspection, palpation is a more important maneuver for detecting masses. Nipple discharge is assessed by gently squeezing the nipples
A 15 year old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?
A.Fatigue and anorexia
B.Fever and petechiae
C.Swollen neck lymph glands and lethargy
D.Enlarged liver and spleen
B.Fever and petechiae
a disorder of the blood forming tissue/ proliferation of immature WBC
Leukemia
After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia?
A.“ The disease is an infection resulting in increased white blood cell production.”
B.“The disease is a type of cancer characterized by an increase in immature white blood cells.”
C.“The disease is an inflammation associated with enlargement of the lymph nodes.”
D.“The disease is an allergic disorder involving increased circulation antibodies in the blood.”
B.“The disease is a type of cancer characterized by an increase in immature white blood cells.”
*Leukemia is a neoplastic, or cancerous, disorder of blood forming tissues that is characterized by a proliferation of immature white blood cells. Leukemia is not an infection, inflammation or allergic disorder.
Laboratory findings indicate that a child with leukemia is also anemic. The nurse interprets this finding as most likely resulting from which of the following?
A.Inadequate dietary folic acid intake
B.Decreased red blood cell production
C.Increased destruction of red blood cells by lymphocytes
D.Progressive replacement of bone marrow with scar tissue
B.Decreased red blood cell production
*The anemia seen in children with leukemia is caused by the bone marrow’s overproduction of immature white blood cells at the expense of producing red blood cells and platelets. Treatment for the anemia may include Erythropoietin (also known as EPO) : a growth factor that stimulates the production of red blood cells. (remember it’s use with CKD?)
Which of the following statements would the nurse use to describe to the parents why their child with leukemia is at risk for infections?
A.“Play activities are too strenuous.”
B.“Vitamin C intake is reduced over a period for time.”
C.“The number of red blood cells in inadequate for carrying oxygen.”
D.“Immature white blood cells are incapable of handling an infectious process.
D.“Immature white blood cells are incapable of handling an infectious process.
*The normal amount of WBC are capable of fighting an infection is decreased. Although there is an increased number of immature white blood cells, they are unable to combat infection. Therefore a child with leukemia is subject to infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia( decreased granulocytes/ type of WBC’s) While increased activity may cause fatigue it does not put the child at risk for infection.
After teaching a child with leukemia scheduled for a bone marrow aspiration about the procedure, the nurse determines that the teaching has been successful when the child identifies which of the following as the puncture site?
A.Right lateral side of the right wrist.
B.Middle of the chest
C.Distal end of the thigh
D.Back of the hipbone
D.Back of the hipbone
*Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest, the back of the hip bone. This area is close to the body’s surface but removed from vital organs. The area is large, so specimens can easily be obtained. For infants, the proximal tibia and the posterior iliac crest are used. The middle of the chest of sternum is the usual site for bone marrow aspiration in an adult.
A 10 year old with leukemia is taking immunosuppressive drugs. The child should:
A.Continue with her immunizations
B.Not receive any live attenuated vaccines
C.Receive vitamin and mineral supplements
D.Stay away from her peers
B.Not receive any live attenuated vaccines
*If immunosuppressed , you can develop severe forms of the disease ( measles, mumps rubella, oral polio vaccine if given the live vaccine) Inactivated vaccines may be given if necessary, but the client is not able to adequately produce needed antibodies and it is recommended that immunizations be delayed for 3 months after the immunosuppressive drugs have been discontinued.
A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which of the following risk factors would the nurse discuss?
A.Family history
B.Lifestyle choices
C.Age
D.Menopause or hormonal events
C.Age
*Because more than 50% of the cancers occur in people who are older than age 65, the single most important factor in determining risk would be age.
A nurse is palpating a female client breast while assessing for breast disease, In the illustration below indicate/ click on the area of the breast in which tumors are most commonly found
A. Upper outer Quadrant
When the nurse is teaching the client and family how to manage possible nausea and vomiting at home , which of the following should be discussed?
A.Eating frequent, small meals throughout the day
B.Eating three normal meals a day
C.Eating only cold foods with no odor
D.Limiting the amount of fluid intake
A.Eating frequent, small meals throughout the day
*Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft bland diet low in fat and sugar . Frequent small meals are usually better tolerated. It is not necessary to restrict the diet to cold foods. Fluid intake should be encouraged to avoid dehydration
Which of the following has been associated with fatigue from cancer chemotherapy?
A.Decreased quality of life
B.Increased risk of infection
C.Improved disease prognosis
D.Increased pain
A.Decreased quality of life
*Negative outcomes due to fatigue may include diminished quality of life, loss of self esteem, depression, caregiver strain and fatigue, social isolation, decreased functional status and poor disease prognosis. Increased risk of infection is not related to fatigue but is related to immunosuppression secondary to chemotherapy. Fatigue does not indicate an improved prognosis. It does not cause increased pain. Cancer pain is caused by many factors, including bone metastasis, neve compression, infiltration of the tumor into normal structures and ischemia
A 40 year old female is losing most of her hair as a result of chemotherapy. Which of the following statements best explains chemotherapy induced alopecia?
A.“The new growth of hair will be gray”
B.“The hair loss is temporary”
C.“New hair growth will always be the same texture and color as it was before chemotherapy”?
D.“The client should avoid use of wigs when possible”
B.“The hair loss is temporary”
*Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but the texture and color of new hair growth may be different. Clients who will be receiving chemotherapy should be encouraged to purchase a wig while they still have hair so that they can match the color and texture of their hair. Loss of hair, or alopecia, is a serous threat to self-esteem and should be addressed quickly before treatment
The nurse is teaching a 17 year old client and the clients family about what to expect with high dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? A.Fever B.Chills C.Tachycardia D.Dyspnea
A.Fever
*Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection. It usually occurs in response to an elevated temperature or change in cardiac function
insertion of radioactive implants Check skin: risk for breaks/ infection
Brachytherapy
