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1

The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring?

A. Acute
B. Chronic
C. Delayed
D. Hyperacute

B. Chronic rejection.

2

Which characteristics are seen with acute transplant rejection?

A. Treatment is supportive
B. Only occurs with transplanted kidneys
C. Organ must be removed when it occurs
D. The recipient's T cytotoxic lymphocytes attack the foreign organ
E. Long-term use of immunosuppressants necessary to combat the rejection
F. Usually reversible with additional or increased immunosuppressant therapy

D, E, F
D. The recipient's T cytotoxic lymphocytes attack the foreign organ, E. Long-term use of immunosuppressants necessary to combat the rejection, F. Usually reversible with additional or increased immunosuppressant therapy.

3

What is the most common cause of secondary immunodeficiency disorders?

A. Chronic stress
B. T-cell deficiency from HIV
C. Drug-induced immunosuppression
D. Common variable hypogammaglobulinemia

C. Drug-induced immunosuppression.

4

A 28-year-old male Gulf War veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient's problem?

A. He has posttraumatic stress disorder
B. He has multiple chemical sensitivities
C. He needs to wear a mask when he paints
D. He is looking for an excuse to break up with his girlfriend

B. He has multiple chemical sensitivities.

5

Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis?

A. Type I or IgE-mediated hypersensitivity reaction
B. Type II or cytotoxic hypersensitivity reaction
C. Type III or immune-complex mediated hypersensitivity reaction
D. Type IV or delayed hypersensitivity reaction

C. Type III or immune-complex mediated hypersensitivity reaction.

6

The patient's breast cancer has metastasized. Which mediation for metastasis is better tolerated and has fewer and milder side effects than other chemotherapy medications?

A. Capecitabine (Xeloda)
B. Vinorelbine (Navelbine)
C. Doxorubicin (Adriamycin)
D. Eribulin mesylate (Halaven)

B. Vinorelbine (Navelbine).

7

A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion?

A. Weekly injections of water or saline into the expander will be required
B. The expander cannot be placed until healing from the mastectomy is complete
C. This method of breast reconstruction uses the patient's own tissue to replace breast tissue
D. The nipple from the affected breast will be saved to be grafted onto the reconstructed breast

A. Weekly injections of water or saline into the expander will be required.

8

A 56-year-old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do?

A. Determine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis
B. Ensure that the patient has realistic expectations about the outcome and possible complications of the surgery
C. Inform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases
D. Let the patient know that although the shape will be different from the other breast, the nipple can be reconstructed from other erectile tissue

B. Ensure that the patient has realistic expectations about the outcome and possible complications of the surgery.

9

A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of the breast. What is an appropriate nursing intervention for this patient?

A. Provide the patient with information about surgical breast reconstruction
B. Restrict visitors and phone calls until the patient feels better about herself
C. Arrange for a reach to Recovery visitor or similar resource available in the community
D. Encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital

C. Arrange for a Reach to Recovery visitor or similar resource available in the community.

10

Following a modified radical mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do?

A. Avoid skin-softening agents on the arm
B. Protect the arm from any type of trauma
C. Abduct and adduct the arm at the shoulder hourly
D. Keep the arm positioned so that is in straight and dependent alignment

B. Protect the arm from any type of trauma.

11

During the immediate postoperative period following a mastectomy, the nurse initially institutes which exercises for the affected arm?

A. Have the patient brush or come her hair with the affect arm
B. Perform full passiv e range-of-motion (ROM) exercises to the affected arm
C. Ask the patient to flex and extend the fingers and wrist of the operative side
D. Have the patient crawl her fingers up the wall, raising her arm above her head

Ask the patient to flex and extend the fingers and wrist of the operative side.

12

A patient with a positive breast biopsy tells the nurse that she read about tamoxifen (Nolvadex) on the internet and asks about its use. The best response by the nurse includes which information?

A. Tamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer
B. Tamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer
C. Tamoxifen is the treatment of choice after surgery if the tumor has receptors for estrogen and progesterone on its cells
D. Because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has not been successful

C. Tamoxifen is the treatment of choice after surgery if the tumor has receptors for estrogen and progesterone on its cells.

13

What describes the use of high-dose brachytherapy radiation?

A. May be completed in 4 days
B. Follows local excision of tumor
C. Alternative to traditional radiation therapy for early-stage breast cancer
D. Used to treat possible local residual cancer cells following a mastectomy
E. Used to reduce tumor size and stabilize metastatic lesions for pain relief

A, C
A. May be completed in 5 days, C. Alternative to traditional radiation therapy for early-stage breast cancer.

14

Lymphatic mapping with sentinel lymph node dissection (SLND) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family?

A. If one sentinel lymph node is positive for malignant cells, all the sentinel lymph nodes will be removed
B. If malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection will be done
C. Lymphatic mapping indicates which lymph nodes are most likely to have metastasis and all of those nodes are removed
D. Lymphatic mapping with with SLND provides metastatic lymph nodes to test for responsiveness to chemotherapy

C. Lymphatic mapping indicates which lymph nodes are most likely to have metastasis and all of those nodes are removed.

15

A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can can usually expect to undergo what other treatment?

A. Chemotherapy
B. Radiation therapy
C. Hormonal therapy
D. Sentinel lymph node dissection

D. Sentinel lymph node dissection.

16

The health care provider of a patient with a positive biopsy of a 2-cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient?

A. "It doesn't matter what I would do. It is a decision you have to make for yourself."
B. "There are advantages and disadvantages of both procedures. What do you know about these procedures?"
C. "I would choose the modified radical mastectomy because it would ensure that the entire tumor was removed."
D. "The lumpectomy maintains a nearly normal breast but the survival rate is not as good as it is with a mastectomy."

B. "There are advantages and disadvantages of both procedures. What do you know about these procedures?"

17

The best prognosis is indicated in the patient with breast cancer when diagnostic studies reveal...

A. Negative axillary lymph nodes
B. Aneuploid DNA tumor content
C. Cells with high S-phase fractions
D. An estrogen receptor- and progesterone receptor-negative tumor

A. Negative axillary lymph nodes.

18

The nurse would be most concerned when the patient's breast examination reveals which finding?

A. A large, tender, moveable mass in the upper inner quadrant
B. An immobile, hard, nontender lesion in the upper outer quadrant
C. A 2- to 3-cm, firm, defined, mobile mass in the lower outer quadrant
D. A painful, immobile mass with reddened skin in the upper outer quadrant

B. An immobile, hard, nontender lesion in the upper outer quadrant.

19

Which patient probably as the highest risk of breast cancer?

A. 60-year-old obese man
B. 58-year-old woman with sedentary lifestyle
C. 55-year-old woman with fibrocystic breast changes
D. 65-year-old woman with a sister diagnosed with breast cancer

D. 65-year-old woman with a sister diagnosed with breast cancer.

20

Which benign breast disorder occurs most often during lactation and is commonly caused by Staphylococcus aureus?

A. Mastitis
B. Ductal ectasia
C. Fibroadenoma
D. Senescent gyneomastia

A. Mastitis.

21

Which characteristics describe an intraductal papilloma?

A. Assocaited with breast trauma
B. Occurs in 10% of women ages 15 to 40
C. Has multicolored, sticky nipple discharge
D. Is associated with an increased cancer risk
E. Is more common in women ages 40 to 60
F. Has wartlike growth in mammary ducts near nipple

D, E, F
D. Is associated with an increased cancer risk, E. Is more common in women ages 40 to 60, F. Has wartlike growth in mammary ducts near nipple.

22

A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it...

A. Commonly becomes malignant over time
B. Can be controlled with hormone therapy (HT)
C. Makes it more difficult to examine the breasts
D. Will eventually cause atrophy of normal breast tissue

C. Makes it more difficult to examine the breasts.

23

While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse?

A. "Do you have a high caffeine intake?"
B. "When did you last have a mammogram?"
C. "Is there a history of breast cancer in your mother or sisters?"
D. "Do the size and tenderness of the lumps change with your menstrual cycle?"

D. "Do the size and tenderness of the lumps change with you menstrual cycle?"

24

A 24-year-old female patient has breast cancer with estrogen receptor-negative cells. Which genomic assay test can be used to provide information about the likely recurrence and need for chemotherapy?

A. CA 27-29
B. TNM system
C. Oncotype DX
D. MammaPrint

D. MammaPrint.

25

Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosing malignant breast disorders?

A. Surgical biopsy
B. Mammography
C. Fine-needle aspiration
D. Core (core needle) biopsy

D. Core (core needle) biopsy.

26

When teaching a 24-year-old woman who desires to learn BSE, the nurse knows that it is important to do what?

A. Provide time for a return demonstration
B. Emphasize the statistics related to breast cancer survival and mortality
C. Have the woman set a consistent monthly date for performing the examination
D. Inform the woman that professional examinations are not necessary unless she finds an abnormality

A. Provide time for a return demonstration

27

A woman at the health clinic tells the nurse that she does not do breast self-examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE?

A. It reduces mortality from breast cancer in women under the age of 50
B. It is useful to help women learn how their breasts normally look and feel
C. BSE has little value in detection of cancer and is not recommended anymore
D. BSE is the most common way that malignant tumors of the breast are discovered

B. It is useful to help women learn how their breasts normally look and feel

28

After a 48-ear-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about...

A. Estradiol (Estrace)
B. Raloxifene (Evista)
C. Tamosifen (Nolvadex)
D. Trastuzumab (Herceptin)

C. Tamoxifen (Nolvadex)

29

A 58-year-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best?

A. "I would have a lumpectomy, but you need to decide what is best for you."
B. "Tell me what you understand about the surgical options that are available."
C. "It would not be appropriate for me to make a decision about your health."
D. "There is no need to make a decision rapidly; you have time to think about this."

B. "Tell me what you understand about the surgical options that are available."

30

A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?

A. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation."
B. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."
C. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do."
D. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."

B. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."

31

A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide?

A. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes
B. HT does not appear to increase the risk of breast cancer unless there are other risk factors
C. The patient and her health care provider must weigh the benefits of HI against the risks of breast cancer
D. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer

C. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer.

32

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan?

A. Continue taking antibiotics until all the medication is gone
B. Antibiotics may sometimes be prescribed to prevent infection
C. Unused antibiotics that are more than a year old should be discarded
D. Antibiotics are effective in treating influenza associated with high fevers
E. Hand washing is effective in preventing many viral and bacterial infections

A, B, E
A. Continue taking antibiotics until all the medication is gone, B. Antibiotics may sometimes be prescribed to prevent infection, E. Hand washing is effective in preventing many viral and bacterial infections

33

Which assessment finding in a 36-year-old patient most indicative of a need for further evaluation?

A. Bilateral breast nodules that are tender with palpation
B. A breast nodule that is 1 cm in size, nontender, and fixed
C. A breast lump that increases in size before the menstrual period
D. A breast lump that is small, mobile, with a rubbery consistency

B. A breast nodule that is 1 cm in size, nontender, and fixed

34

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?

A. Platelet count
B. Reticulocyte count
C. Total lymphocyte count
D. Absolute neutrophil count

D. Absolute neutrophil count

35

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile?

A. Mask
B. Gown
C. Gloves
D. Show covers
E. Eye protection

B. Gown, C. Gloves

36

During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask?

A. "Do you currently smoke tobacco?"
B. "Have you ever had a breast injury?"
C. "At what age did you start having menstrual periods?"
D. "Is there a family history of fibrocystic breast changes?"

C. "At what age did you start having menstrual periods?"

37

What action will the admitting nurse include in the care plan for a 30-year-old woman who is neutropenic?

A. Avoid any injections
B. Check temperature every 4 hours
C. Omit fruits or vegetables from the diet
D. Place a "No Visitors" sign on the door

B. Check temperature every 4 hours

38

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care.

A. Hepatitis B vaccine
B. Pneumococcal vaccine
C. Influenza virus vaccine
D. Trimethoprim-sulfamethoxazole
E. Varicella zoster immune globulin

A, B, C
A. Hepatitis B vaccine, B. Pneumococcal vaccine, C. Influenza virus vaccine

39

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis?

A. Avoid commercial salt substitutes
B. Drink 1500 to 2000 mL of fluids daily
C. Take phosphate-binders with each meal
D. Choose high-protein foods for most meals
E. Have several servings of dairy products daily

A, C, D

A. Avoid commercial salt substitutes, C. Take phosphate-binders with each meal, D. Choose high-protein foods for most meals

40

A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about...

A. Blood transfusion
B. Bone marrow biopsy
C. Filgrastim (Neupogen) administration
D. Erythropoietin (Epogen) administration

B. Bone marrow biopsy

41

After receiving change-of-shift report, which patient should the nurse assess first?

A. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange
B. Patient with stage 4 chronic kidney disease who has an elevated phosphate level
C. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L
D. Patient who has just returned form having hemodialysis and has a heart rate of 124/min

D. Patient who has just returned form having hemodialysis and has a heart rate of 124/min.

42

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority?

A. Methods to prevent perinatal HIV transmission
B. Ways to sterilize needles used by injectable drug users
C. Prevention of HIV transmission between sexual partners
D. Means to prevent transmission through blood transfuisions

C. Prevention of HIV transmission between sexual partners.

43

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows. Which information should the nurse report immediately to the health care provider?

A. The patient has an outflow volume of 1800 mL
B. The patient's peritoneal effluent appears cloudy
C. The patient has abdominal pain during the inflow phase
D. The patient's abdomen appears bloated after the inflow

B. The patient's peritoneal effluent appears cloudy.

44

Which laboratory will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?

A. Prothrombin time
B. Erythrocyte count
C. Fibrinogen degradation products
D. Activated partial thromboplastin time

D. Activated partial thromboplastin time.

45

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)?

A. Teach the patient about how to use tissues to dispose of respiratory secretions
B. Stock the patient's room with all the necessary personal protective equipment
C. Interview the patient to obtain the names of family members and close contacts
D. Tell the patient's family members the reason for the use of airborne precautions

B. Stock the patient's room with all the necessary personal protective equipment.

46

A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?

A. The LPN/LVN administers the erythropoietin subcutaneously
B. The LPN/LVN assists the patient to ambulate out in the hallway
C. The LPN/LVN administers the iron supplement and phosphate binder with lunch
D. The LPN/LVN carries a tray containing low-protein foods into the patient's room

C. The LPN/LVN administers the iron supplement and phosphate binder with lunch.

47

Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis?

A. Maintaining good nutrition
B. Avoiding alcohol ingestion
C. Taking lactulose (Cephulac)
D. Using vitamin B supplements

B. Avoiding alcohol ingestion.

48

The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider?

A. Neutropenia
B. Increasing fatigue
C. Thrombocytopenia
D. Frequent constipation

A. Neutropenia.

49

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?

A. Assign the patient to a private room
B. Avoid intramuscular (IM) injections
C. Use rinses rather than a soft toothbrush for oral care
D. Restrict activity to passive and active range of motion

B. Avoid intramuscular (IM) injections.

IM injections can be risk for infection.

50

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first?

A. Notify the patient's health care provider
B. Document the QRS interval measurement
C. Check the medical record for most recent potassium level
D. Check the chart for the patient's current creatinine level

C. Check the medical record for most recent potassium level.

51

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching?

A. Many medications have interactions with antiretroviral drugs
B. Less frequent CD4 level monitoring is needed in older adults
C. Hospice care is available for patients with terminal HIV infection
D. Progression of HIV infection occurs more rapidly in older patients

A. Many medications have interactions with antiretroviral drugs.

52

A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication?

A. Creatinine 1.6 mg/dL
B. Oxygen saturation 89%
C. Hemoglobin level 13 g/dL
D. Blood pressure 98/56 mmHg

C. Hemoglobin level 13 g/dL.

53

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?

A. Discourage deep breathing to reduce risk for splenic rupture
B. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain
C. Schedule immunization with the pneumococcal vaccine (Pneumovax)
D. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery

C. Schedule immunization with the pneumococcal vaccine (Pneumovax).

54

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/uL. Which action will the nurse include in the plan of care?

A. Use low-molecular-weight heparin (LMWH) only
B. Administer the warfarin (Coumadin) at the scheduled dose
C. Teach the patient about the purpose of platelet transfusions
D. Discontinue heparin and flush intermittent IV lines using normal saline

D. Discontinue heparin and flush intermittent IV lines using normal saline.

55

A patient with diabetes who has bacterial pneumonia is being treated with IB gentamicin (Garamycin) 60 mg IV BID. The nurse will monitor for adverse effects of the medication by evaluating the patient's...

A. Blood glucose
B. Urine osmolality
C. Serum creatinine
D. Serum potassium

C. Serum creatinine.

56

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first?

A. Patient whose latest CD4 count is 250/uL
B. Patient whose rapid HIV-antibody test is positive
C. Patient who has had 10 liquid stools in the last 24 hours
D. Patient who has nausea from prescribed antiretroviral drugs

C. Patient who has had 10 liquid stools in the last 24 hours.

57

Following the successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching?

A. Potential impact of chemotherapy treatment on fertility
B. Application of soothing lotions to treat residual pruritus
C. Use of maintenance chemotherapy to maintain remission
D. Need for follow-up appointments to screen for malignancy

D. Need for follow-up appointments to screen for malignancy.

58

Before administration of captopril (Capoten) to a patient with stage 2 chronic kidney disease (CKD), the nurse will check the patient's...

A. Glucose
B. Potassium
C. Creatinine
D. Phosphate

B. Potassium.

59

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?

A. Potential complication: seizures
B. Potential complication: infection
C. Potential complication: neurogenic shock
D. Potential complication: pulmonary edema

B. Potential complication: infection.

60

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient?

A. The antiretroviral medications used to treat HIV infection are teratogenic
B. Most infants born to HIV-positive mothers are not infected with the virus
C. Because she is at an early stage of HIV infection, the infant will not contract HIV
D. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART)

B. Most infants born to HIV-positive mothers are not infected with the virus.

61

The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required?

A. Multivitamin with iron
B. Magnesium hydroxide
C. Acetaminophen (Tylenol)
D. Calcium phosphate (PhosLo)

B. Magnesium hydroxide.

62

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient?

A. Consequences of aging on cell-mediated immunity
B. Decrease in antibody production associated with aging
C. Impact of poor nutrition on immune function in older people
D. Incidence of cancer-stimulating infections in older individuals

A. Consequences of aging on cell-mediated immunity.

63

A patient who is human immunodeficiency virus (HIV)-infected has a CD4 cell count of 400/uL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?

A. HIV genotype and phenotype
B. Patient's social support system
C. Potential medication side effects
D. Patient's ability to comply with ART schedule

D. Patient's ability to comply with ART schedule.

64

A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?

A. Increased calories are needed because glucose is lost during hemodialysis
B. Unlimited fluids are allowed because retained fluid is removed during dialysis
C. More protein is allowed because urea and creatinine are removed by dialysis
D. Dietary potassium is not restricted because the level is normalized by dialysis

C. More protein is allowed because urea and creatinine are removed by dialysis.

65

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best?

A. "Thinking about dying will not improve the course of AIDS."
B. "It is important to focus on the good things about your life now."
C. "Do you think that taking an antidepressant might be helpful to you?"
D. "Can you tell me more about the kind of thoughts that you are having?"

D. "Can you tell me more about the kind of thoughts that you are having?".

66

A 37-year-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?

A. Urine volume
B. Creatinine level
C. Glomerular filtration rate (GFR)
D. Blood urea nitrogen (BUN) level

C. Glomerular filtration rate (GFR).

67

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time?

A. Oral acyclovir (Zovirax)
B. Oral saquinavir (Invirase)
C. Nystatin (Mycostatin) tablet
D. Aerosolized pentamidine (NebuPent)

B. Oral saquinavir (Invirase).

It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV.

68

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan?

A. Driving is allowed when starting this medication
B. Report any bizarre dreams to the health care provider
C. Continue to use contraception while on this medication
D. Take this medication in the morning on an empty stomach

C. Continue to use contraception while on this medication.

Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant.

69

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for...

A. Potassium level
B. Total cholesterol
C. Serum phosphate
D. Serum creatinine

C. Serum phosphate.

If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification.

70

After receiving the change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?

A. 56-year-old with frequent explosive diarrhea
B. 33-year-old with a fever of 100.8 F (38.2 C)
C. 66-year-old who has white pharyngeal lesions
D. 23-year-old who is complaining of severe fatigue

B. 33-year-old with a fever of 100.8 F (38.2 C).

Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock.

71

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4 cell count of 800/uL and an undetectable viral load. What is the priority nursing intervention at this time?

A. Teach about the effects of antiretroviral agents
B. Encourage adequate nutrition, exercise, and sleep
C. Discuss likelihood of increased opportunistic infections
D. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS)

B. Encourage adequate nutrition, exercise, and sleep.

The CD4 level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4 cells to maintain a normal CD4 count.

72

Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful?

A. Split-pea soup, English muffin, and nonfat milk
B. Oatmeal with cream, half a banana, and herbal tea
C. Poached eggs, whole-wheat toast, and apple juice
D. Cheese sandwich, tomato soup, and cranberry juice

C. Poached eggs, whole-wheat toast, and apple juice.

Eggs: high-quality protein
Apple juice: low in potassium

Do not want:
Dairy: high phosphate
Banana: high potassium

73

The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care?

A. The patient's blood glucose level is 142 mg/dL
B. The patient complains of feeling "constantly tired"
C. The patient is unable to state the side effects of the medicaitons
D. The patient states, "Sometimes I miss a dose of zidovudine (AZT)"

D. The patient states, "Sometimes I miss a dose of zidovudine (AZT)".

Missing doses of ART can lead to drug resistance.

Elevated blood glucose and fatigue are common side effects of ART.

74

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the...

A. Bowel sounds
B. Bowel glucose
C. Blood urea nitrogen (BUN)
D. Level of consciousness (LOC)

A. Bowel sounds.

Kayexalate should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds)

75

Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?

A. 44-year-old with sickle cell anemia who says "my eyes always looks sort of yellow"
B. 23-year-old with no previous health problems who has a nontender lump in the axilla
C. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
D. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

B. 23-year-old with no previous health problems who has a nontender lump in the axilla.

Patient's age and nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment.

76

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient?

A. Review foods that are higher in protein
B. Teach about the benefits of daily exercise
C. Discuss a change in antiretroviral therapy
D. Talk about treatment with antifungal agents

C. Discuss a change in antiretroviral therapy.

A frequent first intervention for metabolic disorders is a change in ART.

77

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?

A. Blood pressure
B. Phosphate level
C. Neurologic status
D. Creatinine clearance

B. Phosphate level.

Caltrate binds phosphorus and prevents mineral and bone disease in patients with CKD.

78

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

A. Assessing the patient for sings and symptoms of infection
B. Teaching the patient the purpose of neutropenic precautions
C. Administering subcutaneous filgrastim (Neupogen) injection
D. Developing a discharge teaching plan for the patient and family

C. Administering subcutaneous filgrastim (Neupogen) injection.

SQ medication is in LPN/LVN's education and scope of practice.

79

Which statement by a 62-year-old patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective?

A. "I need to get most of my protein from low-fat dairy products"
B. "I will increase my intake of fruits and vegetables to 5 per day"
C. "I will measure my urinary output each day to help calculate the amount I can drink"
D. "I need to take erythropoietin to boost my immune system and help prevent infection"

C. "I will measure my urinary output each day to help calculate the amount I can drink".

Patient with ESKD measures urine output to determine appropriate oral fluid intake.

80

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review?

A. Viral load testing
B. Enzyme immunoassay
C. Rapid HIV antibody testing
D. Immunofluorescence assay

A. Viral load testing.

ART effectiveness is measured by the decrease in the amount of virus detectable in blood.

81

A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant. Which results should be reported to the transplant surgeon?

A. Patient is Rh positive and donor is Rh negative
B. Six antigen matches are present in HLA typing
C. Results of patient-donor cross matching are positive
D. Panel of reactive antibodies (PRA) percentage is low

C. Results of patient-donor cross matching are positive.

Positive crossmatching is an absolute contraindication to kidney transplantation, since hyperacute rejection will occur after the transplant.

82

A 48-year-old patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which order for the patient will the nurse question?

A. NPO for 6 hours before procedure
B. Ibuprofen (Advil) 400 mg PO PRN for pain
C. Dulcolax suppository 4 hours before procedure
D. Normal saline 500 mL IV infused before procedure

B. Ibuprofen (Advil) 400 mg PO PRN for pain.

NSAIDs should be avoided because IVPs contrast dye is potentially nephrotoxic.

83

A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?

A. The platelet count is 42,000/mL
B. Petechiae are present on the chest
C. Blood pressure (BP) is 94/56 mmHg
D. Blood is oozing from the venipuncture site

A. The platelet count is 42,000/mL.

Platelet transfusions are not usually indicated until the platelet count is below 10,000 - 20,000/mL unless the patient is actively bleeding, and therefore this order should be clarified.

84

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown?

A. Needle stick with a needle and syringe used to draw blood
B. Splash into the eyes when emptying a bedpan containing stool
C. Contamination of open skin lesions with patient vaginal secretions
D. Needle stick injury with a suture needle during a surgical procedure

A. Needle stick with a needle and syringe used to draw blood.

85

A patient with human immunodeficiency virus (HIV) infection has developed Myobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care?

A. The patient will be free from injury
B. The patient will receive immunizations
C. The patient will have adequate oxygenation
D. The patient will maintain intact perineal skin

D. The patient will maintain intact perineal skin.

Manifestation of M. avium is loose, watery stools, which would increase the risk for perineal skin breakdown.

86

A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection. Which patient would be the best choice?

A. Patient who is receiving chemotherapy for liver cancer
B. Patient who is receiving treatment for acute hepatitis C
C. Patient who has a wound infection after cholecystectomy
D. Patient who requires pain management for chronic pancreatitis

D. Patient who requires pain management for chronic pancreatitis.

Chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant.

87

Which patient requires the most rapid assessment and care by the emergency department nurse?

A. The patient with hemochromatosis who reports abdominal pain
B. The patient with neutropenia who has a temperature of 101.8 F
C. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours
D. The patient with thrombocytopenia who has oozing after having a tooth extracted

B. The patient with neutropenia who has a temperature of 101.8 F.

Neutropenic patient with fever may have an infection and is at risk for sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed.

88

A 23-year-old has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

A. Asterixis and lethargy
B. Jaundiced sclera and skin
C. Elevated total bilirubin level
D. Liver 3 cm below costal margin

A. Asterixis and lethargy.

Asterixis and lethargy are consistent with grade 2 hepatic encephalopathy.
The other findings are typical of patients with hepatic failure, but would not indicate need for immediate change.

89

The nurse admits a terminally ill patient to the hospital. What is the first action that the nurse should complete when planning this patient's care?

A. Determine the patient's wishes regarding end-of-life care
B. Emphasize the importance of addressing any family issues
C. Discuss the normal grief process with the patient and family
D. Encourage the patient to talk about any fears or unresolved issues

A. Determine the patient's wishes regarding end-of-life care.

90

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is...

A. Maintaining normal respiratory function
B. Expressing satisfaction with pain control
C. Developing no ongoing pancreatic disease
D. Having adequate fluid and electrolyte balance

A. Maintaining normal respiratory function.

Respiratory failure can occur as a complication of acute pancreatitis.

91

Which patient should the nurse refer for hospice care?

A. 60-year-old with lymphoma whose children are unable to discuss issues related to dying
B. 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse
C. 28-year-old with AIDS-related dementia who needs palliative care and pain management
D. 56-year-old with advanced liver failure whose family members can no longer provide care in the home

C. 28-year-old with AIDS-related dementia who needs palliative care and pain management.

Hospice is designed to provide palliative care for patients at the end of life.

92

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?

A. Give the patient detailed information about possible medication side effects
B. Remind the patient of the importance of taking the medications as scheduled
C. Encourage the patient to join a support group for students who are HIV positive
D. Check the patient's class schedule to help decide when the drugs should be taken

D. Check the patient's class schedule to help decide when the drugs should be taken.

93

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

A. A patient with chronic heart failure
B. A patient who has viral pneumonia
C. A patient who has right leg cellulitis
D. A patient with multiple abdominal drains

A. A patient with chronic heart failure.

Patients with aplastic anemia are at risk for infection because of the low white blood cell production.

94

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?

A. 40-year-old with chronic pancreatitis who has gnawing abdominal pain
B. 58-year-old who has compensated cirrhosis and is complaining of anorexia
C. 55-year-old with cirrhosis and ascites who has an oral temperature of 102 F (38.8 C)
D. 36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain

C. 55-year-old with cirrhosis and ascites who has an oral temperature of 102 F (38.8 C).

The patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy.

95

The following male patients recently arrived in the emergency department. Which one should the nurse assess first?

A. 19-year-old who is complaining of severe scrotal pain
B. 60-year-old with a nontender ulceration of the glans penis
C. 22-year-old who has purulent urethral drainage and back pain
D. 64-year-old who has dysuria after brachytherapy for prostate cancer

A. 19-year-old who is complaining of severe scrotal pain.

Patient's age and symptom suggest possible testicular torsion, which will require rapid treatment in order to prevent testicular necrosis.

96

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to...

A. Administer oxygen therapy at a high flow rate
B. Obtain a urine specimen to send to the laboratory
C. Notify the health care provider about the symptoms
D. Disconnect the transfusion and infuse normal saline

D. Disconnect the transfusion and infuse normal saline.

97

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

A. Teach symptoms of variceal bleeding
B. Draw blood for hepatitis serology testing
C. Discuss the need to increase caloric intake
D. Review the patient's current medication list

D. Review the patient's current medication list.

Some medications can increase the risk for NAFLD, and they should be eliminated.

98

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first?

A. 22-year-old who has noticed a firm, nontender lump on his scrotum
B. 35-year-old who is concerned that his scrotum "feels like a bag of worms"
C. 40-year-old who has pelvic pain while being treated for chronic prostatitis
D. 70-year-old who is reporting frequent urinary dribbling after a prostatectomy

A. 22-year-old who has noticed a firm, nontender lump on his scrotum.

Patient's age and symptoms suggest possible testicular cancer, and should be evaluated by health care provider.

99

A 76-year-old patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to...

A. Vaccinate the patient with sipuleucel-T (Provenge)
B. Provide the patient with information about cryotherapy
C. Teach the patient about placement of intraurethral stents
D. Schedule the patient for annual prostate-specific antigen testing

D. Schedule the patient for annual prostate-specific antigen testing.

Active surveillance requires annual digital rectal exams and prostate-specific antigen testing.

100

A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse prepare for this patient?

A. Administration of immunosuppressant medications
B. Insertion of an arteriovenous graft for hemodialysis
C. Placement of the patient on the transplant waiting list
D. A blood draw for human leukocyte antigen (HLA) matching

A. Administration of immunosuppressant medications.

Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids.

101

Which assessment information is most important for the nurse to report to the health care provider when a patient asks for a prescription for testosterone replacement therapy (TRT)?

A. The patient has noticed a decrease in energy level for a few years
B. The patient's symptoms have increased steadily over the last few years
C. The patient has been using sildenafil (Viagra) several times every week
D. The patient has had a gradual decrease in the force of his urinary system

D. The patient has had a gradual decrease in the force of his urinary system.

The decrease in urinary stream may indicate BPH or prostate cancer, which are contraindications to the use of TRT.

102

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?

A. Draw blood for a new crossmatch
B. Send a urine specimen to the laboratory
C. Administer PRN acetaminophen (Tylenol)
D. Give the PRN diphenhydramine (Benadryl)

C. Administer PRN acetaminophen (Tylenol).

Patient's clinical manifestation are consistent with febrile (showing fever symptoms), nonhemolytic transfusion reaction. Transfusion should be stopped and antipyretics administered for the fever as ordered.

103

After a transurethral resection of the prostate (TURP), a 64-year-old patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first?

A. Increase the flow rate of the bladder irrigation
B. Administer the prescribed IV morphine sulfate
C. Give the patient the prescribed belladonna and opium suppository
D. Manually instill and then withdraw 50 mL of saline into the catheter

D. Manually instill and then withdraw 50 mL of saline into the catheter.

Assessment suggests obstruction by a clot is causing bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots.

104

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

A. Absent bowel sounds
B. Abdominal tenderness
C. Left upper quadrant pain
D. Palpable abdominal mass

D. Palpable abdominal mass.

Palpable abdominal mass may indicate the presence of pancreatic abscess, which will require surgical drainage to prevent sepsis.

105

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?

A. Teach the patient about the medications available for treatment
B. Inform the patient how to protect sexual and needle-sharing partners
C. Remind the patient about the need to return for restesting to verify the results
D. Ask the patient to notify individuals who have had risk contact with the patient

C. Remind the patient about the need to return for retesting to verify the results.

After initial positive antibody test, the next step is retesting to confirm the results.

106

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient's PSA result is most important to report to the health care provider?

A. A 38-year-old who is being treated for acute prostatitis
B. A 48-year-old whose father died of metastatic prostate cancer
C. A 52-year-old who goes on long bicycle rides every weekend
D. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

B. A 48-year-old whose father died of metastatic prostate cancer.

107

The nurse will plan to provide teaching for a 67-year-old patient who has been diagnosed with orchitis about...

A. Pain management
B. Emergency surgical repair
C. Application of heat to the scrotum
D. Aspiration of fluid from the scrotal sac

A. Pain management.

Orchitis is the inflammation of testicles and is very painful.

108

The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

A. The patient complains of right-upper quadrant pain with palpation
B. The patient's hands flap back and forth when the arms are extended
C. The patient as ascites and a 2-kg weight gain from the previous day
D. The patient's skin has multiple spider-shaped blood vessels on the abdomen

B. The patient's hands flap back and forth when the arms are extended.

Asterixis (aka flapper tremor) indicates that the patient has hepatic encephalopathy and hepatic coma may occur.

109

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of...

A. Testicular torsion
B. Testicular trauma
C. Undescended testicles
D. Sexually transmitted infection (STI)

C. Undescended testicles.

Cryptorchidism (undescended testicles: absence of testes in scrotum) is a risk factor for testicular cancer if not corrected before puberty.

110

The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of...

A. Diabetes mellitus
B. High-protein diet
C. Cigarette smoking
D. Alcohol consumption

D. Alcohol consumption.

Alcohol use is one of the most common risk factors for pancreatitis.

111

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best?

A. "Avoid sexual intercourse when using injectable drugs"
B. "It is important to participate in a needle-exchange program"
C. "You should ask those who share equipment to be tested for HIV"
D. "I recommend cleaning drug injection equipment before each use"

B. "It is important to participate in a needle-exchange program".

Needle-exchange programs show decreases and controls rate of HIV infection.

112

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is most appropriate?

A. "Have you been taking any over-the-counter (OTC) medications recently?"
B. "I will talk to the doctor about ordering a prostate specific antigen (PSA) test"
C. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?"
D. "The prostate gland changes in size from day to day, and this may be making your symptoms worse"

A. "Have you been taking any over-the-counter (OTC) medications recently?".

OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction.

113

Which information will the nurse plan to include when teaching a community health group about testicular self-examination?

A. Testicular self-examination should be done in a warm room
B. The only structure normally felt in the scrotal sac is the testis
C. Testicular self-examination should be done at least every week
D. Call the health care provider if one testis is larger than the other

A. Testicular self-examination should be done in a warm room.

The testes will hang lower in the scrotum when the temperature is warm and makes it easier palpate.

114

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan?

A. Cook food thoroughly before eating
B. Choose low fiber, low residue foods
C. Avoid public transportation such as buses
D. Use rectal suppositories if needed for constipation
E. Talk to the oncologist before having any dental work done

A, C, E
A. Cook food thoroughly before eating, C. Avoid public transportation such as buses, E. Talk to the oncologist before having any dental work done

Avoid any way bacteria may invade host.

115

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis?

A. Calcium
B. Bilirubin
C. Amylase
D. Potassium

C. Amylase.

Amylase is elevated in acute pancreatitis.

116

The nurse performing a focused examination to determine possible causes of infertility will assess for...

A. Hydrocele
B. Varicocele
C. Epididymitis
D. Paraphimosis

B. Varicocele.

Persistent varioceles are commonly associated with infertility.

117

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assertive personnel (UAP)?

A. Verify the patient identification (ID) according to hospital policy
B. Obtain the temperature, blood pressure, and pulse before the transfusion
C. Double-check the product numbers on the PRBCs with the patient ID band
D. Monitor the patient for shortness of breath or chest pain during the transfusion

B. Obtain the temperature, blood pressure, and pulse before the transfusion.

118

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may include...

A. Flushing
B. Dizziness
C. Infection
D. Incontinence

A. Flushing.

Hot flashes may occur with decreased testosterone production.

119

After change-of-shift report on the oncology unit, which patient should the nurse assess first?

A. Patient who has a platelet count of 82,000/uL after chemotherapy
b. Patient who has xerostomia after receiving head and neck radiation
C. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C)
D. Patient who is worried about getting the prescribed long-acting opioid on time

C. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C).

120

The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate?

A. "In most cases, breast cancer is not caused by the BRCA gene"
B. "It depends on how you will feel if the test is positive for the BRCA gene"
C. "There are many things to consider before deciding to have genetic testing"
D. "You should decide first whether you are willing to have a bilateral mastectomy"

C. "There are many things to consider before deciding to have genetic testing".

121

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing?

A. Patient age
B. Patient lifestyle
C. Patient symptoms
D. Patient sexual orientation

A. Patient age.

122

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?

A. Hematocrit 32%
B. Pain with deep inspiration
C. Serum sodium 126 mEq/L
D. Decreased breath sounds on left side

C. Serum sodium 126 mEq/L.

Syndrome of inappropriate ADH and the resulting hyponatremia is an oncologic metabolic emergency and will require rapid treatment to prevent complications such as seizures and coma.

123

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

A. Give the patient the prescribed PRN opioid
B. Assess for sensation and strength in the legs
C. notify the health care provider about the symptoms
D. Teach the patient how to use relaxation to reduce pain

B. Assess for sensation and strength in the legs.

Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into epidural space.

124

A 70-year-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. The nurse determines that additional instruction is needed when the patient says which of the following?

A. "I should call the doctor if I have incontinence at home"
B. "I will avoid driving until I get approval from my doctor"
C. "I will increase fiber and fluids in my diet to prevent constipation"
D. "I should continue to schedule yearly appointments for prostate exams"

A. "I should call the doctor if I have incontinence at home".

Incontinence is common for several weeks after a TURP.

125

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?

A. Dry palpebral and oral mucosa
B. Crackles at bilateral lung bases
C. Temperature 100.8 F (38.2 C)
D. No bowel movement for 4 days

C. Temperature 100.8 F (38.2 C).

126

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?

A. Shortness of breath
B. Temperature 100.2 F (37.9 C)
C. Shivering and complaint of chills
D. Generalized muscle aches and pains

A. Shortness of breath.

Rituximab (Rituxan) is a monoclonal antibody and SOB may be a possible anaphylaxis reaction.

127

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

A. 35-year-old patient who has wet desquamation associated with abdominal radiation
B. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer
C. 24-year-old patient who received neck radiation and has blood oozing from the neck
D. 56-year-old patient who developed a new pericardial friction rub after chest radiation

C. 24-year-old patient who received neck radiation and has blood oozing from the neck.

Neck bleeding may indicate possible carotid artery rupture in a patient receiving radiation to neck.

128

A 57-ear-old patient is incontinent of urine following a radical retropubic prostatectomy. The nurse will plan to teach the patient...

A. To restrict oral fluid intake
B. Pelvic floor muscle exercises
C. To perform intermittent self-catheterization
D. The use of belladonna and opium suppositories

B. Pelvic floor muscle exercises.

Pelvic floor exercises improve urinary control.

129

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?

A. The UAP flushes the toilet once after emptying the patient's bedpan
B. The UAP stands by the patient's bed for 30 minutes talking with the patient
C. The UAP places the patient's bedding in the laundry container in the hallway
D. The UAP gives the patient an alcohol-containing mouthwash to use for oral care

B. The UAP stands by the patient's bed for 30 minutes talking with the patient.

Radioactivity is emitted through radioactive implant.

130

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?

A. The platelet count is 52,000/uL
B. The patient is difficult to arouse
C. There are purpura on the oral mucosa
D. There are large bruises on the patient's back

B. The patient is difficult to arouse.

Difficulty in arousing the patient may indicate a cerebral hemorrhage.

131

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?

A. The UAP assists the patient to use dental floss after eating
B. The UAP adds baking soda to the patient's saline oral rinses
C. The UAP puts fluoride toothpaste on the patient's toothbrush
D. The UAP has the patient rinse after meals with a saline solution

A. The UAP assists the patient to use dental floss after eating.

Using dental floss can be a risk for infection and bleeding in patients with pancytopenia.

132

The nurse cares for a patient with lung cancer in a home hospice program. Which action by the nurse is most appropriate?

A. Discuss cancer risk factors and appropriate lifestyle modifications
B. Encourage the patient to discuss past life events and their meaning
C. Teach the patient about the purpose of chemotherapy and radiation
D. Accomplish a thorough head-to-toe assessment several times a week

B. Encourage the patient to discuss past life events and their meaning.

133

A patient returning from surgery for a perineal radical prostatectomy will have a nursing diagnosis of risk for infection related to...

A. Urinary incontinence
B. Prolonged urinary stasis
C. Possible fecal wound contamination
D. Placement of a suprapubic bladder catheter

C. Possible fecal wound contamination.

134

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?

A. Hematocrit of 30%
B. Platelets of 95,000/uL
C. Hemoglobin of 10 g/L
D. White blood cell (WBC) count of 2700/uL

D. White blood cell (WBC) count of 2700/uL.

135

To prepare a 56-year-old male patient with ascites for paracentesis, the nurse...

A. Places the patient on NPO
B. Assists the patient to lie flat in bed
C. Asks the patient to empty the bladder
D. Positions the patient on the right side

C. Asks the patient to empty the bladder.

Emptying bladder to decrease risk of bladder perforation during the procedure.

136

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?

A. Poor oral intake
B. Frequent loose stools
C. Complaints of nausea and vomiting
D. Increase in carcinoembryonic antigen (CEA)

D. Increase in carcinoembryonic antigen (CEA).

Increase in CEA indicates that chemotherapy is not effective.

137

A 53-year-old man is scheduled for an annual physical exam. The nurse will plan to teach the patient about the purpose of...

A. Urinalysis collection
B. Uroflowmetry studies
C. Prostate specific antigen (PSA) testing
D. Transrectal ultrasound scanning (TRUS)

C. Prostate specific antigen (PSA) testing.

138

The nurse palpates enlarged cervical lymph nodes on a patient with diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take?

A. Instruct the patient to apply ice to the neck
B. Advise the patient that this is probably the flu
C. Explain to the patient that this is an expected finding
D. Request that an antibiotic be prescribed for the patient

C. Explain to the patient that this is an expected finding.

Persistent generalized lymphadenopathy is common in the early stages of HIV infection.

139

The nurse assesses a patient who is receiving interleukin-2. Which finding would the nurse report immediately to the health care provider?

A. Generalized muscle aches
B. Complaints of nausea and anorexia
C. Oral temperature of 100.6 F (38.1 C)
D. Crackles heard at the lower scapular border

D. Crackles heard at the lower scapular border.

Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2.

140

Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)?

A. Bladder irrigation decreases the risk of postoperative bleeding
B. Hydration and urine output are maintained by bladder irrigation
C. Antibiotics are infused continuously through the bladder irrigation
D. Bladder irrigation prevents obstruction of the catheter after surgery

D. Bladder irrigation prevents obstruction of the catheter after surgery.

141

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?

A. The patient ambulates several times a day in the room
B. the patient's visitors bring in some fresh peaches from home
C. The patient cleans with a warm washcloth after having a stool
D. The patient uses soap and shampoo to shower every day

B. the patient's visitors bring in some fresh peaches from home.

Fresh fruits are not permitted in a neutropenic diet due to bacteria risk.

142

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate?

A. Add strained baby meats to foods such as casseroles
B. Teach the patient about foods that are high in nutrition
C. Avoid giving the patient foods that are strongly disliked
D. Add extra spice to enhance the flavor of foods that areserved

C. Avoid giving the patient foods that are strongly disliked.

143

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first?

A. 57-year-old with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching
B. 21-year-old with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene
C. 40-year-old who still has left side chest and arm pain 2 months after a left modified radical mastectomy
D. 50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue

D. 50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue.

Doxorubicin (Adriamycin) is a cardiotoxic medication and the patient is showing symptoms of heart failure.

144

The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?

A. Lime sherbert
B. Blueberry yogurt
C. Cream cheese bagel
D. Fresh strawberries and bananas

B. Blueberry yogurt.

Yogurt: high protein and fat content
Cream cheese: low in protein

145

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/uL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?

A. Discuss the need for hospital admission to treat the neutropenia
B. Teach the patient to administer filgrastim (Neupogen) injections
C. Plan to discontinue the chemotherapy until the neutropenia resolves
D. Order a high-efficiency particulate air (HEPA) filter for the patient's home

B. Teach the patient to administer filgrastim (Neupogen) injections.

146

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best?

A. "Tell me what you think is important to know about the surgery"
B. "it is essential that you know enough to provide informed consent"
C. "Many patients do better after surgery if they have more information"
D. "You can wait until after surgery for teaching about pain management"

A. "Tell me what you think is important to know about the surgery".

147

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?

A. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone
B. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone
C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection
D. Hospitalization will be required for several weeks after the stem cell transplant procedure is performed

D. Hospitalization will be required for several weeks after the stem cell transplant procedure is performed.

Strict protective isolation is required for 2-4 weeks after HSCT while waiting for transplanted marrow to start producing cells.

148

The home health nurse cares for a patient who has been receiving interferon therapy of cancer. Which statement by the patient indicates a need for further assessment?

A. "I have frequent muscle aches and pains"
B. "I rarely have the energy to get out of bed"
C. "I experience chills after I inject the interferon"
D. "I take acetaminophen (Tylenol) every 4 hours"

B. "I rarely have the energy to get out of bed".

Fatigue can be a dose-limiting toxicity for use of biologic therapies.

149

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?

A. IL-2 enhances the immunologic response to tumor cells
B. IL-2 stimulates malignant cells in the resting phase to enter mitosis
C. IL-2 prevents the bone marrow depression caused by chemotherapy
D. IL-2 protects normal cells from the harmful effects of chemotherapy

A. IL-2 enhances the immunologic response to tumor cells.

150

A 38-year-old patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

A. Restrict daily dietary protein intake
B. Reposition the patient every 4 hours
C. Place the patient on a pressure-relieving mattress
D. Perform passive range of motion daily

C. Place the patient on a pressure-relieving mattress.

151

The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider?

A. The patient complains of fatigue
B. The patient eats only 25% of meals
C. The patient's apical pulse is irregular
D. The patient's white blood cell (WBC) count is 5000/uL

C. The patient's apical pulse is irregular.

Doxorubicin can cause cardiac toxicity. The dysrhythmia indicates need for a change in therapy.

152

A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?

A. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale)
B. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness
C. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs
D. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief

C. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

For chronic cancer pain, analgesics should be taken on a scheduled basis with additional doses as needed for breakthrough pain.

153

Which action will the nurse include in the plan of care for a patient with right arm lymphedema?

A. Check blood pressure (BP) on both right and left arms
B. Avoid isometric exercise on the right arm
C. Assist with application of a compression sleeve
D. Keep the right arm at or below the level of the heart

C. Assist with application of a compression sleeve.

Compression of the arm assists in improving lymphatic flow toward the heart.

154

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?

A. Offer the patient frequent small snacks between meals
B. Assist the patient to choose favorite foods from the menu
C. Provide teaching about the importance of nutritional intake
D. Apply the ordered anesthetic gel to oral lesions before meals

D. Apply the ordered anesthetic gel to oral lesions before meals.

155

A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?

A. Remove food debris from the teeth and oral mucosa with a stiff toothbrush
B. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth
C. Gargle and rinse the mouth several times a day with an antiseptic mouthwash
D. Rinse the mouth before and after each meal and at bedtime with a saline solution

D. Rinse the mouth before and after each meal and at bedtime with a saline solution.

156

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he never knows what to say to help his wife. Which nursing diagnosis is most appropriate for the nurse to add to the plan of care?

A. Compromised family coping related to disruption in lifestyle
B. Impaired home maintenance related to perceived role changes
C. Risk for caregiver role strain related to burdens of caregiving responsibilities
D. Dysfunctional family processes related to effect of illness on family members

D. Dysfunctional family processes related to effect of illness on family members.

157

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?

A. "After a couple of years, it is likely that I will be able to stop taking the cyclosporine"
B. "If I develop an acute rejection episode, I will need to have other types of drugs given IV"
C. "I need to be monitored closely because I have a greater chance of developing malignant tumors"
D. "The drugs are given in combination because they inhibit different ways the kidney can be rejected"

A. "After a couple of years, it is likely that I will be able to stop taking the cyclosporine".

Cyclosporine, a calcineurin inhibitor, will need to be continued for life.

158

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem?

A. Tell the patient to limit social contacts until regrowth of the hair occurs
B. Encourage the patient to purchase a wig or hat and wear it once hair loss begins
C. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss
D. Inform the patient that hair usually grows back once the chemotherapy is complete

B. Encourage the patient to purchase a wig or hat and wear it once hair loss begins.

159

The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first?

A. Teach the patient how to deep breathe and cough
B. Discuss options for postoperative pain management
C. Explain the postdischarge care of the axillary drains
D. Ask the patient to describe what she knows about the surgery

D. Ask the patient to describe what she knows about the surgery.

160

A patient who has positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4 T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?

A. "The patient meets the criteria for a diagnosis of an acute HIV infection"
B. "The patient will be diagnosed with asymptomatic chronic HIV infection"
C. "The patient has developed acquired immunodeficiency syndrome (AIDS)"
D. "The patient will develop symptomatic chronic HIV infection in less than a year"

C. "The patient has developed acquired immunodeficiency syndrome (AIDS)".

PCP is a diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV.

161

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

A. Infuse the medication over a short period of time
B. Stope the infusion if swelling is observed at the site
C. Administer the chemotherapy through a small-bore catheter
D. Hold the medication unless a central venous line is available

B. Stope the infusion if swelling is observed at the site.

162

A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate?

A. Have the patient eat large meals when nausea is not present
B. Offer dry crackers and carbonated fluids during chemotherapy
C. Administer prescribed antiemetics 1 hour before the treatments
D. Give the patient two ounces of a citrus fruit beverage during treatments

C. Administer prescribed antiemetics 1 hour before the treatments.

163

Which patient statement indicates that the nurse's teaching about tamoxifen (Nolvadex) has been effective?

A. "I can expect to have leg cramps"
B. "I will call if you have any eye problems"
C. "I should contact you if I have hot flashes"
D. "I will be taking the medication for 6 to 12 months"

B. "I will call if you have any eye problems"

Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased.

164

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?

A. "I can buy some aloe vera gel to use on the area"
B. "I will expose the treatment area to a sun lamp daily"
C. "I can use ice packs to relieve itching in the treatment area"
D. "I will scrub the area with warm water to remove the scales"

A. "I can buy some aloe vera gel to use on the area".

165

To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor...

A. Bilirubin levels
B. Ammonia levels
C. Potassium levels
D. Prothrombin time

B. Ammonia levels.

The protein in the blood in the GI tract will be absorbed and may result in an increase in ammonia level because the liver cannot metabolize protein very well.

166

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast?

A. The radiation therapy will take a week to complete
B. Careful skin care in the radiated area will be necessary
C. Visitors are restricted until the radiation therapy is completed
D. Wigs may be used until the hair regrows after radiation therapy

B. Careful skin care in the radiated area will be necessary.

167

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care?

A. Minimize activity until the treatment is completed
B. Establish time to take a short walk almost every day
C. Consult with a psychiatrist for treatment of depression
D. Arrange for delivery of a hospital bed to the patient's home

B. Establish time to take a short walk almost every day.

168

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/uL during chemotherapy is to...

A. Check all stools for occult blood
B. Encourage fluids to 3000 mL/day
C. Provide oral hygiene every 2 hours
D. Check the temperature every 4 hours

A. Check all stools for occult blood.

169

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?

A. Test all stools for the presence of blood
B. Maintain a high-residue, high-fiber diet
C. Clean the perianal area carefully after every bowel movement
D. Inspect the mouth and throat daily for the appearance of thrush

C. Clean the perianal area carefully after every bowel movement.

170

A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

A. Instruct the patient to cough every hour
B. Monitor the patient for shortness of breath
C. Verify the position of the balloon every 4 hours
D. Deflate the gastric balloon if the patient reports nausea

B. Monitor the patient for shortness of breath.

The most common complication of balloon tamponade is aspiration pneumonia.

171

A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure?

A. Pain will be relieved by cutting sensory nerves in the stomach
B. Relief of pressure in the stomach will promote better nutrition
C. Tumor growth will be controlled by the removal of malignant tissue
D. Tumor size will decrease and this will improve the effects of other therapy

D. Tumor size will decrease and this will improve the effects of other therapy.

Debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective.

172

The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular carcinoma in situ (LCIS) about...

A. Lumpectomy
B. Lymphatic mapping
C. MammaPrint testing
D. Tamoxifen (Nolvadex)

D. Tamoxifen (Nolvadex).

Tamoxifen is used as a chemopreventive therapy in some patients with LCIS.

173

A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing?

A. CA 15-3 level testing
B. HER-2 receptor testing
C. Estrogen receptor testing
D. Oncotype DX assay testing

A. CA 15-3 level testing.

Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer.

174

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed?

A. "There are several options that I can consider for treating the cancer"
B. "I will probably need radiation to the breast after having the surgery"
C. "Mastectomy is the best choice to decrease the chance of cancer recurrence"
D. "I can probably have reconstructive surgery at the same time as a mastectomy"

C. "Mastectomy is the best choice to decrease the chance of cancer recurrence".

Survival rates with lumpectomy and radiation or modified radical mastectomy are comparable.

175

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

A. Request that the patient stand on one foot
B. Ask the patient to extend both arms forward
C. Request that the patient walk with eyes closed
D. Ask the patient to perform the Valsalva maneuver

B. Ask the patient to extend both arms forward.

Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy.

176

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective?

A. "After cancer has not recurred for 5 years, it is considered cured"
B. "The cancer will be cured if the entire tumor is surgically removed"
C. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation"
D. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured"

D. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured".

177

A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching?

A. Take aspirin every 4 hours to reduce inflammation
B. Check wound drains for excessive blood or a foul odor
C. Wear a loos-fitting bra to decrease irritation of the sutures
D. Resume normal activities 2 to 3 days after the mammoplasty

B. Check wound drains for excessive blood or a foul odor.

178

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective?

A. "The biopsy will remove the cancer in my prostate gland"
B. "The biopsy will determine how much longer I have to live"
C. "The biopsy will help decide the treatment for my enlarged prostate"
D. "The biopsy will indicate whether the cancer has spread to other organs"

C. "The biopsy will help decide the treatment for my enlarged prostate".

179

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?

A. Patient who is currently HIV negative but has unprotected sex with multiple partners
B. Patient who was infected with HIV 15 years ago and now has a CD4 count of 840/uL
C. HIV-positive patient with a CD4 count of 16-/uL who drinks a fifth of whiskey daily
D. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

D. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis.

180

A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is most appropriate?

A. "The cancer involves only the cervix"
B. "The cancer cells look almost like normal cells"
C. "Further testing is needed to determine the spread of the cancer"
D. "It is difficult to determine the original site of the cervical cancer"

A. "The cancer involves only the cervix".

181

The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful?

A. "I will need to use my right arm and to rest the left one"
B. "I will avoid reaching over the stove with my left hand"
C. "I will keep my left arm in a sling until the incision is healed"
D. "I will stop the left arm exercises if moving the arm is painful"

B. "I will avoid reaching over the stove with my left hand".

182

The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer?

A. Fresh fruit salad
B. Roasted chicken
C. Whole wheat toast
D. Cream of potato soup

B. Roasted chicken.

Minimize diarrhea by avoiding foods high in roughage: fruits and whole grains.

183

The nurse cares for an adolescent patient who is dying. The patient's parents are interested in organ donation and ask the nurse how the decision about brain death is made. Which response by the nurse is most appropriate?

A. "Brain death occurs if a person is flaccid and unresponsive"
B. "If CPR is ineffective in restoring a heartbeat, the brain cannot function"
C. "Brain death has occurred if there is no breathing and certain reflexes are absent"
D. "If respiratory efforts cease and apical pulse is audible, brain death is present"

C. "Brain death has occurred if there is no breathing and certain reflexes are absent".

184

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?

A. Nausea
B. Alopecia
C. Mucositis
D. Hematuria

D. Hematuria.

The adverse effects of intravesical chemotherapy are confined to the bladder.

185

A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient?

A. Infuse the PRBCs slowly over 4 hours
B. Transfuse only leukocyte-reduced PRBCs
C. Administer the scheduled diuretic before the transfusion
D. Give the PRN dose of antihistamine before the transfusion

B. Transfuse only leukocyte-reduced PRBCs.

TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking.

186

Which nursing action should be included in the plan of care for a patient returning to the surgical unit following a left modified radical mastectomy with dissection of axillary lymph nodes?

A. Obtain a permanent breast prosthesis before the patient is discharged from the hospital
B. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes
C. Post a sign at the bedside warning against venipunctures of blood pressures in the left arm
D. Insist that the patient examine the surgical incision when the initial dressings are removed

C. Post a sign at the bedside warning against venipunctures of blood pressures in the left arm.

187

A patient who is scheduled for a right breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. which answer by the nurse is correct?

A. "Benign tumors do not cause damage to other tissues"
B. "Benign tumors are likely to recur in the same location"
C. "Malignant tumors may spread to other tissues or organs"
D. "Malignant cells reproduce more rapidly than normal cells"

C. "Malignant tumors may spread to other tissues or organs".

188

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient?

A. "The EIA test will need to be repeated to verify the results"
B. "A viral culture will be done to determine the progression of the disease"
C. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)"
D. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed"

A. "The EIA test will need to be repeated to verify the results".

After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Western blot is the final test that needs to be done to confirm HIV.

189

If taking interferon...

Make sure patient is not pregnant.

190

A patient has a positive test for HIV and is admitted for pneumocystis pneumonia and has a CD4 count of less than 200. Based on diagnosed criteria of CDC, which statement is correct?

When CD4 is under 200, the patient has AIDS.

191

The nurse will most likely prepare a medication teaching plan about ART for which patient?

A patient who tested positive for HIV 2 years ago and now has cytomegalovirus retinitis.

192

10 days after receiving a bone marrow transplant, a patient develops a skin rash. What is the cause?

Donor T cells are attacking the patient's skin cells.

193

A patient is anxious and is having difficulty breathing after being stung by a wasp. What is the nurse's priority?

Maintain airway patency.

194

On a diagram showing the arm, where is the most common area to locate the cancer for breast cancer?

Right by the axilla.

195

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast?

Skin care for radiation burns.

196

Indicate the area the nurse will assess for positive colon sign.

In the middle. #3.