LACHARITY 2 Flashcards
(40 cards)
The patient describes a burning sensation in the leg. The health care provider tells the nurse that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse is most likely to question the prescription of which drug? 1. Imipramine 2. Carbamazepine 3. Gabapentin 4. Morphine
Ans: 4 Morphine is usually not prescribed for neuropathic pain because pain relief response is poor. Other medications, some antidepressants (e.g.,
imipramine) and some anticonvulsants (e.g., carbamazepine and gabapentin), provide better relief. Focus: Prioritization.
A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain?
- “An Illustrated Guide to the Analgesic Ladder”
- “Common Questions About Radiation Therapy”
- “How to Make Preparations for Your Cancer Surgery”
- “How Nerve Blocks Can Help to Manage Cancer Pain”
Ans: 1 Analgesic drugs are the first-line treatment for cancer pain management. If pain is not controlled by medication, other options are available, including radiation, surgery, and nerve blocks.
Focus: Prioritization.
Which nurse is demonstrating the first step in managing cancer pain by using the ABCDE (ask, believe, choose, deliver, and empower) clinical approach to pain management as recommended by the Agency for Healthcare Research and Quality?
- Nurse J asks if the time of the prescribed dose of medication can be changed.
- Nurse K asks the patient to describe pain and uses a numerical pain scale.
- Nurse L asks the patient to participate and to contribute in pain management.
- Nurse M asks about pain management options that are appropriate for the patient.
Ans: 2 Asking the patient to describe the pain is the first step. The ABCDE step-by-step clinical approach includes ask, believe, choose, deliver, and empower (or enable).
Focus: Prioritization
The nurse assesses the patient and determines that the patient is having frequent breakthrough cancer pain. Which member of the health care team is the nurse most likely to contact first?
- Physical therapist to reevaluate physical therapy routines
- Health care provider to review medication, dosage, and frequency
- Unlicensed assistive personnel to provide more assistance with activities of daily living
- Psychiatric clinical nurse specialist to evaluate psychogenic pain
Ans: 2 Breakthrough pain is defined as rapid onset, short duration, and moderate to severe; a temporary exacerbation related to poorly controlled
around-the-clock dosing of background pain. Frequent breakthrough pain suggests that the around-the-clock dosing needs reevaluation, so the nurse would contact the health care provider and advocate for a change of
medication or dose or frequency. Focus: Prioritization.
The night shift nurse tells the oncoming dayshift nurse that the cancer patient is on around-the-clock dosing of morphine but that the patient might be having end-of-dose pain. Which question is the most important to ask the night shift nurse?
- “How many times did you have to give a bolus dose of morphine?”
- “Did the patient tell you that the pain was greater than a 5/10?”
- “Did you notify the health care provider (HCP), and were changes prescribed?”
- “Did you try any nonpharmaceutical therapies or adjuvant medications?
Ans: 3 The nurse might ask any of these questions, but the most important question is whether the HCP was notified and if any changes were made to address the patient’s pain. If the HCP was not called during the night (which is often the case), then the day shift nurse must assess the patient’s current pain, talk to him or her directly about last night’s pain, and gather data about
the frequency of bolus doses and other options that were tried. Data about last night’s care should be available in the patient’s record if it is not mentioned in report.
Focus: Prioritization.
The nurse is caring for a patient with esophageal cancer. Which task could be delegated to unlicensed assistive personnel (UAP)?
- Assisting the patient with oral hygiene
- Observing the patient’s response to feedings
- Facilitating expression of grief or anxiety
- Initiating daily weights
Ans: 1 Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to observe response to treatments and to help the patient deal with loss or anxiety. The UAP can be directed to weigh the
patient but should not be expected to know when to initiate that measurement.
Focus: Delegation.
A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While the nurse is trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority nursing concept to consider in responding to this patient? 1. Elimination 2. Patient education 3. Cellular regulation 4. Anxiety
Ans: 4 The patient’s physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other concepts are relevant, but if the patient leaves the clinic, the interventions may be delayed or ignored.
Focus: Prioritization.
Which patient is at greatest risk for pancreatic cancer?
- An older African-American man who smokes
- A young white obese woman with gallbladder disease
- A young African-American man with type 1 diabetes
- An elderly white woman who has pancreatitis
Ans: 1 Pancreatic cancer is more common in African Americans, men, and smokers. Other associated factors include older age, alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal irradiation.
Focus: Prioritization.
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients
who must be placed on bleeding precautions? Select all that apply.
1. Provide mouthwash with alcohol for oral rinsing.
2. Use paper tape on fragile skin.
3. Provide a soft toothbrush or oral sponge.
4. Gently insert rectal suppositories.
5. Avoid aspirin or aspirin-containing products.
6. Avoid overinflation of blood pressure cuffs.
Ans: 2, 3, 5, 6 Mouthwash should not include alcohol because it has a drying action that leaves the mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not
recommended. All other options are appropriate. Focus: Prioritization
When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?
- A patient with severe anemia secondary to GI bleeding
- A patient who needs enemas and antibiotics to control GI bacteria
- A patient who needs preoperative teaching for bowel resection surgery
- A patient who needs central line insertion for chemotherapy
Ans: 2 Administering enemas and antibiotics is within the scope of practice of LPNs/LVNs. Although some states and facilities may allow the LPN/LVN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with central line insertion are the responsibilities of the RN. F
focus: Assignment.
A community health center is preparing a presentation on the prevention and detection of cancer. Which task would be best to assign to the LPN/LVN?
- Explain screening examinations and diagnostic testing for common cancers.
- Discuss how to plan a balanced diet and reduce fats and preservatives.
- Prepare a poster on the seven warning signs of cancer.
- Describe strategies for reducing risk factors such as smoking and obesity.
Ans: 3 The LPN/LVN will know the standard seven warning signs and can educate through standard teaching programs. The health care provider
performs the physical examinations and recommends diagnostic testing. The nutritionist can give information about diet. The RN has primary responsibility for educating people about risk factors.
Focus: Assignment.
The health care provider (HCP) tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement is cause for greatest concern?
- “My symptoms will eventually be cured; I’m so happy that I don’t have to worry any longer.”
- “My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family.”
- “My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death.”
- “Initially, I may have to take some time off work for my treatments; I can probably work full time in the future.”
Ans: 3 The nurse should assess what the patient means by having “control over my own life and death.” This could be an indirect statement of suicidal intent. A patient who believes he will be cured should also be assessed for misunderstanding what the HCP said; however, the patient may need to use denial as a temporary defense mechanism. Acknowledgment that the treatments are for control of symptoms and plans for the immediate future suggest an understanding of what the HCP said.
Focus: Prioritization.
For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to unlicensed assistive
personnel (UAP)?
1. Helping the patient to identify patterns of fatigue
2. Recommending participation in a walking program
3. Reporting the amount and type of food consumed from the tray
4. Checking the skin for redness and irritation after the treatment
Ans: 3 The UAP can observe the amount that the patient eats (or what is gone from the tray) and report to the nurse. Assessing patterns of fatigue and skin reaction is the responsibility of the RN. The initial recommendation for exercise should come from the health care provider. Focus: Delegation.
An older patient needs treatment and relief for severe localized pain related to postherpetic neuralgia that developed during chemotherapy. The nurse is most likely to question the prescription of which type of medication?
- Lidocaine patch
- Gabapentinoid
- Capsaicin patch
- Tricyclic antidepressant
Ans: 4 Age, malignancy, immunocompromised conditions (e.g., human immunodeficiency virus), and immunosuppressive medications increase the risk for herpes zoster. Lidocaine patches, gabapentinoids (e.g., gabapentin), and tricyclic antidepressants (e.g., imipramine) are first-line choices for postherpetic neuralgia, which can be a long-term sequela to herpes zoster. However, the American Geriatrics Society recommends that tricyclics should be avoided for older adults because of side effects, such as confusion or
orthostatic hypotension. Capsaicin patches are considered a second-line option. A lidocaine patch would be a good choice for this patient because it can be applied to the local area with limited systemic effects. Focus: Prioritization.
For a patient receiving the chemotherapeutic drug vincristine, which side effect should be reported to the health care provider (HCP)?
- Fatigue
- Nausea
- Paresthesia
- Anorexia
Ans: 3 Paresthesia is a side effect associated with some chemotherapy drugs
such as vincristine. The HCP can modify the dosage or discontinue the drug.
Fatigue, nausea, vomiting, and anorexia are common side effects of many
chemotherapy medications. The nurse can assist the patient by planning for
rest periods, giving antiemetics as ordered, and encouraging small meals
containing high-protein and high-calorie foods. Focus: Prioritization; Test
Taking Tip: In caring for patients with cancer, many nursing interventions
80target the common side effects of chemotherapy, including fatigue, nausea,
vomiting, and anorexia.
An experienced nurse is precepting a newly hired nurse who has 2 years of medical-surgical experience but limited experience with patients who have cancer. The new hire seems to be consistently under medicating the patients’ pain. What should the preceptor do first?
- Reassess all of the patients and administer additional pain medication as needed.
- Write an incident report and inform the nurse manager about the nurse’s performance.
- Determine the new nurse’s understanding and beliefs about cancer pain and treatments.
- Ask the new nurse about past experience in administering pain medications.
Ans: 3 First, the preceptor assesses the newly hired nurse’s knowledge and beliefs about cancer pain and treatment. The nurse has experience, but that past experience may be related to caring for patients with acute pain, such as postoperative or acute Exacerbations of disease. After assessing knowledge,
the preceptor can then correct misconceptions or make suggestions for further study. Reassessing the patients together could be a learning opportunity. Writing an incident report and going to the nurse manager might occur if the new nurse is unable to adapt and correct behavior.
Focus: Prioritization; Test Taking Tip: Recall that the first step in the nursing process is always assessment. In this case, the new nurse’s performance is the focus of the preceptor’s assessment.
For a patient who is receiving chemotherapy, which laboratory result is of particular importance?
- White blood cell count
- Prothrombin time
- Electrolyte levels
- Blood urea nitrogen level
Ans: 1 The white blood cell count is especially important because chemotherapy can decrease white blood cells, particularly neutrophils (known as neutropenia). This leaves the patient vulnerable to infection. The other tests are important in the total management but are less directly specific to chemotherapy. Focus: Prioritization.
For care of a patient who has oral cancer, which task would be appropriate to assign to an LPN/LVN?
- Assisting the patient to perform oral hygiene
- Explaining when brushing and flossing are contraindicated
- Giving antacids and sucralfate suspension as ordered
- Recommending saliva substitutes
Ans: 3 Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient with oral hygiene should be delegated to unlicensed assistive personnel, but the nurse should give specific instructions related to
the condition of the patient’s mouth. Explaining contraindications is the responsibility of the RN. Recommendations for saliva substitutes should
come from the health care provider or pharmacist. Focus: Assignment.
When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs?
- Administration of chemotherapy requires precautions to protect self and others.
- Many chemotherapeutic drugs are vesicants.
- Chemotherapeutic drugs are frequently given through central venous access devices.
- Oral and venous routes of administration are the most common.
Ans: 1 Chemotherapy drugs should be given by nurses who have received additional training in how to safely prepare and deliver the drugs and protect themselves and others from exposure. The other options are relevant, but the general principles of drug administration apply.
Focus: Prioritization.
The oncoming day shift nurse has just received hand over report from the
night shift nurse. List the order of priority for assessing and caring for the
following patients, with 1 being first and 4 being last.
1. A patient who developed tumor lysis syndrome around 5:00 am
722. A patient who is currently pain free but had breakthrough pain during the
night
3. A patient scheduled for exploratory laparotomy this morning
4. A patient with anticipatory nausea and vomiting for the past 24 hours
Ans: 1, 3, 2, 4 Tumor lysis syndrome is an emergency involving electrolyte
imbalances and potential renal failure. A patient scheduled for surgery
should be assessed before leaving the unit, and any final preparations for
surgery should be completed. A patient with breakthrough pain needs a
thorough pain assessment, an investigation of pain patterns, and a chart
review of all attempted pharmaceutical and nonpharmaceutical
interventions; the health care provider may need to be contacted for a change
of dosage or medication. Anticipatory nausea and vomiting has a
psychogenic component that requires assessment, teaching, reassurance, and
administration of antiemetics. Focus: Prioritization.
The nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation?
- “Last night my back really hurt, and I had trouble sleeping.”
- “My leg has been giving out when I try to stand.”
- “My bowels are just not moving like they usually do.”
- “When I try to pass urine, I have difficulty starting the stream.”
Ans: 1 Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms are later signs.
Focus: Prioritization.
The nurse is caring for an older woman with hepatic cancer. Unlicensed assistive personnel informs the nurse that the patient’s level of consciousness is diminished compared with earlier in the shift. Prioritize the steps of
assessment and intervention related to this patient’s change of mental status. 1. Take vital signs, including pulse, respirations, blood pressure, and temperature.
2. Check responsiveness and level of consciousness.
3. Obtain a blood glucose reading; give glucose per protocol.
4. Check electrolyte values.
5. Check ammonia level.
6. Check pulse oximeter readings and administer oxygen as needed.
Ans: 2, 6, 1, 3, 4, 5 Determine level of consciousness and responsiveness along with changes from baseline. Oxygen should be administered immediately in the presence of respiratory distress or risk for decreased
81oxygenation and perfusion. Pulse oximetry can be used for continuous monitoring. Adequate pulse, blood pressure, and respirations are required for cerebral perfusion. Increased temperature may signal infection or sepsis. Blood glucose levels should be checked even if the patient does not have diabetes. Severe hypoglycemia should be immediately treated per protocol. Electrolyte and ammonia levels are relevant data for this patient, and abnormalities in these parameters may be contributing to change in mental
status. (Note: Laboratory results [i.e., electrolytes and ammonia levels] may be concurrently available; however, the nurse should systematically look at data. Look at electrolytes first because these are more commonly ordered. The nurse may have to remind the health care provider to order the ammonia level if the patient with a hepatic disorder is having a change in mental status.)
Focus: Prioritization;
Test Taking Tip: For patients who have a sudden change in mental status or a decreased level of consciousness, assume that the brain is experiencing decreased perfusion, decreased oxygenation, or both until proven otherwise. Giving oxygen and glucose are brain cell–preserving interventions that must occur within several minutes.
The day shift nurse is assessing the patient who has breast cancer and
notices edema of the face, periorbital edema, and tightness around the neck of
the gown. The nurse immediately notifies the health care provider for early
signs and symptoms of superior vena cava syndrome. On the figure below
identify the superior vena cava.
The superior vena cava returns blood from the head, neck, and upper
extremities to the heart. Compression or obstruction of the vessel leads to
congestion of the blood, which causes the early manifestation of edema in the
82face. This is more noticeable when the patient is in a supine position. Edema
of the upper body can progress. Stridor caused by narrowing of the pharynx
or larynx is an ominous sign. Late symptoms include hemorrhage, cyanosis,
mental status changes, decreased cardiac output, and hypotension. Focus:
Prioritization.
For a patient with osteogenic sarcoma, which laboratory value causes the most concern?
- Sodium level of 135 mEq/L (135 mmol/L)
- Calcium level of 13 mg/dL (3.25 mmol/L)
- Potassium level of 4.9 mEq/L (4.9 mmol/L)
- Hematocrit of 40%
Ans: 2 The normal range for calcium is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L). Potentially life-threatening hypercalcemia can occur in cancers with destruction of bone. Other laboratory values are pertinent for overall
patient management but are less specific to bone cancers.
Focus: Prioritization.
