Graduation Exam 4 PDF

GRADUATION (EXAM 4) 1. The nurse is planning discharge teaching for a client with hypothyroidism. Which of the following diet characteristics should be included in the teaching plan for this client? a) High protein and high calorie b) High carbs and low fiber...

GRADUATION (EXAM 4) 1. The nurse is planning discharge teaching for a client with hypothyroidism. Which of the following diet characteristics should be included in the teaching plan for this client? a) High protein and high calorie b) High carbs and low fiber c) High fiber and low calorie d) Restricted fluids and low protein 2. The nurse is reinforcing teaching with a 72 year old client regarding early stage prostate cancer ask the nurse. What statement by the client would require a follow-up by the nurse? a) “Because the cancer grows slowly my physician will take a conservative approach” b) “My age is a factor that contributes to my treatment plan” c) “My physician will recommend surgery to prevent the cancer from spreading” d) “I will have to have my prostate-specific antigen (PSA) monitored regularly” 3. The nurse is presenting a community program to teach a group of well senior citizens about colon health. Which information would be most appropriate to include? a) A bi-annual colonoscopy is suggested b) Ensure that a B-complex vitamin is taken daily to decrease risk. c) A good diet and exercise can prevent colon cancer. d) Diet should include foods that are high fiber and low fat. 4. The nurse is caring for a client with lung cancer. Which finding indicates the development of the syndrome of inappropriate antidiuretic hormone (SIADH)? a) Diminished LOC b) Twitching of hands and tingling of the lips c) Rapid increase in urine output to 400 ml/hr d) Low urine osmolality 5. The nurse is planning care for a client recovering from a transphenoidal hypophysectomy. What nursing interventions would be included in the plan of care for this client? SATA a) Assess neurological status every hour for first 24 hrs b) Teach client to cough and deep breathe c) Teach client to use soft bristle toothbrush d) Teach client to notify nurse of post-nasal drop e) Maintain hourly intake and output record. 6. The nurse has completed teaching for a client that had a malignant melanoma removed. What statement by the client best indicates teaching has been effective? a) “I will avoid sun exposure between 11 am and 3pm” b) “I will make an appointment every 3 years for a skin cancer check” c) “I will wear SPF 15 sunscreen when going out in boat” d) “Melanoma rarely metastasizes” 7. The nurse of a client receiving propylthiouracil (PTU) for hyperthyroidism. What indicates the medication is effective? a) Bounding pulses and decreasing edema. b) Increased respirations and an increase in thyroxine (T4)  c) Decreased basal metabolic rate and thyroid bruit d) Increase in body weight and decrees in pulse rate 8. The nurse is caring for a client with colorectal cancer who will undergo external-beam pelvic radiation. What action is most appropriate to include in the teaching plan? a) Encourage sitz bath and meticulous cleaning b) Test all stools for the presence of blood c) Maintain high-carb diet d) Inspect the mouth and throat for thrush 9. The nurse is caring for a client prescribed hydrocortisone 25 mg by mouth for adrenal insufficiency. Which of the following best indicates the medication is effective? a) Decreased appetite and weight loss b) Decreased hyperexcitability and restlessness c) Decreased weakness and fatigue d) Decreased blood pressure and serum sodium level 10. The nurse is educating a client with stomatitis. What information would be most appropriate to teach the client? a) Rinse mouth with warm water after smoking or eating acidic foods. b) Rinse their mouth with hot water and viscous lidocaine after meals and as needed. c) Rinse their mouth with baking soda and warm water after meals. d) Rinse their mouth with hydrogen peroxide and use a baking soda paste on sores. 11. A 32-year-old client is being seen in the office following 3 weeks after a radical mastectomy. What statement by the client best indicates the client is experiencing appropriate coping? a) “I am doing fantastic since the surgery and I’m back to jogging” b) “I have been helping my family deal with their feelings about the surgery” c) “I have been having difficulty coping with the surgery and cry sometimes” d) “I have been unable to leave the house or talk to my friends about the surgery” 12. A client with hyperaldosteronism is scheduled for an adrenlectomy. Prior to surgery, what nursing intervention would be priority? a) Monitor the blood pressure b) Elevate the patient’s extremities to relieve edema c) Encourage fluids d) Provide a potassium-restricted diet 13. The nurse is caring for a client receiving a continuous ACTH infusion over 24-hours. Which changes are expected if the endocrine negative feedback loops are normal? a) Higher-than-normal cortisol levels; lower-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. b) Lower-than-normal serum cortisol levels; lower-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. c) Higher-than-normal serum cortisol levels; high-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. d) Lower-than-normal serum cortisol levels; higher-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. 14. The nurse is caring for a client who has adrenal insufficiency (Addison’s disease). What statement by the client indicates understanding of the discharge instructions? a) “I wont have to use replacement therapy for the rest of my life” b) “I should never change my medication dose without notifying my HCP” c) “I should wear an alert bracelet at all time and carry medical identification” d) “My condition is not one that is easily worsened by external stress” 15. The nurse caring for a 24-year old client with testicular cancer scheduled to begin treatment. He says: “I don’t know why I should bother with this treatment. This cancer is going to kill me anyways. What do you think? What is the best response? a) “Treatment for testicular cancer works well and the odds of complete remission are good” b) “Why do you say that?” c) “You think your cancer is going kill you despite treatment?” d) “I don’t know, what did your doctor say?” 16. The nurse is caring for a client with diabetes insipidus. What is the priority nursing intervention for this disease process? a) Administer 3% normal saline b) Adequate fluid replacement c) Obtaining daily weights d) Ambulating client TID 17. The nurse is caring for a client diagnosed with Hodgkin’s lymphoma. What will the nurse include in the plan of care? a) Obtaining consent for a bone marrow biopsy to determine response to therapy b) Teach the client about B symptoms and the need for 2-4 cycles of chemotherapy c) Monitor for presence of M protein in urine d) Increase fluids to manage hypercalcemia 18. The nurse is caring for a client undergoing external radiation. What statement best indicates teaching has been effective regarding dry desquamation? a) “I can apply aloe gel to the area to help with discomfort as needed” b) “I can use ice packs on the area to relieve swelling” c) “I can scrub the area with warm soap and water to relieve itching” d) “I can apply a heating pad to the area to relieve discomfort” 19. A client undergoing chemotherapy reports, “I am so tired I can hardly get out of bed in the morning.” What is the most appropriate intervention of the nurse to suggest to the client? a) Strict bed rest until the treatment is completed. b) Group activates together and plan for rest periods in between. c) Follow a daily jogging program to improve stamina d) Take your furosemide (Lasix) in the morning to sleep better at night 20. The nurse is teaching a client that had an outpatient transrectal ultrasound with prostate biopsy. What information should be included in the teaching plan? a) Avoid sexual intercourse for six weeks b) Report fever, chills, and difficulty voiding c) Remove perineal dressing in 24 hours  d) Expect gross hematuria for three to four days 21. A client receiving chemotherapy is also receiving allopurinol and busulfan. The nurse teaches the allopurinol is to prevent emergent complication of chemotherapy, including what sign and symptoms? a) Hypercalcemia and hyperkalemia b) Low platelets and low white blood cells (WBC) c) Hypokalemia and low platelets d) Hypocalcemia and hyperphosphatemia 22. The nurse is developing a plan of care for a client with multiple myeloma. What is the priority intervention to include in the plan of care? a) Providing oral care b) Monitoring red blood cell counts c) Encouraging fluids d) Coughing and deep breathing 23. A client has been admitted with diarrhea, fatigue and nausea die to chemotherapy. What assessment findings would the nurse expect? a) Urinary output 360 ml in 8 hours and respiration 22 per minute b) Urinary output 210 ml in 8 hours and heart rate 58 bpm c) Urinary output 210 ml in 8 hours and pulse 125 bpm d) Urinary output 360 ml in 8 hours and respirations 8 per minute 24. The nurse is preparing to teach a community class about colon cancer. Which risk factors are most appropriate to include in the teaching plan? a) Age over 65 and high-fiber diet b) History of pancreatitis and polyps c) Sedentary lifestyles and vegetarian diet d) High fat diet and alcohol consumption 25. The community health nurse is preparing to teach a group of adults about smoking and lung cancer. What statement should be included in the teaching? a) The risk of smoking is measured by how many cigarettes are smoked per day. b) If you smoke, you should start getting regular screening done at age 50 c) Men are more likely to get lung cancer, but women are more likely to die d) A lingering cough is often the first sign of lung cancer 26. The nurse is caring for client who has multiple myeloma. What is the most important aspect of care? a) The client may develop a decreased in sensation in the extremities b) The final stage of the disease is extended giving the patient time to adapt c) Pain control will require large doses of opioid narcotic medications d) Assessment will include review of electrolytes and renal function 27. The nurse is caring for a client with enlarged cervical lymph nodes. What additional symptoms would indicate a possible diagnosis of Hodgkin’s lymphoma? SATA a) Weight loss b) Bradycardia  c) Tender lymph nodes d) Movable lymph nodes e) Weakness 28. The nurse is caring for a client diagnosed with liver cancer. The client wants to know why chemotherapy is being given by regional perfusion instead of intravenously. What is the reason will the nurse explain to the client? 29. The nurse is caring for a client who has been admitted due to a persistent hoarse cough and smoking history of 30 years. What possible diagnostic studies would the nurse expect to see ordered/prescribed? SATA a) PET b) Chest X-ray c) MRI 30. The nurse is caring for a client who has a high risk for development of breast cancer and has been taking high dose tarnoxifen for the past 2 years. What symptom will the nurse teach the client to report? a) Hot flashes b) Vaginal discharge c) Mood swings d) Visual disturbance 31. The nurse is caring for a client with acute lymphoid leukemia (ALL). What clinical findings would the nurse expect? SATA a) Enlarged lymph b) Fatigue c) Pallor d) Weight gain e) Bleeding gums 32. The nurse is providing care for a hospice client. What signs/symptoms would indicate the client is approaching imminent death? SATA a) Cold, clammy skin b) Loss of muscle movement c) Cheyne-Stokes respirations d) Increased blood pressure e) Mottling of hands 33. A client has developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate the treatment goals for this client have been met? A. Decrease in body weight and increased serum sodium. B. Increase in blood pressure and increase in body weight. C. Increase in urine output and decrease serum sodium. D Decrease in urine output and decrease urine osmolality. 34. A client is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). What information obtained by the nurse is most important to communicate to the health care provider?  A. The client complains of a severe headache. B. The client complains of severe thirst. C. The client has a urine specific gravity of 1.025. D. The client has a serum sodium level of 119 mEg/L 35. The nurse is caring for a client with diabetes insipidus. What assessment finding would be of greatest concern? A. Confusion and lethargy B. Urine output of 800 ml/hr C. Urine specific gravity of 1.003 D. History of a recent head injury 36. The nurse is caring for a client with central diabetes insipidus. When the client's blood pressure is 100/52, what intravenous solution would be the appropriate fluid replacement? A. 0 9% sodium chloride B. 5% dextrose in water C. 3% sodium chloride D. D 4% Albumin solution 37. The nurse is evaluating lab results for a client with diabetes insipidus. What findings would indicate improvement in the client's condition? A. Urine output is increased; specific gravity is decreased. B. Urine output is increased; osmolarity is increased. C. Urine output is decreased; specific gravity is increased. D. Osmolarity is decreased; specific gravity is increased. 38. The nurse is teaching a client just diagnosed with hyperpituitarism and acromegaly who is scheduled for a hypophysectomy. What statement indicates a need for clarification regarding this treatment? A. "I will drink plenty of water whenever I am thirsty after surgery." B. "I'm glad there will be no visible incision after this surgery." C. "I hope I can go back to wearing size 8 shoes instead of size 12." D. "I will wear slip-on shoes after surgery to avoid bending over." 39. The nurse is teaching a client about hypopituitarism. What statement indicates further teaching is needed? A. "Since this is usually caused by a pituitary tumor. I will undergo surgery, radiation, or both." B. "I will need to take hormone replacement for the rest of my life." C. "The reason blood is being drawn is because multiple hormone levels are being checked." D. “I will need to get an MRI also because a pituitary tumor usually does not cause headaches or vision changes." 40. The nurse is preparing a client who is post transsphenoidal hypophysectomy for discharge. Which statement indicates the client understands how to prevent complications from this treatment? A. “I will need to take replacement hormones for six months, then I can stop." B. “I will keep the cat food bowl on the counter, so I don't have to bend over."  C. "I will wash the incision line every day with saline and redress it immediately." D. "I will not blow my nose for 4 days after surgery." 41. The nurse is performing an admission assessment for a client with Cushing’s syndrome. What assessment findings would the nurse expect? Select all that apply. A. Bulging eyes B. Truncal obesity C. Alopecia D. Red purple striae E. Hyperglycemia 42. A client with Cushing syndrome returns to the surgical unit following an adrenalectomy. What nursing action has the highest priority for this client? a. Monitor for erythema and purulent drainage at the surgical site b. Protecting the client’s skin from pressure ulcers c. Monitoring fluid and electrolytes closely d. Preventing severe emotional disturbances 43. The nurse is caring for a cient with Cushing syndrome. What vital signs value is for most concern to the nurse? a. Heart rate of 102 bpm b. Respiratory rate of 26 bpm c. Blood pressure of 156/88 mmHg d. Oral temperature of 101.8F 44. The nurse is caring for a client with pheochromocytoma. The client reports a sudden headache and palpations. What is the priority action? a. Check the client’s blood sugar b. Assess vital signs c. Dimmish stimulation by turning off the lights d. Administer analgesic and sedation 45. The nurse is observing a student nurse performs an assessment on a client who is preoperative for the removal of a pheochromocytoma. What action by the student would require the nurse to intervene? a. The student asks the client to touch his chin to his chest b. The student auscultates and then palpates the abdomen c. The student assesses the blood pressure lying and sitting d. The student feels the neck for an enlarged thyroid gland 46. The nurse is caring for a client who has adrenal insufficiency. What statement by the client indicates understanding of the discharge instructions? A. “I should never change my medication dose without notifying my health care provider” B. “I won’t have to use replacement therapy for the rest of my life” C. “I should wear an alert bracelet at all times and carry medical identification” D. “My condition will not be affected by external stress” 47. The nurse is caring for a client admitted with Addison's disease. When the client repeatedly asks for salty foods, what is the best response? A. Provide the client with saltines and chicken broth. B. Remind the client that they are on a 2 grams daily sodium restriction. C. Request an order from the healthcare provider for spironolactone. D. Hold the hydrocortisone doses for the remainder of the day. 48. The nurse is caring for a client just diagnosed with Addison’s disease. In reviewing the chart and assessing the client. The nurse expects to fine 1,2, and 3….. (missing chart) 49. The nurse is caring for a client prescribed hydrocortisone 25 mg by mouth for adrenal insufficiency. Which of the following best indicates the medication is effective? A. Decreased hyperexcitability and restlessness. B. Decreased appetite and weight loss. C. Decreased weakness and fatigue. D. Decreased blood pressure and serum sodium level. 50. The nurse is caring for a client twelve hours after a total thyroidectomy, When the client develops stridor, what is the nurse's first action? A. Reassure the client that the voice change is temporary. B. Auscultate breath sounds and document the findings. C. Hyperextend the client's neck using pillows to support. D. Call the health care provider for immediate assistance. 51. The nurse is caring for a client being treated with levothyroxine. When the laboratory results show an elevated thyroid stimulating hormone (TSH) level, what change does the nurse anticipate? A. The levothyroxine dose will be increased. B. The levothyroxine dose will be decreased. C. The levothyroxine dose will be unchanged. D. The levothyroxine order will be discontinued. 52. The nurse is caring for a client with hypothyroidism. What client request should make the nurse suspect the hypothyroidism is not adequately controlled? A. A medication to treat diarrhea. B. Medication to help fall asleep. C. Three extra blankets on the bed D. Double portions of meals. 53. The nurse is caring for a client with Graves’ disease who is receiving 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. What teaching should the nurse provide about the reason the client is taking the medications? A. The medications will eliminate the risk for tetany during the postoperative period. B. The medications will decrease the risk of hypometabolism during and after the surgery. C. The medications will normalize metabolism and decrease the vascularity of the gland. D. The medications will assist in differentiating the thyroid and parathyroid glands during surgery. 54. The nurse is caring for a client with hyperthyroidism. What symptoms indicate the client has developed acute thyrotoxicosis? Select all that apply. A. Heart rate of 180 B. Temperature of 103° F C. Seizures D. Vomiting E. Leg cramps 55. N/A 56. N/A 57. N/A 58. Answer only: Administer calcium IV over 30 mintues 59. A newly graduated RN has just finished orientation to the oncology unit. What client would be most appropriate to assign to the new graduate? a. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today. b. A 40-year-old with chemotherapy induced nausea and vomiting who has no urine output. c. A 45-year-old with pancytopenia who needs intravenous erythropoietin d. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV 60. The nurse is receiving change of shift report. When report is completed, what client should the nurses assess first? a. Client who has a platelet count of 82,000/uL after chemotherapy. b. Client who has xerostomia after receiving head and neck radiation c. Client who is neutropenic and has an oral temperature of 100.5F d. Client who is worried about getting the prescribed opioid on time. 61. The nurse is caring for a client with thrombocytopenia after chemotherapy assessment findings would alert the nurse to a possible acute complication? a. Swollen knee joint b. Elevated temp c. Nausea and anorexia d. Frequent urination 62. The nurse is caring for a client with xerostomia. What is the most appropriate nursing action to avoid potential complications? A. Advise the client to mix topical lidocaine with mouthwash and swish as needed for pain. B. Administer analgesics before meals to reduce pain. C. Provide frequent oral care throughout the day. D. Limit liquids with meals to prevent difficulty eating. 63. The nurse is teaching a client about external radiation treatments. What statement indicates the client understands radiation precautions? A. I'll stay away from small children since l am radioactive. B. I will wash these marks off after each treatment. C. I'll put cocoa butter on my skin to keep it moist. D. I will not need to double flush the toilet each time l use the bathroom. 64. The nurse is caring for a client being discharged home following a left radical mastectomy and lymph node dissection. Which of the following are appropriate actions to teach the patient about post mastectomy care? Select all that apply. A. Elevate affected arm as often as possible. B. Avoid analgesics for pain. C. Perform arm exercises daily. D. Avoid all invasive procedures on affected arm. E. Protect affected arm from sunburn. 65. The client is being discharged with a prescription for tamoxifen to decrease the chance of breast cancer recurrence. What statement by the client indicates additional teaching is needed? a. “I should have crackers and ginger ale on hand” b. “I should report any visual changes” c. “I should expect to take this medication for the rest of my life.” d. “I should get up and move frequently to prevent blood clots? 66. The nurse is caring for a client diagnosed with human papillomavirus (HPVP) who reports thin, watery discharge and scant vaginal bleeding. Based on these symptoms, what would be a priority diagnostic test? a. Pelvic examination with cervical scraping for testing for viral DNA and RNA b. Pelvic examination with a salpingogram c. Pelvic examination with Papanicolaou (PAP) test d. Pelvic examination with transvaginal ultrasound 67. The nurse is assessing a 30-year-old client for risk factors for breast cancer. What factors would place the client at risk for breast cancer earlier than age 50? SATA a. Family history of breast cancer b. Client began smoking at age 15-16 years old c. Client is BRCA negative d. Client began menstruating at age 10 e. Client started taking estrogen-based birth control at age 12. 68. The nurse is caring for a client with advanced ovarian cancer. What symptoms are typical of the disease process? A. The client is typically asymptomatic. B. The client typically has continuous virginal bleeding. C. The client typically has urinary frequency. D. The client typically has abdominal distention. 69. The nurse is caring for a patient with an enlarged prostate. The health care provider prescribes a blood test for prostate specific antigen (PSA). What statement is true regarding this test? a. PSA levels alone cannot distinguish between a benign condition or malignant cancer b. Elevated levels of PSA are highly indicative of metastatic cancer of the prostate c. Different PSA types can differentiate between benign prostatic hyperplasia and prostatic cancer d. PSA levels will tell the physician when a prostatectomy indicated 70. The nurse is caring for a 72-year-old client with early stage prostate cancer. The client wife is crying and asks the nurse “Why isn’t the physician testing my husband’s cancer? What is the nurse best response? a. “Watchful waiting is often appropriate for men over the age of 70."  b. “The client must have stage IV cancer before treatment can begin. c. "All prostate cancer should be treated, did the doctor say why?" d. "The client is being treated with hormone therapy which is just as effective." 71. The nurse is educating a client recently diagnosed with early stage testicular. What statement indicates teaching has been successful? a. “Even though my cancer was caught early, the treatment course will be long and difficult.” b. “No matter what treatment I undergo, my sex life will never be the same again.” c. “I may not need chemo or radiation after my orchiectomy.” d. "Chemo and radiation will not affect my ability to have kids later." 72. The nurse is caring for a client who is beginning chemotherapy and at risk for tumor lysis syndrome and volume depletion. What is the priority nursing intervention to prevent these complications? a. Administer intravenous hydration as ordered. b. Monitor uric acid, potassium, and calcium levels. c. Maintain strict intake and output measurements. d. Administer intravenous mannitol for osmotic diuresis. 73. The nurse is caring for a client receiving chemotherapy who is also receiving allopurinol. The nurse teaches that allopurinol is used to prevent emergent complications of chemotherapy. Including what signs and symptoms? a. Low platelets and low white blood cells (WBCs). b. Hypercalcemia and hyperkalemia: c. Hypokalemia and low platelets. d. Hypocalcemia and hyperphosphatemia. 74. The nurse is caring for a client with a malignant mediastinal mass. What is the priority nursing intervention? a. Administer ibuprofen as ordered to decrease inflammation. b. Position the client upright to promote venous return from the head. c. Place the client in Trendelenburg to decrease thoracic pressure. d. Give large volumes of fluid intravenously to increase preload. 75. The nurse is caring for a client, who is being treated for stage IV lung cancer with a large mass. When the client complains about new-onset back pain, what action should the nurse take first? A. Give the client the prescribed opioid for breakthrough pain. B. Assess the client for sensation and strength in the legs. C. Notify the health care provider about the new symptoms. D. Teach the client now to use relaxation to reduce pain. 76. The nurse is caring for a client with multiple myeloma. What is the highest priority nursing intervention? A. Bedrest to prevent the occurrence pathological fractures. B. Ensuring adequate hydration to prevent kidney damage. C. Assessing for size and characteristics of lymph nodes. D. Administration of intravenous immunoglobulin to prevent infection. 77. The nurse is caring for a client with enlarged cervical lymph nodes. What additional symptoms would indicate a possible diagnosis of Hodgkin's lymphoma? Select all that apply. A. Tender lymph nodes  B. Weight loss C. Weakness D. Bradycardia E. Movable lymph nodes 78. The nurse is caring for a client who has acute myelogenous leukemia (AML). When the client asks the nurse whether the planned chemotherapy will be worth undergoing. What 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 often goes into remission with chemotherapy.” c. “The decision about treatment is one that you and the doctor need to make rather than asking me what to do.” d. “You don't need to make a decision about treatment right now because leukemias n adults tend to progress slowly.” 79. The nurse is caring for a client with acute lymphocytic leukemia who is receiving chemotherapy. What laboratory test will the nurse use to determine whether filgrastim is effective for the client? a. Absolute neutrophil count b. Total lymphocyte count c. Reticulocyte count d. Platelet count 80. The nurse is presenting a community program to teach a group of well senior citizens about colon health. What information would be most appropriate to include? a. A good diet and exercise can prevent colon cancer. b. Diet should include foods that are high fiber and low fat. c. Ensure that a B-complex vitamin is taken daily to decrease risk. d. A bi-annual colonoscopy is suggested. 81. The nurse is teaching a client about an upcoming liver tumor debulking. What statement should the nurse include in the teaching? A. Abdominal pain will be relieved by cutting sensory nerves near the liver. B. Decreasing the tumor size will improve the effects of other therapies. C. Relieving the pressure in the abdomen will promote optimal nutrition intake. D. Tumor growth will be controlled by removing all the cancerous tissue. 82. The nurse is caring for a client with metastatic colon cancer who has severe vomiting after each administration of chemotherapy. What action by the nurse is appropriate? A. Have the client eat large meals when nausea is not present. B. Keep the client PO on days the client is receiving chemotherapy. C. Administer prophylactic antiemetics before the treatments. D. Keep the client on a low-fiber, low-residue diet to empty stomach quicker. 83. The nurse is teaching a client with a brain tumor about treatments. What statement should the nurse include in the teaching plan? A. Chemotherapy has limited usefulness because most types do not cross the blood-brain barrier. B. Radiation is contraindicated because it is very toxic to brain tissue. C. Surgery is not recommended because most tumors cannot be removed completely. D. The client will have a ventricular shunt placed with any other treatments. 84. The nurse is checking for risk factors related to oral and esophageal cancers. What question should the nurse include in the risk assessment? A. Have you had frequent ear infections? B. How many cavities have you had in your lifetime? C. Do you use sunscreen? D. Do you drink alcohol frequently? 85. The nurse is caring for a client with a change in mole size, accompanied by color changes, itching burning, and bleeding over the past month. What recommendation should the nurse make? a. Tell the client to watch the lesion and report back in 2 months. b. Refer the client because of the suspicion of melanoma based on her symptoms. c. Ask additional questions regarding irritants that may have caused this condition. d. Suspect that this is simply a normal change to a mole. 86. The nurse is caring for a group of clients. For each of the three clients, recommend hospice or palliative care. 1. A client with 2. A client with 3. A client with 87. Which of the following assessment findings of a client with terminal leukemia would indicate that death is imminent? SATA a. Mottling of the feet b. Kussmal respirations c. Urine output 900 mL/day d. Refusal of food and fluid e. irregular heart rhythm 88. The nurse is caring for a client with small cell lung cancer. What statement indicates teaching has been effective? a. “Chemotherapy will be my main treatment.” b. “I have a 55% chance of survival with radiation therapy." c. "Surgery will be necessary.” d. "Chemotherapy with radiation therapy will improve my prognosis.” 89. The nurse is caring for a client with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. A. Hemoglobin: 9 g/dL; hematocrit: 32% b. B. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased left breath sounds 90. The nurse is caring for a client who smokes. The client states, “I want to have a yearly chest x-ray so if I get cancer, it will be detected early.” What response by the nurse is most appropriate? a. "Chest ×-rays do not detect cancer until tumors are greater than 1 cm or larger." b. "Yearly chest x-rays will cause cancer due to exposure to radiation." c. "A bronchoscopy would be better to detect early lung cancer."  d. “A positive emission tomography (PET) scan is best for smokers.” 91. A community health nurse is teaching a group of women about breast cancer risk factors. Which client has the highest risk for development of breast cancer? A. Sister who started her menses at age 10 B. Sister who died from ovarian cancer at age 58 C. Mother who was diagnosed with breast cancer at age 42 D. Grandmother who dies from breast cancer at age 50 92. While caring for a 32-year-old client who had a radical mastectomy two days ago, the client is tearful and states, “My husband won’t find me attractive now.” What is the most appropriate nursing intervention? A. Encourage the client by telling her everything will be fine in a few months B. Provide reading material about coping and give her time alone C. Sit with the client and allow her to express her feelings D. Instruct the husband on how to be more compassionate 93. The nurse is caring for a client who would benefit from hospice care. What barrier may be encountered when discussing this option with the client and family? A. Medicare/insurance does not cover costs of hospice care. B. B. Some see hospice as “given up” since it’s not curative C. The belief by providers that the patient must be hemodynamically stable. D. Hospice care may not be done in the home by the family. 94. The nurse is caring for a client with syndrome of inappropriate antidiuretic syndrome (SIADH). What IV fluid would be most appropriate to administer? * A. 3% Sodium Chloride (NS) B. 0.9% Sodium Chloride (NS) C. 5% Dextrose D. Lactated Ringers (LR) 95. What assessment findings, of a client with terminal leukemia, indicated death is imminent? A. Mottling of the feet B. Restlessness C. Refusal of food and fluid D. Urine output of 960ml/day’ E. Cheyne-Strokes respirations  96. The nurse has performed discharge teaching for a client with diabetes insipidus. Which of the following statements indicates a need for further teaching? A. “I will wear my medical alert bracelet at all times. B. ”B. “I will gradually decrease my dose of vasopressin.” C. “I will weigh myself every day using the same scale.” D. “I will drink fluids equal to my urine output.” 97. The nurse is caring for a client who has adrenal insufficiency (Addison’s Disease). What statement by the client indicates understanding of discharge instructions? * A. “I should never change my medication dose without my health care provider.” B. “My condition is not one that is easily worsened by external stress.” C. “I should wear an alert bracelet at all times and carry medical identification.” D. “I won’t have to use replacement therapy for the rest of my life.” 98. The nurse is caring for a client who smokes. The client states “I want to have a yearly chest x-ray so that if I get cancer, it will be detected early.” What response by the nurse is most appropriate? * A. “A bronchoscopy would be better to detect early lung cancer.” B. B. “Chest x-rays do not detect cancer until tumors are larger.” C. “A positive emission tomography (PET) scan is bet for smokers.” D. “Yearly chest x-rays cause cancer due to exposure to radiation.” 99. The nurse is caring for a client diagnosed with Addisonian crisis. What findings are expected? * A. Blood pressure 86/41mmHG B. Potassium 5.9mEq/LC. Sodium 128mEq/L C. Calcium 7.8mg/dL D. Heart rate 52 bpm 100. A client with possible pheochromocytoma is admitted for evaluation and diagnostic testing. What signs and symptoms will the nurse assess for during an episodic attack? A. Hypoglycemia B. Hyperkalemia C. Headache D. Hypotension 101. A client undergoing chemotherapy reports, “I am so tired I can hardly get out of bed in the morning.” What is the most appropriate intervention for the nurse to suggest to the client?  A. Follow a daily jogging program to improve stamina B. Take your furosemide (Lasix) in the morning to sleep better at night C. Strict bed rest until treatment is completed D. Group activities together and plan for rest periods in between 102. The nurse is caring for a client with colorectal cancer who will undergo external –beam pelvic radiation. What action is most appropriate to include in the teaching plan? A. Inspect the mouth and throat for thrush B. Test all stools for the presence of blood C. Encourage sitz baths and meticulous cleaning D. Maintain a high-carbohydrate diet 103. A client has develop syndrome of inappropriate antidiuretic hormone (SIADH). Which findings does the nurse anticipate finding? * A. Low urine output and high serum sodium B. Low urine specific gravity and high serum sodium C. High urine and high serum sodium D. High urine specific gravity and low serum sodium 104. The nurse is caring for client prescribed hydrocortisone 25mg by mouth for adrenal insufficiency. Which of the following best indicates the medication is effective? * A. Decreased blood pressure and serum sodium level B. Decreased appetite and weight loss C. Decreased hyperexcitability and restlessness D. Decreased weakness and fatigue 105. The client is being discharged with a prescription for tamoxifen to decrease the chance of breast cancer recurrence. What statement by the client indicates additional teaching is needed? A. “I should report for any visual changes.” B. “I should get up and move frequently to prevent blood clots.” C. C. “I should expect to have this medication for the rest of my life.” D. “I should have crackers and ginger ale on hand.” 106. The nurse is teaching a client that had an outpatient transrectal ultrasound with prostate biopsy. What information should be included in the teaching plan? A. Report fever, chills, and difficulty voiding B. Expect gross hematuria for three to four days  C. Avoid sexual intercourse for six weeks D. Remove perineal dressing in 24 hours 107. The nurse is caring for a client who has Graves Disease. What clinical manifestation would the nurse expect to find? A. Cool skin, thickening of nails, thinning hair B. Slower heart rate, thrombocytopenia, increase breathing capacity C. Goiter, exophthalmos, and palpitations D. Decreased cardiac output, constipation, and decreased bowel sounds 108. A client has develop syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate the treatment goals for this client have been met? * A. Decrease in urine output and decrease urine osmolality B. Increase in urine output and increase in urine osmolality C. Decrease in body weight and absence of wheezes E. Increase in blood pressure and increase in body weight 109. The nurse is caring for a client with diabetes insipidus prescribed desmopressin acetate (DDVAP), a nasal vasopressin spray. What signs and symptoms indicate the medication is not having an adequate therapeutic effect? A. Headache and weight gain B. Nasal irritation and nausea C. An oral intake greater than urinary output D. A urine specific gravity of 1.002 110. The nurse has been informed that a client has a platelet count of 54,000 and WBC of 8,000. What is the priority intervention in planning care for a client? A. Encourage the use of soft bristle tooth brush B. Take the temperature every 4 hours C. Remove flowers from the room D. Implement strict handwashing 111. The nurse is planning care for a client recovering from a transphenoidal hypophysectomy. What nursing interventions would be included in the plan of care for this client? SATA * A. Teach client to cough and deep breathe B. Teach client to notify nurse of post-nasal drip C. Assess neurological status every hour for first 24 hours  D. Teach client to use soft bristle toothbrush E. Maintain hourly intake and output record 112. The nurse is caring for a client with xerostomia. What is the most appropriate nursing action to avoid potential complication? * A. Administer analgesics before meals to reduce pain B. Provide frequent oral care throughout the day C. Provide saline and water to rinse mouth at night D. Advise the client to see a dentist very two months 113. A client with hyperaldosteronism is scheduled for an adrenalectomy. Prior to surgery, what nursing intervention be a priority? A. Monitor the blood pressure B. Provide potassium restricted diet C. Encourage fluids D. Elevate the patient’s extremities to retrieve edema 114. The nurse is caring for a client who has multiple myeloma. What is the most important aspect of care? A. The client may develop a decrease in sedation in the extremities B. Assessment will include review of electrolytes and renal function C. The final stage of the disease is extended giving the patient time to adapt D. Pain control will require large doses of opioid narcotic medications 115. The nurse is performing discharge teaching for a client that had a radical mastectomy and lymph node dissection. Which actions would be appropriate to add to the teaching plan? A. Return to the clinic in two weeks to have the drain emptied B. Elevate the affected area, even while sleeping C. Perform arm exercised daily D. Avoid using acetaminophen for pain E. Avoid future invasive procedures on the affected arm 116. The charge nurse is assigning rooms for four new clients. Only one private room is available on the oncology unit. Which client should be placed in the private room? A. The client with ovarian cancer who is receiving chemotherapy B. The client with breast cancer who is receiving external beam radiation C. C. The client with cervical cancer who is receiving intra-cavitary radiation  D. The client with prostate cancer who has just had a transurethral resection 117. The nurse is performing an admission assessment for a client with Cushing’s syndrome. What assessment finding might be present? * A. Alopecia B. Hyperglycemia C. Bulging eyes D. Poor wound healing E. Truncal obesity 118. The nurse is checking for risk factors to oral, throat, and esophageal cancer. What question should the nurse include in the risk assessment? * A. Have you used chewing tobacco in the past? B. How many cavities have you had in your lifetime? C. Have you had frequent visual problems? D. Did you throw up a lot when you were a child? 119. The nurse is caring for a client receiving propylthiouracil (PTU) for hyperthyroidism. What indicates the medication is effective? * A. Increase in body weight and decrease in pulse rate B. Increase in basal metabolic rate and decrease in body weight C. Increase in respiration and decrease in appetite D. Increase in protein binding of iron and decrease in iron levels 120. The nurse is educating a client with stomatitis. What information would be most appropriate to teach the client? A. Rinse their mouth with hot water and viscous lidocaine after meals and as needed B. Rinse their mouth with baking soda and warm water C. Rinse their mouth with hydrogen peroxide and use a baking soda paste on sores D. Rinse their mouth with water after smoking or eating acidic foods 121. The nurse is caring for a client receiving Levothyroxine Sodium (Synthroid) and notes the thyroid stimulating hormone (TSH) level is elevated. What change in the plan of care should the nurse anticipate regarding this finding? * A. The medication dosage will be decreased B. The medication dosage will be increased C. The medication dosage will not be changed  C. The medication will be discontinued 122. The nurse is planning discharge teaching for a client with hypothyroidism. Which of the following diet characteristics should be included in the teaching plan for the client? A. Restricted fluids and low protein B. High carbohydrate and low fiber C. High protein and high calorie D. D. High fiber and low calorie 123. The nurse has completed teaching for a client that had a malignant melanoma removed. What statement by the client best indicates teaching has been effective? * A. “I will wear SPF 15 sunscreen when going out on a boat.” B. “I will avoid sun exposure between 11am and 3pm.” C. “I will make an appointment every 3 years for a skin cancer check.” D. “Melanoma rarely metastasizes.” 124. Which assessment finding could indicate the onset of thyroid storm? A. Increased heart and increased temperature B. Exophthalmos C. ECG changed of tall peaked T waves D. Numbness and tingling in extremities 125. The nurse is caring for a client with diabetes insipidus. What is the priority nursing intervention for the disease process? A. Adequate fluid replacement B. Obtaining daily weights C. Administering 3% normal saline D. Ambulating client TID 126. The nurse is preparing to administer a chemotherapeutic agent to a 74kg client. The prescription/order sate to give 0.5mg/kg, with a safe dose rang of 20-35mg. The nurse calculates the correct dose as 37mg. the nurse recognizes this dose as not safe. * 127. The nurse is caring for a client who has been admitted due to a persistent hoarse cough and a smoking history of 30 years. What possible diagnostic studies would the nurse expect to see ordered/prescribed? SATA * A. PET B. Chest X-rayC. MRI  D. Sputum culture E. Needle biopsy 128. The nurse is caring for a client who has a high risk for development of breast cancer and has been taking high- dose tamoxifen for the past 2 years. What symptom will the nurse teach the client to report? A. Hot flashes B. Vaginal discharge C. Mood swings D. Visual disturbance 129. The nurse is caring for a client with colon cancer who will undergo an external-beam pelvic radiation. What action is most appropriate to include in the teaching plan? A. Test all stools for the presence of blood B. B. Encourage lukewarm sitz baths C. Polyps are a risk factor for colon cancer D. ? 130. The nurse is caring for a Hispanic woman diagnosed with HPV. Assessment data reveals a thin, watery discharge and scant vaginal bleeding. Based upon these symptoms, what would be a priority diagnostic test? A. Pelvic examination with a salpingogram Rationale: A PAP test is used to determine the presence of cervical cells changes as associated with precancerous changes. Hispanic women are most likely to be diagnosed with cervical cancer. A risk factor for cervical cancer is infection with high-risk strains of HPV 16 and 18. Symptoms of HPS include thin, watery vaginal discharge and vaginal bleeding (spotting). HPV testing is done by obtaining cervical scrapings and sending them for testing of viral DNA or RNA. Vaginal examination with a salpingogram is used to diagnose uterine fibroids. A transvaginal ultrasound is used for diagnosis of ovarian cancer. 131. The nurse is caring for a client with acute lymphoid leukemia (ALL). What clinical findings would the nurse expect? SATA table 30.24 A. Enlarged lymph nodes B. Fatigue C. Pallor D. Weight gain E. Bleeding gums 132. The nurse is caring for a client who is beginning chemotherapy and at risk for tumor lysis syndrome and volume depletion. What is the priority nursing intervention for the nurse to implement to preventthese complications? A. Maintain strict intake and output measurements  B. Monitor uric acid C. IV hydration as ordered D. ? Rationale: Tumor Lysis Syndrome is a complication of chemotherapy as a result of rapid cell destruction and the inability of the kidneys to clear the debris. It occurs primarily in tumors with rapid replication/. Prevention is the best defense. Maintaining adequate kidney functions essential. Of the answer choices,the only one that will prevent complications is to maintain adequate hydration with IV fluids. The patient should not be diuresis as this will further dehydrate the patient. All of the other interventions are important but are not preventative. Lewis page 261. 133. The nurse is caring for a client with enlarged cervical lymph nodes. What additional symptoms would indicate a possible diagnosis of Hodgkin’s lymphoma? SATA * A. Weight loss B. Bradycardia C. Tender lymph nodes D. Movable lymph nodes E. Weakness 134. The nurse is providing care for a hospice client. What signs/symptoms would indicate the client is approaching imminent death? SATA * A. Cold, clammy skin B. Loss of muscle movement C. Cheyne-strokes respirations D. Increased blood pressure E. Mottling of hands 135. The spouse of a 72 year old client diagnosed with early stage prostate cancer asks the nurse “Why isn’t the healthcare provider treating my husband’s cancer? The best response by the nurse would be? * A. Watchful waiting is often appropriate for men over the age of 70 B. The client must have stage IV prostate cancer before receiving treatment C. Prostate cancer is never treated in men over the age of 70 D. The client is being treated with hormone therapy 136. What would the nurse expect to see on the biopsy report for a client that has had a biopsy to diagnose Hodgkin’s disease? A. Reed Sternberg cells B. Gaucher cells  C. Bence Jones cells D. Ryan cells 137. A client is receiving chemotherapy is also receiving allopurinol and busulfan. The nurse teaches the allopurinol is to prevent emergent complications of chemotherapy, including what signs and symptoms? Pg.261 * A. Hypercalcemia and hyperkalemia B. Low platelets and low white blood cells (WBC’s) C. Hypokalemia and low platelets D. Hypocalcemia and hyperphosphatemia 138. The nurse is caring for a client receiving a continuous ACTH infusion over 24 hours. Which changes are expected if the endocrine negative feedback loops are normal? A. Higher-then-normal cortisol levels; lower-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. B. Lower-than-normal serum cortisol levels; lower-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. C. Higher-than-normal serum cortisol levels; higher-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. D. Lower-than-normal serum cortisol levels; higher-than-normal serum Corticotrophin Releasing Hormone (CRH) levels. 139. The nurse is caring for a client undergoing external radiation. What statement best indicated teaching has been effective regarding dry desquamation? Table 15.12 A. “I can apply aloe gel to the area to help with discomfort as needed.” B. “I can use ice packs on the area to relieve swelling.” C. “I can scrub the area with warm soap and water to relieve itching.” D. “I can apply a heating pad to the area to relieve discomfort.” 140. A 32-year-old client is being seen in the office following 3 weeks after a radical mastectomy. Which statement by the client best indicates the client is experiencing appropriate coping? A. “I am doing fantastic since the surgery and I’m back to jogging.” B. “I have been helping my family deal with their feelings about the surgery.” C. C.”I have been having difficulty coping with the surgery and cry sometimes.” D. “I have been unable to leave the house or talk to my friends about the surgery.” 141. The nurse is caring for a client diagnosed with Hodgkin’s lymphoma. What will the nurse include in the plan of care? A. Obtaining consent for a bone marrow biopsy to determine response to therapy  B. Teach the client about B symptoms and the need for 2-4 cycles of chemotherapy C. Monitor for presence of M protein in urine D. Increase fluids to manage hypercalcemia 142. The nurse is caring for a 24-year-old client with testicular cancer scheduled to begin treatment. He says “I don’t know why I should bother with this treatment. This cancer is going to kill me anyways. What do you think?” What is the best response? A. “Treatment for testicular cancer works well and the odds of complete remission are good” B. “Why do you say that? C. “You think your cancer is going to kill you despite treatment?” D. “I don’t know, what did your doctor say? 143. The nurse is reinforcing reaching with a 72 year old client regarding early stage prostate cancer asks the nurse. What statement by the client would require follow-up by the nurse? A. “Because the cancer grows slowly my physician will take a conservative approach” B. “My age is a factor that contributes to my treatment plan.” C. “My physician will recommend surgery to prevent the cancer from spreading.” D. “I will have to have my prostate-specific antigen (PSA) monitored regularly.” 144. The nurse is presenting a community program to teach a group of well senior citizens about colon health. Which information would be most appropriate to include? * A. A bi-annual colonoscopy is suggested B. Ensure that a B-complex vitamin is taken daily to decrease risk C. A good diet and exercise can prevent colon cancer D. Diet should include food that high fiber and low fat 145. The nurse is caring for a client with lung cancer. Which finding indicates the development of the syndrome of inappropriate antidiuretic hormone (SIADH)? A. Diminished level of consciousness B. Twitching of hands and tingling of the lips C. Rapid increase in urine output to 400ml/hour D. Low urine osmolality 146. The nurse is developing a plan of care with multiple myeloma. What is the priority intervention to include in the plan of car? * A. Providing oral care B. Monitoring red blood cells  C. Encouraging fluids D. Coughing and deep breathing 147. The nurse is preparing to teach a community class about colon cancer. What risk factors are most appropriate to include the teaching plan? A. Age over 65 and high-fiber diet B. History of pancreatitis and polyps C. Sedentary lifestyles and vegetarian diet D. High fat diet and alcohol consumption 148. The nurse is caring for a client diagnosed with liver cancer. The client wants to know why chemotherapy is being given regional perfusion instead of intravenously. What reason will nurse explain to the client? A. “Drug therapy can be continued at home with little difficulty.” B. “Toxic effects of chemotherapeutic drugs are confined to the C. C. Deliver to actual site of the tumor Rationale: Regional perfusion permits relative isolation of the tumor and saturation the drug(s) selected. This method of drug administration requires medical and nursing supervision and cannot be continued at home. Although toxic effect are confined mainly to the treated area, some migration may still occur. Combinations of chemotherapeutic drugs are administered via intravenous or oral routes, not via regional perfusion. 149.A community health nurse is teaching a group of women about breast cancer risk factors. Which client has the highest risk for developing breast cancer? Mother who was diagnosed with breast cancer at age 42 150.While caring for a 32-year-old client who had a radical mastectomy two days ago, the client is tearful and states, “My husband won’t find me attractive now.” What is the most appropriate nursing intervention? Sit with the client and allow her to express her feelings 151.The nurse is caring for a client who would benefit from hospice care. What barrier may be encountered when discussing this option with the client and family? Some see hospice as “Giving up” since it is not curative 152.A client undergoing chemotherapy reports, “I am so tired I can hardly get out of bed in the morning.” What is the most appropriate intervention for the nurse to suggest to the client? Group activities together and plan for rest periods in between 153.The nurse is caring for a client with syndrome of inappropriate antidiuretic syndrome (SIADH). What IV fluid would be most appropriate to administer? 3% sodium chloride (NS) 154.What assessment findings of a client with terminal leukemia, indicate death is imminent? SATA A. Mottling of the feet/hands B. Restlessness C. Refusal of food and fluids D. Cheyne stokes respirations E. Loss of muscle movement F. Cold, clammy skin 155.The spouse of a 72-year-old client diagnosed with early-stage prostate cancer asks the nurse “Why does the health care provide treating my husband cancer? The best response by the nurse would be? Watchful waiting is often appropriate for men over the age of 70 156.The nurse has performed discharge teaching for a client with diabetes insipidus. Which of the following statements indicate a need for further teaching? I will gradually decrease my dose of vasopressin 157.The community health nurse is preparing to teach a group of adults about smoking and cancer prevention. The nurse would explain that which. Symptoms of lung cancer is typically noticed first. Persistent cough 158.The nurse is teaching a client that had an outpatient transrectal ultrasound with prostate biopsy. What information should be included in the teaching plan? Reports fever, chills, and difficulty voiding. 159.The nurse is caring for a client who has adrenal insufficiency. (Addison's disease). What statement by the client indicates understanding of the discharge instruction? I should always wear an alert bracelet and carry medical identification. 160.The nurse caring for a client who smokes. The client states, “I want to have a yearly chest X ray so that if I get cancer, it would be detected early. What response by the nurse is most appropriate? Chest X rays do not detect cancer until two months and larger. 161.The nurse is caring for a client diagnosed with Addisonian crisis. What findings are expected? A. Blood pressure 86. / 41mm Hg. B. Potassium 5.9 mEg/L. C. Sodium 128 mEg/L. 162.The nurse is caring for a client receiving a continuous ACTH infusion over 24 hours. Which changes are expected if the endocrine negative feedback loops are normal? Higher than normal cortisol levels, lower than normal serum Corticotrophin Releasing Hormone (CRH) levels. 163.What would the nurse expect to see on the biopsy report for a client that has had a biopsy to diagnose Hodgkin's disease? Reed Sternberg cells. 164.The nurse is caring for a client prescribed hydrocortisone 25 milligram by mouth for adrenal insufficiency, which of the following best indicates the medication is effective. Decrease weakness and fatigue. 165.A client is diagnosed. With multiple myeloma and ask the nurse about the diagnosis. The knows bases the response on what description disorder. Malignant Proliferation of plasma cells. 166.The client Is being discharged with a prescription for tamoxifen to decrease the chance of breast cancer recurrence. What statement by the client indicates additional teaching is needed? I should expect to take this medication for the rest of my life. 167.The nurse is caring for a client with a radium implant. What is the best action by the nurse? Utilize the phone to answer any lengthy questions. 168.The 24-year-old client with testicular cancer is scheduled to begin treatment. What priority intervention should the nurse implement? Discuss the important of sperm banking before treatment begins. 169.A client has developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings does the nurse anticipate finding? High urine specific gravity and low serum sodium. 170.A client receiving chemotherapy is also receiving allopurinol and busulfan. The nurse teaches the allopurinol is to prevent emergency complications of chemotherapy, including what signs and symptoms? Hypocalcemia and hyperphosphatemia. 171.The nurse is caring for a client with colorectal cancer who will undergo external beam pelvic radiation. What is the most appropriate to include in the teaching plan? Encourage sitz bath and meticulous cleaning. 172.The nurse is caring for a client with diabetes insipidus, prescribed nasal desmopressin, acetate, (DDAVP), a nasal vasopressin spray. What signs or symptoms indicates the medication is not having an adequate therapeutic effect? A urine gravity of 1.002 173.The nurse is performing discharge teaching for a client that had a radical mastectomy and lymph node dissection. Which actions would be appropriate to add to the teaching plan? A. Elevates the affected arm even while sleeping. B. Perform arm exercises daily. C. Avoid future invasive procedures on the affected arm. 174.The nurse is caring for a client who has grave disease. What clinical manifestations would the nurse expect to find? Goiter, exophthalmos, and palpitations.The nurse has performed discharge teaching for a client with diabetes insipidus. Which of the following statements indicates a need for further teaching?  I will drink fluids equal to my urine output. 175.The client has developed syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicates the treatment goals for this client have been met? Decrease in body weight and absence of wheezes 176.The nurse is caring for a client with xerostomia. What is the most appropriate nursing action to avoid potential complication? Provide saline and water to rinse mouth at night 177.A client with possible pheochromocytoma is admitted for evaluation and diagnostic testing. What signs and symptoms will the nurse assess for during an episodic attack? Headache 178.The nurse has been informed a client has a platelet counts of 54,000 and WBC of 8,000. What is the priority intervention in planning cared for the client? Encourage the use of soft bristle toothbrush 179.The nurse is planning care for a client recovering from a transsphenoidal hypophysectomy. What nursing interventions would be included in the plan of care for this client? SATA B. Teach the client to notify nurse of postnasal drip C. Assess neurological status every hour for first 24hrs E. Maintain hourly intake and output 180.A client with hyperaldosteronism is scheduled for an adrenalectomy. Prior to surgery, what intervention would be a priority? Monitor the blood pressure 181.The nurse is caring for a client receiving propylthiouracil (PTU) for hyperthyroidism, what indicates the medication is effective? 182.The charge nurse is assigning rooms for four new clients. Only one private room is available on the oncology unit. Which client should be placed in the private room? The client with cervical cancer who is receiving intra-cavitary radiation 183.The nurse is caring for a client who has multiple myeloma. What is the most important aspect of care? Assessment will include review of electrolytes and renal function 184.The nurse he's performing an admission assessment for the client with Cushing syndrome. What assessment findings might be present? SATA A. Alopecia B. Hyperglycemia. C. Poor wound healing D. Truncal obesity. 185.The nurse is educating a client with stomatitis. What information would be most appropriate to teach  the client? Rinse the mouth with baking soda and warm water after meals. 186.The nurse is checking for risk factors related to oral, throat, and esophageal cancer. What question should the nurse include in the risk assessment? Have you used chewing tobacco in the past? 187.The nurse is caring for a client receiving levothyroxine sodium (Synthroid) and note the thyroid stimulating hormone (TSH) level is a little bit elevated. What changes in the plan of care should the nurse anticipate regarding this finding? The medication dosage will be increase 188.The nurse is planning discharge teaching for a client with hypothyroidism. Which of the following diet characteristics should be included in the teaching plan for this client? High fiber and low calories 189.The nurse is performing discharge teaching for a client that had a radical mastectomy and lymph node dissection. Which action would be appropriate to hard to the teaching plan? A. Elevate the affected home even while sleeping. B. Perform an exercise daily. C. Avoid future invasive procedure on the affected arm. 190.Which assessment findings could indicate the onset of thyroid storm Increased heart rate and increased temperature? 191.The nurse is caring for a client with diabetes insipidus. What is the priority nursing intervention for this disease process? Adequate fluid replacement 192.The nurse has completed teaching for a client that had a malignant Melanoma remove. What statement by the clients best indicates that teaching has been effective? I will avoid sun exposure between 11am-3pm 193.The nurse is caring for a patient with systemic lupus erythematosus. what is the most likely complication? Renal insufficient. 194.The nurse is caring for a client who has been admitted due to a persistent hoarse cough and a smoking history of 30 years. What possible diagnostic studies would the nurse expect to see ordered/prescribed? SATA A. PET B. Chest x-ray C. MRI D. Needle biopsy 195.The nurse is caring for a client who has a high risk for development of breast cancer and has been taking high dose tamoxifen for the past two years. What symptoms will the nurse teach the client to report? Visual disturbance 196.The nurse is caring for a client with colon cancer who will undergo external beam pelvic radiation. What action is most appropriate to include in the teaching plan? Encourage Lukewarm sitz baths. 197.The nurse is caring for a client diagnosed with liver cancer. The client wants to know why chemotherapy is being given by regional perfusion instead of intravenously. What reason will the nurse explain to the client? 198.The nurse is caring for a Hispanic woman diagnosed with HPV assessment data reveals a thin watery discharge and scant vaginal bleeding. Based upon the symptoms, what would be a priority diagnostic test? A PAP tests 199.The nurses caring for a client with a T4 spinal cord injury. when the client suddenly feels flushed and DIAPHORETIC What is the priority action for the nurse to take? The patient should be sit upright to decrease their blood pressure. 200.The nurse is caring for a client with acute lymphoid leukemia. (ALL) What clinical findings would the nurse expect? SATA. A. Enlarge lymph nodes B. Fatigue, C. Pallor. D. Bleeding gums 201.The nurse is caring for a client who is beginning chemotherapy and at risk for tumor lysis syndrome and volume depletion. What is the nursing intervention for thew nurse to implement to prevent these complications? Maintain adequate hydration with IV fluids 202.The nurse is caring for a client with enlarge cervical lymph nodes. What additional symptoms would indicate a possible diagnosis of Hodgkin’s lymphoma? SATA A. Weight loss B. Movable lymph nodes C. Weakness 203.A client is diagnosed with multiple myeloma and asks the nurse about the diagnosis. The nurse bases the response on what description disorder? Malignant proliferation of plasma cel 204.The nurse teaching a community about the risks for basal cell carcinoma. What element should the nurse include in the teaching plan?  Basal cell carcinoma Is locally invasive cancer 205.The nurse is caring for a client with non-small cell lung cancer (NSCLC). The nurse understands what factor increases the client’s risk for tumor lysis syndrome. Chemotherapy began 2 days ago. 206.The nurse is caring for a client who has been administered and IV Vesicant chemotherapeutic agents. Complications related to infusing chemotherapy agents would lead to what priority nursing intervention Request the health care professional prescribe placement of peripherally placed central catheter. 207.The nurse is caring for a client having diagnostic testing for the possibility of colon cancer. What assessment finding leads to the nurse to suspect a right sided tumor? Diarrhea 208.The nurse is caring for a client with Addison's disease who is in crisis. What is the priority nursing intervention? Administer IV Hydrocortisone 209.The nurse is caring for a client with primary hyperparathyroidism. The last lab values include a serum phosphorus level of 1.7 mg/dL and calcium of 14 mg/dL. What nursing action should be included in the plan of care? Monitor clients, fluid intake and output. 210.The nurse is caring for a client diagnosed with Addisonian crisis. What findings are expected? SATA A. Blood pressure 86 / 41 mm Hg B. Potassium. 5.9 meq/L C. Sodium 128 meq/L. 211.The nurse is caring for a client with lymphoma who has a central venous catheter for chemotherapy. The nurse notes that the client has developed severe facial swelling and a headache. What complication should the nurse suspect? Superior vena cava syndrome 212.The nurse is caring for a client adrenal medulla tumor who has a sudden severe hypertensive event. The nurse recognizes that the 24-hour urine specimen will show what abnormality? Fractionated Metanephrines 213.The nurse is assessing a 30-year-old client for risk factors for breast cancer. What risk factors would place the client at risk for breast cancer earlier than age 50? SATA A. Client started taking extra gene-based birth control at age 12. B. Client began smoking at age 15 to 16 years old. C. Family history of breast cancer. D. Client began menstruating at age 10. 214.The nurse is caring for a client with primary hypothyroidism. What assessment findings required. Immediate notification to the health care provider.  Increase weakness and lethargy 215.The nurse is completing a physical assessment on a client and notes hyperpigmentation of the skin in the Palmer creases. What is most likely the cause of these findings? Increase ACTH. 216.Which conditions may lead the nurse to suspect that a client is at risk for colorectal cancer? Polyps and a BMI of 42. 217.The nurse is caring for a client with enlarged cervical lymph nodes. What additional symptoms would indicate a possible diagnosis of Hodgkin's lymphoma? A. Weakness B. Weight loss C. Movable lymph nodes 218.The nurse is caring for a client with small cell lung cancer. What statement indicate teaching has been effective? Chemotherapy will be my main treatment. 219.A 32-year-old client is being seen in the office 3 weeks after a radical mastectomy. What statement by the client Best indicates the client is experiencing appropriate coping? I have been having difficulty coping with the surgery and cry sometimes. 220.The nurse is caring for a client who received chemotherapy for leukemia 24 hours ago and has had a decrease in urine output to 30ml/hour. What condition is the most likely cause of the client symptoms? Tumor lysis syndrome? 221.The nurse is caring for a client with hypoparathyroidism. When the client has tingling of the lips, smooth muscle spasm, and dysphagia, what is the priority intervention? Administer calcium IV over 30 minutes. 222.A nurse is caring for a client with breast cancer who is to undergo lymphatic mapping and sentinel lymph node dissection (SLND). What should the nurse explain in the purpose of this procedure? Stages the cancer by identifying lymph nodes draining from the tumor site. 223.The nurse is planning care for a client recovering from a transsphenoidal hypophysectomy what nursing interventions would be included? In the plan of care. A. Monitor for nasal drainage. B. Maintain head of bed at 30 degrees at all times. C. Access neurological status every hour for first 24 hours. 224.The nurse is caring for a client with myxedema. What findings indicate immediate intervention is needed? Lethargy and temperature 96.0 F 225.The nurse is caring for a client with left sided lung cancer. Which finding would be most important for  the nurse to report to the health care provider. Serum sodium of 126mEq/L 226.Is caring for a client prescribed nasal desmopressin acetate (DDAVP). What signs of symptoms indicate the medication is having the desired therapeutic effect? Increase in urine osmolarity 227.Pheochromocytoma: excessive secretion of catecholamine (Alpha & Beta RECEPTORS): Dopamine, epinephrine (adrenaline), and norepinephrine: hallmark sign HTN & HTN Crisis : DO NOT palpate abdomen 228.Which hormone changes should the nurse expect when a pt receives a continuous ACTH infusion if negative feedback loops are normal: higher than normal cortisol levels, lower than normal serum CRH levels 229.Know if TSH is high and T3 T4 is high should you decrease, increase, or keep levothyroxine (Synthroid) dose the same 230.With increase in ACTH - cortisol leave will be high 231.S/S of hyperparathyroidism - nurse watches for heart dysrhythmias 232.If TSH levels are high - increases levothyroxine dose 233.S/S hypocalcemia - Trousseau sign, Chvostek sign, numbness and tingling ( also signs of hyperphosphatemia) 234.Know hypo aldosterone - fluid and hyperkalemia 235.Hyperaldosteronism - FVO hypokalemia 236.SIADH - low sodium and high fluids 237.After a thyroidectomy have SATA: trach kit, suction, IV calcium gluconate, humidified O2 238.DI? - vasopressin, low specific gravity 239.SIADH - high specific gravity and low osmo