Nursing Practice Exam Questions (PDF)

Cellular regulation 25-30 Giddens: Concepts for Nursing Practice, 3rd Edition MULTIPLE CHOICE 1. Which of the following options should the nurse incorporate into the plan of care as a primary prevention strategy for reduction of the risk for cancer? a. Yearly mammography for women aged 40 years and...

Cellular regulation 25-30 Giddens: Concepts for Nursing Practice, 3rd Edition MULTIPLE CHOICE 1. Which of the following options should the nurse incorporate into the plan of care as a primary prevention strategy for reduction of the risk for cancer? a. Yearly mammography for women aged 40 years and older b. Using skin protection during sun exposure while at the beach c. Colonoscopy at age 50 and every 10 years as follow-up d. Yearly prostate specific antigen (PSA) and digital rectal exam for men aged 50 and over ANS: B Primary prevention of cancer involves avoidance to known causes of cancer, such as sun exposure. Secondary screening involves physical and diagnostic examination. OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 2. While the nurse is collecting a health history on a patient admitted for colon cancer, which of the following questions should the nurse ask as a priority? a. “Have you noticed any blood in your stool?” b. “Have you been experiencing nausea?” c. “Do you have back pain?” d. “Have you noticed any swelling in your abdomen?” ANS: A Early colon cancer is often asymptomatic, with occult or frank blood in the stool being an assessment finding in a patient diagnosed with colon cancer. If pain is present, it is usually lower abdominal cramping. Constipation and diarrhea are more frequent findings than nausea or ascites. OBJ: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential 3. While planning care for a patient experiencing fatigue due to chemotherapy, which of the following is the most appropriate nursing intervention? a. Prioritization and administration of nursing care throughout the day b. Completing all nursing care in the morning so the patient can rest the remainder of the day c. Completing all nursing care in the evening when the patient is more rested d. Limiting visitors, thus promoting the maximal amount of hours for sleep ANS: A Pacing activities throughout the day conserves energy, and nursing care should be paced as well. Fatigue is a common side effect of cancer and treatment; and while adequate sleep is important, an increase in the number of hours slept will not resolve the fatigue. Restriction of visitors does not promote healthy coping and can result in feelings of isolation. OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance TEST BANK FOR CONCEPTS FOR NURSING PRACTICE 3RD EDITION BY GIDDENS 4. The nurse is caring for a patient who received a recent bone marrow transplant. The nurse would monitor for which of the following clinical manifestations that could indicate a potentially life-threatening situation? a. Mucositis b. Confusion c. Depression d. Mild temperature elevation ANS: D The earliest sign of infection in an immunosuppressed patient can be a mild fever. Mucositis, confusion, and depression are possible clinical manifestations but are representative of less life-threatening complications. OBJ: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential 5. While the nurse is obtaining the health history of a 75-year-old female patient, which of the following has the greatest implication for the development of cancer? a. Being a woman b. Family history of hypertension c. Cigarette smoking as a teenager d. Advancing age ANS: D Aging is a non-modifiable risk factor for the development of cancer with an associated increase seen with aging. In terms of gender and age, lifetime risk is higher for males than females. Family history of co-morbidities such as hypertension is not directly correlated with cancer development. Cigarette smoking as a teenager for the patient is a risk factor but may have mitigated impact at this point in time based on the patient’s stated age and length of time as a non-smoker. OBJ: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential 6. In caring for a patient admitted with lung cancer, which of the following should the nurse expect to find on assessment? a. No use of accessory muscles during respirations b. Orthostatic hypotension upon change of positioning c. Clear sputum d. Weight loss compared to last admission ANS: D Common signs/symptoms of lung cancer include coughing, hemoptysis, and weight loss, shortness of breath and chest pain. The nurse should expect to see weight loss and altered breathing patterns. Clear sputum and orthostatic blood pressure changes would not be seen. OBJ: NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation 7. A female patient complains of a “scab that just won’t heal” under her left breast. During your conversation, she also mentions chronic fatigue, loss of appetite, and slight cough, attributed to allergies. What is the nurse’s best action? a. Continue to conduct a symptom analysis to better understand the patient’s symptoms and concerns. b. End the appointment and tell the patient to use skin protection during sun exposure. c. Suggest further testing with a cancer specialist and provide the appropriate literature. d. Tell her to put a bandage on the scab and set a follow-up appointment in 1 week. ANS: A A comprehensive health history is vital to treating and caring for the patient. Often times, symptoms are vague. The nurse should conduct a symptom analysis to gather as much information as possible. Questions should address the duration of the symptoms and include the location, characteristics, aggravating and relief factors, and any treatments taken thus far. OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 8. A patient with prostate cancer is taking hormonal therapy to control tumor growth. He reports that his left calf is swollen and painful. Which of the following would be the nurse’s best action? a. Instruct the patient to keep the leg elevated. b. Measure the calf circumference and compare the measurement with the right calf circumference measurement. c. Apply ice to the calf after a 10-minute massage of the area. d. Document assessment findings as an expected response with estrogen therapy. ANS: B A nurse should be aware of potential complications from hormonal therapy such as the development of thrombus formation. Massaging a calf that is swollen and painful is never correct, because this action might break a clot, causing formation of an embolus, which could then travel to the lungs. OBJ: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential 9. A patient being evaluated for breast cancer is not certain whether she and her family should participate in a genetic screening plan since no one can guarantee the results. What is the nurse’s best response? a. “If you have a family history of breast cancer, the chances for you to have this type of cancer increases.” b. “The decision is up to you in the final analysis.” c. “If there is no family history, then there is no need to go through the process.” d. “If your insurance will pay for the screening, then there is no associated risk.” ANS: A Individuals with a family history of breast cancer (especially 1st degree relatives) are at increased risk for disease occurrence. The nurse should inform the patient of the outcome measures of the screening plan. The nurse should not dissuade the patient from the process based on stating there is no family history, as there is no evidence that an adequate family history has been obtained. Similarly, to correlate the need for genetic testing with insurance and no implied risk cannot be stated equivocally. Although the decision is up to the patient in the final analysis, that response does not address relevant information about the purpose of genetic screening. OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 10. A nurse is reviewing assessment findings for a female patient admitted to the oncology unit. Which finding should alert the nurse to contact the physician? a. Blood pressure 130/88 b. Noticeable difference in circumference of lower legs c. Presence of goiter previously identified on prior admission d. Negative guaiac test ANS: B Examination findings relative to oncology patients and neoplastic growth manifest as visible lesions, physical asymmetry, palpable masses, abnormal sounds or the presence of blood on screening tests. A blood pressure of 130/88 is within normal range as is a negative guaiac test. Observation of a previous goiter which is consistent with a prior admission is not a concern. The detection of physical asymmetry as seen by a difference in circumference should be reported to the physician. OBJ: NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation Practice Questions 1. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow 2. The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count 3. When caring for a client with cervical cancer who has an internal radiation implant, the nurse would observe which principles? Select all that apply. 1. Limiting the time with the client to 1 hour per shift. 2. Keeping pregnant persons out of the client’s room. 3. Placing the client in a private room with a private bath. 4. Wearing a lead shield when providing direct client care. 5. Removing the dosimeter film badge when entering the client’s room. 6. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client. 4. While giving care to a client with cervical cancer who has an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse would take which initial action? 1. Call the primary health care provider (PHCP). 2. Reinsert the implant into the vagina. 3. Pick up the implant with gloved hands and flush it down the toilet. 4. Pick up the implant with long-handled forceps and place it in a lead container. 5. The nurse would plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors. 2. Restrict fluid intake. 3. Teach the client and family about the need for hand hygiene. 4. Insert an indwelling urinary catheter to prevent skin breakdown. 6. The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client’s pain needs to include which assessment? 1. The client’s pain rating 2. Nonverbal cues from the client 3. The nurse’s impression of the client’s pain 4. Pain relief after appropriate nursing intervention 7. The nurse is caring for a client who is postoperative following a pelvic exenteration, and the surgeon changes the client’s diet from NPO (nothing by mouth) status to clear liquids. The nurse would check which priority item before administering the diet? 1. Bowel sounds 2. Ability to ambulate 3. Incision appearance 4. Urine specific gravity 8. A client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment finding would the nurse expect to note specifically in the client? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes 9. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal bleeding 4. Abdominal distention 10. The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1. Facial edema in the morning 2. Weight loss of 20 lb (9 kg) in 1 month 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 4. Serum sodium level of 136 mg/dL (136 mmol/L) 5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L) 6. Numbness and tingling of the lower extremities 11. A client who has been receiving radiation therapy for bladder cancer states to the nurse, “I feel like I am urinating through my vagina.” The nurse interprets that the client may be experiencing which condition? 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress caused by the diagnosis of cancer 4. Altered perineal sensation as a side effect of radiation therapy 12. The nurse is instructing a client to perform a testicular self-examination (TSE). The nurse would provide the client with which information about the procedure? 1. To examine the testicles while lying down 2. That the best time for the examination is after a shower 3. To gently feel the testicle with one finger to feel for a growth 4. That TSEs should be done at least every 6 months 13. The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings would the nurse expect to note? Select all that apply. 1. Pathological fracture 2. Urinalysis positive for Bence Jones protein 3. Hemoglobin level of 15.5 g/dL (155 mmol/L) 4. Calcium level of 9.0 mg/dL (2.25 mmol/L) 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) 14. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse would take which most appropriate action? 1. Measure abdominal girth. 2. Irrigate the nasogastric tube. 3. Continue to monitor the drainage. 4. Notify the surgeon. 15. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? 1. Age younger than 50 years 2. History of colorectal polyps 3. Family history of colorectal cancer 4. Chronic inflammatory bowel disease 16. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing action is most appropriate? 1. Clamp the surgical drain. 2. Change the dressing as prescribed. 3. Notify the surgeon. 4. Remove and replace the perineal packing. 17. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? 1. The passage of flatus 2. Absent bowel sounds 3. The client’s ability to tolerate food 4. Bloody drainage from the colostomy 18. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? 1. Dysuria 2. Hematuria 3. Urgency on urination 4. Frequency of urination 19. The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1. “I change my pouch every week.” 2. “I change the appliance in the morning.” 3. “I empty the urinary collection bag when it is two-thirds full.” 4. “When I’m in the shower, I direct the flow of water away from my stoma.” 20. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the primary health care provider will request which prescriptions? Select all that apply. 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Decreased oral sodium intake 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone 21. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes 22. The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign or symptom of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. Electrocardiographic changes 23. As part of chemotherapy education, the nurse teaches a client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. “I should avoid blowing my nose.” 2. “I may need a platelet transfusion if my platelet count is too low.” 3. “I’m going to take aspirin for my headache as soon as I get home.” 4. “I will count the number of pads and tampons I use when menstruating.” 24. The community health nurse is instructing a group of young clients about breast selfexamination. The nurse would instruct the clients to perform the examination at which time? 1. At the onset of menstruation 2. Every month during ovulation 3. Weekly at the same time of day 4. One week after menstruation begins 25. A client is diagnosed as having a intestinal tumor. The nurse would monitor the client for which complications of this type of tumor? Select all that apply. 1. Flatulence 2. Peritonitis 3. Hemorrhage 4. Fistula formation 5. Bowel perforation 6. Lactose intolerance 26. The nurse is caring for a client after a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Avoiding arm exercises in the immediate postoperative period 4. Maintaining an intravenous site below the antecubital area on the affected side 27. The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis who is at risk for vitamin B12 deficiency. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply. 1. Meat 2. Corn 3. Liver 4. Apples 5. Bananas 28. The nurse is instructing a client with iron-deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction would the nurse tell the client? 1. Administer the iron at mealtimes. 2. Administer the iron through a straw. 3. Mix the iron with cereal to administer. 4. Add the iron to apple juice for easy administration. 29. Laboratory studies are performed for a client suspected to have iron-deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1. Elevated hemoglobin level 2. Decreased reticulocyte count 3. Elevated red blood cell count 4. Red blood cells that are microcytic and hypochromic Answers 1. Answer: 1 Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma. Test-Taking Strategy: Focus on the subject, laboratory findings in multiple myeloma. Noting the name of the disorder and recalling the pathophysiology of the disease and that proliferation of plasma cells in the bone occurs will direct you to the correct option. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Multiple Myeloma Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 645. 2. Answer: 1 Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse would administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client. Test-Taking Strategy: Note the strategic word, priority. Recalling the pathophysiology of this disorder and that hypercalcemia can occur will direct you to the correct option. Level of Cognitive Ability: Creating Client Needs: Physiological Integrity Integrated Process: Nursing Process—Planning Clinical Judgment/Cognitive Skill: Generate Solutions Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Multiple Myeloma Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 646. 3. Answer: 2, 3, 4 Rationale: The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per shift. The client must be placed in a private room with a private bath. Lead shielding can be used to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client’s room. Children younger than 16 years of age and pregnant individuals are not allowed in the client’s room. Test-Taking Strategy: Focus on the subject, radiation precautions. Recalling the time frame related to exposure to the client will assist in eliminating option 1. From the remaining options, select the correct options because of the possible risks associated with exposure to radiation. Level of Cognitive Ability: Analyzing Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process—Implementation Clinical Judgment/Cognitive Skill: Take Action Content Area: Foundations of Care: Safety Health Problem: Adult Health: Cancer: Cervical/Uterine/Ovarian Priority Concepts: Cellular Regulation; Safety Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 381, 388. 4. Answer: 4 Rationale: In the event that a radiation source becomes dislodged, the nurse would first encourage the client to lie still until the radioactive source has been placed in a safe, closed container. The nurse would use long-handled forceps to place the source in the lead container that should be in the client’s room. The nurse would then call the radiation oncologist and document the event and the actions taken. It is not within the scope of nursing practice to insert a radiation implant. Test-Taking Strategy: Note the strategic word, initial. The initial action would be to prevent self-contamination from radiation exposure. This will direct you to the correct option. Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process—Implementation Clinical Judgment/Cognitive Skill: Take Action Content Area: Foundations of Care: Safety Health Problem: Adult Health: Cancer: Cervical/Uterine/Ovarian Priority Concepts: Cellular Regulation; Safety Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. p. 381. 5. Answer: 3 Rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids need to be encouraged. Invasive measures such as an indwelling urinary catheter need to be avoided to prevent infections. Test-Taking Strategy: Eliminate option 1 because of the closed-ended word all. Next, eliminate option 2 because it is not reasonable to restrict fluids in a client receiving chemotherapy who is at risk for fluid and electrolyte imbalances. Eliminate option 4 because of the risk of infection that exists with this measure. Level of Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process—Planning Clinical Judgment/Cognitive Skill: Generate Solutions Content Area: Foundations of Care: Safety Health Problem: N/A Priority Concepts: Caregiving; Infection Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. p. 388. 6. Answer: 1 Rationale: The client’s self-report is a critical component of pain assessment. The nurse needs to ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurse’s impression of the client’s pain is inappropriate in determining the client’s level of pain. Assessing pain relief is an important measure, but this option is not related to the subject of the question. Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate option 3 because the nurse is not the client of the question. From the remaining options, the subjective data from the client will provide the most accurate description of the pain. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Caring Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Foundations of Care: Vital Signs Health Problem: N/A Priority Concepts: Caregiving; Pain Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 107-108. 7. Answer: 1 Rationale: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options 2, 3, and 4 are unrelated to the data in the question. Test-Taking Strategy: Note the strategic word, priority, and the words NPO status to clear liquids in the question. The correct option is the only one that relates to gastrointestinal function. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Take Action Content Area: Foundations of Care: Perioperative Care Health Problem: Adult Health: Cancer: Cervical/Uterine/Ovarian Priority Concepts: Patient Judgment; Nutrition Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 340-341. 8. Answer: 4 Rationale: Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related specifically to the disease. Test-Taking Strategy: Options 1 and 2 are comparable or alike and are rather vague symptoms that can occur in many disorders. Option 3 can be eliminated because, in such a disorder, weight loss is most likely to occur. Also, recalling that Hodgkin’s disease affects the lymph nodes will direct you to the correct option. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Lymphoma: Hodgkin’s and Non-Hodgkin’s Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 640-642. 9. Answer: 4 Rationale: Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer. Test-Taking Strategy: Eliminate options 2 and 3 first because they are comparable or alike. From the remaining options, consider the anatomical location of the cancer. This will assist in directing you to the correct option. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Cervical/Uterine/Ovarian Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 1243-1244. 10. Answer: 1, 3, 6 Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136 mmol/L) is a normal level. Test-Taking Strategy: Note the subject, an oncological emergency. Recalling the signs and symptoms of oncological emergencies will help you identify the correct options. Also, recalling the normal calcium, potassium, and sodium levels will direct you to the correct options. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Laryngeal and Lung Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 261. 11. Answer: 2 Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts; if this occurs, the client may experience drainage of urine through the vagina. The client’s complaint is not associated with options 1, 3, or 4. Test-Taking Strategy: Focus on the subject, a complication of bladder cancer and the data in the question. Noting the words voiding through the vagina should direct you to the correct option. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Analysis Clinical Judgment/Cognitive Skill: Analyze Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Bladder and Kidney Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 1248-1249. 12. Answer: 2 Rationale: The TSE is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client needs to gently roll the testicles, feeling for any lumps. Test-Taking Strategy: Focus on the subject, the procedure for performing TSE. Eliminate option 4 first because of the words 6 months. Next, eliminate option 3 because of the word one. From the remaining options, eliminate option 1 by trying to visualize the process of the self-examination. Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Take Action Content Area: Health Assessment/Physical Exam: Testicles Health Problem: Adult Health: Cancer: Testicular Priority Concepts: Clinical Judgment; Health Promotion Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 1485-1486. 13. Answer: 1, 2, 5 Rationale: Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with multiple myeloma may experience pathological fractures, hypercalcemia, anemia, recurrent infections, and renal failure. In addition, Bence Jones proteinuria is a finding. A serum calcium level of 9.0 mg/dL (2.25 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. A serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) is elevated, indicating a renal problem. Test-Taking Strategy: Focus on the subject, characteristics of multiple myeloma. Think about the pathophysiology of the disorder, and analyze the values given to direct you to the correct options. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Multiple Myeloma Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 814-815. 14. Answer: 3 Rationale: Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse needs to continue to monitor the drainage. The nurse does not need to notify the surgeon at this time. Abdominal girth is measured to detect the development of distention. Following gastrectomy, a nasogastric tube would not be irrigated unless there are specific surgeon prescriptions to do so. Test-Taking Strategy: Note the strategic words, most appropriate, and focus on the subject, the immediate postoperative period. This will direct you to the correct option. Remember that drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and then to yellow or clear. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Clinical Judgment/Cognitive Skill: Take Action Content Area: Foundations of Care: Perioperative Care Health Problem: Adult Health: Cancer: Esophageal/Gastric/Intestinal Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Elsevier. pp. 861-862. 15. Answer: 1 Rationale: Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease. Test-Taking Strategy: Note the strategic words, further teaching is necessary. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Noting the words younger than in option 1 will direct you to this option. Level of Cognitive Ability: Evaluating Client Needs: Health Promotion and Maintenance Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Evaluate Outcomes Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Esophageal/Gastric/Intestinal Priority Concepts: Patient Education; Health Promotion Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 948. 16. Answer: 2 Rationale: Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. Therefore, the nurse would change the dressing as prescribed. A surgical drain would not be clamped, because this action will cause the accumulation of drainage within the tissue. The nurse does not need to notify the surgeon at this time. Drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse would not remove the perineal packing. Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate options 1 and 4, knowing that these are inappropriate interventions. Recalling that serosanguineous drainage is expected following this type of surgery will assist in directing you to the correct option. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Clinical Judgment/Cognitive Skill: Take Action Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Esophageal/Gastric/Intestinal Priority Concepts: Clinical Judgment; Tissue Integrity Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11 ed.). St. Louis: Mosby. pp. 342-343, 956. 17. Answer: 1 Rationale: Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse would assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. The client would remain NPO (nothing by mouth) until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy. Test-Taking Strategy: Focus on the subject, the colostomy beginning to function. This will assist in eliminating option 2. Knowledge of general postoperative measures will assist in eliminating option 3. Focus on the subject to assist in eliminating option 4 as a correct option. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Foundations of Care: Perioperative Care Health Problem: Adult Health: Cancer: Esophageal/Gastric/Intestinal Priority Concepts: Clinical Judgment; Elimination Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 954-956. 18. Answer: 2 Rationale: The most common sign in clients with cancer of the bladder is hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also symptoms of a bladder infection. Test-Taking Strategy: Focus on the subject, bladder cancer, and note the strategic word, most. Options 1, 3, and 4 are symptoms that are associated most often with bladder infection. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Bladder and Kidney Priority Concepts: Cellular Regulation; Elimination Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. pp. 1044, 1065. 19. Answer: 3 Rationale: The urinary collection bag needs to be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma. Test-Taking Strategy: Note the strategic words, need for more education. These words indicate a negative event query and therefore eliminate the options that indicate client understanding. Noting the words two-thirds full will assist in directing you to the correct option. Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Evaluate Outcomes Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Bladder and Kidney Priority Concepts: Patient Education; Elimination Reference: Potter, P., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of nursing. (10th ed.). St. Louis: Mosby. p. 1171. 20. Answer: 1, 2, 5, 6 Rationale: Cancer is a common cause of SIADH. In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal. Test-Taking Strategy: Focus on the subject, treatment for SIADH, and recall that in SIADH excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. This will assist in answering this question. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Planning Clinical Judgment/Cognitive Skill: Generate Solutions Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Laryngeal and Lung Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 397, 1236-1238. 21. Answer: 3 Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs. Test-Taking Strategy: Note the strategic word, early. Think about the pathophysiology associated with this disorder and focus on the strategic word to assist in eliminating options 1, 2, and 4. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: N/A Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 388-389. 22. Answer: 4 Rationale: Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave. Test-Taking Strategy: Note the strategic word, late. Focus on the name of the oncological emergency, hypercalcemia, to direct you to the correct option. Eliminate options 1 and 2 because they are not signs of hypercalcemia. Eliminate option 3 because it is an early sign of hypercalcemia. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Prostate Priority Concepts: Cellular Regulation; Fluids and Electrolytes Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. p. 398. 23. Answer: 3 Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 109/L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin need to be avoided because of their antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding. Test-Taking Strategy: Note the strategic words, further teaching is needed. These words indicate a negative event query and the need to select the incorrect measure about selfcare and preventing bleeding. Recalling the effects of bone marrow suppression will direct you to the correct option. Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Evaluate Outcomes Content Area: Adult Health: Oncology Health Problem: Adult Health: Hematological: Bleeding/Clotting Disorders Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 248. 24. Answer: 4 Rationale: The breast self-examination needs to be performed regularly, 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue. Test-Taking Strategy: Option 3 can be eliminated easily because of the word weekly. Eliminate options 1 and 2 next because they are comparable or alike in the similarity that exists regarding the hormonal changes that occur during these times. Level of Cognitive Ability: Applying Client Needs: Health Promotion and Maintenance Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Take Action Content Area: Health Assessment/Physical Exam: Breasts Health Problem: Adult Health: Cancer: Breast Priority Concepts: Patient Education; Health Promotion Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 1436-1437. 25. Answer: 2, 3, 4, 5 Rationale: Complications of intestinal tumors include bowel perforation, which can result in hemorrhage and peritonitis. Other complications include bowel obstruction and fistula formation. Flatulence can occur but is not a complication; lactose intolerance also is not a complication of intestinal tumor. Test-Taking Strategy: Focus on the subject, complications of an intestinal tumor. Think about the location and pathophysiology associated with this type of tumor to answer correctly. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Esophageal/Gastric/Intestinal Priority Concepts: Cellular Regulation; Clinical Judgment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 949. 26. Answer: 2 Rationale: Following mastectomy, the arm needs to be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws would be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring. Test-Taking Strategy: Focus on the subject, preventing lymphedema. Note the relationship between the words lymphedema in the question and elevating in the correct option. Also, using general principles related to gravity will direct you to the correct option. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Clinical Judgment/Cognitive Skill: Take Action Content Area: Adult Health: Oncology Health Problem: Adult Health: Cancer: Breast Priority Concepts: Clinical Judgment; Tissue Integrity Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 1443-1443. 27. Answer: 1, 3 Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as meats and liver. Test-Taking Strategy: Focus on the subject, foods rich in vitamin B12. Note that apples and bananas are comparable or alike in that they are fruits. This will help you eliminate these options first. Option 2 can also be eliminated because it is a vegetable. The remaining options are the correct options. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Take Action Content Area: Adult Health: Hematological Health Problem: Adult Health: Hematological: Anemias Priority Concepts: Nutrition, Patient Education References: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 799-800; Lewis, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). St. Louis: Mosby. p. 610. 28. Answer: 2 Rationale: In iron-deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement needs to be administered through a straw or medicine dropper placed at the back of the mouth, because the iron stains the teeth. Clients need to be instructed to brush or wipe their teeth after administration. Iron is administered between meals, because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not mixed with liquids, cereal, or other food items. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike and because medication would not be added to apple juice or food. Next, note the word liquid in the question. This will assist you in recalling that iron in liquid form stains teeth. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Clinical Judgment/Cognitive Skill: Take Action Content Area: Adult Health: Hematological Health Problem: Adult Health: Hematological: Anemias Priority Concepts: Patient Education; Health Promotion References: Burchum, J., & Rosenthal, L. (2019). Lehne’s pharmacology for nursing care. (10th ed). St. Louis: Elsevier. p.651; Lilley, L., Rainforth Collins, S., & Snyder, J. (2020). Pharmacology and the nursing process. (9th ed.). St. Louis: Mosby. p.850. 29. Answer: 4 Rationale: In iron-deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in clients with iron-deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated. Test-Taking Strategy: Focus on the subject, laboratory findings. Eliminate options 1 and 3 first, knowing that the hemoglobin and red blood cell counts would be decreased. From the remaining options, select the correct option over option 2 because of the relationship between anemia and red blood cells. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Clinical Judgment/Cognitive Skill: Recognize Cues Content Area: Adult Health: Hematological Health Problem: Adult Health: Hematological: Anemias Priority Concepts: Cellular Regulation; Gas Exchange Reference: Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2021). Concepts for interprofessional collaborative care. (10th ed.). St. Louis: Saunders. pp. 798-799.