401 EXAM 2 combined exemplar

During a routine physical examination of a client's lungs, the nurse notes a pink papule that is flat and erythematous with surface crusting on the client's upper chest. The nurse should notify the physician of this finding because the nurse suspects the papule might indicate what?

A) Squamous cell carcinoma

B) Basal cell carcinoma

C) Actinic keratosis

D) Malignant melanoma

B

The nurse is teaching a group of community members about preventing skin cancer. Which participant would be at the greatest risk for skin cancer?

A) A 25-year-old lifeguard at the community pool who wears sunscreen

B) A baby underneath a large beach umbrella

C) A 60-year-old farmer who wears a cap when working

D) A teenager who wears a ski outfit when skiing

C

dark-skinned client tells the nurse of plans to bask in the sun on an upcoming vacation. The nurse questions the client about sunscreen use. Which response indicates the client needs further education?

A) "I don't need sunscreen because I am dark-skinned already."

B) "I will avoid the sun between the peak hours of 10 a.m. and 4 p.m."

C) "I can still experience sun damage despite my dark skin tones."

D) "The melanocytes in my skin provide me with increased protection from the sun."

A

The nurse is caring for an older adolescent client diagnosed with malignant melanoma. Which nursing diagnoses would be appropriate when planning this client's care? Select all that apply.

A) Impaired Skin Integrity

B) Risk for Compromised Human Dignity

C) Anxiety

D) Risk for Acute Confusion

E) Disturbed Body Image

ACE

The nurse is talking to a group of young adults about decreasing the risk for skin cancer. A young woman asks the nurse about the safety of ultraviolet light tanning salons. Which response by the nurse is most appropriate?

A) "Using tanning beds without clothing contaminates skin and leads to infections."

B) "Tanning from ultraviolet light is safer than sunshine."

C) "Using sunscreen will prevent skin cancers, even in tanning beds."

D) "Exposure to ultraviolet light used in tanning beds can cause skin cancer."

D

client is scheduled to have a suspected cancerous lesion removed from the arm. When planning care for this client, which outcome would be a priority?

A) The client will make nutritional changes.

B) The client will experience minimal pain after healing.

C) The client will heal without signs of infection.

D) The client will not need to make lifestyle changes.

C

The nurse is reviewing the medical records for several clients who will be seen in the clinic today. According to the ABCD rule, which client may require removal of the skin lesion?

A) A client with a lesion that is symmetrical with an irregular border, a single color, and diameter change from 4 mm to 5 mm

B) A client with a lesion that is symmetrical, with a smooth border, a single color, and diameter that has stayed the same

C) A client with a lesion that is asymmetrical with a regular border, two colors, and diameter change from 4 mm to 3 mm

D) A client with a lesion that is asymmetrical with an irregular border, two colors, and diameter change from 5 mm to 7 mm

D

The nurse is caring for a client who has recently been diagnosed with skin cancer. The client is tearful and states, "How did I get skin cancer? I don't believe in tanning!" Which response by the nurse is indicated at this time?

A) "Can you tell me more about your feelings?"

B) "This is unusual, as skin cancer normally only occurs in sunbathers."

C) "Sun exposure can happen as we carry out our daily activities."

D) "We frequently never find out why cancer strikes."

C

nurse working in an outpatient dermatology clinic is caring for a client who has been diagnosed with a lentigo maligna. Which statement is inappropriate for the nurse to include in the client's teaching plan?

A) The lesion is also called Robertson freckle.

B) The lesion is a precursor to melanoma.

C) The lesion is a tan or black patch on the skin that looks like a freckle.

D) The lesion grows slowly, becoming mottled, dark, thick, and nodular.

A

Client presents to the primary care clinic for an annual physical. The nurse caring for the client notes that the client's healthcare provider uses the ABCD mnemonic to assess suspicious skin lesions. What does the "D" in ABCD represent?

A) Diameter of lesion greater than 8 mm

B) Distance of lesion to an additional lesion

C) Diameter of lesion greater than 6 mm

D) Depth of lesion

C

What is the most common cause of skin cancer?

A) Exposure to melanin

B) UV radiation from sunlight

C) Damage from chemicals

D) Inflammation from psoriasis

B

The nurse is assessing a 78-year-old client who was recently diagnosed with skin cancer. The physician has mentioned including topical treatments in the patient's treatment plan. What other assessments may the nurse need to conduct to help guide the physician when deciding whether to use topical treatments for this client?

A) An assessment for coagulation disorders

B) An assessment for dementia

C) An assessment for cardiovascular disease

D) An assessment for diabetes

B

Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents?

A) "Since neither of you actually has sickle cell disease, your baby is not at risk."

B) "Your baby has the disease, as you both carry the trait."

C) "We are required to test all babies for sickle cell disease."

D) "Have you talked to a genetic counselor about your concerns?"

C

A nurse educator is teaching a group of parents how to prevent a sickle cell crisis in the child with sickle cell disease. What precipitating factors that could contribute to a sickle cell crisis should the nurse teach the parents? Select all that apply.

A) Increased fluid intake

B) High altitudes

C) Fever and infection

D) Emotional or physical stress

E) Warm temperatures

BCD

nurse is assigned to care for a client with sickle cell disease who is being admitted with splenic sequestration crisis. Which room would be the most appropriate for this client?

A) Private room

B) Semi-private room

C) Contact-isolation room

D) Airborne-isolation room

A

client in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. The client reports a pain level of 8 on a pain scale from 1 to 10. Which nursing diagnosis is a priority for this client?

A) Fluid Volume Excess

B) Risk for Self-Mutilation

C) Knowledge Deficit

D) Acute Pain

D

client is admitted to the emergency department in a sickle cell crisis. The nurse assesses the client and documents the following clinical findings: temperature 102°F, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority?

A) Apply oxygen per nasal cannula at 3 L/minute.

B) Assess and document peripheral pulses.

C) Administer morphine sulfate 10 mg IM.

D) Administer Tylenol 650 mg by mouth.

A

The nurse is planning care for a young child who is admitted with sickle cell crisis. The parents are with the child, and neither has much information about the disease. When planning care for this family, the nurse will set which goal with this family?

A) The child will drink adequate amounts of fluid each day.

B) The child will play outside in the sun.

C) The family will not have the child vaccinated.

D) The family will plan vacations in high-altitude areas.

A

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis. Which medication should the nurse expect to administer to this client?

A) Acetaminophen (Tylenol)

B) Ibuprofen (Advil)

C) Meperidine (Demerol)

D) Hydroxyurea

D

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease. The client is at risk for infection. Which medication does the nurse expect to administer to this client?

A) Acetaminophen

B) Penicillin

C) Morphine sulfate

D) Tamoxifen

B

pediatric nurse is educating the client with sickle cell disease and the client's family regarding the genetic implications of the disease. Which information is inappropriate for the nurse to share with the client's family?

A) If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 50%.

B) The disorder is transmitted as an autosomal recessive genetic defect.

C) The sickle cell gene may have originated to protect against lethal forms of malaria.

D) In African Americans, sickle cell disease occurs in 1 of every 365 births.

A

An emergency department nurse is caring for a child in sickle cell crisis. The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply.

A) The client has profound pallor and fatigue.

B) The client is in extreme pain.

C) The client has profound hypotension and shock.

D) The client has a fever.

E) The client's chest CT reveals a pulmonary infarct.

BD

nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis. Which intervention is inappropriate for the nurse to include in this plan of care?

A) Administer prescribed analgesic medications around the clock.

B) Place client in position of comfort.

C) Use heat or cold packs as tolerated.

D) Support the client's joints and extremities with pillows.

C

Which race is at highest risk of inheriting sickle cell disease?

A) African American

B) Caucasian

C) Hispanic

D) Asian

A

nurse is screening a client for prostate cancer. Which assessment findings would cause the nurse to suspect that the client has prostate cancer? Select all that apply.

A) Fatigue

B) Upper extremity weakness

C) Back pain

D) Hematuria

E) Scrotal edema

ACD

The nurse is preparing an educational program on risk factors for the development of prostate cancer. Which information will the nurse include as being the greatest risk factor for developing prostate cancer?

A) The client's age

B) A family history

C) A history of a vasectomy

D) A diet high in fat

A

While receiving discharge teaching, an adult client recovering from a prostatectomy is distressed to learn that episodes of incontinence may occur. Which should the nurse teach the client to help minimize incontinence?

A) Proper administration of incontinence medication

B) Steps to change the Foley catheter bag every day

C) Fluid restriction

D) Kegel exercises

D

The nurse is planning care for a client scheduled for a prostatectomy. The client's spouse wants to know if the client will have any limitations after the surgery. Which complications is the client likely to have that should be incorporated into his plan of care? Select all that apply.

A) Constipation

B) Gynecomastia

C) Impaired Urinary Elimination

D) Risk for Falls

E) Sexual Dysfunction

CE

nursing instructor is teaching a group of student nurses about the risk factors for prostate cancer. Which statement will the nursing instructor include?

A) "African American men are at lowest risk for prostate cancer."

B) "Asian American and Native American men have the highest risk for developing prostate cancer."

C) "Approximately one in eight men ages 70 and older will be diagnosed with prostate cancer."

D) "A diet low in dairy increases a man's risk for developing prostate cancer."

C

The nurse is assessing a client for symptoms of prostate cancer. Which symptoms would indicate the client is experiencing an enlarged prostate? Select all that apply.

A) Hematuria

B) Dysuria

C) Weight loss

D) Bone pain

E) Fatigue

AB

client with prostate cancer is being discharged from the hospital. Which educational topic is inappropriate for this client?

A) Provide information on doses of complementary herbs.

B) Teach the client and his family methods of pain control.

C) Stress the importance of keeping client appointments with healthcare providers.

D) Provide the client and the client's family information on support groups.

A

Which hormone(s) is (are) believed to have a role in the development of prostate cancer?

A) Prolactin

B) Endorphins

C) Estrogens

D) Androgens

D

What is the primary reason that prostate cancer rarely metastasizes to the bowel?

A) The capsular artery supplies blood to the bowel before the prostate.

B) The inferior vesical artery supplies blood to the bowel before the prostate.

C) The rectourethral fistula acts as a physical barrier to metastasis.

D) The Denonvilliers fascia acts as a physical barrier to metastasis.

D

What approach is appropriate for interpreting the prostate-specific antigen (PSA) level as a diagnostic factor for prostate cancer?

A) A PSA level higher than 4.0 ng/mL indicates prostate cancer.

B) A PSA level lower than 4.0 ng/mL indicates prostate cancer.

C) A fluctuating PSA level indicates prostate cancer.

D) An abnormal PSA level alone is not enough to diagnose prostate cancer.

D

nurse is caring for a 42-year-old male client who was recently diagnosed with prostate cancer. What characteristic of the prostate cancer does the nurse need to be aware of for a client of this age compared to older men with prostate cancer?

A) The cancer will likely be more aggressive for the younger client.

B) The cancer will likely grow more slowly in the younger client.

C) The cancer will likely be more responsive to treatment in the younger client.

D) The cancer will likely not metastasize as quickly in the younger client.

A

73-year-old man was just diagnosed with stage II prostate cancer. The client's wife hears the word "cancer" and immediately begins crying. She says, "How long does he have to live?" Which response by the nurse is appropriate?

A) "Don't worry about how long he will live. Just live every day to the fullest and enjoy the time you have left together."

B) "If we treat the cancer aggressively with surgery and radiation, he should live several more years."

C) "Prostate cancer is usually aggressive in older men, so he may only have a short time to live."

D) "Older men who are diagnosed with prostate cancer usually die from causes other than the cancer."

D

The nurse is caring for a client in a community clinic who wishes to quit smoking. The client asks the nurse, "If I quit smoking, will my risk of lung cancer be the same as a nonsmoker?" Which is the best response by the nurse?

A) "No one knows for sure what the risk is for someone who quits smoking."

B) "Your risk of lung cancer will be equal to that of a nonsmoker."

C) "Your risk of lung cancer will decline if you quit, but it will remain higher than a nonsmoker's."

D) "Your risk of lung cancer will never drop because the damage has already been done."

C

The nurse is planning care to address ineffective airway clearance for a client with lung cancer. Which interventions should the nurse include in the client's plan of care? Select all that apply.

A) Suction the airway as needed.

B) Help the client turn, cough, and deep breathe as needed.

C) Provide chest percussion as ordered.

D) Educate the client about smoking cessation.

E) Administer pneumococcal vaccine.

ABC

A nurse is caring for a client recovering from a wedge resection of the left lung for a tumor. What would be appropriate goals for the nursing diagnosis of ineffective airway clearance? Select all that apply.

A) Minimize accumulation of fluid.

B) Participation in care by the client

C) Maintain a patent airway.

D) Maintain current weight.

E) Express feelings and concerns.

AC

The nurse is caring for a client who is undergoing diagnostic tests to rule out lung cancer. The client asks the nurse why a computed tomography (CT) scan was ordered. What is the best response by the nurse?

A) "The doctor prefers this test."

B) "To rule out the possibility that your problems are caused by pneumonia."

C) "It is more specific in diagnosing your condition."

D) "Why are you concerned about this test?"

C

Which type of lung cancer typically spreads by local invasion?

A) Small-cell carcinoma

B) Adenocarcinoma

C) Squamous cell carcinoma

D) Large-cell carcinoma

C

Which individuals are more likely to develop lung cancer without a history of smoking?

A) An individual under age 50

B) An individual with a genetic abnormality on chromosome 6

C) An individual over age 50

D) An individual with a genetic abnormality on chromosome 8

B

The client with lung cancer who presents with dysphagia likely has a tumor located where?

A) By the trachea

B) By the esophagus

C) By the mediastinum

D) By the pleura

B

The nurse is caring for a 72-year-old client who was just diagnosed with early stage lung cancer. What is an important independent nursing intervention that can improve the client's prognosis?

A) Provide client teaching related to a nutritional diet

B) Refer the client to a smoking cessation therapy group

C) Advocate for an immediate initiation of treatment

D) Encourage the client to form a strong support group

C

The nurse is providing discharge teaching to an older adult client with lung cancer. What changes in activities of daily living can the nurse suggest to help the older adult maintain independence?

A) Wear shirts with buttons

B) Use a self-leveling spoon

C) Wear shoes with laces

D) Use a shower chair

D

A client is receiving chemotherapy for acute lymphocytic leukemia. While providing care for this client, which clinical manifestations would indicate tumor lysis syndrome? Select all that apply.

A) Thrombocytopenia

B) Cardiac arrhythmia

C) Respiratory distress

D) Changes in urine output

E) Upper-extremity edema

BD

An adult client reports to the nurse an inability to tolerate usual exercise and the feeling of fatigue. The client states that these symptoms have been gradual over time. Which physical assessment findings, along with the client's verbal complaints, would indicate chronic lymphocytic leukemia (CLL)? Select all that apply.

A) Joint pain

B) Pallor

C) Splenomegaly

D) Abnormal bleeding

E) Edema

BCE

The nurse is teaching a class at a local community center about decreasing risk factors for cancer. Which risk factors should the nurse include in the teaching regarding leukemia? Select all that apply.

A) Smoking

B) Diets low in fat

C) Exposure to infectious agents

D) Bloom syndrome

E) Decreased exercise

ACD

The nurse is planning care for a client with acute myeloid leukemia (AML). Which diagnoses are priorities for this client to minimize the risk of complications associated with AML? Select all that apply.

A) Risk for Infection

B) Ineffective Thermoregulation

C) Imbalanced Nutrition, Less than Body Requirements

D) Fluid Volume Excess

E) Risk for Bleeding

AE

young school-age boy is admitted with newly diagnosed acute lymphocytic leukemia. The multidisciplinary team is meeting to plan care for this child and family. Which statement by the parents should receive priority in the nursing planning process?

A) "His brother is upset about the amount of time we are away from home."

B) "Can we plan a trip out of town sometime this summer?"

C) "We are afraid that he will dislodge his central line at school."

D) "How are we going to pay for his treatment?"

C

The nurse is assisting the healthcare provider with a bone marrow aspiration and biopsy on a client who has leukemia. The client also has thrombocytopenia. Upon completing the test, which intervention is a priority for the nurse?

A) Dispose of the equipment used, and clean the area properly.

B) Label and refrigerate the specimen obtained by the physician.

C) Hold pressure on the wound for approximately 5 minutes.

D) Make certain the client understands the purpose of the test.

C

The nurse is caring for a client with leukemia who is experiencing neutropenia as a result of chemotherapy. Which action should the nurse include in the plan of care for this client?

A) Replace hand hygiene with gloves.

B) Restrict visitors with communicable illnesses.

C) Restrict fluid intake.

D) Insert an indwelling urinary catheter to prevent skin breakdown.

B

nurse working in the pediatric intensive care unit (PICU) is caring for a child with leukemia. What is the most common type of leukemia in children?

A) Chronic lymphocytic leukemia

B) Acute lymphocytic (lymphoblastic) leukemia

C) Acute myeloid (myeloblastic) leukemia

D) Chronic myeloid (myelogenous) leukemia.

B

pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL). When providing education to the child's parents regarding this disease, which topics should the nurse include? Select all that apply.

A) ALL is characterized by abnormal proliferation of all bone marrow elements.

B) This form of leukemia is the most common type among children and adolescents.

C) Most cases of ALL result from the malignant transformation of B cells.

D) Malignant lymphocytes are able to effectively maintain immunity.

E) The onset of ALL is usually gradual.

BC

A nurse is caring for a client with chronic myeloid leukemia (CML) who is neutropenic. Which interventions will the nurse implement to ensure this client's safety? Select all that apply.

A) Teach the client to maintain good personal hygiene.

B) Encourage the client to eat a diet low in protein.

C) Administer granulocyte colony-stimulating factor (G-CSF) as ordered.

D) Administer neutrophil colony-stimulating factor (N-CSF) as ordered.

E) Administer a prophylactic gram-negative antibiotic.

AC

A nurse is planning care for a client with leukemia. The nurse chooses "Risk for Bleeding" as the nursing diagnosis. Which interventions support this nursing diagnosis? Select all that apply.

A) Educate client to not strain during bowel movements.

B) Use nonelectric razor when providing grooming for client.

C) Limit parenteral injections.

D) Apply pressure to arterial puncture sites for 5 minutes.

E) Encourage client to deep breathe and huff cough frequently.

AC

A client who presents with complaints of easily bruising, bleeding gums, and petechiae may be suffering from what complication of leukemia?

A) Thrombocytopenia

B) Anemia

C) Hepatomegaly

D) Neutropenia

A

The nurse is speaking with a client who wants information regarding colorectal cancer. Which statement indicates the client understood the information presented by the nurse?

A) The risk of colorectal cancer decreases with age.

B) Colorectal cancer can be detected in early stages by measuring the level of the carcinogenic embryonic antigen (CEA).

C) Colorectal cancer occurs more frequently in clients who have a history of inflammatory bowel disease.

D) Colorectal cancer has no symptoms in the early stage and there are no definitive diagnostic tests.

C

The nurse provides an educational session for community members about the risk factors for colorectal cancer. Which participant statement indicates that teaching has been effective? Select all that apply.

A) "There is a genetic link in the development of colorectal cancer."

B) "People with other bowel diseases are at increased risk for developing this cancer."

C) "Eating a diet high in red meat reduces the risk for developing this type of cancer."

D) "Eating cereal fiber reduces the risk of developing colorectal cancer."

E) "Taking aspirin and a multivitamin each day reduces the risk of colorectal cancer."

ABE

A client recovering from surgery to place a permanent colostomy as treatment for colon cancer is concerned that her spouse will no longer find her sexually attractive. Which response by the nurse is the most appropriate?

A) "Tell me more about the concerns you are having."

B) "Would you like me to speak with your husband for you?"

C) "Do not worry about sex right now. It is more important to focus on recovery."

D) "I will refer you to a counselor to talk about your concerns."

A

A client has just been told that a colectomy and ileostomy are needed to treat a new diagnosis of colon cancer. Which diagnosis should the nurse use to plan this client's preoperative nursing care?

A) Knowledge Deficit

B) Risk for Disuse Syndrome

C) Risk for Perioperative-Positioning Injury

D) Anticipatory Grieving

D

The nurse is evaluating care provided to a client recovering from surgery for colorectal cancer. Which outcomes indicate that care has been successful? Select all that apply.

A) Client reports pain level as an 8 on a rating scale of 0 to 10.

B) Client has an hourly urine output of 45 mL.

C) Client performs morning care with assistance.

D) Client states family members will care for the ostomy at home.

E) Client tolerates full liquid diet and is requesting solid food.

BCE

A nurse is caring for a client who has had a double-barrel colostomy. Which is true regarding the proximal stoma? Select all that apply.

A) It is also called the mucous fistula.

B) It diverts feces to the abdominal wall.

C) It expels mucus from the distal colon.

D) It is a functional stoma.

E) It expels mucus from the proximal colon.

BD

A client has colorectal cancer at stage I, T2. What has the tumor invaded?

A) The submucosa of the bowel

B) The muscularis propria of the bowel

C) The perirectal tissues

D) The lymph nodes

B

A client with colorectal cancer has no metastasis in regional lymph nodes. What can the nurse conclude from this about metastasis of this cancer?

A) The distal lymph nodes and other major organs will also not have metastasis.

B) The tumor has instead metastasized to distal lymph nodes.

C) The nurse cannot conclude anything about metastasis to other areas of the body.

D) The tumor has instead metastasized through the circulatory system to other major organs.

C

Which complaint by the client should the nurse report to the physician as a potential indication of colorectal cancer?

A) Abdominal pain

B) Constipation

C) Diarrhea

D) Rectal bleeding

D

The nurse is assessing several children with polyps in the colon and rectum. Which child is at highest risk of developing colorectal cancer in adulthood?

A) A 4-year-old with isolated juvenile polyps

B) A 6-month-old with diffuse juvenile polyposis of infancy

C) A 12-year-old with juvenile polyposis coli

D) A 7-year-old with adenomatous polyps

C

The nurse is assessing an older adult client recently diagnosed with colorectal cancer. What information is important for the nurse to ask for when completing the geriatric assessment?

A) The names, addresses, and birthdates of all of the client's children

B) The client's food diary for the past month

C) A complete list of all medications and supplements the client is currently taking

D) Whether the client has ever had a gastrointestinal disorder that caused diarrhea

C

The nurse is reviewing data collected during a health history and physical assessment and determines that a client is at risk for developing breast cancer. Which data supports this client's risk for developing breast cancer? Select all that apply.

A) Age 60

B) Breastfed both children

C) Sister had breast cancer

D) Body mass index 22

E) Menopause at age 58

ACE

The nurse is instructing a group of women between the ages of 40 and 50 about early detection of breast cancer. What should the nurse include in this teaching?

A) Perform monthly breast self-exams.

B) See a healthcare provider if there is a strong family history of breast cancer.

C) Have a yearly mammogram.

D) Have a clinical breast exam performed by a healthcare provider every 5 years.

C

The nurse is providing care to a client who was recently diagnosed with breast cancer. The nurse is providing education regarding the possible treatment options. Which options will the nurse include in the teaching session? Select all that apply.

A) Mastectomy

B) Hormone therapy

C) Lumpectomy

D) Palliative care

E) Radiation

ABCE

A client prescribed tamoxifen (Nolvadex) for breast cancer treatment asks the nurse how the medication works. What is the best response by the nurse?

A) "Tamoxifen works by inhibiting the cellular mitosis of breast cancer."

B) "Tamoxifen works by blocking estrogen receptors on breast tissue."

C) "Tamoxifen works by binding to the DNA of breast cancer cells."

D) "Tamoxifen works by inhibiting the metabolism of breast cancer cells."

B

The nurse instructs a client recovering from a mastectomy on ways to prevent lymphedema. Which client statement indicates that teaching has been successful?

A) "I should do the exercises on my affected arm every day."

B) "I have to take no special precautions."

C) "I should avoid cleansing my skin with soap."

D) "Eating fresh fruits and vegetables will prevent my arm from swelling."

A

While completing a physical examination, the nurse suspects a client has breast cancer. What did the nurse assess in this client? Select all that apply.

A) Rash along the inside of the right arm

B) Left nipple retraction

C) Palpable lump in the upper outer right quadrant

D) Scaliness near the right nipple

E) Pain when extending the left arm

BCD

Which form of breast cancer is the most malignant form?

A) Infiltrating ductal carcinoma

B) Inflammatory carcinoma of the breast

C) Carcinoma of the mammary ducts

D) Paget disease

B

A woman has a family history of breast cancer, and genetic testing has revealed a mutation in BRCA2. If this woman develops breast cancer, what is the most likely mechanism for why the cancer developed?

A) The cells' ability to accurately translate the RNA was impaired.

B) The cells underwent mitosis rather than meiosis.

C) The cells' ability to suppress tumor growth was impaired.

D) The cells were stimulated to undergo rapid cell division.

C

Why should the nurse tell a client who has undergone surgery for breast cancer to avoid wearing deodorant on the affected side?

A) Deodorant can stimulate tumor growth in remaining cancer cells.

B) Deodorant can inhibit the production of sweat, which stimulates healing.

C) Deodorant can harbor bacteria and increase the client's risk for infection.

D) Deodorant can irritate the skin and slow the healing process.

D

The nurse is providing community teaching related to risk factors for breast cancer for a group of young women. Which woman might the nurse identify as being at a higher risk for developing breast cancer at a young age?

A) A 28-year-old woman who received radiation for a spinal cord tumor at L3 during childhood

B) A 26-year-old woman who had a 32-year-old brother with breast cancer

C) A 34-year-old woman who has breastfed four children

D) A 42-year-old woman who has a second cousin diagnosed with breast cancer at age 58.

B

The nurse is caring for a 78-year-old woman who was recently diagnosed with breast cancer. What consideration may the nurse need to make for this woman that she may not need to make for younger women with breast cancer?

A) Discussing the woman's life expectancy

B) Arranging transportation to appointments

C) Ensuring the woman has adequate emotional support

D) Providing teaching related to breast-conservation treatments

B

A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client?

A) Vitamin B6 levels

B) Vitamin B12 levels

C) Potassium levels

D) Iron levels

B

A client experiencing fatigue, pallor, and dyspnea on exertion has a complete blood count drawn. Which red blood cell disorder should the nurse anticipate the client is experiencing?

A) Polycythemia

B) Erythropoiesis

C) Herpes simplex

D) Anemia

D

A client with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this client has adequate amounts of iron in the diet? Select all that apply.

A) Legumes

B) Orange juice

C) Yeast

D) Okra

E) Peas

ABE

An older adult client with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care?

A) Loss of the kidney hormone erythropoietin

B) A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels

C) The renal dialysis used to treat the chronic renal failure

D) Loss of blood through the urine because the failing kidney does not function properly

A

A nursing student is preparing an educational program on hemolytic anemia for the residents of an assisted living center. Which extrinsic causes of hemolytic anemia should the student include in the program? Select all that apply.

A) Bacterial infection

B) Thalassemia

C) Blood transfusion reaction

D) Prosthetic heart valves

E) Acetaminophen use

ACD

The home healthcare nurse is preparing a care plan for a client with severe anemia. The client currently lives alone and states, "I can't even walk to the kitchen without getting winded." What would be the priority nursing diagnosis for this client?

A) Hopelessness

B) Activity Intolerance

C) Imbalanced Nutrition, Less than Body Requirements

D) Anxiety

B

The nurse is evaluating a client's understanding of dietary needs to treat dietary deficiency anemia. Which client statement indicates a need for additional teaching?

A) "I will eat more fruits and vegetables, especially green leafy ones, to get more iron in my diet."

B) "I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads."

C) "I will decrease foods high in vitamin C, as they decrease my absorption of iron."

D) "I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."

C

The nurse suspects that a client with severe shortness of breath in the absence of cyanosis is experiencing anemia. Which laboratory tests should the nurse review to confirm anemia? Select all that apply.

A) Serum electrolytes

B) Cardiac enzymes

C) Hemoglobin

D) Blood sugar

E) Hematocrit

CE

The nurse is caring for an older adult client with hemolytic anemia. When planning care for this client, which should the nurse take into consideration regarding this diagnosis?

A) It causes the red blood cells to be microcytic.

B) It is associated with a decrease in the reticulocyte count.

C) It is the result of blood loss.

D) It is a result of the premature destruction of red blood cells.

D

The nurse is instructing a client with iron deficiency anemia about appropriate menu choices. Which diet choice indicates that teaching has been effective?

A) Tofu with mixed vegetables in curry, milk, whole-wheat bun

B) Broiled fish, lettuce salad, grapefruit half, carrot sticks

C) Pork chop, mashed potatoes and gravy, cauliflower, tea

D) Roast beef, steamed spinach, tomato soup, orange juice

D

A nurse is educating a client with anemia about the pathophysiological mechanisms of anemia. Which should be excluded in the nurse's teaching plan for this client?

A) Altered hemoglobin synthesis

B) Altered DNA synthesis

C) Decreased hemolysis

D) Bone marrow failure

C

A nurse is providing discharge instructions to a client with iron deficiency anemia who is experiencing glossitis. Which statements will the nurse include in the discharge teaching for this client? Select all that apply.

A) Monitor the condition of the lips and tongue daily.

B) Use an alcohol-based mouthwash every 2 to 4 hours.

C) Provide frequent oral hygiene.

D) Apply a non-petroleum-based lubricating jelly or ointment to the lips after oral care.

E) Use a soft toothbrush or sponge to provide oral care.

ACE

Which form of anemia can be prevented by a change in diet?

A) Iron deficiency anemia

B) Aplastic anemia

C) Blood loss anemia

D) Hemolytic anemia

A

A NICU nurse is caring for several newborns with anemia. Which infant with anemia would the nurse be least concerned about?

A) A baby born at 32 weeks' gestation after the mother suffered from abruptio placentae

B) A baby born at 38 weeks' gestation who has a blood group incompatibility with the mother

C) A baby born at 35 weeks' gestation who suffered birth trauma to the head

D) A baby born at 39 weeks' gestation via a scheduled cesarean section

D

During a treatment meeting on an oncology unit, the nurse learns that a client is scheduled for chemotherapy before and after surgery. What are the purposes for this client to receive chemotherapy at these specific times? Select all that apply.

A) Eradicate all cancer cells.

B) Shrink the tumor.

C) Kill remaining cancer cells.

D) Allow the immune system to kill cancer cells.

E) Improve wound healing.

BC

The nurse has completed a seminar teaching a group in the community about ways to reduce cancer risks. The nurse returns a month later to evaluate the effectiveness of the seminar. Which statements made by members of the group indicate retention and application of the material presented by the nurse to reduce the risk of developing cancer? Select all that apply.

A) "I started using sunscreen when I work outside."

B) "I began drinking two glasses of red wine a day with dinner."

C) "I have reduced my intake of fiber."

D) "I have increased the amount of fried fish in my diet."

E) "I am trying to quit smoking."

AE

The nurse is preparing a seminar that discusses the risk and incidence of cancer and culture. What information is considered culturally correct when teaching about the risk of developing cancer?

A) African Americans are more likely to develop cancer than any other ethnic group.

B) Native Americans have the highest incidence of prostate cancer.

C) The incidence and mortality rate of all types of cancers are lowest in the Caucasian population.

D) The Hispanic population has the lowest mortality rate of any racial or ethnic group.

A

A preschool-age child is seen in a pediatric oncology clinic. The nurse assigned to care for the client anticipates a diagnosis of cancer. Which reactions are considered common for the preschool-age child to experience with illnesses and hospitalizations? Select all that apply.

A) Unawareness of the illness and its severity

B) Understanding of what cancer is and how it is treated

C) Thoughts that they caused their illness and are being punished

D) Confusion as to why a parent is unable to make the illness go away

E) Acceptance, especially if able to discuss the disease with children their own age

CD

A client being treated for cancer has a tumor designation of Stage IV, T4, N3, M1. What does this staging indicate to the nurse?

A) The tumor will respond to chemotherapy.

B) The tumor is small in size.

C) The tumor has metastasized with lymph node involvement.

D) There is one single tumor to treat.

C

The nurse is providing discharge instructions to a client being treated for cancer. For which symptoms should the client be instructed to call for help at home? Select all that apply.

A) Difficulty breathing

B) Significant increase in vomiting

C) Desire to end life

D) Improved sense of well-being

E) New onset of bleeding

ABCE

The nurse instructs a group of community members on the difference between benign and malignant neoplasms. Which participant statements indicate that teaching has been effective? Select all that apply.

A) "Benign tumors grow slowly."

B) "Malignant tumors are easy to remove."

C) "Benign tumors stay in one area."

D) "Malignant tumors crowd out surrounding tissue."

E) "Malignant tumors can grow back."

ACE