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CONTRACTS Definition of Contract- A legally binding agreement made between two or more persons, intended to create legal obligation between them and to be legally enforceable. An agreement is an exchange of promises between two or more parties. (Offer and acceptance) Concept of a Contract A contract is an agreement that is enforceable by law. A contract therefore has legal implications for the parties who enter into a contract. A mere agreement is not legally binding and therefore neither of the parties is liable if anyone breaks the agreement. What makes a contract different from an agreement? A contract requires not only an agreement between parties but also something of value must be passed from one party to the next to make the contract binding. For example, you offer to sell a friend your used text books for $1000.00. After inspecting your textbooks the friend agrees and pays $1000.00. The $1000.00 paid here is the consideration i.e. something of value that is passed from one party to the next. Consideration is the price paid for a promise. You promised to let your friend have your textbooks if he paid $1000.00. This $1000.00 makes the agreement binding. You are therefore obligated to deliver the books to your friend and cannot decide to sell the books to someone else or to ask for a higher price. Your neighbour asks you to mow his lawn after which he will pay you $200.00. You accept this offer and mow the lawn. The work done here is an act of forbearance. You are giving something of value to your neighbour to receive payment for the job. The consideration in this case is the work done by you. It is the price that you have paid for the promise to be paid money for the job. Consideration passes from promise to promise. Characteristics of a Simple Contract There must be offer and acceptance. The offerer is the party that makes the offer and the offeree is the person that the offer is being made to. There must a clear offer and clear acceptance for a contract to be binding. There is an agreement of the minds. An offer is a promise in exchange for performance by another party. An offer can be revoked or terminated under certain conditions. There are also times when an offer can be negotiated to create a counter-offer. Acceptance occurs when an offeree agrees to be mutually bound to the terms of the contract by giving consideration, or something of value like money, to seal the deal. Keep in mind that acceptance follows the mirror image rule, in that acceptance is valid if the product or service rendered is exactly what was contained in the offer. Consideration is the price paid by one party for the promise of the other. Thus if one party promises to provide goods or services, something of value must be given in exchange. This may be in the form of money, goods, services or it may be an act of forbearance. The capacity to contract – Parties to the contract must be over 18 years, of sound mind, not under the influence of drugs or incarcerated. There must be no force, misrepresentation or fraud. Persons should not be forced to sign a contract e.g. blackmail. They should not be lied to e.g. giving the wrong year of a car. Fraud may involve forging someone’s signature. There must be an obvious intention to create legal relations. This is based on the actions of the parties e.g. offer, acceptance and consideration. A contract must be legal- thus, agreements made between parties concerning illegal drugs and any other illegal activity is not a contract. Terms and Concepts Misrepresentation- referring to a false statement of fact made by one party to another party, which has the effect of inducing that party into the contract Types of Misrepresentation- Innocent – untrue statement with reasonable grounds for belief Negligent- untrue but without reasonable grounds. Fraudulent – untrue with the knowledge of the truth to mislead. Breach - Breach of contract is a legal cause of action in which a binding agreement or bargained-for exchange is not honored by one or more of the parties to the contract by non-performance or interference with the other party's performance Void -Contract is the contracts that cannot be enforceable. Voidable- the Voidable Contract is the contract in which one party has the right to enforce or rescind the contract. Rules governing offer and acceptance An offer must be communicated to the other party The offer may be made generally or a specific person, but acceptance must be made by a specific person/s Conditions attached must be brought to the attention of the offeree at the time of the offer for the offeree to be bound. Acceptance must be communicated to the offerer. The offeree must act positively to constitute acceptance. Offer can be revoked before acceptance unless consideration was given. Revocation has to reach the offeree before the offeree has accepted. Acceptance must be unconditional. No counter offers. An offer can be accepted by the person to whom the offer is made. Offer must be within a specified or reasonable time. Offer lapses if time is expired, rejected by offeree, death of offerer or offerree Use the post – Offer is only made when the post reaches the offeree and it is accepted once offeree posts the acceptance whether it is lost or not. Consideration – consideration should either be good or valuable since it is the price one pays to secure the legal obligation on the part of the other. Consideration must be : Real – that is it should be well defined. One should be able to convert it to cash or something of value. Transferable and not already obligated to do by law. Lawful – the subject should be a lawful act or the contract is void. Consideration must not be past i.e past payments not considered Executed – When both parties have fulfilled their obligations (eg Purchase of goods on credit) Executory – The contract still has to be completed. Differences between a Simple & a Speciality Contract & Contract of record. A simple contract can be made orally, in writing or by the implications deemed from the actions of the parties. A specialty contract must be signed by the parties sealed, for example with a company seal and finally it must be delivered. Simple contracts: Be in writing Oral Implied by conduct Consideration is the most important element No special form Examples of specialty contracts include: 1. Mortgages and leases for over three years 2. Sale of land 3. Contracts of insurance 4. Hire purchase agreements 5. Transfer of company shares 6. Assignments of copyright Characteristics of a Speciality Contract Conditions of Simple Contracts must be present. Must be in writing Signed by both parties Stamped or sealed Attestation or witness Delivered by a promisor. Delivery may be made subject to a condition to be performed later giving rise to a escrow. Something of value, such as a deed, stock, money, or written instrument, that is put into the custody of a third person by its owner, a grantor, an obligor, or a promisor, to be retained until the occurrence of a contingency or performance of a condition. An escrow also refers to a writing deposited with someone until the performance of an act or the occurrence of an event specified in that writing. The directions given to the person who accepts delivery of the document are called the escrow agreement and are binding between the person who promises and the person to whom the promise is made. The writing is held in escrow by a third person until the purpose of the underlying agreement is accomplished. When the condition specified in the escrow agreement is performed, the individual holding the writing gives it over to the party entitled to receive it. This is known as the second delivery. Difference between an Offer & an Invitation to Treat An invitation to treat is not an offer but an invitation to bid or bargain for an item. For example, at an auction persons may bid on various items presented. An invitation to treat also occurs also when goods are advertised for sale in the media or in shop windows. Goods in a shop window or goods advertised are not an offer by the owners of the goods but are technically an invitation for interested persons to make an offer. Conditions under which Offer and Acceptance are communicated An offer must be very clearly made. An offer can be made to one person, a group or to the whole world. For example, offering a reward for a lost wallet is an offer to anyone finding the wallet. In cases where there is a counter-offer the original offer is no longer valid. A counter offer is an implied rejection of the original offer. For example: John offers to sell Paula a laptop for $10,000. Paula subsequently offers him $8000.00 as she thought $10,000 was too expensive. Paula has rejected John’s original offer and has made a counter-offer of $8,000. Acceptance must also be clear. In the case of a counter offer a clear acceptance to the new offer must be identified. Contracts may be made orally, in writing or they may be implied. Oral Contracts Are based on what the parties said. For example, asking someone to wash your car for payment Written Contracts Both offerer and offeree must sign the contract document Implied Contracts Implied Contracts are made by the observed actions of the parties involved. For example, someone who sits at a table in a restaurant and places an order has implied that he will pay for the food that will be served. Ways in which Contracts may be Terminated Contracts may be brought to an end: (a) By performance of the parties i.e. each party completing his obligations as stipulated by the contract. (b) By frustration i.e. an event through no fault of the parties that make one party unable to perform the contract. For example: if one party suffers a prolonged illness which makes him unable to perform the contract. (c) By lapse of time i.e. if the time limit set for the contract to be executed by both parties has been passed. For example, sellers of real estate usually require that the buyers pay the full balance on the property within a certain time period after the initial down payment has been made. (d) By the mutual agreement of all parties. (e)If one of the parties become bankrupt after the contract has been signed. (f) By changes in law i.e. where a legal contract is rendered illegal through changes in law. (g) By notice e.g. some firms require that employees give at least one month notice when resigning their positions. (h) If one party dies. (i) By breach of contract-When one party defaults on his part of the agreement i.e. he does not perform his part of the contract. REMEDIES FOR BREACH OF CONTRACT Damages –compensation in case of a breach contract Rescission –to cancel the contract to return parties to former state before contract by mutual agreement of both parties Restitution – Returning property, money and goods after a breach. Waiver of Breach- Non breaching party acceptance of substandard performance Limitation of Liability – a clause that limits liability to a certain point such as the purchase price Specific performance – When damages are not an appropriate remedy the breaching party will have to perform a specific act. Liquidated damages- stipulated amount in a contract that the injured party would receive in the event of a breach of contract. Validity of Contracts Mr. Larry was delighted to see a 50% discount on his favourite brand of shoes at a shoe store 15 miles away. He took sometime off from work to travel to the store. When he arrived at the store he was told that that the brand advertised was sold out but he could choose from other brands available. Mr. Larry was very angry and requested that he be refunded his travelling expenses. Is the owner of the store obligated to refund Mr. Larry his travelling expenses? Answer The advertisement appearing in the newspaper is not an offer by the store but an invitation to treat. Therefore readers were being invited to make an offer for items advertised. The owners of the store are therefore in no way obligated to Mr. Larry. Hope stopped at a convenience store on her way home to purchase a few items. She handed the cashier her credit card and was surprised when she was told that it declined. She apologized and explained that she did not know why her card declined but she will call the bank in the morning. Susan further explained that she had just enough cash with her to get home and so she could not pay for the goods. The cashier was very angry and asked the manager to intervene. The manager insisted that she pay for the goods. Is Sandra obligated to pay for the goods? Answer Sandra has entered into a contract with the convenience store. She made the offer at the cashier counter when she presented the goods to be cashed. The cashier accepted the offer by cashing the goods. In this situation it is up to the manager of the convenience store to accept Hope’s apology

NUR 204: EXAM 1 COMPLETE STUDY GUIDE SECTION 1: CANCER PATHOPHYSIOLOGY & EPIDEMIOLOGY Cellular Characteristics • Cancer is uncontrolled cell growth caused by genetic damage. • Apoptosis: The body's natural ability to destroy abnormal or cancerous cells. Malignant cells fail to undergo apoptosis. • Angiogenesis: Malignant cells can create their own blood supply for nourishment, making them very difficult to eliminate. • Progression to Malignancy: Hyperplasia (rapid increase in normal cells) → Dysplasia (abnormal cells) → Carcinoma in situ (localized cancerous cells) → Malignancy. Tumor Types & Staging • Primary vs. Secondary: The primary tumor is where the cancer originated. Secondary tumors are the sites of metastasis (e.g., lung cancer that spreads to the liver means the liver contains secondary tumors). • TNM Staging System: o T = Tumor size. o N = Lymph Node involvement. o M = Metastasis (Spread). • Number Staging (0-4): Stage 0 (In situ, abnormal cells haven't spread) to Stage IV (Distant metastasis, spread to distant body parts). Risk Factors & Prevention (Live Lecture Focus) • Modifiable vs. Non-modifiable: Age, genetics (BRCA mutations), and gender are non-modifiable. Smoking, alcohol, obesity, and sedentary lifestyle are modifiable. • Environmental Factors: o Physical: UV light (tanning beds), radiation. o Chemical: Tobacco, alcohol, workplace pesticides/cleaners. o Biological: Viral infections (HPV causes cervical cancer, Hep B/C causes liver cancer), poor diet. • Nurse's Role in Community Screenings: Skin cancer screenings are highly effective for community health fairs because they are non-invasive. Screening Guidelines • Breast: Mammograms starting at age 40 (earlier if high risk). • Colorectal: Colonoscopy every 10 years starting at age 45. • Prostate: PSA blood screening at age 50. • Tumor Markers: PSA (Prostate) and BRCA1/BRCA2 (Breast). SECTION 2: IMPACT OF CANCER & NURSING CARE Physiological Impacts • Pain: Very common, affecting up to 80% of advanced cancer patients. • Infection/Neutropenia: Dangerously low white blood cells. Live Lecture Note: Any spike in temperature (even a low-grade fever like 100.4°F) is a massive red flag for impending sepsis and must be addressed immediately. • GI Issues: Nausea, vomiting, and mucositis (painful mouth inflammation). For mucositis: avoid spicy/acidic foods and use lidocaine rinses. Cognitive & Psychosocial Impacts • Delirium (HIGH YIELD): Acute, sudden confusion. Live Lecture Note: Delirium is reversible. The nurse must treat the underlying cause. Interventions include reorienting the patient, clustering care, avoiding interruptions, and simulating day/night to regulate circadian rhythms (lights on during the day, off at night). • Financial & Psychosocial: Cancer treatments are grueling and expensive, leading to lost employment and depression. Nurses should facilitate early referrals to social workers and case managers. Nursing Safety & Medication Administration • Extravasation Safety: Vesicant chemotherapy drugs can severely damage tissue if they leak outside the vein. Live Lecture Note: If chemo is given via a peripheral IV, the nurse MUST check for blood return every single hour to prevent extravasation. If extravasation occurs: stop the infusion immediately. • Chemotherapy PPE: The nurse must wear proper PPE (e.g., double gloves, chemo gown, face protection) and dispose of chemo materials in designated hazardous waste bins (e.g., yellow bins). • Neutropenic Precautions (Reverse Isolation): Protecting the highly vulnerable patient from the nurse/visitors. Includes strict hand hygiene, no sick visitors, and avoiding crowds. SECTION 3: ONCOLOGIC EMERGENCIES • Spinal Cord Compression: Early signs include back pain, muscle weakness, loss of sensation, and bowel/bladder incontinence. • Brain Metastasis/Increased ICP: Personality changes, seizures, altered speech/balance. • Hypercalcemia: Confusion, severe muscle weakness, arrhythmias, and ECG changes. • Superior Vena Cava (SVC) Syndrome: Tumor compresses the SVC causing facial/neck edema and dyspnea. • Tumor Lysis Syndrome (TLS): Rapid cell death causes severe electrolyte imbalances (hyperkalemia, hyperuricemia). • SIADH: Tumor triggers excessive antidiuretic hormone (ADH), leading to massive water retention, dilutional hyponatremia, and confusion. SECTION 4: SELECTED CANCERS Lymphedema What is it? A frequent cancer treatment complication where fluid builds up in an extremity (typically on one side), causing severe swelling. • Signs & Symptoms: Swelling, a feeling of heaviness, decreased range of motion, and tightness in the skin. • Common complication of: Breast cancer treatments, specifically resulting from lymph node dissection/removal, radiation therapy, or chemotherapy. • Nursing Priorities & Treatment: o Elevate the affected arm above heart level. o Use compression sleeves as prescribed. o Encourage range-of-motion exercises to prevent stiffness. o ABSOLUTE SAFETY RULE: NO blood pressures, NO IVs, and NO blood draws on the affected arm. • Breast Cancer: o Live Lecture Note: Ductal breast cancer is the most common type (originating in the milk ducts). o Signs: Hard mass, nipple retraction, "orange peel" skin (peau d'orange). o Hormone Receptors: If the tumor is estrogen-receptor positive, treatment must avoid estrogen as it will feed the tumor. o Lymphedema Care: Swelling in the arm due to lymph node removal. Rule: No blood pressures, IVs, or blood draws on the affected arm. Elevate the arm and use compression. • Lung Cancer: o Live Lecture Note: Often asymptomatic in the early stages, leading to late diagnosis. o Signs: Chronic cough, hemoptysis (rust-colored/bloody sputum), dyspnea. High risk for brain metastasis. • Colorectal Cancer: o Live Lecture Note: A hallmark sign is "ribbon-like" or pencil-thin stool, caused by a tumor pressing in the rectum and narrowing the passageway. Other signs: rectal bleeding, changes in bowel habits, anemia. • Pancreatic Cancer (HIGH MORTALITY): o Live Lecture Note: High mortality because early symptoms are incredibly vague; usually caught too late. o Whipple Procedure: Surgery that removes the head of the pancreas but leaves a portion behind so the patient retains some insulin secretion. Nursing Priority: You must strictly monitor for manifestations of diabetes (hypo/hyperglycemia) because pancreatic function is deeply impaired. • Skin Cancer: o Types: Basal cell (slow-growing, sun-exposed areas), Squamous cell (more serious), Melanoma (most deadly, highly metastatic). o Melanoma ABCDEs: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving. • Brain Tumors: o Live Lecture Note: Primary brain tumors are typically benign. Malignant brain tumors have usually metastasized from somewhere else. SECTION 5: INFLAMMATION & IMMUNITY BASICS • Acute vs. Chronic Inflammation: Acute is short-term and protective (redness, heat, swelling, pain). Chronic is prolonged, causing tissue damage. Exam Tip: Chronic inflammation heavily increases the risk for cardiovascular disease. • Infection vs. Inflammation: Inflammation does not always mean infection (e.g., sprains, allergies). Systemic infection signs include fever, tachycardia, and confusion. Rule: Always draw a blood culture before starting antibiotics. SECTION 6: AUTOIMMUNE & INFLAMMATORY DISORDERS Detailed Osteoarthritis (OA) (Live Lecture Focus) • Pathophysiology: OA is a degenerative joint disease causing progressive cartilage breakdown. It is characterized by the friction of "bone on bone" as cartilage degenerates, which leads to the formation of bone spurs and bone cysts (fluid-filled cavities). • Key Distinction: There is NO systemic inflammation; OA is localized to the affected joints. • Risk Factors: Natural wear and tear of aging, trauma, joint overuse (e.g., repetitive work or sports), obesity, genetics, and a sedentary lifestyle. • Complications: Because OA causes a lack of mobility and a sedentary lifestyle, patients are at a highly increased risk for cardiovascular disease, diabetes, and obesity. Patients over 65 should also be screened for iron overload (hemochromatosis), which can accelerate the progression of OA. Patients are also at high risk for depression and anxiety due to loss of independence and chronic pain. • Signs & Symptoms: Joint pain, stiffness, crepitus (cracking of the joints), muscle atrophy, and limited range of motion. • Treatment: o Non-surgical first: Physical therapy, exercise (specifically swimming/water exercises to take pressure off the joints), and weight loss. o Medications: Acetaminophen (monitor for liver toxicity), NSAIDs like ibuprofen/naproxen (monitor for kidney toxicity), and cortisone injections into the joint. o Surgical: Joint replacement (e.g., hip or knee). Nursing Priority: Ambulate the patient right away after surgery to prevent complications. Detailed Rheumatoid Arthritis (RA) (Live Lecture Focus) • Pathophysiology: A chronic autoimmune disease where the body's immune system mistakenly attacks the synovial tissue and fluid in the joints. • Risk Factors: Increased age (highest onset in the 60s), genetics, females (especially those who have never given birth), obesity, smoking, and high stress. o Trigger mechanism: Someone with a genetic susceptibility who experiences an external trigger (like an infection or trauma) can kickstart the autoimmune reaction. • Signs & Symptoms: Symmetric joint swelling and pain (usually in the hands and feet), morning stiffness lasting longer than 1 hour, fever, malaise, and weakness. Patients experience flare-ups (severe symptoms) and remissions (no symptoms). • Rheumatoid Nodules: The most common visible manifestation of RA. These are detachable, movable subcutaneous knots or swellings of varying sizes, typically found in the fingers/hands. • Diagnostics: Elevated ESR and C-reactive protein (CRP) indicate inflammation. Positive Rheumatoid Factor (RF) and ANA (anti-nuclear antibody) blood tests. • Medications & Safety: o Treated with DMARDs (Disease-Modifying Antirheumatic Drugs). o Priority: DMARDs suppress the immune system, putting the patient at a severe risk for infection. o Hydroxychloroquine teaching: Long-term use can cause retinal damage and glaucoma leading to blindness; patients MUST see an optometrist regularly for eye exams. Systemic Lupus Erythematosus (SLE): • Multisystem autoimmune disease attacking self-tissues. • Symptoms: Butterfly rash on the face, photosensitivity, joint pain. • Complications: Cardiovascular disease (pericarditis) and kidney failure (lupus nephritis). • Triggers: Teach patients to avoid UV light/sun exposure, severe stress, exhaustion, and infections to prevent flare-ups. Peritonitis (LIFE THREATENING): • Inflammation of the peritoneum (abdomen). • Symptoms: Rigid, board-like abdomen, rebound tenderness. • Complication: Septic shock and death. SECTION 7: HIV / AIDS & HYPERSENSITIVITY HIV/AIDS: • A retrovirus that specifically targets and destroys CD4 T-cells. • Transmission Phase: The virus is most highly infectious during the initial phase when the viral load is the highest. • Opportunistic Infections: When CD4 drops < 200 (AIDS), the patient is at extreme risk for deadly infections like Tuberculosis, Pneumocystis pneumonia (PCP), and Kaposi sarcoma. • PrEP (Pre-Exposure Prophylaxis): Reduces risk of contracting HIV but does NOT replace safe sex practices (condoms). Risk Factors & At-Risk Populations: o Individuals with multiple sexual partners without protection, and those who share IV drug needles. o Substance use (drugs/alcohol) is a major risk factor because it lowers inhibitions, leading to unprotected sex. o Incarcerated populations or those in closed settings (due to sharing needles, self-tattooing, and sexual violence). o Pregnant or lactating women (due to the risk of perinatal transmission). Phases of HIV Progression: 1. Acute Infection Phase: Occurs 2 to 4 weeks after exposure. The risk of transmission is at its absolute highest because the viral load in the blood is massive. Patients exhibit flu-like symptoms (fever, malaise, fatigue). 2. Chronic Infection Phase: Patients are often asymptomatic, meaning they may not even realize they are infected. They can still transmit the virus if their viral load is high enough. This stage can last for a decade or longer. 3. AIDS: If left untreated, HIV progresses to AIDS. Diagnosis is confirmed when the CD4 T-cell count falls below 200. Immune system damage is severe, creating a very high risk for fatality and opportunistic infections (such as Tuberculosis, Kaposi sarcoma, and fungal infections). • PrEP vs. PEP (Crucial Difference): o PrEP (Pre-Exposure Prophylaxis): Medication taken prophylactically to prevent the transmission of HIV to an HIV-negative person. It does NOT replace safe sex practices (condoms must still be used). o PEP (Post-Exposure Prophylaxis): Medication taken after accidental exposure (e.g., a broken condom, a needle stick injury, or sexual assault). It MUST be taken within 72 hours of exposure to be effective. It is taken daily for 28 days and is not meant for regular, ongoing use. Anaphylaxis: • Severe allergic reaction triggering massive histamine release. • Patho: Causes increased capillary permeability, where blood vessels leak fluid into the tissues, leading to profound hypotension and airway edema. • Priority Treatment: Epinephrine IM. • High-Risk Factor: Patients taking Beta-blockers or Alpha-adrenergic blockers are at a high risk of death because these medications reduce the effectiveness of epinephrine, preventing the reversal of the shock. SECTION 8: INFECTIONS & SAFETY PROTOCOLS Meningitis (SAFETY RULE): • Diagnosed via Lumbar Puncture (testing CSF). • Live Lecture Safety Rule: If the patient shows signs of Increased Intracranial Pressure (ICP) (like severe headache, altered mental status), a CT scan of the head MUST be performed BEFORE a lumbar puncture. Performing a lumbar puncture when ICP is high can cause fatal brain herniation. • Risk Groups: College dorm students, unvaccinated individuals. Lumbar Puncture (Live Lecture Safety Rules) • Purpose: To draw out and test the cerebrospinal fluid (CSF) specifically to screen for and confirm a diagnosis of meningitis. • Position: The patient should be laying on their side with their knees pulled to their chest (fetal position) to help open up the spinal column for needle insertion. • Contraindication & Safety Priority: A lumbar puncture is completely contraindicated if the patient has Increased Intracranial Pressure (ICP). o Rule: A CT scan of the head MUST be performed BEFORE a lumbar puncture to rule out increased ICP. Performing a lumbar puncture on a patient with increased ICP can cause fatal brain herniation Sinusitis: • Inflammation of the sinuses causing facial pressure ("like you got punched in the face"), congestion, and post-nasal drip. • Live Lecture Rule: Treat with hydration, nasal irrigation, and steam. AVOID over-the-counter antihistamines and decongestants because they cause rebound inflammation (making symptoms worse when they wear off). Influenza: • FACTS Mnemonic: Fever, Aches, Chills, Tiredness, Sudden onset. High risk for secondary pneumonia in older adults and pregnant women. SECTION 9: MEDICATIONS HIGHLIGHTED IN LIVE LECTURE 1 Your instructor specifically highlighted these medications and their nursing implications during the recorded lectures: 1. Analgesics & Anti-inflammatories • Opioids (Cancer Pain): A major side effect is delayed gastric emptying and severe constipation. Intervention: Administer stool softeners, encourage hydration and mobility. Monitor for decreased respirations and drowsiness (which creates a fall risk). • Acetaminophen (Tylenol): Used for mild OA pain. Warning: Hepatotoxic (toxic to the liver) if too much is given. • Ibuprofen/Naproxen (NSAIDs): Used for OA/RA inflammation. Warning: Nephrotoxic (toxic to the kidneys) and can cause GI bleeding. • Corticosteroids (Cortisone): Can be injected directly into joints for OA inflammation. 2. Neurological & Emergency Medications • Mannitol: An osmotic diuretic used specifically to lower elevated Intracranial Pressure (ICP) in patients with brain tumors. • Phenytoin & Levetiracetam (Keppra): Anti-epileptic medications used to prevent seizures in patients with brain metastasis/tumors. • Epinephrine: The absolute first-line priority treatment for anaphylaxis. Works to constrict blood vessels and open the airway. • Hydroxychloroquine (DMARD): Used for RA and Lupus. Warning: Can cause retinal toxicity. Patients require regular eye exams (every 6 months) and must use photosensitivity precautions. SECTION 10: SAMPLE QUESTIONS & ANSWERS Q1: The client’s cancer is staged as T1, N2, M1 according to the TNM classification system. How would the nurse interpret this staging? A. One tumor that is nonresponsive to treatment with distant metastasis B. Leukemia indicated that is confined to the bone marrow C. A 2-cm tumor with one regional lymph node involved and no distant metastasis D. Small tumor with extension into two lymph nodes and one site of distant metastasis Answer: D. Rationale: T = small primary tumor, N = extension to regional lymph nodes, M = distant metastasis has occurred. Q2: The nurse is assessing an older client at a checkup visit. Which reported change would alert the nurse to the possibility of colon cancer? A. Pencil-thin stool B. Erectile dysfunction C. Reduced urine stream D. Persistent pain in the lower back and legs Answer: A. Rationale: Tumors growing in the colon/rectum compress the passageway, resulting in ribbon-like or pencil-thin stool. Q3: A nurse is performing a cancer screening assessment on several clients. Which of the following findings is a possible manifestation of cancer? (Select all that apply) A. Temperature 36° C (96.8° F) B. Sore that does not heal C. Difficulty swallowing D. Blood in the urine E. Rhinitis Answer: B, C, D. Rationale: Using the CAUTION mnemonic, signs include sores that do not heal, difficulty swallowing, and unusual bleeding/discharge. Q4: A nurse is caring for a client who has breast cancer. The client asks why the treatment plan contains a combination therapy of three different medications. Which of the following responses should the nurse make? (Select all that apply) A. “Combination chemotherapy decreases the risk of medication resistance.” B. “Combination chemotherapy attacks cancer cells at different stages of cell growth.” C. “Combination chemotherapy increases production of platelets.” D. “Combination chemotherapy stimulates the immune system.” Answer: A, B. Rationale: Using multiple chemo drugs reduces drug resistance and attacks the cell at various phases of the cell cycle. Q5: A nurse is caring for a burn client whose calculated 24-hour intravenous fluid requirements are determined to be 5000 mL. What is the total volume (mL) that the nurse should infuse after the first 8 hours of fluid resuscitation has infused? Answer: 2500 mL. Rationale: Standard burn fluid resuscitation protocols require half (50%) of the 24-hour total to be administered in the first 8 hours following the burn injury. Q6: The nurse is caring for a client who has a systemic infection. What is the best method to prevent infection transmission? A. Obtaining an immunization B. Implementing proper hand hygiene C. Wearing gloves D. Managing the client’s fever Answer: B. Rationale: Strict hand hygiene remains the most effective method for preventing the transmission of infectious organisms. Q7: The nurse is assessing a client with systemic lupus erythematosus (SLE). Which of the following laboratory findings should the nurse anticipate? (Select all that apply) A. Positive ANA titer B. Increased hemoglobin C. Pancytopenia D. Urine positive for protein and RBCs Answer: A, C, D. Rationale: SLE causes an autoimmune response (Positive ANA), bone marrow suppression (pancytopenia), and lupus nephritis, which damages the kidneys causing protein and blood to spill into the urine. Q8: A nurse is providing teaching to a client who is to receive a vaccination following a deep puncture wound to the foot. Which information would the nurse include? A. “You will need to receive this vaccination annually.” B. “Your passive immunity will be boosted by receiving this shot.” C. “I am administering this vaccination to help protect you against tetanus.” D. “This immunization requires three separate injections several weeks apart.” Answer: C. Rationale: Tetanus vaccination is indicated for deep puncture wounds. Q9: A nurse is assessing a client who is being treated with interferon alfa-2b for malignant melanoma. The nurse should identify that which of the following findings are adverse effects of this medication? (Select all that apply) A. Tinnitus B. Muscle aches C. Peripheral neuropathy D. Bone loss E. Depression Answer: B, C, E. Rationale: Interferon therapy causes significant flu-like symptoms (muscle aches, chills), peripheral neuropathy, and mood changes including severe depression. Q10: A nurse is reviewing the medical record of a client. Which of the following findings are risk factors for ovarian cancer? (Select all that apply) A. Previous history of endometriosis B. Family history of colon cancer C. First pregnancy at age 24 D. First period at age 14 E. Use of oral contraceptives for 10 years Answer: A, B. Rationale: Endometriosis and a family history of associated cancers (like colon or breast BRCA mutations) increase the risk for ovarian cancer. (Pregnancy and oral contraceptive use typically decrease the risk). Q11: The nurse is caring for a client whose white blood cell count is 6000/mm3. Which differential value would the nurse discuss with the health care provider? A. Eosinophils 700/mm3 (Reference range: 50–400/mm3) B. Monocytes 500/mm3 (Reference range: 100–800/mm3) C