Medical-Surgical Nursing 13th Edition Test Bank Chapter 15 PDF

Preview

Summary

Practice test study questions for the Medical-Surgical Nursing13th Edition complete all chapters included 1-18....

Description

1. The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A) Monthly self-breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams Ans: B Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 570,000 Americans were expected to die from a malignant process in 2011. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer.

2. A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine Ans: A Feedback: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.

Page 1

3. The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, “Research has shown that certain foods indeed appear to increase the risk of cancer.” Which of the following menu selections would be the best choice for potentially reducing the risks of cancer? A) Smoked salmon and green beans B) Pork chops and fried green tomatoes C) Baked apricot chicken and steamed broccoli D) Liver, onions, and steamed peas Ans: C Feedback: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.

4. Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention? A) Yearly Pap tests B) Testicular self-examination C) Teaching patients to wear sunscreen D) Screening mammograms Ans: C Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.

Page 2

5. The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery Ans: C Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

6. The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient? A) Impaired nutritional status B) Cognitive changes C) Diarrhea D) Alopecia Ans: A Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this patient. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.

Page 3

7. While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A) Stopping the administration of the drug immediately B) Notifying the patient's physician C) Continuing the infusion but decreasing the rate D) Applying a warm compress to the infusion site Ans: A Feedback: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped.

8. A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A) Pruritis (itching) B) Nausea and vomiting C) Altered glucose metabolism D) Confusion Ans: B Feedback: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Confusion, alterations in glucose metabolism, and pruritis are not common adverse effects.

9. A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia? A) Interrupted sleep pattern B) Hot flashes C) Epistaxis (nose bleed) D) Increased weight Ans: C Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

Page 4

10. The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize? A) Adjust the dose to the patient's present symptoms. B) Wash hands with an alcohol-based cleanser following administration. C) Use gloves and a lab coat when preparing the medication. D) Dispose of the antineoplastic wastes in the hazardous waste receptacle. Ans: D Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.

11. A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patient's family and friends? A) “Your family should likely gather at the bedside in case there's a negative outcome.” B) “Make sure she doesn't eat any food in the 24 hours before the procedure.” C) “Wear a hospital gown when you go into the patient's room.” D) “Do not visit if you've had a recent infection.” Ans: D Feedback: Before HSCT, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the patient's contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.

Page 5

12. A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients? A) Encourage several small meals daily. B) Provide skin care to maintain skin integrity. C) Assist the patient with hygiene, as needed. D) Assess the integrity of the patient's oral mucosa regularly. Ans: B Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

13. You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform? Select all that apply. A) Use a lip lubricant. B) Scrub the tongue with a firm-bristled toothbrush. C) Use dental floss every 24 hours. D) Rinse the mouth with normal saline. E) Eat spicy food to aid in eradicating the yeast. Ans: A, C, D Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

14. The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient? A) Fatigue related to altered metabolic processes B) Altered nutrition: less than body requirements related to anorexia C) Risk for infection related to altered immunologic response D) Body image disturbance related to weight loss and anorexia Ans: C Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patient's immunity is suppressed, he or she will be at a high risk for infection. The other listed nursing diagnoses are valid, but they are not as high a priority as is risk for infection.

Page 6

15. An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do? A) Periodically apply ice to the area. B) Keep the area cleanly shaven. C) Apply petroleum jelly to the affected area. D) Avoid using soap on the treatment area. Ans: D Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

16. The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patient's care needs are unable to be met in a home environment. What might you suggest as an alternative? A) Discuss a referral for rehabilitation hospital. B) Panel the patient for a personal care home. C) Discuss a referral for acute care. D) Discuss a referral for hospice care. Ans: D Feedback: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have fewer than 6 months to live. Each of the other listed options would be less appropriate for the patient's physical and psychosocial needs.

Page 7

17. The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A) “These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies.” B) “These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer.” C) “Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy.” D) “Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.” Ans: A Feedback: Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and should not be belittled. Radiation destroys both cancerous and normal cells.

18. A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? A) The patient requests that her family bring her makeup and wig. B) The patient begins to discuss the future with her family. C) The patient reports less disruption from pain and discomfort. D) The patient cries openly when discussing her disease. Ans: A Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem.

Page 8

19. A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A) Administer an antiemetic. B) Administer an antimetabolite. C) Administer a tumor antibiotic. D) Administer an anticoagulant. Ans: A Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

20. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic? A) “Smoking is the reason you are here.” B) “The doctor left orders for you not to smoke.” C) “You are anxious about the surgery. Do you see smoking as helping?” D) “Smoking is OK right now, but after your surgery it is contraindicated.” Ans: C Feedback: Stating “You are anxious about the surgery. Do you see smoking as helping?” acknowledges the patient's feelings and encourages him to assess his previous behavior. Saying “Smoking is the reason you are here” belittles the patient. Citing the doctor's orders does not address the patient's anxiety. Sanctioning smoking would be highly detrimental to this patient.

Page 9

21. An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patient's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A) Malignant cells contain more fibronectin than normal body cells. B) Malignant cells contain proteins called tumor-specific antigens. C) Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D) The nuclei of cancer cells are unusually large, but regularly shaped. Ans: B Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

22. A patient's most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient's cancer cells spread? A) Hematologic spread B) Lymphatic circulation C) Invasion D) Angiogenesis Ans: B Feedback: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

Page 10

23. The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread Ans: A, B, E Feedback: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.

24. A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, “They tell me my cancer is malignant, while my coworker's breast tumor was benign. I just don't understand at all.” When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type? A) Slow rate of mitosis of cancer cells B) Different proteins in the cell membrane C) Differing size of the cells D) Different molecular structure in the cells Ans: B Feedback: The cell membrane of malignant cells also contains proteins called tumor-specific antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.

Page 11

25. An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? A) Adhering to primary tumor cells B) Inducing mutation of cells of another organ C) Phagocytizing healthy cells D) Invading healthy host tissues Ans: D Feedback: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

26. The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply. A) Malignant melanoma B) Brain cancer C) Breast cancer D) Esophageal cancer E) Liver cancer Ans: C, D, E Feedback: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nit...