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AH1 NCLEX EXAM 3 (CH. 19-20, 37, 39-41, 45-47, 58-59) (1).
AH1 NCLEX EXAM 3 (CH. 19-20, 37, 39-41, 45-47, 58-59) (1).
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AH1 NCLEX EXAM 3 (CH. 19-20, 37, 39-41, 45-47,58-59)
A nurse is assessing a client with a genetic history of cancer. Which assessment finding
requires immediate nursing intervention?
A. Blood pressure 140/90
B. Nagging cough with hoarseness
C. Nasal congestion for several days
D. Muscle tension in the cervical spine - ANS-B. Nagging cough with hoarseness
•A nagging cough with hoarseness is one of the seven warning signs of cancer. Given the
genetic predisposition combined with the assessment data, there is cause for concern so the
nurse must intervene here first. Other findings can be subsequently addressed.
The nurse understands that normal cells and benign cells share which characteristics? (Select
all that apply.)
A. No migration
B. Orderly growth
C. Tight adherence
D. Specific morphology
E. Large nuclear-to-cytoplasmic ratio - ANS-A. No migration
B. Orderly growth
C. Tight adherence
D. Specific morphology
•Normal cells and benign cells do not migrate, have orderly growth, demonstrate tight
adherence, and have specific morphology. A cancerous (malignant) cell's nucleus is larger than
that of a normal cell and the cancer cell is smaller than a normal cell. The nucleus occupies
much of the space within the cancer cell, creating a large nuclear-to-cytoplasmic ratio.
Which primary prevention strategy does the nurse recommend to a client concerned about
development of cancer?
A. Removal of mole on the abdomen
B. Have a fecal occult blood test annually
C. Obtain a baseline colonoscopy at 50 years old
D. Women should speak to their provider about a mammogram - ANS-A. Removal of mole on
the abdomen
,•Primary prevention of cancer involves removal of "at risk" tissue. The other choices listed are
secondary prevention strategies, which involve screening for early detection of cancer.
A client asks the nurse why his colorectal cancer is being tested for genetic mutations even
though no one else in the family has ever had cancer. What is the nurse's best response?
A. "Colorectal cancer is rare and most cases are caused by a genetic mutation."
B. "The results of this testing will indicate what caused your cancer so you can avoid further
exposure."
C. "Many tumors have one or more genetic differences that can help determine the most
effective treatment options."
D. "Genetic testing of tumor cells can help determine the stage of your cancer and whether it
has spread to other organs." - ANS-C. "Many tumors have one or more genetic differences that
can help determine the most effective treatment options."
An older client reports all of the following changes since his last checkup. Which changes alert
the nurse to the possibility of prostate cancer? Select all that apply.
A. Bloody urine
B. Constipation intermittent with diarrhea
C. Erectile dysfunction
D. Night sweats and fever
E. Persistent pain in the lower back and legs
F. Reduced urine stream - ANS-A. Bloody urine
D. Night sweats and fever
E. Persistent pain in the lower back and legs
F. Reduced urine stream
Which specific cancer types have a higher rate of occurrence among the Hispanic/Latino
population of the United States compared with the non-Hispanic white population? Select all
that apply.
A. Breast
B. Colorectal
C. Gall bladder
D. Liver
E. Lung
F. Prostate
G. Stomach - ANS-C. Gall bladder
D. Liver
G. Stomach
infection-related, less access to healthcare
How does a mutation in a suppressor gene, such as BRCA1, increase the risk for cancer
development?
A. Converting a proto-oncogene into an oncogene
,B. Removing the control over proto-oncogene expression
C. Reducing the amount of cyclins produced by the oncogenes
D. Inhibiting the recognition of abnormal cells through immunosurveillance - ANS-B. Removing
the control over proto-oncogene expression
A client's cancer is staged as T1, N2, M1 according to the TNM classification system. How does
the nurse interpret this report?
A. The client has two tumors that are nonresponsive to treatment.
B. The client has leukemia confined to the bone marrow.
C. The client has a 2-cm tumor with one regional lymph node involved and no distant
metastasis.
D. The client has a small primary tumor extension into two lymph nodes and one site of distant
metastasis. - ANS-D. The client has a small primary tumor extension into two lymph nodes and
one site of distant metastasis.
Which statements made by a 62-year-old client alert the nurse to the possibility that he may be
at increased genetic risk for cancer development? Select all that apply.
A. An older aunt died from a brain tumor while she had breast cancer.
B. He had two benign colon polyps removed during his most recent routine colonoscopy.
C. His sister died from cancer of the appendix.
D. His brother is being treated for breast cancer.
E. His 32-year-old daughter has been recently diagnosed with cervical cancer.
F. One person in each of the previous three generations of his family died from lung cancer. -
ANS-C. His sister died from cancer of the appendix.
D. His brother is being treated for breast cancer.
The nurse is caring for a 25-year old client with a history of sickle cell disease (SCD). Today the
client reports pain that is rated as a "9" on a 0-to-10 scale. Nursing assessment reveals
grimacing, abdominal guarding, fever of 103.9º F, pale yellow hard palate, and several very
small ulcers on the lower extremities.
1. Which concern will the nurse address as the priority?
A. Acute pain
B. Hyperthermia
C. Potential for infection
D. Impaired tissue perfusion - ANS-A. Acute pain
The client's pain must be controlled first and foremost. All other problems can be addressed
after the acute pain is managed.
The health care provider diagnoses the client with acute sickle cell crisis. Which drug does the
nurse anticipate will be prescribed for pain control at this time? (Select all that apply.)
, A. Meperidine IV push prn
B. Acetaminophen rectally prn
C. Morphine sulfate IM scheduled doses
D. Hydromorphone IV push scheduled doses
E. Morphine sulfate IV push scheduled doses - ANS-D. Hydromorphone IV push scheduled
doses
E. Morphine sulfate IV push scheduled doses
A client in sickle cell crisis often needs approximately 48 hours of IV analgesia. Morphine and
hydromorphone (Dilaudid) are given IV on a regular schedule, or by using a patient-controlled
analgesia (PCA) pump. Once relief is obtained, the IV dose can be tapered and oral drugs may
be given. PRN dosages should be avoided because they do not provide adequate pain relief.
Acetaminophen will not address the degree of pain that is being experienced. IM injections
should be avoided because absorption is impaired by poor perfusion and sclerosed skin.
Laboratory results have been completed. When reviewing the report, which result does the
nurse anticipate? (for sickle cell)
A. Hct 40%
B. HbS 90%
C. WBC 8000/mm3
D. Total bilirubin 0.5 mg/dL - ANS-B. HbS 90%
The HbS is reflective of a client with sickle cell disease (SCD). Clients with SCD usually have
low Hct, high WBC, and high total bilirubin. The other values shown here are within normal
limits.
The health care provider's orders include hydroxyurea. When the nurse administers the drug,
the client asks about the purpose of this medication.
4a. What is the appropriate nursing response?
4b. What follow-up laboratory value will the nurse monitor while the client is receiving
hydroxyurea? - ANS-ANS:
4a. Hydroxyurea has been successfully used to reduce the sickling of RBCs.
4b. CBC—Hydroxyurea suppresses bone marrow function, so it is important to monitor
complete blood counts.
Four days later, the client admitted with sickle cell crisis is preparing for discharge.
Which teaching point will the nurse provide? (Select all that apply.)
A. Be sure to get a flu shot annually.
B. Drink at least 3 to 4 L of fluid daily.
C. Alcoholic beverages may be consumed moderately.
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