Exam (elaborations)
Hematological & Oncology (1)
Hematological & Oncology (1)
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Hematological & OncologyThe nurse provides instructions to the client who received cryosurgery (cervical ablation) for a
local stage 0 cervical tumor. Which instruction should the nurse give the client?
1.
To avoid tub baths
2.
That pain indicates a complication of the procedure
3.
To call the primary health care provider if a watery discharge is noted
4.
To call the primary health care provider discharge remains odorous after 1 week - CORRECT
ANSWER-1.
To avoid tub baths
Rationale:
Healing after cryosurgery takes about 10 weeks. Tub baths and sitz baths need to be avoided.
Showers or sponge baths should be taken during this time. Mild pain may occur and continue for
several days after this procedure. A clear, watery discharge is expected. For about 14 days, this is
followed by discharge that contains debris, which may be odorous. If the discharge continues for
more than 8 weeks, an infection is suspected.
A client has undergone vaginal hysterectomy for the treatment of uterine cancer. In the
postoperative plan of care, the nurse should avoid which activity?
1.
Using pneumatic compression boots
2.
Assisting with range-of-motion leg exercises
3.
Removing antiembolism stockings twice daily
4.
Elevating the knees and placing extra pillows under the knees - CORRECT ANSWER-Elevating
the knees and placing extra pillows under the knees
Rationale:
The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as with any
other major surgery. For this reason, the nurse implements measures that will prevent this
complication. Pneumatic compression boots, range-of-motion exercises, and antiembolism
stockings (if prescribed) are all helpful. The nurse should avoid using the knee gatch on the bed or
elevating the knees with the use of pillows, which inhibits venous return, therefore placing the
client more at risk for deep vein thrombosis or thrombophlebitis.
,The nurse has taught a postmenopausal woman at risk for breast cancer how to do breast
self-examination (BSE). The nurse determines that the client understands the procedure if the
client makes which statement?
1.
"I will palpate my breasts while standing in front of the mirror."
2.
"I will do the exam 14 days after the start of my menstrual cycle."
3.
"I will use the pads of my fingers and press deeply to feel lumps."
4.
"I will examine my right breast with my right hand, and vice versa." - CORRECT ANSWER-"I will
use the pads of my fingers and press deeply to feel lumps."
Rationale:
Women who are postmenopausal are taught to do BSE on the same day of every month. Before
menopause, women should do the procedure 7 days after the start of the menstrual cycle when
the breasts are least tender. Each breast is examined with the opposite hand. The pads of the
fingers should be used for palpation, and the client should press deeply, feeling for lumps. The
client may use a circular, up-and-down, or wedge method of assessment. Consistency of use of
the same method is more important than the actual method used. The client should inspect the
breasts while standing in front of a mirror. The client should palpate the breasts while in the
shower because soapy wet skin makes it easy to slide the pads of the fingers across breast tissue,
or the client can palpate the breasts while in the supine position.
A client is being admitted to the hospital after receiving a radiation implant after being diagnosed
with cervical cancer. Which priority action should the nurse implement in the care of this client?
1.
Encourage the family to visit.
2.
Admit the client to a private room.
3.
Place the client on protective isolation.
4.
Encourage the client to take frequent rest periods. - CORRECT ANSWER-Admit the client to a
private room.
Rationale:
The client who has a radiation implant is placed in a private room and has limited visitors. This
reduces the exposure of others to the radiation. Protective isolation is unnecessary; rather,
individuals other than the client need to be protected. Frequent rest periods are a helpful general
intervention but are not a priority for the client in this situation.
,The nurse is assessing a client with a diagnosis of multiple myeloma for dehydration related to
hypercalcemia. The nurse notifies the primary health care provider of which signs/symptoms of
hypercalcemia? Select all that apply.
1.
Fatigue
2.
Nausea
3.
Diarrhea
4.
Anorexia
5.
Scant urine output - CORRECT ANSWER-1. Fatigue
2.
Nausea
4.
Anorexia
Rationale:
Clients with multiple myeloma are at risk for hypercalcemia. Fatigue, nausea, anorexia, vomiting,
polyuria, weakness, and constipation, along with dehydration, are signs/symptoms of moderate
hypercalcemia. The nurse needs to monitor for these signs/symptoms and report them
immediately to the primary health care provider. Activity is encouraged. A fluid intake of 3000 mL
daily is required to dilute the calcium overload and to prevent protein from precipitating in the renal
tubules. A high-calorie diet is encouraged, because a low-fiber diet can lead to constipation.
A client is admitted to the hospital with a diagnosis of infiltrating ductal carcinoma of the breast.
Which expected manifestation should the nurse assess the client for?
1.
Bilateral palpable masses
2.
Pain in the breast and edema
3.
A fixed, irregularly shaped mass
4.
A round-shaped mass that is moveable - CORRECT ANSWER-A fixed, irregularly shaped mass
Rationale:
Infiltrating ductal carcinoma of the breast usually presents as a fixed, irregularly shaped mass. The
mass is usually single and unilateral and is painless, nontender, and hard to the touch.
, The nurse is teaching a client who is scheduled for radiation therapy about the therapy. Which
statement by the client indicates a need for further teaching?
1.
"I'm certain that this will do the trick."
2.
"I will be radioactive after the therapy."
3.
"This is just one of several options I have for treatment."
4.
"This treatment is great, because it is invisible and very effective." - CORRECT ANSWER-"I will be
radioactive after the therapy."
Rationale:
A need for further teaching occurs when the client states that she or he will be radioactive after the
therapy. Education by the nurse can eliminate the fear and misconceptions of radiation therapy
and support the client and family. Some of the most common fears and misconceptions include
fear of being burned, fear of being radioactive, the radioactive treatment, treatment failure, and the
adverse effects. The remaining statements are correct although additional information may need
to be provided to the client.
The nurse is caring for a postoperative client who had a mastectomy with axillary lymph node
dissection. How should the nurse position the client to promote prevent lymphedema?
1.
Side-lying on the affected side
2.
Supine with the client's head resting on one pillow
3.
High-Fowler's with both arms positioned on an over bed table
4.
Semi-Fowler's with the affected arm elevated above the level on the heart - CORRECT
ANSWER-Semi-Fowler's with the affected arm elevated above the level on the heart
Rationale:
After mastectomy with axillary lymph node dissection, the nurse should position the client in a
semi-Fowler's position, with the affected arm elevated above the level of the heart. This position
helps to promote drainage and prevent lymphedema. The other positions are not appropriate for
this client.
The nurse reviews the result of the white blood cell count of a client diagnosed with Hodgkin's
disease who has received chemotherapy. The result of the test is reported as 2000 mm3 (2 ×
109/L). After analyzing the result, what conclusion concerning the client's white blood cell count
should the nurse make?
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