Questions Part 3

1. You are monitoring your patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation?

1.     "Last night my back really hurt, and I had trouble sleeping."
2.     "My leg has been giving out when I try to stand."
3.     "My bowels are just not moving like they usually do."
4.     "When I try to pass urine, I have difficulty starting the stream."

2. For a patient with osteogenic sarcoma, which laboratory value causes you the most concern?

1.     Sodium level of 135 mEq/L
2.     Calcium level of 13 mg/dL
3.     Potassium level of 4.9 mEq/L
4.     Hematocrit of 40%

3. An athletic young man was recently diagnosed with Ewing sarcoma. He has pain, low- grade fever, and anemia. The surgeon recommends amputation of the right lower leg for an operable tumor. The patient tells you he is leaving the hospital to go on a long hiking trip. What is the priority nursing diagnosis?

1.     Acute Pain related to tumor invasion of soft tissue
2.     Fatigue related to anemia
3.     Ineffective Coping related to loss of body image
4.     Noncompliance related to personal values

4. Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention?

 
1.     Platelet count
2.     Electrolyte levels
3.     Hemoglobin level
4.     Hematocrit

5. People at risk are the target populations for cancer screening programs. Which of these asymptomatic patients need extra encouragement to participate in cancer screening? (Select all that apply.) 

1.     A 21-year-old white American woman who is sexually inactive, for a Pap test
2.     A 30-year-old Asian-American woman, for an annual mammogram
3.     A 45-year-old African-American man, for a prostate-specific antigen test
4.     A 50-year-old African-American man, for a fecal occult blood test
5.     A 50-year-old white American woman, for a colonoscopy
6.     A 70-year-old Asian-American woman with normal results on three previous Pap tests, for a Pap test

6. A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the physician, you would anticipate which initial order for the treatment of this patient? 

1.     A fluid bolus
2.     Fluid restrictions
3.     Urinalysis
4.     Sodium-restricted diet

7. You are providing end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened. What should you do?

1.     Obtain an order for morphine elixir.
2.     Alert the rapid response team and call the physician for orders.
3.     Deliver breaths at 20/min with a bag-valve mask and prepare for intubation.
4.     Sit quietly with the patient and offer emotional support and comfort.

8. You are asked to float to a different nursing unit. During report, you are told that the patient is receiving IV administration of vincristine (Oncovin) that should be completed within the next 15 minutes. The IV site is intact, and the patient is not having any problems with the infusion. You are not certified in chemotherapy administration. What is your priority action? 

1.     Ask the nurse to stay until the infusion is finished, because you are not certified.
2.     Assess the IV site; check the progress of the infusion and the patient's condition.
3.     Contact the charge nurse and explain that you are not chemotherapy certified.
4.     Look up drug side effects and monitor, because the infusion is almost complete.

9. A few minutes after you have given an intradermal injection of an allergen to a patient who is undergoing skin testing for allergies, the patient reports feeling anxious, short of breath, and dizzy. Which action included in the emergency protocol should you take first? 

1.     Start oxygen at 4 L/min using a nasal cannula.
2.     Obtain IV access with a large-bore IV catheter.
3.     Give epinephrine (Adrenalin) 0.3 mL intramuscularly.
4.     Administer 3 mL of nebulized albuterol (Proventil) 0.083%.

 10. You are working with a student nurse to care for an HIV-positive patient with severe esophagitis caused by Candida albicans. Which action by the student indicates that you need to intervene most quickly? 

1.     Putting on a mask and gown before entering the patient's room
2.     Giving the patient a glass of water after administering the ordered oral nystatin (Mycostatin) suspension
3.     Suggesting that the patient should order chile con carne or chicken soup for the next meal
4.     Placing a "No Visitors" sign on the door of the patient's room