A 37-year-old client with uterine cancer asks the nurse, “Which is the most common type of cancer in women?” The nurse replies that it’s breast cancer. Which type of cancer causes the most deaths in women?
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Solution
Lung cancer
Option B: Lung cancer is the most deadly type of cancer in both women and men.
Options A, C, and D: Breast cancer ranks second in women, followed (in descending order) by colon and rectal cancer, pancreatic cancer, ovarian cancer, uterine cancer, lymphoma, leukemia, liver cancer, brain cancer, stomach cancer, and multiple myeloma.
Lydia undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?
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Solution
“Keep the stoma moist.”
Option D: The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated.
Option A: The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma.
Option C: The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.
Cristina undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
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Solution
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Option B: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis.
Option A: No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0.
Option C: If the tumor and regional lymph nodes can’t be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0.
Option D: A progressive increase in tumor size, no demonstrable metastases of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
A 35-year-old client with vaginal cancer asks the nurse, “What is the usual treatment for this type of cancer?” Which treatment should the nurse name?
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Solution
Radiation
Option C: The usual treatment for vaginal cancer is external or intravaginal radiation therapy.
Option A: Less often, surgery is performed.
Option B: Chemotherapy typically is prescribed only if vaginal cancer is diagnosed in an early stage, which is rare.
Option D: Immunotherapy isn’t used to treat vaginal cancer.
A 51-year-old female client tells the nurse-in-charge that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?
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Solution
Nonmobile mass with irregular edges
Option B: Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges.
Option C: A mobile mass that is soft and easily delineated is most often a fluid-filled benign cyst.
Option D: Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass.
Option A: Nipple retraction — not eversion — may be a sign of cancer.
Honey, a 23-year old client complains of substernal chest pain and states that her heart feels like “it’s racing out of the chest”. She reports no history of cardiac disorders. The nurse attaches her to a cardiac monitor and notes sinus tachycardia with a rate of 136beats/minutes. Breath sounds are clear and the respiratory rate is 26 breaths/minutes. Which of the following drugs should the nurse question the client about using?
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Solution
Cocaine
Option C: Because of the client’s age and negative medical history, the nurse should question her about cocaine use. Cocaine increases myocardial oxygen consumption and can cause coronary artery spasm, leading to tachycardia, ventricular fibrillation, myocardial ischemia, and myocardial infarction.
Option A: Barbiturate overdose may trigger respiratory depression and slow pulse.
Options B and D: Opioids can cause marked respiratory depression, while benzodiazepines can cause drowsiness and confusion.
During the endorsement, which of the following clients should the on-duty nurse assess first?
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Solution
The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving L.V. diltiazem (Cardizem)
Option D: The client with atrial fibrillation has the greatest potential to become unstable and is on L.V. medication that requires close monitoring.
Options C and A: After assessing this client, the nurse should assess the client with thrombophlebitis who is receiving a heparin infusion, and then the 58- year-old client admitted 2 days ago with heart failure (his signs and symptoms are resolving and don’t require immediate attention).
Option B: The lowest priority is the 89-year-old with end-stage right-sided heart failure, who requires time-consuming supportive measures.
Robert, a 57-year-old client with acute arterial occlusion of the left leg undergoes an emergency embolectomy. Six hours later, the nurse isn’t able to obtain pulses in his left foot using Doppler ultrasound. The nurse immediately notifies the physician and asks her to prepare the client for surgery. As the nurse enters the client’s room to prepare him, he states that he won’t have any more surgery. Which of the following is the best initial response by the nurse?
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Solution
Explain the risks of not having the surgery
Option A: The best initial response is to explain the risks of not having the surgery.
Options B, C, and D: If the client understands the risks but still refuses the nurse should notify the physician and the nurse supervisor and then record the client’s refusal in the nurses’ notes.
Diagnostic assessment of Francis would probably not reveal:
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Solution
Leukocytosis
Option B: Chronic Lymphocytic leukemia (CLL) is characterized by increased production of leukocytes and lymphocytes resulting in leukocytosis, and proliferation of these cells within the bone marrow, spleen and liver.
During routine care, Francis asks the nurse, “How can I be anemic if this disease causes increased my white blood cell production?” The nurse in-charge best response would be that the increased number of white blood cells (WBC) is:
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Solution
Crowd red blood cells
Option A: The excessive production of white blood cells crowd out red blood cells production which causes anemia to occur.