Which of the following clinical manifestations does the nurse most likely observe in a client with Hodgkin's disease?
Difficulty swallowing.
Painless, enlarged cervical lymph nodes.
Difficulty breathing.
A feeling of fullness over the liver
What action is correct for handling the lymph node biopsy specimen for histologic examination for a client with a suspected diagnosis of Hodgkin's disease?
Call the laboratory and ask for specific instructions.
Place the specimen on a sponge in gloved hand. Next, place the sponge on the gloved hand. Then, pull the glove over the speciman and take it to the laboratory.
Place the specimen in a container and send it to the laboratory when someone is available to take it.
Call for a laboratory technician to assist the physician
The client with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. After the procedure, what does the nurse assess first?
Vital signs
The incision.
The airway.
Neurologic signs.
The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic examination will reveal which of the following?
Tay-Sachs cells.
Sarcoidosis cells.
Reed-Sternberg cells.
Duchenne's cells.
When assessing the client with Hodgkin's disease, the nurse is alert for which of the following findings?
Herpes zoster infections.
Discolored teeth.
Hemorrhage.
Hypercellular immunity.
The client with Hodgkin's disease develops B symptoms. These manifestations indicate which of the following?
The client has a low-grade fever (temperature lower than 100°F
The client has a weight loss of 5% or less of body weight.
The client has night sweats.
The client probably has not progressed to an advanced stage
The client tells his nurse that he wants to be sure that he is receiving the latest staging technique for his lymphoma. The nurse tells the client that which of the following is being used less often in the staging of lymphomas?
Body scans.
Radiography
Blood studies
Exploratory laparotomy with lymph node biopsy.
The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. Which of the following describes the involvement of the disease?
Involvement of a single lymph node.
Involvement of two or more lymph nodes on the same side of the diaphragm.
Involvement of lymph node regions on both sides of the diaphragm.
Diffuse disease of one or more extralymphatic organs.
A client is undergoing a bone marrow aspiration and biopsy. What is the best way for the nurse to help the client handle her stress?
Allow the client's family to stay with her as long as possible.
Stay with the client and hold her hand without speaking
Encourage the client to take slow, deep breaths to relax.
Allow the client time to express her feelings.
The nurse explains to the client with Hodgkin's disease that a bone marrow biopsy will be taken after the aspiration. What should the nurse explain about the biopsy?
"Your biopsy will be performed before the aspiration because enough tissue may be obtained so that you won't have to go through the aspiration."
"You will feel a pressure sensation when the biopsy is taken but should not feel actual pain; if you do, tell the doctor so that you can be given extra numbing medicine."
"You may hear a crunch as the needle passes through the bone, but when the biopsy is taken, you will feel a suction-type pain that will last for just a moment."
"You will be shaved and cleaned with an antiseptic agent, after which the doctor will inject a needle without making an incision to aspirate out the bone marrow."
A client with advanced Hodgkin's disease is readmitted because death is imminent. The goal of nursing care is to help relieve the client's
fear of pain.
fear of further therapy.
feelings of isolation.
feelings of social inadequacy.
The client is a survivor of non-Hodgkin's lymphoma. Which of the following statements indicates the client needs additional information?
"Regular screening is very important for me."
"The survivor rate is directly proportional to the incidence of second malignancy."
"The survivor rate is indirectly proportionate to the incidence of second malignancy."
"It is important for survivors to know the stage of the disease and their current treatment plan."
The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?
Eggs.
Lettuce.
Citrus fruits.
Cheese.
The nurse should instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?
Whole grains.
. Green leafy vegetables.
Meats and dairy products.
Broccoli and brussels sprouts.
The nurse has just admitted a 35-year-old female client who has a serum vitamin B12 concentration of 800 pg/mL. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol use?
Total bilirubin, 0.3 mg/dL.
Serum creatinine, 0.5 mg/dL.
Hemoglobin, 16 g/dL.
Folate, 1.5 ng/mL.
The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?
Schilling's test, elevated.
Intrinsic factor, absent.
Sedimentation rate, 16 mm/hour.
Red blood cells (RBCs), 5.0 million/µL3.
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?
Eat animal protein and dark green leafy vegetables every day
Avoid exposure to others with acute infections.
Practice yoga and meditation to decrease stress and anxiety
Get 8 hours of sleep at night and take naps during the day.
A client comes to the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching?
"I have been drinking plenty of fluids."
"I have been gargling with warm salt water for my sore tongue."
"I have three to four loose stools per day."
"I take a vitamin B12 tablet every day."
A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client
adds dried fruit to cereal and baked goods.
cooks tomato-based foods in iron pots.
drinks coffee or tea with meals.
adds vitamin C to all meals.
A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance?
"What daily activities were you able to do 6 months ago compared with the present?"
"How long have you had this problem?"
"Have you been able to keep up with all your usual activities?"
"Are you more tired now than you used to be?"
Into which site or sites would the nurse expect to administer vitamin B12 ordered for a client with pernicious anemia? Select all that apply.
Median cutaneous.
Greater femur trochanter.
Ventrogluteal.
Dorsogluteal.
Which position would most help to decrease a client's discomfort when the client's spouse injects vitamin B12 using the ventrogluteal site?
Lying on the side with legs extended.
Lying on the abdomen with toes pointed inward.
Leaning over the edge of a low table with hips flexed.
Standing upright with the feet one shoulder's-width apart.
The primary purpose of the Schilling test is to measure the client's ability to
store vitamin B12.
digest vitamin B12.
absorb vitamin B12.
produce vitamin B12.
The nurse implements which of the following for the client who is starting a Schilling test?
Administering methylcellulose (Citrucel).
Starting a 24- to 48-hour urine specimen collection.
Maintaining NPO status.
Starting a 72-hour stool specimen collection
A 16-year-old client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly and hepatomegaly. Which of the following would be the primary focus of nursing care for this client?
Providing activities of daily living on the time schedule of his homeland.
Offering foods of his preference to increase his intake of calories.
Decreasing his cardiac demands by promoting a 1:3 ratio of rest to activity as tolerated.
Listening to his concerns about his hospitalization.
client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response?
"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid."
"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."
"The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction."
"The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."
An African-American woman had experienced severe palpitations, weakness, and shortness of breath after taking bacitracin (Bactrim). As a part of the discharge planning, the nurse evaluates the client's knowledge about her
increased folic acid needs.
congenital enzyme deficiency.
restricted activity in hot weather.
need for blood transfusions.
The nurse administers packed red blood cells (PRBCs) to a client. Which of the following nursing actions is appropriate?
Discontinue the intravenous catheter if a blood transfusion reaction occurs.
Administer the PRBCs through a percutaneously inserted central catheter line with a 20-gauge needle.
Flush PRBCs with 5% dextrose and 0.45% normal saline.
Stay with the client during the first 15 minutes of infusion.
A client had received 25 mL of PRBCs when she began to experience low lack pain and mild itching. After stopping the infusion, the nurse should
administer prescribed aspirin and antihistamines.
collect blood and urine samples to be sent to the laboratory
administer prescribed diuretics, oxygen, and morphine.
administer prescribed vasopressors.
A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection?
Hematocrit.
Partial thromboplastin time.
Hemoglobin concentration.
Prothrombin time.
client states that she is afraid of receiving vitamin B12 injections because of potential toxic reactions. What is the nurse's best response to relieve these fears?
"Vitamin B12 will cause ringing in the ears before a toxic level is reached."
"Vitamin B12 may cause a very mild skin rash initially."
"Vitamin B12 may cause mild nausea but nothing toxic."
"Vitamin B12 is generally free of toxicity because it is water soluble."
Which of the following nursing interventions is appropriate for a client with a platelet count of 31,000/mm3?
Pad sharp surfaces to avoid minor trauma when walking.
. Assess for spontaneous petechiae in the extremities.
Keep the room darkened.
Check for blood in the urine
A client with a history of systemic lupus erythematosus was admitted with a severe viral respiratory infection and diffuse petechiae. Based on these data, it is most important that the nurse further evaluate the client's recent
quality and quantity of food intake.
type and amount of fluid intake.
weakness, fatigue, and ability to get around.
length and amount of menstrual flow.
When a client with thrombocytopenia complains of a severe headache, the nurse interprets that this may indicate which of the following?
Stress of the disease
Cerebral bleeding.
A migraine headache.
Sinus congestion.
The nurse evaluates that the client correctly understands how to report signs of bleeding when she makes which of the following statements?
"Petechiae are large red skin bruises."
"Ecchymoses are large purple skin bruises."
"Purpura is an open cut on the skin."
"Abrasions are small pinpoint red dots on the skin."
The client states she does not understand what causes idiopathic thrombocytopenic purpura (ITP). The nurse provides which of the following explanations?
It is believed that the platelets are coated with antibodies and the spleen sees them as foreign bodies.
It is believed that the liver identifies the platelets as foreign bodies.
It is now believed that the syndrome is related to an underactive immune system.
The cause is unknown.
The nurse should instruct the client with a platelet count of less than 150,000/µL to avoid which of the following activities?
Ambulation.
Valsalva's maneuver.
Visiting with children.
Semi-Fowler's position.
If a client who is taking Bufferin Arthritis Strength caplets develops prolonged bleeding from a superficial injury, the nurse recognizes that this clinical manifestation most likely reflects
a prothrombin time (PT) of 10 seconds.
an activated partial thromboplastin time (aPTT) of 40 seconds.
a bleeding time of 8 minutes.
a coagulation time (CT) of 8 minutes
A client's bone marrow report reveals normal stem cells and precursors of platelets (megakaryocytes) in the presence of decreased circulating platelets. The nurse recognizes a knowledge deficit when the client makes which of the following statements?
"I need to stop flossing and throw away my hard toothbrush."
"I am glad that my report turned out normal."
"Now I know why I have all these bruises."
"I shouldn't jump off that last step anymore."
Which early symptom does the nurse observe in a client with thrombocytopenia who has developed a hemorrhage?
Tachycardia.
Bradycardia.
Decreased PaCO2.
Narrowed pulse pressure.
The client with ITP asks the nurse why she has to take steroids. Which is the nurse's best response?
Steroids destroy the antibodies and prolong the life of platelets.
Steroids neutralize the antigens and prolong the life of platelets.
Steroids increase phagocytosis and increase the life of the platelets.
Steroids alter the spleen's recognition of platelets and increase the life of the platelets.
A client is to be discharged on prednisone. Which of the following statements indicates that the client understands important concepts about the medication therapy?
"I need to take the medicine in divided doses at morning and bedtime."
"I am to take 40 mg of prednisone for 2 months and then stop."
"I need to wear or carry identification that I am taking prednisone."
"Prednisone will give me extra protection from colds and flu."
When teaching the client older than 50 years of age who is receiving long-term prednisone therapy, which of the following actions does the nurse recommend?
Take the prednisone with food.
Take over-the-counter drugs as needed.
Exercise three to four times a week.
Eat foods that are low in potassium.
The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client?
Floor exercises
Stretching.
Running
Walking
The nurse notes that the daily white blood cell (WBC) count in a client with aplastic anemia has dropped overnight from 3,900 to 2,900/µL. What is the appropriate nursing intervention
Continue monitoring the client.
Call the laboratory to verify the report
Document the finding.
Call the physician and place the client in reverse isolation.
A client who had an exploratory laparotomy 3 days ago has a WBC differential with a shift to the left. The nurse instructs unlicensed personnel to report which clinical manifestation?
Swelling around the incision.
Redness around the incision.
Elevated temperature.
Purulent wound drainage.
A client with neutropenia has an ANC of 900. What is the client's risk of infection?
Normal risk.
Moderate risk.
High risk.
Extremely high risk
What nursing action is important in preventing cross-contamination?
Change gloves immediately after use.
Stand 2 feet from the patient.
Speak minimally when in the room.
Wear long-sleeved shirts.
A client states, "I don't want any more tests. Who cares what kind of leukemia I have? I just want to be treated now." What is the nurse's best response?
"I'm sure you are frustrated and want to be well now."
"Your treatment can be more effective if it is based on more specific information about your disease."
"Now, you know the tests are necessary and that you are just upset right now."
"I understand how you feel."
During the induction stage for treatment of leukemia, the nurse should remove which items that the family has brought into the room?