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1. An adolescent with a diagnosis of osteogenic sarcoma is to have the affected leg amputated followed by chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. The nurse responds that the best approach would be:
a. A detailed explanation of amputation and chemotherapy
b. Straightforward honesty about the amputation with brief information about chemotherapy
c. A discussion of choices of treatment, indicating that the final one cannot be made until the time of surgery
d. Provision of information about chemotherapy and the suggestion that the amputation may be a possibility
2. A terminally ill client tells the nurse, "I would love to learn speak German before I die." The nurse's response to the clients desire to learn a foreign language should be based on the awareness that:
a. Converstions and activities should focus on pleasant experiences
b. Clients should be encouraged to set meaningful goals for themselves
c. Activities that support the client's denial should not be encouraged
d. The energies expended on such an activity would not justify the outcome
3. A terminally ill client is moving gradually toward resolution of feelings about impending death. Basing the plan of care on the research of Elizabeth Kubler-Ross, the nurse should use nonverbal interventions after having assessed that the client is in the:
a. Anger stage
b. Denial stage
c. Bargaining stage
d. Acceptance stage
4. The nurse is aware that value clarification is a technique useful in therapeutic communication in that it helps:
a. Make clients aware of their personal values
b. Provide information related to clients' needs
c. Assist clients in making correct decisions related to their health
d. Alter clients' value systems to make them more socially acceptable
5. A 30-year old female dancer notices that a mole on her ankle has turned dark brown and seeks medical attention. A diagnosis of malignant melanoma is made. This client has increased her chance of survival by early treatment because melanoma spreads:
a. By seeding across membranes of body tissues
b. By runner-like chains of cells to satellite tumors
c. Through invasion of the lymphatic system and bloodstream
d. Through direct extension into subcutaneous tissue and to bone
6. A client who is to receive radiation says to the nurse, " My family and friends say that I will get a radiation burn." The best response by the nurse would be:
a. "It will be no worse than a sunburn."
b. "A localized skin reaction usually occurs."
c. "Have they had experience with this type of radiation?"
d. "Daily application of an emollient will prevent the burn."
7. A client is scheduled for radiation treatments Monday through Friday. The client asks why the treatments will not be given on Saturday and Sunday. The nurse's best response would be:
a. "The department operates Monday through Friday."
b. "This schedule gives normal cells time to recover."
c. "Your energy level will be increased greatly by a five-day schedule"
d. "Side effects are eliminated when treatment is administered for five rather than seven days."
8. A client is receiving radiation therapy. When teaching about skin care to the irradiated area, the nurse should instruct the client to:
a. Apply no lotions or powders to the area
b. Cover the area with a sterile gauze bandage
c. Put warm compresses on the site once a day
d. Lie on the back and unaffected side when sleeping
9. A client who has just had a colostomy, has an uneventful 24-hour postoperative course. Seventy-two hours after surgery, the primary nursing intervention for this client would be:
a. Keeping an accurate record of vital signs and oral intake
b. Emphasizing the importance of regulating the diet to form stool
c. Teaching care of the incision and how to perform colostomy irrigations
d. Observing and reporting drainage and the condition of the abdominal incision
10. When performing colostomy care, it is important for the nurse to teach the client to care for the skin around the stoma by:
a. Avoiding the use of soap or irritating agents
b. Rinsing with hydrogen peroxide and applying a gauze pad
c. Pouring saline over the stoma and wiping away fecal matter
d. Washing the area gently with soap and water before applying an appliance
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1 comment:
These queastions came from Mosby's review questions book.
1-b Honesty is essential to help the client accept the loss of the leg; only a brief discussion of chemotherapy is needed to avoid overwhelming the client.
2-b The client's goal is meaningful, and the nurse should do everything possible to help the client achieve it.
d-if the client wants to work for the goal, the energy expenditure is justified.
3-d When acceptance is reached the individual is beginning to withdraw; communication is simple, concise, and most often nonverbal. a,b,c research has shown that these stages need verbal intervention and communication
4-a Value clarification is a technique that uncovers individuals' vales so that the individuals can be more aware of them and their effect on others.
5-c Melanoma spreads by extension and through cutaneous lymph channels to lymph nodes and ultimately to the bloodstream.
a-seeding occurs when a body cavity is opened, as in surgery, and cancer cell are carried across the cavity; b-the initial lesion may be surrounded by satellite lesions, but chains of lesions have not been identified; d-melanomas enlarge in size but do not necessarily invade bone tissue.
6-b A radiation dermatitis occurs three to six weeks after the start of treatment.
a-the word burn may increase the client's anxiety and should be avoided; c-this response does not answer the client's concern; d-emollients are contraindicated; they may alter the claculated x-ray route and injure healthy tissue
7-b Both malignant and healthy cells are affected by radiation; time between courses of treatments allow normal cells to repair.
8-a These should be avoided because they contain alchohol and metals that can exacerebate the skin reaction.
9-d Because of the recent trauma of surgery, hemorrhage and infection at the operative site are primary problems that can occur.
a-the client will have a nasogastric tube to suction and be kept NPO until peristalsis returns; there should be no oral intake; b-this is inappropriate at this time; observing for bleeding and infection takes priority during the first 48 hours; c-this is not the appropriate time for this teaching; an abdominal dressing usually is in place.
10-d This removes microorganisms and irritants and maintains skin integrity.
a-although irritating agents should not be used, soap is the agent of choice the cleanse the skin around the stoma; b-hydrogen peroxide may be irritating and is unnecessary; c-wiping can cause skin irritation, and a secondary infection caused by bacteria or fungi may develop.
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