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For a patient with osteogenic sarcoma, you would be particularly vigilant for elevations in which laboratory value?
- A. Sodium
- B. Calcium
- C. Potassium
- D. Hematocrit
Correct Answer: B
Rationale: Osteogenic sarcoma, a bone cancer, often triggers hypercalcemia bone destruction releases calcium into blood, risking arrhythmias or kidney damage, a life-threatening shift demanding close watch. Sodium and potassium imbalances aren't bone-specific, more tied to general metabolism or treatment side effects. Hematocrit reflects anemia, common in cancer but not osteogenic sarcoma's hallmark. Calcium's spike, linked to osteolysis, makes it the nurse's focus elevations signal tumor activity or progression, prompting urgent interventions like fluids or bisphosphonates, a vigilance rooted in this cancer's skeletal impact and metabolic havoc.
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The nurse is assessing a 14-year-old girl with a tumor. Which of the following findings would indicate Ewing sarcoma?
- A. Child complains of dull bone pain just above the knee.
- B. Palpation reveals non-tender swelling on the right ribs.
- C. Parents report a mass on the abdomen that crosses the midline.
- D. Palpation reveals asymptomatic mass on the upper back.
Correct Answer: B
Rationale: Ewing sarcoma is a rare bone cancer primarily affecting children and adolescents, typically arising in flat bones like the pelvis, chest wall (e.g., ribs), or vertebrae, and the diaphysis of long bones. A hallmark is a palpable, non-tender mass, making non-tender swelling on the ribs a strong indicator, as it aligns with the tumor's common chest wall location and lack of initial pain sensitivity. Dull bone pain above the knee suggests a long bone issue, possibly osteosarcoma, which favors the metaphysis, not Ewing's typical diaphysis site. An abdominal mass crossing the midline is more characteristic of Wilms tumor or neuroblastoma, not Ewing sarcoma. An asymptomatic upper back mass could suggest various tumors, but lacks specificity for Ewing's flat bone preference. Nurses must recognize this presentation to facilitate prompt imaging and biopsy, critical for early diagnosis and treatment planning in pediatric oncology.
A 50-year-old patient, body weight 98 kg and height 1.82 m, has been diagnosed with type 2 diabetes based on increased fasting blood glucose levels (8.2 and 7.9 mmol/L). This gave the patient such a shock that he started a strict calorie-restricted diet. Two weeks later, his fasting blood glucose is 6.8 mmol/L and he has lost 1 kg. Question: What is the most likely explanation for the sharp reduction of the blood glucose level and the limited reduction in weight of only ±1%?
- A. The insulin-stimulated glucose uptake in muscle tissue has increased
- B. The insulin-stimulated inhibition of hepatic glucose production has increased
- C. The insulin-stimulated uptake of free fatty acids in muscle tissue has increased
- D. The insulin-stimulated inhibition of glycerol production in the liver has increased
Correct Answer: B
Rationale: Type 2's glucose drop calorie cut reins in liver's sugar spill, insulin works better there. Muscle uptake helps, fat shifts less, glycerol's minor liver's the quick fix, weight lags nurses see this, a chronic tweak.
A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching?
- A. Foods high in vitamin A and vitamin C are important.
- B. I'll have to cut down on the amount of bacon I eat.
- C. I'm so glad I don't have to give up my juicy steaks.
- D. Vegetables, fruit, and high-fiber grains are important.
Correct Answer: C
Rationale: Diet plays a significant role in cancer prevention, and nurses often educate clients on evidence-based dietary adjustments. Foods rich in vitamins A and C, such as carrots and citrus fruits, are known to have antioxidant properties that may reduce cancer risk by neutralizing free radicals. Reducing processed meats like bacon is advised due to their association with colorectal cancer, linked to nitrates and high fat content. Similarly, high vegetable, fruit, and fiber intake is recommended for their protective effects against various cancers, including colon cancer. However, excessive red meat consumption, such as steaks, is a known risk factor for cancers like colorectal and prostate cancer due to saturated fats and carcinogenic compounds formed during cooking. The client's statement about not giving up steaks suggests a misunderstanding, indicating the nurse must clarify that limiting red meat, not just processed meat, is part of a cancer-preventive diet. This additional teaching is essential to ensure the client adopts a comprehensive approach to reducing cancer risk.
Postoperative care at the completion of bimaxillary surgery:
- A. Is likely to be complicated by the presence of intermaxillary fixation (IMF).
- B. Involves awake rather than asleep extubation.
- C. Requires gentle removal of the tracheal tube to avoid damage of mandibular plates and screws.
- D. Involves reinsertion of a nasal tracheal tube when complicated by airway bleeding or obstruction requiring emergency reintubation.
Correct Answer: A
Rationale: Bimaxillary surgery's postoperative phase is complex. Intermaxillary fixation (IMF) aligns jaws but restricts mouth opening, complicating airway management, vomiting, and oral care raising aspiration or obstruction risks. Awake extubation is preferred, ensuring airway reflexes return, critical with IMF and swelling. Gentle tube removal prevents surgical site trauma (e.g., plates), though mandibular hardware is internal, less tube-accessible. Emergency reintubation may use nasal routes due to IMF, addressing bleeding/obstruction. HDU care is case-specific, not mandatory. IMF's presence drives tailored strategies, prioritizing airway security and patient stability in this high-risk recovery period.
Which of the following appropriately describes diastolic dysfunction?
- A. The rate of filling of the ventricles during diastole is slowed
- B. The left ventricle is dilated
- C. The preload (end ventricular diastolic volume) is increased
- D. The left ventricular ejection fraction is decreased
Correct Answer: A
Rationale: Diastolic dysfunction stiffens ventricles slowed filling in diastole nails it, as relaxation flops, hiking pressure. Dilated LV or high preload fits systolic; low EF's not here preserved in HFpEF. Dyssynchrony's another beast. Clinicians peg this slow fill, a chronic heart kink distinct from pump fail.