Nokea
The client is diagnosed with laryngeal cancer and is scheduled for a laryngectomy next week. Which intervention would be priority for the clinic nurse?
- A. Assess the client's ability to swallow
- B. Refer the client to a speech therapist
- C. Order the client's preoperative lab work
- D. Discuss the client's operative unit
Correct Answer: B
Rationale: Laryngectomy severs voice referring to a speech therapist pre-op sets up post-surgical communication, a priority as clients lose speech, facing isolation without aids like electrolarynx training. Swallowing matters, but airway and cancer trump function now. Labs are routine, delegated often; unit talk's secondary. Nurses push this referral, easing the mute transition, a proactive step in laryngeal cancer's life-altering prep, ensuring clients adapt to this voiceless future from day one.
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Risk factors for developing COPD include:
- A. Seasonal respiratory conditions and family history of emphysema
- B. Age, high fat diet and sedentary lifestyle
- C. History of cardiovascular and autoimmune conditions
- D. Indoor and outdoor air pollution
Correct Answer: D
Rationale: COPD risk factors center on chronic airway damage. Seasonal respiratory conditions may exacerbate, not cause, COPD, though family history of emphysema suggests genetic risk (e.g., alpha-1 antitrypsin deficiency), but it's less primary than exposure. Age is a factor as lung function declines naturally, but high fat diet and sedentary lifestyle are more linked to obesity or cardiovascular disease, not directly COPD. Cardiovascular and autoimmune histories don't drive COPD etiology smoking and pollution do. Indoor (e.g., biomass smoke) and outdoor air pollution (e.g., particulates) are major irritants, causing inflammation and irreversible airflow limitation, per Deravin and Anderson (2019). Pollution's role is critical globally, especially in occupational or urban settings, outweighing secondary factors by directly triggering the chronic inflammatory cascade defining COPD pathogenesis.
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?
- A. Remove food debris from the teeth and oral mucosa with a stiff toothbrush.
- B. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
- C. Gargle and rinse the mouth several times a day with an antiseptic mouthwash.
- D. Rinse the mouth before and after each meal and at bedtime with a saline solution.
Correct Answer: D
Rationale: Head and neck radiation trashes the mouth ulcers and ropey saliva need saline rinses to clean gently, easing pain without wrecking tissue. Stiff brushes shred mucosa; peroxide burns it; antiseptic washes sting and dry. Nurses in oncology teach this saline's soothing, safe, and fights infection risk in a radiated, vulnerable mouth.
In infective endocarditis
- A. oslers nodes are tender
- B. Janeway lesions are tender
- C. Right ventricular MI is more likely to be acute than subacute
- D. A+C
Correct Answer: A
Rationale: Endocarditis Osler's nodes hurt, Janeway's don't, right heart's acute in IVDU. Nurses feel this chronic pain clue.
A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may indicate leukemia?
- A. Abdominal pain
- B. Increased activity level
- C. Increased appetite
- D. Petechiae
Correct Answer: D
Rationale: Leukemia often presents with bone and joint pain due to marrow infiltration by leukemic cells, but petechiae small red or purple spots from minor bleeds under the skin are a key additional sign of bleeding tendencies from thrombocytopenia, a common leukemia consequence. This reflects bone marrow failure to produce adequate platelets, making it a critical finding for nurses to note during assessment. Abdominal pain might occur from organ enlargement (e.g., splenomegaly), but it's less specific and not a primary complaint here. Increased activity level and appetite contradict leukemia's typical fatigue and anorexia due to metabolic demands of proliferating cells and anemia. Recognizing petechiae prompts urgent blood work and referral, aligning with nursing's role in early detection of pediatric leukemia, ensuring timely intervention to manage this life-threatening condition effectively.
The disease progress of cancers, such as cervical or Hodgkin's, can be classified according to a clinical staging system. Place the description of stages 0-IV in the correct order.
- A. Metastasis
- B. Limited local spread
- C. Cancer in situ
- D. Tumor limited to tissue of origin
Correct Answer: C
Rationale: Clinical staging tracks cancer progression: starting with cancer in situ, where abnormal cells stay confined, non-invasive stage 0. Next, tumor limited to tissue of origin marks stage I, with localized growth but no spread. Limited local spread, stage II, shows slight extension beyond the origin. Extensive local and regional spread, stage III, involves nearby tissues or nodes. Metastasis, stage IV, indicates distant spread, the most advanced. The sequence cancer in situ, tumor limited to origin, limited spread, extensive spread, metastasis reflects increasing severity, guiding treatment from surveillance to aggressive therapy. Nurses use this to educate patients, aligning interventions with disease extent, critical for prognosis in cancers like cervical or Hodgkin's.