Nokea
The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurse's assessment should include examination for the signs and symptoms of what complication?
- A. Tumor lysis syndrome (TLS)
- B. Syndrome of inappropriate antidiuretic hormone (SIADH)
- C. Disseminated intravascular coagulation (DIC)
- D. Hypercalcemia
Correct Answer: A
Rationale: Non-Hodgkin lymphoma's fast cell turnover, plus recent chemo, primes for TLS dead cells dump potassium, phosphorus, and uric acid, risking kidney failure days post-treatment. SIADH (low sodium) and hypercalcemia (bone mets) are less tied to this timeline. DIC's bleeding chaos isn't lymphoma's usual post-chemo hit. Nurses hunt TLS signs fatigue, nausea, arrhythmias knowing it's a fatal oncology curveball if missed early.
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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.
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.
Which of the following is a treatment option for a client with infective endocarditis?
- A. Bedrest
- B. Antimicrobials
- C. Diet modification
- D. Antihypertensive
Correct Answer: B
Rationale: Infective endocarditis bacterial valve infection needs antimicrobials to kill pathogens like *Streptococcus*, the root cause, halting damage and sepsis. Bedrest aids recovery but doesn't treat. Diet tweaks support health, not infection. Antihypertensives manage pressure, irrelevant to endocarditis's microbial core. Nurses anticipate antibiotics, often IV for weeks, targeting the source, a priority to save valves and lives in this high-mortality condition, aligning with infectious disease protocols.
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 statements on NAFLD is false?
- A. Weight loss is the prime way of management
- B. Long-term management is needed
- C. Patients should be referred to specialists for further evaluation
- D. Metformin should be used as first-line treatment in patients with NAFLD and diabetes mellitus
Correct Answer: D
Rationale: Weight loss (5-10%) is prime for NAFLD, long-term care is essential, and specialist referral aids complex cases all true. Statins manage dyslipidemia safely in NAFLD. Metformin, though first-line for diabetes, isn't for NAFLD itself lacking evidence for steatosis reversal making this false. Physicians must clarify this in chronic care planning.