Nokea
The nurse is collecting data from the client undergoing testing for possible basal cell carcinoma (BCC). Which information in the client’s health history should the nurse identify as risk factors for BCC?
- A. Taking immune-suppressing medications
- B. 10-pack-year history of cigarette smoking
- C. Has fair skin color, red hair, and blue eyes
- D. Had bone exposure to high radon gas levels
- E. Works as a laborer in road construction
Correct Answer: A, C, E
Rationale: Immune-suppressing drugs weaken the immune system, and cellular changes can occur more aggressively. B. Smoking history is a risk factor for lung cancer, not BCC. C. Persons with fair skin, blond or red hair, and blue, green, or gray eyes have a higher risk for BCC due to the ease of sunburn with sun exposure if the skin is not protected. D. Exposure to indoor radon gas is a risk factor for lung cancer, not BCC. Radon is a radioactive colorless, odorless, tasteless, and chemically inert gas. It is formed by the natural radioactive decay of uranium in rock, soil, and water. E. Frequent participation in outdoor activities with exposure to sunlight is a risk for BCC due to the damage caused by UV light. UV light damages DNA.
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Which client is at highest risk for developing a lymphoma?
- A. The client diagnosed with chronic lung disease who is taking a steroid.
- B. The client diagnosed with breast cancer who has extensive lymph involvement.
- C. The client who received a kidney transplant several years ago.
- D. The client who has had ureteral stent placements for a neurogenic bladder.
Correct Answer: C
Rationale: Immunosuppression post-transplant (C) increases lymphoma risk (e.g., PTLD). Steroids (A) are lower risk, breast cancer (B) involves metastasis, and stents (D) are unrelated.
Which sign/symptom will the nurse expect to assess in the client diagnosed with a vaso-occlusive sickle cell crisis?
- A. Lordosis.
- B. Epistaxis.
- C. Hematuria.
- D. Petechiae.
Correct Answer: C
Rationale: Vaso-occlusive crisis causes ischemia; hematuria (C) results from renal infarction. Lordosis (A) is spinal, epistaxis (B) is bleeding, and petechiae (D) indicate thrombocytopenia.
The client undergoing intensive chemotherapy for Hodgkin’s lymphoma (HL) is hospitalized with fever and depressed immune system functioning. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication’s effectiveness?
- A. Hemoglobin
- B. Platelet count
- C. Absolute neutrophil count (ANC)
- D. Reed-Sternberg cells
Correct Answer: C
Rationale: A. Epoetin alfa, not filgrastim, is used to treat anemia that is associated with cancer, and its effectiveness would be reflected in the Hgb values. B. Oprelvekin (Neumega), not filgrastim, enhances the synthesis of platelets. C. The nurse should monitor the ANC. Filgrastim (Neupogen) is usually discontinued when the client’s absolute neutrophil count (ANC) is above 1000 cells/mm3. Filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog, is used to stimulate the proliferation and differentiation of granulocytes and treat neutropenia. D. Reed-Sternberg cells are found in lymph node biopsy cells and are indicative of Hodgkin’s lymphoma; they are not monitored to determine the effectiveness of filgrastim, which is used to treat neutropenia.
The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell crisis secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for the client?
- A. Administer meperidine (Demerol) intravenously.
- B. Admit the client to a private room and keep in reverse isolation.
- C. Infuse D5W 0.33% NS at 150 mL/hr via pump.
- D. Insert a 22-French Foley catheter with a urimeter.
Correct Answer: C
Rationale: Hydration with IV fluids (C) prevents sickling in vaso-occlusive crisis. Meperidine (A) is avoided (risks seizures), isolation (B) is excessive, and Foley (D) is unnecessary.
Which sign would the nurse expect to assess in the client diagnosed with idiopathic thrombocytopenic purpura (ITP)?
- A. Petechiae on the anterior chest, arms, and neck.
- B. Capillary refill of less than three (3) seconds.
- C. An enlarged spleen.
- D. Pulse oximeter reading of 95%.
Correct Answer: A
Rationale: ITP causes low platelets, leading to petechiae (A). Capillary refill (B) is normal, splenomegaly (C) is not primary, and SpO2 95% (D) is normal.