Nokea
When assignments are being made for clients with alterations related to gastrointestinal (GI) cancer, which client would be the most appropriate to delegate to an LPN/LVN?
- A. A client with severe anemia secondary to GI bleeding
- B. A client who needs enemas and antibiotics to control GI bacteria
- C. A client who needs preoperative teaching for bowel resection surgery
- D. A client who needs central line insertion for chemotherapy
Correct Answer: B
Rationale: Delegating in GI cancer care hinges on scope LPN/LVNs handle routine tasks like administering enemas and antibiotics, a straightforward intervention to curb bacteria, fitting their training under RN oversight. Severe anemia from bleeding demands RN assessment for stability or transfusion, beyond LPN scope. Preoperative teaching requires detailed education and evaluation, an RN's domain. Central line insertion involves advanced skills and risks, reserved for RNs or specialists. Enemas and antibiotics align with LPN/LVN capabilities, optimizing team roles while keeping complex care with RNs, a practical choice in managing GI cancer's multifaceted needs safely and efficiently.
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A 65-year-old female presented to the emergency room with complaint of progressively worsening fatigue, shortness of breath, and palpitations. Upon assessment, heart rate is 130 beats per minute and irregular, and there is positive jugular vein distention. Heart tones reveal a high-pitched holosystolic murmur. Which of the following disorders are consistent with these findings?
- A. Mitral regurgitation
- B. Mitral stenosis
- C. Mitral valve prolapse
- D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral regurgitation leaks blood back holosystolic murmur, irregular tachycardia, JVD, and dyspnea fit, as left heart flops, backing up into veins. Stenosis murmurs diastolic; prolapse clicks midsystolic; aortic regurgitation's early diastolic. Nurses tie this to MR's volume overload, anticipating echo, a match for this failing valve tale.
A client has a platelet count of 9800/mm^3. What action by the nurse is most appropriate?
- A. Assess the client for calf pain, warmth, and redness.
- B. Instruct the client to call for help to get out of bed.
- C. Obtain cultures as per the facility's standing policy.
- D. Place the client on protective isolation precautions.
Correct Answer: B
Rationale: A platelet count of 9800/mm^3 is severely low (normal is 150,000-450,000/mm^3), indicating thrombocytopenia, a common chemotherapy side effect that heightens bleeding risk. The most appropriate action is instructing the client to call for help before getting out of bed to prevent falls or injuries that could trigger uncontrolled bleeding, such as intracranial hemorrhage. Assessing for calf pain, warmth, and redness checks for thrombosis, which is unrelated to low platelets thrombosis risk rises with high counts. Obtaining cultures relates to infection, tied to low white cells, not platelets. Protective isolation is for neutropenia, not thrombocytopenia. This safety-focused intervention minimizes physical risk, crucial in oncology where low platelets demand proactive prevention to avoid life-threatening bleeds, empowering the client while ensuring nurse oversight.
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.
The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
- A. Impaired nutritional status
- B. Cognitive changes
- C. Diarrhea
- D. Alopecia
Correct Answer: A
Rationale: Neck radiation hits the oral mucosa, salivary glands, and throat, causing mucositis, taste loss, pain, and dysphagia leading to impaired nutrition. Patients struggle to eat, risking weight loss and weakness, a top concern in head-and-neck cases. Cognitive changes tie to brain radiation, not neck. Diarrhea aligns with abdominal radiation, not this site. Alopecia occurs with whole-brain radiation, not localized neck treatment, where hair loss is minimal unless the scalp's in the field. Nurses must prep patients for these site-specific effects, ensuring dietary support (e.g., soft foods, supplements) to maintain strength through therapy, a key part of oncology care planning.
Which of the following is NOT associated with obesity?
- A. Non-Alcoholic Fatty Liver Disease
- B. Obstructive Sleep Apnea
- C. Increased mortality
- D. Type 1 Diabetes Mellitus
Correct Answer: D
Rationale: Obesity piles on NAFLD, apnea, death risk, back ache; type 1's autoimmune, not fat-driven. Nurses link this chronic weight web, not islet crash.