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Which set of classification values indicates the most extensive and progressed cancer?
- A. T1 N0 M0
- B. T10 N0 M0
- C. T1 N1 M0
- D. T4 N3 M1
Correct Answer: D
Rationale: TNM staging gauges cancer extent: T (tumor size), N (node involvement), M (metastasis). T4 N3 M1 marks the worst T4 signals a large, invasive tumor, N3 extensive nodal spread, M1 distant metastases, painting a picture of widespread, advanced disease. T1 N0 M0 is small, localized, no spread early stage. T10 isn't standard (likely T1), still less severe. T1 N1 M0 has minor nodal involvement, not extensive. T4 N3 M1's combination screams progression, guiding nurses to expect aggressive care or palliation, a stark contrast to earlier stages' hopeful prognosis, critical for planning in advanced cancer.
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When educating a female client on the signs and symptoms of myocardial infarction, the nurse recognizes which of the following should be included in the teaching?
- A. Pain usually resolves with rest and relaxation
- B. Older adults and women often present with atypical signs and symptoms
- C. Women experience intermittent claudication
- D. Substernal chest pain is the most common symptom in women
Correct Answer: B
Rationale: MI in women skews odd fatigue, nausea, not just chest pain, hit older females especially, a teaching must as atypical signs delay care. Rest eases angina, not MI. Claudication's PAD, not heart. Substernal pain's common, less so in women. Nurses stress this quirk, boosting recognition in this sneaky killer.
The definition of Chronic Heart Failure is:
- A. Failure of the heart to adequately pump blood to the body.
- B. Long-term inability of the heart to meet metabolic demands required to maintain homeostasis.
- C. Prolonged enlargement of the left ventricle impacting on the contractility of the muscle.
- D. Long term fluid build-up, causing increase in blood volume and reducing the ability of the heart to maintain blood flow.
Correct Answer: B
Rationale: Chronic heart failure (CHF) is a syndrome, not a singular defect. Failure to pump adequately describes acute failure but lacks chronicity's scope. CHF is the heart's prolonged inability to meet metabolic demands for oxygen and nutrients, disrupting homeostasis per Farrell (2017) encompassing systolic (reduced ejection) and diastolic (impaired filling) dysfunction. Left ventricular enlargement may occur (e.g., dilated cardiomyopathy), but it's a cause or result, not the definition; contractility varies. Fluid buildup (congestion) is a feature, not the essence blood volume rises secondary to neurohormonal activation (e.g., renin-angiotensin system), not as the primary failure. The metabolic demand focus captures CHF's systemic impact fatigue, edema, dyspnea reflecting chronic adaptation failure over structural or fluid-centric descriptions.
Patients on insulin therapy should receive essential education on the following EXCEPT:
- A. Insulin injection technique
- B. Stopping all oral hypoglycaemic agents
- C. Recognition and self-management of hypoglycaemia
- D. Sick day management
Correct Answer: B
Rationale: Insulin therapy education for diabetes patients covers injection technique, hypoglycemia recognition and management, sick day rules, and safe driving, per diabetes care standards. However, stopping all oral hypoglycemic agents isn't universally essential many patients continue agents like metformin or SGLT-2 inhibitors alongside insulin for synergistic effects, depending on glycemic control needs. Assuming cessation oversimplifies treatment plans, potentially reducing efficacy. Education must tailor to individual regimens, not mandate stopping orals, making this the exception. Physicians ensure comprehensive teaching to enhance adherence and safety, critical in chronic disease management.
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical-surgical unit. Which client should the nurse see first?
- A. A client with pain that is two days post-operative from a prostatectomy
- B. A client ready for discharge education after treatment of an acute kidney injury
- C. A client with hypertension with a blood pressure of 172/92 mm Hg
- D. A client with a history of asthma complaining of increased dyspnea
Correct Answer: D
Rationale: Asthma's increased dyspnea flags airway risk ABCs prioritize breathing, as bronchospasm could crash fast, needing nebulizers or oxygen. Post-op pain's manageable, discharge education waits, hypertension's high but stable. Nurses hit dyspnea first, ensuring airflow, a life-first call in this shift-start triage.
A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
- A. Administer a dose of allopurinol (Aloprim).
- B. Assess the client's serum potassium level.
- C. Gently inquire about advance directives.
- D. Prepare the client for emergency surgery.
Correct Answer: C
Rationale: Superior vena cava syndrome (SVCS) occurs when cancer (often lung or lymphoma) obstructs the superior vena cava, impairing venous return from the head and upper body. It's often a late-stage manifestation with a poor prognosis, though treatable with radiation or stenting. After stabilizing the client (e.g., with oxygen, positioning), gently inquiring about advance directives is most appropriate, as it opens a compassionate discussion about goals of care amid a potentially terminal condition. Allopurinol and potassium levels relate to tumor lysis syndrome, not SVCS. Surgery is rare for SVCS, with non-invasive options preferred. This action respects the client's autonomy and prepares for realistic outcomes, aligning with oncology nursing's holistic approach to end-of-life care in advanced disease.