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Drill #1 With Rationale

1. A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history,
the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:

a. testosterone therapy during childhood.


b. sexually transmitted disease.
c. early onset of puberty.
d. cryptorchidism.

2. A client with cancer is being evaluated for possible metastasis. Which of the following is one of the most
common metastasis sites for cancer cells?

a. Liver
b. Colon
c. Reproductive tract
d. White blood cells (WBCs)

3. Oncology nurse education question about a client who seeks care for hoarseness that has lasted for 1 month. To
elicit the most appropriate information about this problem, the nurse should ask which question?

a. "Do you smoke cigarettes, cigars, or a pipe?"


b. "Have you strained your voice recently?"
c. "Do you eat a lot of red meat?"
d. "Do you eat spicy foods?"

4. A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:

a. a decreased serum creatinine level.


b. hypocalcemia.
c. Bence Jones protein in the urine.
d. a low serum protein level.

5. During a routine checkup, the nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for
signs and symptoms of cancer. What is the most common AIDS-related cancer?

a. Squamous cell carcinoma


b. Multiple myeloma
c. Leukemia
d. Kaposi's sarcoma

Answers and Rationale

1) D
- Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular
cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps
orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin
combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early
onset of puberty aren't risk factors for testicular cancer.

2) A
- The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone,
and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

3) A
- Persistent hoarseness may signal throat cancer, which commonly is associated with tobacco use. To assess the
client's risk for throat cancer, the nurse should ask about smoking habits. Although straining the voice may cause
hoarseness, it wouldn't cause hoarseness lasting for 1 month. Consumption of red meat or spicy foods isn't
associated with persistent hoarseness.
4) C
- Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn't rule it out.
Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum
protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.

5) D
- Kaposi's sarcoma is the most common cancer associated with AIDS. Squamous cell carcinoma, multiple myeloma,
and leukemia may occur in anyone and aren't associated specifically with AIDS.

6. A client in the final stages of terminal cancer tells his nurse: "I wish I could just be allowed to die. I'm tired of
fighting this illness. I have lived a good life. I only continue my chemotherapy and radiation treatments because
my family wants me to." What is the nurse's best response?

a. "Would you like to talk to a psychologist about your thoughts and feelings?"
b. "Would you like to talk to your minister about the significance of death?"
c. "Would you like to meet with your family and your physician about this matter?"
d. "I know you are tired of fighting this illness, but death will come in due time."

7. Which client has the highest risk of ovarian cancer?

a. 30-year-old woman taking oral contraceptives


b. 45-year-old woman who has never been pregnant
c. 40-year-old woman with three children
d. 36-year-old woman who had her first child at age 22

8. An oncology nurse educator is speaking to a women's group about breast cancer. Nurse test questions and
comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the
audience have made all of the following statements. Which one is accurate?

a. Mammography is the most reliable method for detecting breast cancer.


b. Breast cancer is the leading killer of women of childbearing age.
c. Breast cancer requires a mastectomy.
d. Men can develop breast cancer.

9. During a breast examination, which finding most strongly suggests that the client has breast cancer?

a. Slight asymmetry of the breasts


b. A fixed nodular mass with dimpling of the overlying skin
c. Bloody discharge from the nipple
d. Multiple firm, round, freely movable masses that change with the menstrual cycle

10. The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client
that a diagnosis of breast cancer is confirmed by:

a. breast self-examination.
b. mammography.
c. fine needle aspiration.
d. chest X-ray.

Answers and Rationale

6) C
- The nurse has a moral and professional responsibility to advocate for clients who experience decreased
independence, loss of freedom of action, and interference with their ability to make autonomous choices.
Coordinating a meeting between the physician and family members may give the client an opportunity to express
his wishes and promote awareness of his feelings as well as influence future care decisions. All other options are
inappropriate.

7) B
- The incidence of ovarian cancer increases in women who have never been pregnant, are over age 40, are
infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or
endometrial cancer. The risk of ovarian cancer is reduced in women who have taken oral contraceptives, have had
multiple births, or have had a first child at a young age.

8) D
- The correct nurse test questions answer is: Men can develop breast cancer, although they seldom do. The most
reliable method for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes
more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small,
confined, and in an early stage.

9) B
- A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many
women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign
condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic
breasts, a benign condition.

10) C
- Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A
breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early.
Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib
metastasis.

11. The nurse should be prepared to manage complications after abdominal aortic aneurysm resection. Which of
the following complications is most common postoperatively?

a. Renal failure
b. Hemorrhage and shock
c. Graft occlusion
d. Enteric fistula

12. A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue
and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular
disorder. When exploring the chief complaint, the nurse should find out if the client has any other common
cardiovascular symptoms, such as:

a. shortness of breath.
b. insomnia.
c. irritability.
d. lower substernal abdominal pain.

13. Cardiovascular nursing questions about a nurse who records a client's history and discovers several risk factors
for coronary artery disease. Which cardiac risk factors are considered controllable?

a. Diabetes, hypercholesterolemia, and heredity


b. Diabetes, age, and gender
c. Age, gender, and heredity
d. Diabetes, hypercholesterolemia, and hypertension

14. A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight
confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart
sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over
the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary
artery catheter insertion because:

a. the client is experiencing heart failure.


b. the client is going into cardiogenic shock.
c. the client shows signs of aneurysm rupture.
d. the client is in the early stage of right-sided heart failure.

15. The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the
nurse watch for most carefully?
a. Increase in blood pressure
b. Increase in blood volume
c. Low serum potassium level
d. High serum sodium level

Answers and Rationale

11) B
- Hemorrhage and shock are the most common complications after abdominal aortic aneurysm resection. Renal
failure can occur as a result of shock or from injury to the renal arteries during surgery. Graft occlusion and enteric
fistula formation are rare complications of abdominal aortic aneurysm repair.

12) A
- Common signs and symptoms of cardiovascular dysfunction include shortness of breath, chest pain, dyspnea,
palpitations, fainting, fatigue, and peripheral edema. Insomnia seldom indicates a cardiovascular problem.
Although irritability may occur if cardiovascular dysfunction leads to cerebral oxygen deprivation, this symptom
more commonly reflects a respiratory or neurologic dysfunction. Lower substernal abdominal pain occurs with some
GI disorders.

13) D
- Answer to this cardiovascular nursing questions - Controllable risk factors include hypertension,
hypercholesterolemia, obesity, lack of exercise, smoking, diabetes, stress, alcohol abuse, and use of
contraceptives. Uncontrollable risk factors for coronary artery disease include gender, age, and heredity.

14) B
- This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding
blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized
weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal.
Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema
as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly
deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased
blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.

15) C
- Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for
signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume
decreases, and urine output increases.

16. A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing
up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of:

a. right-sided heart failure.


b. acute pulmonary edema.
c. pneumonia.
d. cardiogenic shock.

17. After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg P.O. daily. The nurse
should teach the client that this medication has been prescribed to:

a. control headache pain.


b. enhance the immune response.
c. prevent intracranial bleeding.
d. reduce platelet agglutination.

18. A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse exam questions is, which
nursing diagnosis takes highest priority at this time?

a. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical
conduction
b. Anxiety related to an actual threat to health status, invasive procedures, and pain
c. Ineffective family coping related to knowledge deficit and a temporary change in family dynamics
d. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time

19. The nurse is educating a client who's at risk for coronary artery disease (CAD). The nurse tells the client that
CAD has many risk factors. Risk factors that can be controlled or modified include:

a. gender, obesity, family history, and smoking.


b. inactivity, stress, gender, and smoking.
c. obesity, inactivity, diet, and smoking.
d. stress, family history, and obesity.

20. While receiving a heparin infusion to treat deep vein thrombosis, a client reports that the gums bleed when
brushing the teeth. What should the nurse do first?

a. Stop the heparin infusion immediately.


b. Notify the physician.
c. Administer a coumarin derivative, as prescribed, to counteract heparin.
d. Reassure the client that bleeding gums are a normal effect of heparin.

Answers and Rationale

16) B
- Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may
be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema. In right-sided heart
failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the
client would have a temperature spike and sputum that varies in color. Cardiogenic shock would show signs of
hypotension and tachycardia.

17) D
- TIAs are considered forerunners of cerebrovascular accident (CVA). Because CVAs may result from clots in
cerebral vessels, aspirin is prescribed to prevent clot formation by reducing platelet agglutination. A 325-mg dose
of aspirin is inadequate to relieve headache pain in an adult. Aspirin has no effect on the body's immune response.
Intracranial bleeding isn't associated with TIAs, and the action of aspirin probably would worsen any bleeding
present.

18) A
- For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis
because myocardial function may be depressed from anesthetics or a long cardiopulmonary bypass time, leading to
decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume
deficit and impaired electrical conduction. The nurse exam other options may be relevant but take lower priority at
this time because maintaining cardiac output is essential to sustaining the client's life.

19) C
- The risk factors for coronary artery disease that can be controlled or modified include obesity, inactivity, diet,
stress, and smoking. Gender and family history are risk factors that can't be controlled.

20) B
- Because bleeding gums are an adverse effect of heparin that may indicate excessive anticoagulation, the nurse
should notify the physician, who will evaluate the client's condition. Laboratory tests, such as partial
thromboplastin time, should be performed before concluding that the client's bleeding is significant. The prescribed
heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion,
unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to
counteract heparin. Bleeding gums aren't a normal effect of heparin.

21. A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects
this client's stools to be:

a. coffee-ground-like.
b. clay-colored.
c. black and tarry.
d. bright red.
22. A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top
priority?

a. Fatigue
b. Excessive fluid volume
c. Ineffective breathing pattern
d. Imbalanced nutrition: Less than body requirements

23. Nursing Test banks question about a client that comes to the emergency department complaining of acute GI
distress. When obtaining the client's history, the nurse inquires about the family history. Which disorder has a
familial basis?

a. Hepatitis
b. Iron deficiency anemia
c. Ulcerative colitis
d. Chronic peritonitis

24. The physician orders a stool culture to help diagnose a client with prolonged diarrhea. The nurse who obtains
the stool specimen should:

a. take the specimen to the laboratory immediately.


b. apply a solution to the stool specimen.
c. collect the specimen in a sterile container.
d. store the specimen on ice.

25. While palpating a client's right upper quadrant (RUQ), the nurse would expect to find which of the following
structures?

a. Sigmoid colon
b. Appendix
c. Spleen
d. Liver

Answers and Rationale

21) C
- Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of
digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-
ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract
bleeding.

22) C
- In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure
on the diaphragm and interfere with respiration. If uncorrected, this may lead to atelectasis or pneumonia.
Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it
can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after
the client establishes and maintains an effective breathing pattern.

23) C
- Ulcerative colitis is more common in people who have family members with the disease. (The same is true of
some types of GI cancers, ulcers, and Crohn's disease.) Hepatitis, iron deficiency anemia, and chronic peritonitis
are acquired disorders that don't run in families.

24) C
- The nurse should collect the stool specimen using sterile technique and a sterile stool container. The stool may be
collected for 3 consecutive days; no follow-up care is needed. Although a stool culture should be taken to the
laboratory as soon as possible, it need not be delivered immediately (unlike stool being examined for ova and
parasites). Applying a solution to a stool specimen would contaminate it; this procedure is done when testing stool
for occult blood, not organisms. The nurse shouldn't store a stool culture on ice because the abrupt temperature
change could kill the organisms.
25) D
- The RUQ contains the liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of the colon, portions of
the ascending and transverse colon, and a portion of the right kidney. The sigmoid colon is located in the left lower
quadrant; the appendix, in the right lower quadrant; and the spleen, in the left upper quadrant.

26. The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the
drainage bag to help relieve gas. The nurse should teach him that this action:

a. destroys the odor-proof seal.


b. won't affect the colostomy system.
c. is appropriate for relieving the gas in a colostomy system.
d. destroys the moisture-barrier seal.

27. For a client with cirrhosis, deterioration of hepatic function is best indicated by:

a. fatigue and muscle weakness.


b. difficulty in arousal.
c. nausea and anorexia.
d. weight gain.

28. Nursing board exams questions about a client with severe abdominal pain is being evaluated for appendicitis.
What is the most common cause of appendicitis?

a. Rupture of the appendix


b. Obstruction of the appendix
c. A high-fat diet
d. A duodenal ulcer

29. A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical
site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement,
the nurse should add which "related-to" phrase?

a. Related to major surgery required by bowel resection


b. Related to the presence of bacteria at the surgical site
c. Related to malnutrition secondary to bowel resection with anastomosis
d. Related to the presence of a nasogastric (NG) tube postoperatively

30. A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11
seconds. The nurse expects to administer:

a. spironolactone (Aldactone).
b. phytonadione (Mephyton).
c. furosemide (Lasix).
d. warfarin (Coumadin).

Answers and Rationale

26) A
- Any hole, no matter how small, will destroy the odor-proof seal of a drainage bag. Removing the bag or
unclamping it is the only appropriate method for relieving gas.

27) B
- Hepatic encephalopathy, a major complication of advanced cirrhosis, occurs when the liver no longer can convert
ammonia (a by-product of protein breakdown) into glutamine. This leads to an increased blood level of ammonia —
a central nervous system toxin — which causes a decrease in the level of consciousness. Fatigue, muscle
weakness, nausea, anorexia, and weight gain occur during the early stages of cirrhosis.

28) B
- Nursing Board Exams Rationale - Appendicitis most commonly results from obstruction of the appendix, which
may lead to rupture. A high-fat diet or duodenal ulcer doesn't cause appendicitis; however, a client may require
dietary restrictions after an appendectomy.

29) B
- The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that
putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli,
Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is
considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition
seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium,
and chloride) is completed in the small intestine. An NG tube is placed through a natural opening, not a wound,
and therefore doesn't increase the client's risk of infection.

30) B
- Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin
synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk
of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin
synthesis. Spironolactone and furosemide are diuretics and have no effect on bleeding or clotting time. Warfarin is
an anticoagulant that prolongs PT.

31. The nurse is teaching a client with pernicious anemia who requires vitamin B12 replacement therapy. Which
statement indicates that the client understands the treatment program

a. "I'll swallow one vitamin B12 pill every morning for 2 weeks."
b. "I'll take a vitamin B12 pill once each month for life."
c. "I'll need an injection of vitamin B12 every month for life."
d. "I'll only need daily injections of vitamin B12 until my blood count improves."

32. A client who is receiving cyclosporine (Sandimmune) must practice good oral hygiene, including regular
brushing and flossing of the teeth, to minimize gingival hyperplasia. Good oral hygiene also is essential to minimize
gingival hyperplasia during long-term therapy with certain drugs. Which of the following drugs falls into this
category?

a. procainamide (Pronestyl)
b. azathioprine (Imuran)
c. phenytoin (Dilantin)
d. allopurinol (Zyloprim)

33. Hematology questions and answers about the nurse who is caring for a 32-year-old client admitted with
pernicious anemia. Which set of findings should the nurse expect when assessing the client?

a. Pallor, bradycardia, and reduced pulse pressure


b. Pallor, tachycardia, and a sore tongue
c. Sore tongue, dyspnea, and weight gain
d. Angina, double vision, and anorexia

34. Which nursing diagnosis should the nurse expect to see in a plan of care for a client in sickle cell crisis?

a. Imbalanced nutrition: Less than body requirements related to poor intake


b. Disturbed sleep pattern related to external stimuli
c. Impaired skin integrity related to pruritus
d. Pain related to sickle cell crisis

35. A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the
client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

a. Intrinsic factor
b. Hydrochloric acid
c. Histamine
d. Liver enzyme
31) C
- In pernicious anemia, the gastric mucosa doesn't secrete intrinsic factor, a protein necessary for vitamin B12
absorption. Without intrinsic factor, vitamin B12 replacements taken orally won't be absorbed; therefore, vitamin
B12 must be administered through the I.M. or deep subcutaneous routes. Clients must take vitamin B12 each day
for 2 weeks initially, then weekly for several months, then once each month for life.

32) C
- Gingival hyperplasia may occur with long-term administration of phenytoin, an anticonvulsant. This adverse effect
presumably is dose related. Frequent toothbrushing removes food particles and helps prevent infection; regular
dental care and frequent gum massage also are recommended. Gingival hyperplasia isn't a reported adverse effect
of procainamide, azathioprine, or allopurinol.

33) B
- Hematology Questions and Answers for number 3 is B - Pallor, tachycardia, and a sore tongue are all
characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth,
beefy red tongue; a wide pulse pressure; palpitations; angina; weakness; fatigue; and paresthesia of the hands
and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in
pernicious anemia.

34) D
- In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion,
ischemia, and extreme pain. Therefore, option D is the appropriate choice. Although nutrition is important, poor
nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal
stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia
can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus.

35) A
- Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin
binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't
influence vitamin B12 absorption.

36. A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort.
The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

a. Ambenonium (Mytelase)
b. Pyridostigmine (Mestinon
c. Edrophonium (Tensilon)
d. Carbachol (Carboptic)

37. A client with seizure disorder comes to the physician's office for a routine checkup. Knowing that the client
takes phenytoin (Dilantin) to control seizures, the nurse assesses for which common adverse drug reaction?

a. Excessive gum tissue growth


b. Drowsiness
c. Hypertension
d. Tinnitus

38. Neurosurgical nursing question about teaching a client about levodopa-carbidopa (Sinemet) therapy for
Parkinson's disease, the nurse should include which instruction?

a. "Report any eye spasms."


b. "Take this medication at bedtime."
c. "Stop taking this drug when your symptoms disappear."
d. "Be aware that your urine may appear darker than usual."

39. A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse
prepares the client for various diagnostic tests. The nurse expects the physician to order:

a. electromyography (EMG).
b. Doppler scanning.
c. Doppler ultrasonography.
d. quantitative spectral phonoangiography.

40. The nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with
myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by:

a. genetic dysfunction.
b. upper and lower motor neuron lesions.
c. decreased conduction of impulses in an upper motor neuron lesion.
d. a lower motor neuron lesion.

Answers and Rationale

36) C
- Because of its short duration of action, edrophonium is the drug of choice for diagnosing myasthenia gravis. It's
also used to differentiate myasthenia gravis from cholinergic toxicity. Ambenonium is used as an antimyasthenic.
Pyridostigmine serves primarily as an adjunct in treating severe anticholinergic toxicity; it's also an antiglaucoma
agent and a miotic. Carbachol reduces intraocular pressure during ophthalmologic procedures; topical carbachol is
used to treat open-angle and closed-angle glaucoma.

37) A
- Phenytoin can lead to excessive gum tissue growth. However, brushing the teeth two or three times daily helps
retard such growth. Some clients may require excision of excessive gum tissue every 6 to 12 months. Phenytoin
may cause central nervous system stimulation, leading to insomnia, nervousness, and twitching; it doesn't cause
drowsiness. Other adverse reactions to phenytoin include hypotension, not hypertension; and visual disturbances,
not tinnitus.

38 D
- Neurosurgical nursing answer - Levodopa-carbidopa, used to replace insufficient dopamine in clients with
Parkinson's disease, may cause harmless darkening of the urine. The drug doesn't cause eye spasms, although
blurred vision is an expected adverse effect. The client should take levodopa-carbidopa shortly before meals, not at
bedtime, and must continue to take it for life.

39) A
- To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved
muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with
fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in
multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must
accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral
phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.

40) D- Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a
lower motor neuron lesion at the myoneural junction. It isn't a genetic disorder. A combined upper and lower motor
neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the
spinal cord would cause decreased conduction of impulses at an upper motor neuron.

41. A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the
nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide?
a. Presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin
b. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
c. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t
found
d. Alteration in the size, shape, and organization of differentiated cells

42. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related
to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
a. “Client verbalizes feelings of anxiety.”
b. “Client doesn’t guess at prognosis.”
c. “Client uses any effective method to reduce tension.”
d. “Client stops seeking information.”

43. A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a
nursing diagnosis of Risk for injury. Which “related-to” phrase should the nurse add to complete the nursing
diagnosis statement?
a. Related to visual field deficits
b. Related to difficulty swallowing
c. Related to impaired balance
d. Related to psychomotor seizures

44. A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any
treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
a. hair loss.
b. stomatitis.
c. fatigue.
d. vomiting.

45. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client
that a diagnosis of breast cancer is confirmed by:
a. breast self-examination.
b. mammography.
c. fine needle aspiration.
d. chest X-ray.

46. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for
the neck stoma, the nurse should include which instruction?
a. “Keep the stoma uncovered.”
b. “Keep the stoma dry.”
c. “Have a family member perform stoma care initially until you get used to the procedure.”
d. “Keep the stoma moist.”

47. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid
and electrolyte imbalance induced by chemotherapy?
a. Urine output of 400 ml in 8 hours
b. Serum potassium level of 3.6 mEq/L
c. Blood pressure of 120/64 to 130/72 mm Hg
d. Dry oral mucous membranes and cracked lips

48. Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that
the purpose of performing the examination is to discover:
a. cancerous lumps.
b. areas of thickness or fullness.
c. changes from previous self-examinations.
d. fibrocystic masses.

49. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The
nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor for cervical
cancer?
a. Onset of sporadic sexual activity at age 17
b. Spontaneous abortion at age 19
c. Pregnancy complicated with eclampsia at age 27
d. Human papillomavirus infection at age 32
11. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead
the nurse to suspect that a client has colorectal cancer?
a. Duodenal ulcers
b. Hemorrhoids
c. Weight gain
d. Polyps

Rationale:
1.Answer D. Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The
presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called
anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called
hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type
normally isn’t found is called metaplasia.

2.Answer A. Verbalizing feelings is the client’s first step in coping with the situational crisis. It also helps the health
care team gain insight into the client’s feelings, helping guide psychosocial care. Option B is inappropriate because
suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly.
Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent
the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn’t
appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.

3.Answer C. A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait
and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from
dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain
tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe
dysfunction.
4.Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment
site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

5.Answer C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of
cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early.
Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib
metastasis.

6.Answer D. The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of
petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend
placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin
performing stoma care without assistance as soon as possible to gain independence in self-care activities.

7.Answer D. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte
imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than
40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.

8.Answer C. Women are instructed to examine themselves to discover changes that have occurred in the breast.
Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a
malignancy, or masses that are fibrocystic as opposed to malignant.

9.Answer D. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical
cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners,
and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren’t risk factors for
cervical cancer.

10.Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting
conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

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