Question 1

The nurse is caring for several clients in a women's health clinic. Based on the data collected, which client's history is most concerning for an increased risk of endometrial cancer?

Accepted Answer

Endometrial cancer arises from the inner lining of the uterus and forms after the development of unregulated endometrial overgrowth (ie, hyperplasia). Although typically slow growing, it can metastasize to the myometrium (ie, uterine muscle tissue), cervix, and nearby lymph nodes and eventually beyond the pelvis. Many signs of endometrial cancer are nonspecific (eg, lower back or abdominal pain), but the hallmark symptom is abnormal uterine bleeding (eg, heavy, prolonged, intermenstrual, and/or postmenopausal bleeding). As with many cancers, the client's family and genetic history (eg, BRCA mutation carrier) are significant risk factors; however, prolonged estrogen exposure without adequate progesterone is the greatest risk factor for developing endometrial cancer. Factors increasing estrogen exposure and endometrial cancer risk include: Conditions associated with infrequent or anovulatory menstrual cycles (eg, polycystic ovary syndrome, infertility, late menopause, early menarche) (Option C) Obesity Tamoxifen (a medication given for breast cancer) (Option A) Progestin-containing contraceptives (ie, birth control pills) are associated with a decreased endometrial cancer risk because progestins thin the uterine lining, therefore preventing endometrial hyperplasia. (Option B) Ectopic pregnancy with a ruptured ovary or preterm birth is not associated with endometrial cancer, although never giving birth at term gestation may increase ovarian cancer risk. (Option D) Infection with a high-risk type of human papillomavirus increases cervical (not endometrial) cancer risk. Educational objective: Endometrial cancer is a slow-growing malignancy that arises from the inner lining of the uterus. Major risk factors include conditions associated with infrequent or anovulatory menstrual cycles (eg, polycystic ovary syndrome, infertility), obesity, and tamoxifen therapy.

Question 2

The nurse cares for a client with an exacerbation of inflammatory bowel disease (IBD).  The client tells the nurse about being infected with tuberculosis (TB) 10 years ago but never being medicated.  Which prescription is of concern and prompts the nurse to notify the health care provider (HCP)?

Accepted Answer

11ecbb05_c9e1_ecea_b433_459ca95a3a14_MD0009_00 Tuberculosis is an infection caused by the Mycobacterium tuberculosis microorganism. A client with active, primary TB disease has a positive tuberculin skin test (TST), usually feels sick, has symptoms, and can spread the disease to others if not treated with medications. A client with a latent TB infection (LTBI) has a positive TST, negative chest x-ray, is asymptomatic, cannot transmit the disease to others, and can complete a full course of treatment to prevent activation of the disease. Malignancy, immunosuppressant medications, including chemotherapy, and prolonged debilitating disease (eg, HIV), can convert LTBI to active disease. A client with LTBI who begins treatment with a corticosteroid (Prednisone) is at increased risk for conversion to active TB disease. Therefore, the nurse should notify the HCP. (Option A) Lansoprazole (Prevacid) is a proton pump inhibitor used to treat ulcer disease, erosive esophagitis, and gastroesophageal reflux disease. It does not convert LTBI to active disease. (Option B) Metronidazole (Flagyl) is an antimicrobial medication used to treat IBD and does not convert LTBI to active disease. (Option D) Sulfasalazine (Azulfidine) is a gastrointestinal anti-inflammatory medication used to treat IBD and does not convert LTBI to active disease. Educational objective: A client with LTBI has a positive TST, is asymptomatic, and cannot transmit the disease to others. Malignancy, immunosuppressant medications, chemotherapy, and prolonged debilitating disease (eg, HIV) can convert LTBI to active disease.

Question 3

The clinic nurse is completing a health history for a client with suspected rheumatic fever (RF). Which question is most important for the nurse to ask to establish a diagnosis?

Accepted Answer

11ecbb05_c9e7_441c_b433_fb96f6be81ae_MD0009_00 RF is an acute inflammatory disease of the heart. It is a complication that occurs 2-3 weeks after a streptococcal pharyngitis. RF is caused by a delayed-onset autoimmune reaction involving anti-streptococcal antibodies that cross-react with the antigens in the heart and other organs. Recurrent, untreated streptococcal pharyngitis will lead to faster onset and increased severity of rheumatic heart disease due to increased autoimmune activity. RF affects the heart, skin, joints, and central nervous system. The presence of 2 major criteria or 1 major and 2 minor criteria and evidence of a preceding streptococcal infection indicate a high probability of RF. (Option A) Failing to complete a course of antibiotics can cause illness to reoccur and is the cause of resistant strains of infections. It could contribute to the risk for RF, but it is not part of the criteria for diagnosing it. (Option B) Family history is not a risk factor for RF. (Option D) Fever is a symptom of many illnesses, not just RF. Educational objective: Streptococcal pharyngitis precedes the development of RF by 2-3 weeks. The nurse should ask about a streptococcal throat infection when collecting health history information in a client suspected of having RF.

Question 4

The clinic nurse performs an admission assessment on a client diagnosed with systemic lupus erythematosus (SLE). Which characteristic cutaneous manifestation of SLE would the nurse most likely assess?

Accepted Answer

11ecbb05_c9e3_9a9b_b433_f9771452f9e5_MD0009_00 SLE is an autoimmune disorder in which the body's immune system produces autoantibodies that attack the body's tissues and cells. It is characterized by alternating periods of exacerbation (flare) and remission. The skin is one of the target organs commonly affected by the disease. The characteristic cutaneous manifestation of SLE (> 50%) is a flat or raised red rash that forms a butterfly shape across the bridge of the nose and cheeks. It is often related to sunlight exposure (ultraviolet light) and is more pronounced during a disease flare (Option A). Recurrent oral ulcers are also very common. (Options B, C, and D) Although petechiae, pruritus, and urticaria may be associated cutaneous manifestations, they are not characteristic specifically to SLE. Educational objective: The characteristic cutaneous manifestation of SLE is a flat or raised red rash that forms a butterfly shape across the bridge of the nose and cheeks.

Question 5

A clinic nurse is reviewing charts for clients who have appointments later in the day. Which of the following clients should the nurse recognize as appropriate recipients of a prescription for emtricitabine/tenofovir? Select all that apply.

Accepted Answer

HIV is a viral infection of CD4⁺ (T helper) cells that results in progressive immune system impairment. It is most frequently transmitted via blood, unprotected sexual contact, shared needles, and parenteral equipment, or perinatally from mother to child. Primary prevention and modification of risky behaviors are essential health care strategies for HIV because there is no known cure. ⁺ Preexposure prophylaxis (PrEP) is a preventive strategy in which antiretroviral therapy is prescribed for clients whose risk for contracting HIV is high. Emtricitabine/tenofovir (eg, Truvada) is a commonly used combination therapy for PrEP in high-risk individuals (eg, clients using recreational IV drugs, clients whose spouses have HIV, men who have sex with men) (Options A, C, and D). PrEP should be combined with other prevention methods such as safer sex practices, regular HIV testing, and counseling for risk reduction. (Option B) Tuberculosis infection does not increase the risk of contracting HIV. However, HIV infection places clients at risk for opportunistic infections (eg, tuberculosis). Antiretroviral therapy (which may include emtricitabine/tenofovir) can lower the risk for opportunistic infections in clients with HIV. (Option E) HIV can be transmitted through needlestick injury, but the risk is low. Therefore, standard precautions are sufficient to prevent HIV transmission in health care workers (eg, phlebotomists). Educational objective: Preexposure prophylaxis is prescribed to prevent HIV infection in clients at high risk (eg, men who have sex with men, clients whose spouses have HIV, clients who use recreational IV drugs). Emtricitabine/tenofovir is commonly used for this purpose.

Question 6

A nurse is discharging a client who has been hospitalized with streptococcal infective endocarditis (IE). Which statement by the client would indicate a need for further teaching?

Accepted Answer

Clients with IE usually have fever for several days during the initial stages of antibiotic therapy. By the time they are discharged, fever subsides or becomes occasional and low-grade. The nurse should teach the client to monitor temperature regularly at home. Persistent temperature elevations may mean that the antibiotic therapy is ineffective or complicationshave developed. The client should notify the HCP if a fever persists at home. (Option A) A client who has had IE is at risk for reoccurrence. This client should receive prophylactic antibiotics for certain high-risk procedures (eg, manipulation of gingival tissue). (Option B) IE causes the formation of vegetations on valve and endocardial surfaces. Embolization to various organ sites can occur. Slurred speech could indicate that embolization has caused a possible stroke. (Option D) IE can require IV antibiotics for up to 4-6 weeks. The client may be discharged home once hemodynamically stable, and a home health nurse will come to administer the antibiotics through the client's PICC line. Educational objective: The nurse should teach the client with IE to expect to receive IV antibiotics for several weeks after returning home and to report a persistent fever; any signs of embolization such as slurred speech, one-sided weakness, or paralysis; or a painful, cold extremity. Prophylactic antibiotics will be required for certain high-risk procedures.

Question 7

A clinic nurse examines a client with a tentative diagnosis of primary Sjögren's syndrome.  Which finding observed by the nurse would most likely be associated with this syndrome?

Accepted Answer

Sjögren's syndrome is an autoimmune condition. It causes inflammation of the exocrine glands (eg, lacrimal, salivary), resulting in decreased production of tears and saliva and leading to dry eyes (xerophthalmia) and dry mouth (xerostomia). Treatment with over-the-counter, preservative-free artificial tears can relieve eye dryness, burning, itching, irritation, pain, and a gritty sensation in the eyes. Wearing goggles can protect the eyes from outdoor wind and dust. Dry mouth is treated with artificial saliva. Using a room humidifier and not sitting in front of fans and air vents can also help (Option A). (Option B) Early-morning low back stiffness is seen with ankylosing spondylitis. (Option C) Multiple tender points are characteristic of fibromyalgia. (Option D) Thickening of the skin is seen with scleroderma. Educational objective: Sjögren's syndrome is an autoimmune condition that can cause dry eyes and mouth. Clients are instructed to use artificial tears and saliva.

Question 8

The nurse is caring for a client with scleroderma. Which assessment finding indicates the most serious complication of the disease and requires priority intervention?

Accepted Answer

Scleroderma is an overproduction of collagen that causes tightening and hardening of the skin and connective tissue. This is a progressive disease without a cure, and treatment is aimed at managing complications. Renal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. Early recognition and treatment of renal crisis is needed to prevent acute organ failure. Even with treatment, this can be fatal. (Option B) Raynaud phenomenon can develop secondary to scleroderma. It is characterized by vasospasm-induced color changes in the fingers, toes, ears, and nose. This requires urgent treatment (eg, immersing hands in warm water) but is not life-threatening. (Option C) Pulmonary fibrosis is a progressive complication of scleroderma that is defined as scarring of lung tissue, which then causes reduced function, dry cough, and dyspnea. Some clients may be placed on oxygen. This is not immediately life-threatening. (Option D) Heartburn and dysphagia (difficulty swallowing) are common symptoms associated with scleroderma. This is due to the disease process of internal scarring, and it is not life-threatening. Educational objective: Scleroderma is caused by collagen overproduction; it is a lifelong disease without a cure. Treatment is aimed at controlling symptoms and preventing further complications. Renal crisis is life-threatening and should be recognized and treated immediately.

Question 9

The nurse prepares to administer IV vancomycin to an 80-year-old client with a methicillin-resistant Staphylococcus aureus infection. The nurse should notify the health care provider about which serum laboratory results before administering the drug? Select all that apply.

Accepted Answer

Vancomycin is a glycopeptide antibiotic that is excreted by the kidneys. It is used to treat serious infections with gram-positive microorganisms (Staphylococcus aureus [methicillin-resistant Staphylococcus aureus]) and diarrhea associated with Clostridium difficile. Serum vancomycin trough level is monitored before the 4th dose (15-20 mg/L [10.4-13.8 µmol/L] is optimal). Blood urea nitrogen (BUN) and creatinine levels are monitored regularly (usually 2-3 times/week) in clients receiving the drug due to increased risk of nephrotoxicity, especially in those with impaired renal function, receiving aminoglycosides, and who are >60 years old. The health care provider (HCP) can lower the dose, decrease the drug administration frequency, or discontinue vancomycin. It is important to know the baseline values of BUN and creatinine to monitor trending and identify if there is an increase. Before administering this drug, the nurse should notify the HCP that the client's BUN (60 mg/dL [21.4 mmol/L]) and creatinine (2.1 mg/dL [185.6 µmol/L]) are both increased. The normal range for BUN is 6-20 mg/dL (2.1-7.1 mmol/L) and creatinine is 0.6-1.3 mg/dL (53-115 µmol/L). (Option C) An elevated glucose level (>110 mg/dL [6.1 mmol/L]) is expected in a client with an infection due to physiological stress and gluconeogenesis; this does not need to be reported to the HCP. (Option D) A hemoglobin level of 15 g/dL (150 g/L) is normal (13.2-17.3 g/dL [132-173 g/L] in adult men; 11.7-15.5 g/dL [117-155 g/L] in adult women) and does not need to be reported to the HCP. (Option E) A magnesium level of 1.5 mEq/L (0.75 mmol/L) is normal (1.5-2.5 mEq/L [0.75-1.25 mmol/L]) and does not need to be reported to the HCP. (Option F) A white blood cell count of 14,000/mm³ (14.0 × 10⁹/L) is elevated and expected in a client with a serious infection; this does not need to be reported to the HCP. Educational objective: As nephrotoxicity can occur, monitoring of vancomycin trough level to maintain optimal drug level and renal function is indicated in clients receiving vancomycin, especially in those with impaired renal function and who are >60 years old.

Question 10

The nurse is planning teaching for a client newly diagnosed with Sjögren's syndrome. Which measures will the nurse include in the teaching plan? Select all that apply.

Accepted Answer

Sjögren's syndrome is a chronic autoimmune disorder in which moisture-producing exocrine glands of the body are attacked by white blood cells. The most commonly affected glands are the salivary and lacrimal glands, leading to dry eyes (xerophthalmia) and dry mouth (xerostomia). Dryness in these areas can lead to corneal ulcerations, dental caries, and oral thrush. Other areas that can be affected and their symptoms include: Skin - dry skin and rashes Throat and bronchi - chronic dry cough Vagina - vaginal dryness and painful intercourse Treatment is focused on alleviating symptoms as there is currently no cure for Sjögren's syndrome. Over-the-counter or prescribed drops are used to relieve itching, burning, dryness, and gritty sensation in the eyes. Wearing goggles may offer further protection from drying caused by the wind. Dry mouth is treated with sugarless gum and candy or artificial saliva. Regular dental appointments to prevent dental caries are recommended. Lubricants (eg, K-Y Jelly) help to ease vaginal dryness. Use of lukewarm water and mild soap when showering can prevent dry skin. Avoiding low-humidity environments (eg, centrally heated houses, airplanes) and using humidifiers to maintain adequate humidity (mainly at night) are also recommended. (Option D) Clients with Sjögren's syndrome are advised to avoid decongestants as they cause further dryness to the mouth and nasal mucosa. These clients should also avoid oral irritants (eg, coffee, alcohol, nicotine) and acidic drinks (eg, carbonated beverages, juices) and instead sip water frequently. Educational objective: Clients with Sjögren's syndrome need measures to combat the effects of damaged moisture-producing glands. These include eye drops, sugar-free candy or artificial saliva, vaginal lubricants, frequent dental examinations, lukewarm showers with mild soap, and avoiding decongestants.

Question 11

An adult client with bacterial pneumonia becomes increasingly disoriented and somnolent. Which assessment findings indicate that the client may be in septic shock? Select all that apply.

Accepted Answer

Sepsis is an overwhelming response to infection that causes impaired organ function. Septic shock occurs when sepsis causes cardiovascular collapse and/or impairs the body's ability to maintain normal metabolic and cellular processes. Manifestations of septic shock include: Fever or hypothermia (>100.4 F [38 C]; <96.8 F [36 C]) - Either fever or low body temperature is found in sepsis and septic shock. Fever occurs in response to infection, whereas low body temperature can occur as shock worsens due to metabolic alterations and inadequate tissue perfusion (Option C). Hypotension - Systolic blood pressure <90 mm Hg or mean arterial pressure <65 mm Hg in a client with infection may indicate septic shock. Altered perfusion from hypotension may cause lactic acid accumulation and metabolic acidosis (Option A). Prolonged capillary refill - A refill time >3-4 seconds in adults indicates inadequate tissue perfusion as a result of altered peripheral circulation and hypotension (Option B). Tachycardia - A resting heart rate >90/min is common in septic shock to compensate for decreased systemic vascular tone and hypotension. WBC count >12,000/mm³ (12 x 10⁹/L) or immature neutrophils (bands) of >10% - An increased WBC count, especially with bands, indicates severe infection (Option E). (Option D) Clients with septic shock typically develop decreased urine output (ie, <0.5 mL/kg/hr) due to inadequate organ perfusion. Educational objective: Septic shock is a life-threatening systemic response to infection that causes impaired organ function, cardiovascular collapse, and/or impairment of normal metabolic and cellular processes. Signs of septic shock include fever or hypothermia, hypotension, tachycardia, and leukocytosis.

Question 12

The clinic nurse reinforces teaching to a client with systemic lupus erythematosus. Which instructions will the nurse include? Select all that apply.

Accepted Answer

Systemic lupus erythematosus (SLE) is an autoimmune disorder (the body's immune system erroneously attacks body tissues) that results in inflammation and damage to many body parts. Symptoms vary widely among affected individuals, but most experience painful/swollen joints, extreme fatigue, skin rashes, and kidney problems. The symptoms typically appear for periods of time (called flares) alternating with periods of remission. There is no cure for SLE, but it can be treated with immunosuppressants (eg, corticosteroids) or immunomodulators (eg, hydroxychloroquine). Pneumonia and annual influenza vaccinations are recommended for those with SLE as they are more susceptible to infections. These individuals should avoid contact with sick people and report fever to their health care provider (Options A and D). Both physical and emotional stress can exacerbate SLE. Therefore, clients should follow a healthy lifestyle (eg, 7-8 hours of sleep, no smoking). Balanced exercise with alternating periods of rest is recommended (Option B). Sunlight is known to worsen the rash of SLE and should be avoided when possible (especially between 10 AM-4 PM); protective clothing and sunscreen application are recommended during periods of sun exposure (Option C). (Option E) The rash of SLE should be cleansed only with mild soap. Harsh soap and chemicals should be avoided. The rash is not due to bacterial infection. Educational objective: Clients with SLE should be advised to avoid harsh sunlight and ultraviolet light exposure as well as harsh soaps and chemicals. These clients often receive corticosteroids and are susceptible to infection; therefore, annual influenza vaccination (eg, killed vaccines) is important.

Question 13

The nurse reviews the most current laboratory results of assigned clients. Which result should the nurse report to the health care provider immediately?

Accepted Answer

Almost all post kidney transplant clients are prescribed immunosuppressant drugs (eg, cyclosporine, azathioprine, prednisone) to help prevent organ rejection. This client's immunocompromised condition increases the risk for developing infection. Therefore, early recognition and prompt treatment of infection are critical to survival. The nurse should notify the health care provider (HCP) immediately of any signs or symptoms of an infection as well as abnormal urinalysis findings. (Option A) Cellulitis is a bacterial infection (eg, Staphylococcus aureus, streptococci) that causes inflammation of the subcutaneous tissues. An increased WBC count (normal 4,000-11,000/mm³ [4.0-11.0 × 10⁹/L]) would be expected in this client, so immediate notification of the HCP is not necessary. (Option B) Clients with chronic kidney injury have a decreased level of the hormone erythropoietin, resulting in decreased erythrocyte production. Decreased hematocrit (normal 39%-50% [0.39-0.50] for males, 35%-47% [0.35-0.47] for females) and hemoglobin (normal 13.2-17.3 g/dL [132-173 g/L] for males, 11.7-15.5 g/dL [117-155 g/L for females) levels would be expected in this client, so immediate notification of the HCP is not necessary. (Option C) An elevated postprandial serum glucose (>140 mg/dL [7.8 mmol/L]) would be expected in a client with type 2 diabetes mellitus, so immediate notification of the HCP is not necessary. Educational objective: Clients who have undergone kidney (or any organ) transplantation are prescribed immunosuppressant drugs to help prevent organ rejection and are therefore at increased risk for developing infection. The nurse should notify the HCP immediately of any signs or symptoms of an infection.

Question 14

The nurse is caring for a client with immune thrombocytopenic purpura. Which client statements indicate a need for further teaching? Select all that apply.

Accepted Answer

Immune thrombocytopenic purpura (ITP) is an autoimmune condition in which antibodies bind to and cause destruction of platelets. Clients with ITP have a platelet count <150,000/mm³ (150 x 10⁹/L) and are at increased risk of bleeding. Key teaching to reduce the client's risk of bleeding includes: Use soft-bristle toothbrushes, gentle flossing, and nonalcoholic mouthwashes. These prevent periodontal disease and gingival bleeding (Option A). Avoid activities that may cause trauma (eg, high-intensity sports). Appropriate exercise includes low-impact activity (eg, walking) while wearing nonskid footwear to help prevent falls (Option B). Take prescribed stool softeners and laxatives as needed. These medications prevent hard stools and straining, which can cause anorectal fissuring, bleeding, and hemorrhoids (Option D). (Option C) Clients with ITP should use electric razors instead of safety or straight razors. Electric razors have a more complete guard, reducing the risk of accidentally nicking the skin. (Option E) Clients with ITP should avoid nonsteroidal anti-inflammatory drugs (eg, aspirin, ibuprofen, ketorolac), which further impair platelet function. Acetaminophen and opiates are better options for pain management. Educational objective: Clients with immune thrombocytopenic purpura (ITP) have low platelet counts and an increased risk of bleeding. Appropriate care for clients with ITP includes safe exercise; using stool softeners, electric razors, and soft-bristle toothbrushes; and avoiding nonsteroidal anti-inflammatory drugs.

Question 15

The nurse is obtaining a client's health history during a routine physical and wellness examination. Which of the following statements by the client should cause the nurse to suspect potential Hodgkin lymphoma? Select all that apply.

Accepted Answer

NCLEX® CHANGE AS OF 2017 - Please note that select-all-that-apply (SATA) questions on NCLEX can now include any number of correct responses. Only ONE option or up to ALL options may be correct. UWorld questions now reflect this change. Visit NCSBN® NCLEX FAQs for more information. Lymphoma is a form of cancer that begins in the body's lymphatic system (eg, lymph nodes, spleen) and is characterized by abnormal growth of lymphocytes. It is usually classified within two major subtypes, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL), and is further identified by numerous subcategories. To be diagnosed with Hodgkin lymphoma, malignant Reed-Sternberg cells must be found in the lymphatic tissue. Furthermore, Hodgkin lymphoma tends to follow a predictable path of metastasis, whereas NHL tends to be more widely disseminated. The most common clinical manifestation of any form of lymphoma is the presence of at least one painless, enlarged lymph node, often in the neck, underarm, or groin (Option B). Clients may also present with or develop fever; significant, unexplainable, and/or unintentional weight loss (>10% of body weight); and/or drenching night sweats (ie, "B symptoms"); which typically associate with a poor prognosis (Options A, C, and E). Additional indications are nonspecific (eg, itching, fatigue), although some clients are asymptomatic at the time of diagnosis (Option D). It is critical that nurses are alert to potential symptoms of lymphoma because early identification and treatment improve the client's chance for complete remission. Educational objective: Lymphoma is a form of cancer beginning in the body's lymphatic tissues. The most common clinical manifestation of any form of lymphoma is the presence of at least one painless, enlarged lymph node. Additional manifestations include fever; significant, unintentional weight loss; night sweats; itching; and fatigue.

Question 16

The oncology nurse is caring for a client with tumor lysis syndrome.  Which prescription should the nurse question?

Accepted Answer

11ecbb05_c9de_6a78_b433_51dec9cd7d34_MD0009_00 Tumor lysis syndrome (TLS), an oncologic emergency, occurs when cancer treatment successfully kills cancer cells, resulting in the release of intracellular components (eg, potassium, phosphate, nucleic acids). Clients with TLS develop significant imbalances of serum electrolytes and metabolites. TLS may result in the following life-threatening conditions: Hyperkalemia (>5.0 mEq/L [5.0 mmol/L]) that can cause lethal dysrhythmias Large amounts of nucleic acids (normally converted to uric acid and excreted by the kidneys) that can overwhelm the kidneys and cause hyperuricemia and acute kidney injury (AKI) from uric acid crystal formation Hyperphosphatemia (>4.4 mg/dL [1.42 mmol/L]) that can cause AKI and dysrhythmias Hypocalcemia (<8.6 mg/dL [2.15 mmol/L]) that can cause tetany and cardiac dysrhythmias Potassium-sparing medications (eg, spironolactone) can worsen hyperkalemia (Option D). Loop or osmotic diuretics may be prescribed to increase urine output and lower serum potassium. Sodium polystyrene sulfonate (Kayexalate) also helps to reduce potassium. (Options A and B) Hypouricemic agents (eg, allopurinol) prevent the formation of uric acid, and aggressive fluid hydration (eg, IV normal saline) flushes out the kidneys to avoid the accumulation of toxins. Hydration therapy also dilutes serum potassium, lowering the risk for lethal dysrhythmias. (Option C) Health care providers often prescribe mealtime phosphate binders (eg, sevelamer, lanthanum carbonate, calcium acetate) to prevent absorption of additional nutritional phosphorus. Educational objective: Tumor lysis syndrome is an oncologic emergency that results in hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. Treatment includes aggressive hydration, correction of electrolyte abnormalities (eg, loop diuretics, phosphate binders), and hypouricemic agents (eg, allopurinol).

Question 17

The nurse is reviewing medical histories with several clients during a community health screening event. Which of the following client statements indicate a risk factor for cervical cancer? Select all that apply.

Accepted Answer

11ecbb05_c9df_a2f9_b433_5b0e94d6e072_MD0009_00 Cervical cancer is a malignancy of the cervix (a portion of the uterus) that normally occurs near the meeting point of the vaginal and uterine epithelia (the transformation zone), located in the endocervical canal. Uterine epithelial cells in this area are rapidly and constantly replaced with squamous cells (ie, squamous metaplasia), a natural process that also increases the risk for abnormal cell changes and cancer. The most important risk factor for cervical cancer is persistent human papillomavirus (HPV) infection, a common, transient, and often asymptomatic sexually transmitted infection (STI) that can be identified in almost all clients with cervical cancer (Option E). Most other risk factors are related to acquiring, clearing, or increasing the cancer-causing effects of HPV infection, including: Having multiple sexual partners (ie, >1 lifetime partner), which increases the chance of HPV exposure (Option A) Smoking tobacco, which is believed to promote cell mutation and increase the likelihood of HPV infection (Option B) Being infected with other STIs (eg, gonorrhea, chlamydia), which increases the likelihood of HPV infection (Option D) (Option C) Condoms help to prevent HPV transmission between partners, and not taking oral contraceptives is associated with a decreased risk for cervical cancer. Educational objective: Cervical cancer is a malignancy of the cervix associated with persistent human papillomavirus (HPV) infection. Most other risk factors for cervical cancer relate to increasing risk for or ability to clear HPV infections, including multiple sexual partners, history of other sexually transmitted infections, and smoking.

Question 18

The community health nurse provides an education program about risk factors for prostate cancer. Which of the following statements by program attendees indicate that teaching has been effective? Select all that apply.

Accepted Answer

Prostate cancer is a slow-growing and predictable malignancy. If not treated, it can metastasize to nearby lymph nodes, liver, lungs, and bone. Clients should discuss the risks and benefits of screening for prostate cancer (eg, checking serum prostate-specific antigen) with their health care provider. Certain factors place clients at greater risk, and early screening can detect prostate cancer before it becomes invasive (metastasizes). The nurse should educate clients about risk factors. Nonmodifiable risk factors (eg, those the client cannot control) include African American ethnicity, having a first-degree relative with prostate cancer, and increasing age (>50) (Options A, D, and E). Clients can lower the risk for prostate cancer by avoiding modifiable (ie, those the client can control) risk factors, which include: Diet high in red meat, animal fat, high-fat dairy products, and refined carbohydrates (Option B) Low fiber intake Obesity (Option C) Long-term use of NSAIDs (eg, aspirin, ibuprofen) can be a protective factor against certain types of cancer (eg, colorectal, prostate). However, before regularly taking NSAIDs, clients should speak with their health care provider because NSAIDs can increase the risk for adverse effects (eg, cardiovascular disease, bleeding). Educational objective: Risk factors for developing prostate cancer include African American ethnicity, having a first-degree relative with prostate cancer, increasing age (>50), and a diet high in red meat, animal fat, high-fat dairy products, and refined carbohydrates.

Question 19

The nurse reviews the serum laboratory results of a client who was seen in the clinic 2 days ago for worsening joint pain from a flare of systemic lupus erythematosus. Which result is of greatest concern and prompts the nurse to notify the health care provider?

Accepted Answer

Systemic lupus erythematosus (SLE) is an autoimmune disorder in which an abnormal immune response leads to chronic inflammation of different parts of the body. SLE ranges in severity from mild (eg, affecting skin, muscles, joints) to severe (eg, affecting kidneys, heart, lung, blood vessels, central nervous system) disease. Increased creatinine (normal 0.6-1.3 mg/dL [53-115 µmol/L]), increased blood urea nitrogen (normal 6-20 mg/dL [2.1-7.1 mmol/L]), and an abnormal urinalysis (eg, protein, red blood cells, cellular casts) can indicate the presence of lupus nephritis (occurring in 50%), a potentially serious complication of SLE. Early recognition and aggressive immunosuppressive treatment are essential to preserve renal function and prevent irreversible kidney damage (Option A). (Option B) An elevated erythrocyte sedimentation rate (normal <30 mm/hr) can indicate the presence of an active inflammatory process and would be expected in a client with an inflammatory disease such as SLE, especially during a disease flare. This is nonspecific and does not give information as to which organ is being attacked by inflammation. (Option C) A positive antinuclear antibody (ANA) titer (>1:40) indicates the presence of ANAs, which the body produces against it own DNA and nuclear material. This would be expected in a client diagnosed with SLE. (Option D) Anemia, mild leukopenia (white blood cell count <4,000/mm³ [4.0×10⁹/L]), and thrombocytopenia (platelet count <150,000/mm³ [150×10⁹/L]) are often present in SLE. The nurse would report these to the health care provider, but they are not of greatest concern. Educational objective: Increased serum creatinine (>1.3 mg/dL [115 µmol/L]), increased blood urea nitrogen (>20 mg/dL [7.1 mmol/L]), and an abnormal urinalysis can indicate the presence of lupus nephritis, a potentially serious complication of SLE in which inflammation of the kidney can lead to renal injury. Early recognition and treatment are essential to preserve renal function and prevent irreversible kidney damage.

Question 20

A client receiving a first dose of IV cefazolin has developed a diffuse rash, hypotension, and shortness of breath. Place the nurse's subsequent actions in the correct order. All options must be used.

Accepted Answer

Anaphylactic shock has an acute onset (20-30 minutes) caused by a systemic IgE-mediated hypersensitivity allergic reaction to drugs (eg, antibiotics), foods (eg, shellfish, peanuts), diagnostic agents (eg, contrast), biologic agents (eg, blood, vaccines), and venom (eg, bees, snakes) and results in circulatory failure, laryngeal edema, and severe bronchoconstriction. Management of anaphylactic shock includes: Stop the infusion that is causing the reaction and call for help (eg, rapid response team) (Option E). Ensure patent airway, then administer oxygen via a high-flow nonrebreather mask and prepare for intubation if needed (Option B). Give epinephrine intramuscularly. Epinephrine counteracts the effect of the histamines released, dilating bronchial smooth muscles and providing vasoconstriction. Most deaths from anaphylaxis are due to delaying epinephrine. Maintain blood pressure with normal saline IV fluid (Option C). Administer adjunctive therapies: Bronchodilators (eg, albuterol) to dilate the small airways and reverse bronchoconstriction, antihistamines (eg, diphenhydramine) to modify the hypersensitivity reaction, and corticosteroids (eg, methylprednisolone) to decrease airway inflammation and swelling associated with the allergic reaction (Option A). Continue to reassess vital signs for any changes (Option D). Educational objective: In a client who is experiencing an anaphylactic reaction to an IV medication, it is imperative to first stop the infusion; ensure airway patency and administer oxygen; give epinephrine and initiate IV fluids; and administer adjunctive therapies (antihistamines, bronchodilators, corticosteroids).

Exam 1: Adult Health

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A client receiving a first dose of IV cefazolin has developed a diffuse rash, hypotension, and shortness of breath. Place the nurse's subsequent actions in the correct order. All options must be used.