NCLEX QUESTIONS EXAM MED SURG

NCLEX QUESTIONS EXAM MED SURG

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Sage8620Preview Peds C 17 terms Aly The nurse is caring for a client with AML what is the most important information to teach the client and the clients family?

• Teach the client and the family how to rate pain using

the number scale.

• Teach the client to eat fresh fruits and veggies daily.
• Teach the client to exercise frequently.
• Teach the client and the family about the need for hand

hygiene.

• Teach the client and the family about the need for hand hygiene.

A patient comes into the ED with pain and says she was recently diagnosed with cancer but was unsure of the name, she states that she was told that it was a bone marrow cancer that was fast growing and grows in the WBC's. What kind of cancer would you suspect in the patient?

• Chronic Myeloid Leukemia (CML)
• Acute Lymphatic Leukemia (ALL)
• Acute Myeloid Leukemia (AML)
• Chronic Lymphatic Leukemia (CLL)

C. AML

• A nurse is receiving report on a recently admitted 4-

year-old male patient with acute lymphocytic leukemia (ALL). Based on the pathophysiology of the cancer, what would the most important nursing diagnosis be while treating this patient?

a. Imbalanced Nutrition: Less than body requirements

• Risk for Infection
• Acute pain
• Impaired Skin Integrity
• Risk for Infection is the most important nursing diagnosis because patients with

ALL are at higher risk of infection due to the overproduction of immature WBCs.Immature WBCs are not developed enough to fight off pathogens.

• A 5-year-old patient comes to the emergency room

with a high fever, swollen lymph nodes, fatigue and dyspnea. The mother explained that she had brought the child in because she was worried he had the flu based on his symptoms. However, she also explained that the symptoms have been present for about 3 weeks now.Because of this the nurse is concerned that there is a more serious underlying problem such as acute lymphocytic leukemia, especially after finding some bruising on the child's arms. Which of the tests below can be used to diagnose acute lymphocytic leukemia -

SELECT ALL THAT APPLY?

• CBC panel
• Bone marrow biopsy and/or aspiration
• Lymph node biopsy
• Uric acid level
• Leukocyte differential
• Bone scan

a, b, d, and e. In patients with ALL, a CBC will show anemia, thrombocytopenia and neutropenia. A bone marrow biopsy and/or aspiration will show proliferation of immature WBCs. It is common that uric acid levels be elevated in patients with ALL. A leukocyte differential can differentiate between the different types of leukocyte cells to determine increased level of immature WBCs.A 42 year old male presents to the E.D. following a weekend getaway to Vegas. He states when out at a pool party he has increased pain in his groin, neck, and under arm. He admits to drinking ETOH but denies illicit drug use. He states he has been extremely tired for the past few month and has night sweats. Upon assessment vitals are 124/76 BP, pulse 72, RR 18, 98% spo2 on room air, and a temp of 100.3 degrees Fahrenheit. Physical exam reveals swollen lymph nodes. The nurse would expect a

diagnosis of which of the following:

• Human Immunodeficiency Virus infection
• Hodgkin's Lymphoma
• Avian Influenza
• Chlamydia infection
• Hodgkin's Lymphoma

A recently diagnosed Hodgkin's Lymphoma patient is admitted to inpatient surgical unit for scheduled lymphadenectomy. Which of the following assessments requires immediate intervention by the nurse.

• Temperature of 100.3 degrees Fahrenheit (37.9 degrees

Celsius)

• Weight loss of 2.2 lbs (1 kg) in 4 days.
• Pale, dry mucous membranes.
• Increased fatigue when mobile.
• Temperature of 100.3 degrees Fahrenheit (37.9 degrees Celsius)

A 68- year old male recently diagnosed with Chronic Myeloid Leukemia (CML) calls in to the clinic stating he missed his last dose of his Tyrosine Kinase Inhibitor. What should the nurse instruct the patient to do?

• Double the next dose to make up for the missed

medication

• Take the missed dose as soon as possible as long as it

isn't almost time for the next dose

• Immediately go to the nearest Emergency Room
• Skip the dose and resume as scheduled tomorrow
• Take the missed dose as soon as possible as long as it isn't almost time for the

next dose. Tyrosine Kinase Inhibitor drugs target the abnormal protein produced by the oncogene found in CML cells, so it is very important for patients to take these exactly as prescribed. Any missed doses should be taken as soon as possible.Which clinical manifestations are most consistent with Chronic Myeloid Leukemia?

• Splenomegaly and Lymphadenopathy
• Weight gain and anemia
• Genetic Testing- translocation between two genes no

effect on the blast cells

• Sudden onset of SOB and high BP
• Splenomegaly and Lymphadenopathy An enlarged spleen and lymph nodes

are commonly seen with CML due to excess white blood cell storage in these organs. Fatigue and night sweats will also often accompany these manifestations.A nurse is caring for a client with chronic lymphocytic leukaemia, with an elevated WBC and a new prescription for Rituximab (Rituxan). For which of the following adverse effects should the nurse monitor?A.Hypoglycemia

• Hyperglycemia
• Hypercalcemia
• Hyperphosphatemia
• Hyperglycemia

. A nurse is taking care of a 72 year old female patient diagnosed with chronic lymphocytic leukemia, the patient

requires additional teaching when she states:

• A family history of chronic lymphocytic leukemia.
• "B symptoms" are fevers, night sweats, and weight gain.
• Early treatment does increase survival rate.
• I will have an increased risk of bacterial infections

requiring IV antibiotics.

• "B symptoms" are fevers, night sweats, and weight gain.
• Multiple myeloma is a form of hematologic cancer. A

significant clinical manifestation of this disease is bone destruction. Which of following clinical manifestations can occur as a result of multiple myeloma?

• hypocalcemia
• hyperkalemia
• hypokalemia
• hypercalcemia
• hypercalcemia (Calcium > 10.2 mg/dl); patient experiences excessive thirst,

dehydration, constipation, confusion

Rational: extensive bone destruction causes ionized calcium loss

. Mr. Jones goes to see his PCP today because his nagging back pain has suddenly become severe. He indicates that the pain is located on his spine. The PCP suspects that Mr. Jones has multiple myeloma, so he orders blood work and diagnostic tests to confirm what he suspects. Which of following two diagnostic tests confirm a positive result for multiple myeloma?

• Bun and Creatinine
• Urinalysis and Bone Marrow Biopsy
• AST and ALT
• MRI and Cheek Swab
• Urinalysis and Bone Marrow Biopsy

Rational: Urinalysis will show M proteins and the Bone Marrow Biopsy is the

hallmark diagnostic criterion when it shows more than 10% plasma cells.A nurse begins her shift by reviewing her patient's electrolyte values after receiving report from the

previous nurse. Labs: Na = 127 mEq/L, Mg = 1.5 mg/dl, Cl =

100 mEq/L, Ca = 11.3 mg/dl Which electrolyte imbalance is a priority for the nurse to monitor in this patient suspected of having multiple myeloma and why?Ca = 11.3 mg/dl is hypercalcemia; hypercalcemia can be indicative of bone issues and malignancies A nursing instructor is teaching students at a community health clinic about cancers that predominantly affect minorities. She classifies the risk based on age, gender and ethnic background. After finishing the lecture, the student nurses should recognize that which group is most at risk for multiple myeloma?

• Caucasian women over age 65
• Asian men under age 60
• African-American men over age 60
• All persons are at an equal risk for Multiple Myeloma
• African-American men over age 60

Rational: Men have a higher incidence than women, the risk of multiple myeloma

increases with age; most people are diagnosed in their mid-60s. African American men are twice as likely to develop multiple myeloma as Caucasian men.The nurse is explaining treatment options of multiple myeloma to a newly diagnosed patient. Which statement by the patient represents an understanding of the available treatments and outcomes?

• " Chemotherapy and radiation will cure my disease"
• "No treatment is needed if I don't have any symptoms"
• "Stem cell transplants alone will cure me"
• "A combination of therapies will be needed to cure me"
• "No treatment is needed if I don't have any symptoms" Regular visits with your

physician and monitoring of your disease are all that is required if you have no signs or symptoms. Should you develop signs and symptoms, you and your physician may decide to begin treatment.What is the gold standard for the diagnosis of Non- Hodgkin's lymphoma?

• CBC - This shows variation in lab values but is not a

definitive diagnosis.

• Biopsy - This is the definitive diagnosis and types

protein markers.

• CT scan - This can be used to stage the lymphoma.
• History and Physical - This provides information on the

patient but does not a guarantee a diagnosis.

• Biopsy - This is the definitive diagnosis and types protein markers.