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AVERAGE: 1. A male client undergoes a laryngectomy to treat laryngeal cancer.

When teaching the client how tocare 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. .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 shouldrecommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. Theclient should begin performing stoma care without assistance as soon as possible to gain independence inself-care activities 2. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer.The nurse reviews the clients 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 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 byeclampsia arent risk factors for cervical cancer. 3. Which intervention is appropriate for the nurse caring for a male client in severe pain receiving acontinuous I.V. infusion of morphine? a. Assisting with a naloxone challenge test before therapy begins b. Discontinuing the drug immediately if signs of dependence appear c. Changing the administration route to P.O. if the client can tolerate fluids d. Obtaining baseline vital signs before administering the first dose Answer D. The nurse should obtain the clients baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. Analoxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist.The nurse shouldnt discontinue a narcotic agonist abruptly because withdrawal symptoms may occur.Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the abilityto tolerate fluids. 4. 19. When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess: a. short-term memory impairment. b. tactile agnosia. c. seizures. d. contralateral homonymous hemianopia. Answer B. Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor.Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of thefrontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobetumor. 5. A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment findingsuggests that the client has developed stomatitis (inflammation of the mouth)? a. White, cottage cheeselike patches on the tongue b. Yellow tooth discoloration c. Red, open sores on the oral mucosa d. Rust-colored sputum

Answer C. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resultingin ulcers on the oral mucosa that appear as red, open sores. White, cottage cheeselike patches on thetongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow toothdiscoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggestsa respiratory disorder, such as pneumonia. 6. The nurse is caring for clients over the age of 70. The nurse is aware that when giving medications to older clients, it is best to a. start low, go slow b. avoid stopping a medication entirely c. avoid drugs with side effects that impact cognition d. review the drug regimen yearly ANSWER: A. Start low, go slow to prevent aspiration 7. Mr. F.O age 52 had laryngectomy due to cancer of the larynx. Discharge instructions are given to Mr. F.O and his family response by written communication from Mr. F.O or verbal response from the family will be a signal to the nurse that the instructions need to be reclarified. A. it is acceptable to take over the counter medications now that condition is stable B. the suctioning at home must be a clean procedure, not sterile C. report swelling, pain or excessive drainage D. cleanses skin around the stoma, use hydrogen peroxide and rinse with water, pat dry Answer : (B) Rationale: It is common and accepted practice to use 'clean' rather than sterile technique during suctioning in the home environment, although scientific evidence to support or discount either technique in home care is lacking. 6. The nurse is assigned to care for a client who has a leaking intracranial aneurysm. To minimize the risk of rebleeding, the nurse should plan to A) restrict visitors to immediate family B) avoid arousal of the client except for family visits C) keep clients hips flexed at no less than 90 degrees D) apply a warming blanket for temperatures of 98 degrees Fahrenheit or less answer is A: restrict visitors to immediate family Maintaining a quiet environment will assist in minimizing cerebral rebleeding. When family vis- it, the client should not be disturbed. If the client is awake, topics of a general nature are better choices for discussion than topics that result in emotional or physiological stimulation. 7. The use of atropine for treatment of symptomatic bradycardia is contraindicated for a client with which of the following conditions? A) Urinary incontinence B) Glaucoma C) Increased intracranial pressure D) Right sided heart failure answer is B: Glaucoma Atropine is contraindicated in clients with angle- closure glaucoma because it can cause pupillary dilation with an increase in aqueous humor, lead- ing to a resultant increase in optic pressure.