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A patient with chronic low back pain is on extended release morphine twice
a day for pain control. The patient has a pain contract in place. He requests
a refill for his pain medication. Upon review of his request for pain
medication refills you note that he has requested his pain medication at
least 10 days later than expected the last three times. You have the patient
come in to assess his use of the pain medication. He reports that he takes
the pain medication once a day and he only uses the second dose if
needed. What do you anticipate next?
A. Authorization of a refill for his medication
B.Instruction for use of extended release medication, review of the pain
contract, decrease in dose to once a day
C. Discontinuation of medication
D. Change in the orders for one tablet of the extended release morphine
daily with a second tablet daily as needed ---------CORRECT ANSWER------
-----------C. Discontinuation of medication
Extended release narcotics for chronic pain are meant to be taken on
schedule and not as needed. A pain contract typically indicates that
the narcotic will be taken as prescribed.
Among the reasons for a primary risk assessment for the development of
cancer in women are all of the following EXCEPT:
A. Detecting a trait or characteristic of cancer can be associated with the
development of cancer
B. Identifying the client who has started menses before age 12 as a risk
factor in the development of cancer
,C. Recognizing that living in certain areas of the United States have been
found to be conclusive risk factors for developing cancer
D. Understanding that the discovery of a family history that includes at least
one family member who has been diagnosed with cancer as a risk factor ---
------CORRECT ANSWER-----------------C. Recognizing that living in certain
areas of the United States have been found to be conclusive risk factors for
developing cancer.
Cancer occurrence in various parts of the USA is a risk factor due to
various carcinogens, but it is by no means conclusive.
Tests commonly incorporated in the diagnostic workup of women's cancer
include all EXCEPT:
A. Cancer-related checkups including examinations for thyroid, skin, lymph
node and ovarian cancer
B. Clinical breast exam (CBE), a manual breast examination performed by
a trained clinician
C. Mammography, an x-ray allowing visualization of a the internal structure
of the breast
D. Screening done on symptomatic clients to evaluate authenticity of
disease process ---------CORRECT ANSWER-----------------D. Screening
done on symptomatic clients to evaluate authenticity of disease process
Screening is done on asymptomatic clients in the diagnostic workup
stage.
A 38 year old female client has undergone a right modified radical
mastectomy for breast cancer. Post operatively, she experiences incisional
pain and swelling and limited movement of her right arm. The surgeon has
informed her that four of the lymph nodes were positive for cancer and that
she will have to undergo chemotherapy. As the nurse caregiver for this
,client, which of the following is an immediate problem related to potential
health?
A. Pain
B. Impaired mobility of arm
C. Disturbed body image
D. Grieving ---------CORRECT ANSWER-----------------A. Pain
The pain postoperatively must be evaluated and treated prior to any
of the other options.
Nurses caring for the female cancer patient must be acquainted with a
special perspective that focuses on the female. These perspectives include
all EXCEPT:
A. Coping skills supporting family interactions
B. Emotional support regarding questions about changes in body image
C. Informational support regarding lifestyle changes
D. Decision making support regarding the type of surgery that best suites
the clients cancer ---------CORRECT ANSWER-----------------D. Decision
making support regarding the type of surgery that best suites the clients
cancer.
Helping the client make a decision about the type of surgery she must
undergo is clearly not in the nurses' scope of practice.
Knowledge of the breasts and their functions include:
A. The breasts are supported by and attached to the chest wall, resting on
the major scapular chest muscle
B. The areolas deliver milk through the opening in the nipple
, C. Fibrosis, cysts, mastitis, contribute more than 70% added risk to
developing breast cancer
D. The major hormones affecting the breast are estrogen, progesterone,
and prolactin ---------CORRECT ANSWER-----------------D. The major
hormones affecting the breast are estrogen, progesterone, and prolactin
The other statements are false.
Treatment of breast cancer involves many modalities. All of the answers
below are correct EXCEPT:
A.Staging which shows the size and spread of the malignancy
B.Identifying the presence of the BRCA ½ factor predicting risk for optimum
treatment
C.Performing breast-sparing surgery (lumpectomy)
D.incorporating chemotherapy as an adjunct to surgery ---------CORRECT
ANSWER-----------------B. Identifying the presence of the BRCA ½ factor
predicting risk for optimum treatment.
Identification of the BRCA ½ factor is used in the screening of breast
cancer not in the treatment phase
A 65 year old African American female has been diagnosed with lung
cancer and is scheduled for a left thoracotomy. As the nurse caring for this
client you understand that the major determining factor of this client's
health is the fact that
A. She is African American and lacks health insurance
B. She chose to smoke all of her adult life
C. Her mother died of lung cancer at about the same age