D454 Adult Health III - Set 4 - Part 2

Correct Answer: Anxiety related to perceived threat of death

Option d is correct because restlessness, difficulty focusing, avoidance of eye contact, and needing repeated information are classic manifestations of anxiety related to a life-threatening diagnosis rather than knowledge deficit. Option a is incorrect because deficient knowledge would present as a lack of prior exposure to information, but this patient's inability to retain teaching is caused by anxiety interfering with concentration and processing. Option b is incorrect because denial would present as the patient minimizing the diagnosis or refusing to acknowledge its severity, whereas this patient is actively engaging with teaching but unable to focus. Option c is incorrect because noncompliance implies willful refusal to follow treatment recommendations, but the patient's behavior reflects emotional distress and difficulty processing information rather than intentional resistance.

Correct Answer: What has helped you cope with stress before

Option a is correct because asking about previous coping strategies identifies the patient's existing strengths and mechanisms, which provides a foundation for developing an individualized plan to support her through treatment. Option b is incorrect because calling family members without first assessing the patient's coping resources and preferences may not align with her wishes and does not explore her personal resilience strategies. Option c is incorrect because asking about treatment plan understanding focuses on knowledge assessment rather than emotional coping, and the patient's immediate need is psychological support rather than clinical education. Option d is incorrect because suggesting a support group is premature without first understanding the patient's existing coping mechanisms, as the nurse should assess before recommending specific interventions or resources.

Correct Answer: Avoid the pasta to prevent permanent food aversions

Option b is correct because forcing patients to eat foods they find repulsive during chemotherapy can create permanent food aversions, so patients should be advised to avoid strongly disliked foods during treatment. Option a is incorrect because forcing consumption of disliked foods during chemotherapy does not improve nutritional status and instead risks creating a lasting psychological aversion to previously enjoyed meals and flavors. Option c is incorrect because adding extra seasoning does not effectively counteract chemotherapy-induced taste changes and may cause gastrointestinal irritation in a patient whose mucosa is already vulnerable from treatment effects. Option d is incorrect because a liquid-only diet is unnecessarily restrictive, reduces caloric and protein intake, and is not warranted when the patient can tolerate other solid foods that do not trigger aversion.

Correct Answer: Hydration prevents renal damage from abnormal proteins

Option d is correct because multiple myeloma produces excessive abnormal immunoglobulin proteins that can damage the kidneys, and adequate hydration is essential to flush these proteins through and protect renal function. Option a is incorrect because while chemotherapy can cause fluid loss through vomiting and diarrhea, the specific reason for monitoring intake and output in myeloma relates to renal protection from immunoglobulin proteins. Option b is incorrect because multiple myeloma patients generally require increased hydration rather than fluid restriction, as adequate fluid intake is essential to protect the kidneys from damage caused by circulating proteins. Option c is incorrect because while myeloma does cause hypercalcemia from bone destruction, the primary nursing focus on fluid monitoring relates to preventing renal failure from immunoglobulin protein accumulation rather than calcium alone.

Correct Answer: Anesthetic gel before meals and saline mouth rinses

Option c is correct because applying prescribed anesthetic gel before meals reduces pain to improve intake, and gentle saline rinses before and after meals promote healing without damaging the fragile oral tissue. Option a is incorrect because hydrogen peroxide damages healing oral tissue and delays mucosal recovery, and restricting intake to only cold foods unnecessarily limits nutritional variety and caloric intake for the patient. Option b is incorrect because antiseptic mouthwash is too harsh for chemotherapy-damaged oral mucosa and can worsen ulceration, and high-fiber foods may be difficult to chew and swallow with active mouth sores. Option d is incorrect because lemon glycerin swabs dry and irritate oral mucosa rather than promoting healing, and carbonated beverages can cause stinging pain on contact with open ulcers and inflamed tissue.

Correct Answer: A persistent cough that does not resolve

Option d is correct because a persistent cough is the most common first symptom people notice with lung cancer, though by the time symptoms appear the disease is often already at an advanced stage. Option a is incorrect because unexplained weight loss is a systemic sign that may occur with advanced lung cancer but is not typically the earliest symptom that prompts a patient to seek medical evaluation. Option b is incorrect because sharp pleuritic chest pain is more commonly associated with pulmonary embolism or pleurisy, and lung cancer pain tends to present as a dull ache rather than sharp inspiratory discomfort. Option c is incorrect because shortness of breath at rest usually indicates advanced disease or significant airway obstruction, and it is not the earliest presenting symptom most patients report with lung cancer.

Correct Answer: Smoking cessation remains the primary prevention focus

Option a is correct because while low-dose CT screening is recommended for high-risk individuals, smoking cessation is always the primary teaching focus since it directly reduces cancer risk rather than simply detecting it. Option b is incorrect because normal screening results do not guarantee lung health, as CT scans may miss early-stage cancers and cannot detect all smoking-related damage occurring at the cellular or molecular level. Option c is incorrect because screening detects existing disease rather than preventing it, and relying on screening alone gives false security while the patient continues the behavior directly causing lung cancer risk. Option d is incorrect because advising someone to quit only after an abnormal result delays critical intervention, as significant and potentially irreversible damage accumulates with every year of continued tobacco use.

Correct Answer: A biopsy of the tissue is required for confirmation

Option b is correct because a definitive diagnosis of lung cancer requires a tissue biopsy for histological examination, as imaging studies alone cannot confirm the presence or type of malignant cells. Option a is incorrect because no single blood test can definitively diagnose lung cancer, as tumor markers may be elevated in various conditions and are not specific enough for a conclusive cancer diagnosis. Option c is incorrect because while imaging identifies suspicious masses, it cannot distinguish between benign and malignant tissue, and definitive diagnosis always requires pathological examination of a tissue specimen obtained through biopsy. Option d is incorrect because waiting six months for repeat imaging delays diagnosis and treatment, which is dangerous when dealing with a potentially malignant lung mass that could progress to an advanced stage.

Correct Answer: Assess her understanding of available treatment options

Option d is correct because assessing the patient's understanding of treatment options allows the nurse to identify knowledge gaps, address fears, and support informed decision-making without dismissing her concerns or preferences. Option a is incorrect because immediately presenting data about cure rates does not address the patient's underlying fear of surgery and may feel dismissive of her emotional concerns about the procedure. Option b is incorrect because directing the patient to follow the surgeon's recommendation removes her from the decision-making process and does not address the source of her anxiety about surgical intervention. Option c is incorrect because telling the patient radiation is equally effective may not be accurate for her specific staging and diagnosis, and providing potentially misleading information violates the principle of truthful communication.

Correct Answer: Distant metastasis to the bone from breast cancer

Option a is correct because constant gnawing bone pain in a patient with a breast cancer history is highly suspicious for distant metastasis to bone, particularly in the pelvis and iliac crest region. Option b is incorrect because while osteoarthritis is common, constant gnawing pain unrelieved by standard analgesics in a patient with prior breast cancer warrants evaluation for metastatic disease before assuming a benign diagnosis. Option c is incorrect because stress fractures typically present with activity-related pain that improves with rest, and the constant gnawing quality described here is more characteristic of metastatic bone disease. Option d is incorrect because muscular strain produces localized soft tissue pain that generally responds to rest and over-the-counter medications, unlike the persistent bone pain described in this clinical scenario.

Correct Answer: The biopsy results help determine the treatment plan

Option c is correct because the purpose of a prostate needle biopsy is to obtain tissue for pathological analysis, which provides the histological grading needed to guide appropriate treatment planning and decision-making. Option a is incorrect because while staging is important, the primary purpose of the initial needle biopsy is tissue diagnosis and grading rather than staging, which involves additional imaging and clinical assessment. Option b is incorrect because the biopsy does not validate the physical examination technique, as its purpose is to obtain tissue samples for pathological analysis to confirm or rule out malignancy. Option d is incorrect because prostate biopsies are not routine procedures performed on all men of a certain age, as they are indicated only when clinical findings or laboratory results suggest the need for further evaluation.

Correct Answer: Perform pelvic floor muscle exercises regularly

Option a is correct because pelvic floor muscle exercises, commonly known as Kegel exercises, are the primary recommended intervention for managing urinary incontinence following radical prostatectomy to strengthen sphincter control. Option b is incorrect because restricting fluid intake does not address the underlying cause of post-prostatectomy incontinence and may lead to dehydration, concentrated urine, and increased risk of urinary tract infection. Option c is incorrect because absorbent pads are a temporary management tool rather than a primary intervention, and the focus should be on exercises that actively restore urinary sphincter strength and continence. Option d is incorrect because surgical bladder repair is not a first-line intervention for post-prostatectomy incontinence, as conservative measures like pelvic floor exercises are attempted first and are effective for most patients.

Correct Answer: Fluid retention is a known side effect of abiraterone

Option d is correct because abiraterone used in advanced prostate cancer treatment can cause significant fluid retention as a known side effect, and ankle swelling with tight-fitting shoes is a classic presentation. Option a is incorrect because dismissing the swelling as unrelated to medication fails to recognize the well-documented association between abiraterone therapy and fluid retention that requires ongoing monitoring and management. Option b is incorrect because while peripheral edema warrants assessment, new ankle swelling in a patient recently started on abiraterone is most likely a medication side effect rather than an acute cardiac emergency. Option c is incorrect because while hypoalbuminemia can cause peripheral edema, the most likely explanation in a patient newly started on abiraterone is the known fluid retention side effect of this specific medication.

Correct Answer: Gather more detailed information about the family history

Option b is correct because the nurse should first collect detailed family history including which relatives were affected, at what ages, and what cancer types to determine whether standard or accelerated screening is appropriate. Option a is incorrect because scheduling an immediate colonoscopy without first gathering complete family history details may result in inappropriate timing or screening protocol selection for the patient's actual risk level. Option c is incorrect because a first-degree relative diagnosed with colon cancer at a relatively young age is clinically significant and should not be dismissed, as it may indicate a hereditary cancer syndrome. Option d is incorrect because while dietary recommendations may be part of overall health teaching, they do not replace the essential first step of thoroughly assessing family cancer history to guide appropriate screening decisions.

Correct Answer: Most colorectal cancers occur in people without family history

Option c is correct because the majority of colorectal cancer cases develop in individuals without a known family history, which is why age-based screening guidelines apply to the general population regardless of family risk. Option a is incorrect because colorectal cancer screening is specifically designed to detect precancerous polyps and early-stage cancers before symptoms develop, as waiting for symptoms often means the disease has advanced. Option b is incorrect because while family history influences screening timing and frequency, standard screening guidelines exist for all adults at average risk based on age, independent of family cancer history. Option d is incorrect because evidence-based screening guidelines strongly recommend colorectal cancer screening for all eligible adults, and framing it as entirely optional minimizes the life-saving benefit of early detection.

Correct Answer: Flu-like symptoms are expected and managed with acetaminophen

Option a is correct because interferon therapy commonly produces flu-like side effects including muscle aches and chills, which are expected and effectively managed with acetaminophen rather than treatment discontinuation. Option b is incorrect because flu-like symptoms are a well-documented expected side effect of interferon therapy rather than an allergic reaction, which would present with hives, respiratory distress, or anaphylactic features. Option c is incorrect because stopping interferon therapy without provider guidance based on expected side effects is inappropriate and could compromise the patient's cancer treatment effectiveness and overall plan of care. Option d is incorrect because flu-like symptoms from interferon do not constitute an emergency, and routine management with acetaminophen is the standard approach unless symptoms become severe or debilitating over time.

Correct Answer: This severe fatigue may require a treatment change

Option d is correct because while mild flu-like symptoms are expected with interferon, severe debilitating fatigue that prevents basic daily functioning may indicate the need for dosage adjustment or treatment modification. Option a is incorrect because although some fatigue is expected with interferon therapy, the inability to get out of bed and perform basic tasks for two weeks represents a severity level that exceeds normal expected side effects. Option b is incorrect because advising increased exercise to a patient who cannot get out of bed is unrealistic and dismisses the severity of her symptoms, which likely require medical intervention rather than lifestyle modification. Option c is incorrect because increasing the dose of a medication that is already causing debilitating fatigue would worsen the patient's condition rather than resolve it, as the fatigue is a dose-related adverse effect.

Correct Answer: The absolute neutrophil count

Option b is correct because filgrastim is a colony-stimulating factor that specifically stimulates neutrophil production, so its effectiveness is directly measured by monitoring the absolute neutrophil count over time. Option a is incorrect because total white blood cell count includes multiple cell types and does not specifically reflect neutrophil recovery, which is the targeted effect of filgrastim therapy for chemotherapy-induced neutropenia. Option c is incorrect because hemoglobin and hematocrit reflect red blood cell status and anemia, not neutrophil production, and filgrastim does not stimulate erythropoiesis or affect red blood cell counts directly. Option d is incorrect because platelet count reflects megakaryocyte function and thrombocyte production, which is not the target of filgrastim therapy, as filgrastim specifically stimulates the neutrophil cell line.

Correct Answer: Her tumor type responds to targeted HER-two therapy

Option c is correct because HER-two positive breast cancers are treated with targeted therapy like trastuzumab that specifically blocks the HER-two receptor, while tamoxifen targets estrogen receptors found in different tumor types. Option a is incorrect because tamoxifen use is determined by estrogen-receptor status of the tumor rather than patient age, and both younger and older patients may receive tamoxifen if their cancer is estrogen-receptor positive. Option b is incorrect because the choice between tamoxifen and trastuzumab depends on tumor receptor characteristics, not cancer stage, and making assumptions about the friend's staging is inaccurate and speculative. Option d is incorrect because breast cancer medications are not interchangeable, as treatment selection is based on specific molecular markers including estrogen-receptor and HER-two status that determine which targeted therapy will be effective.

Correct Answer: AML frequently goes into remission with induction therapy

Option a is correct because acute myeloid leukemia frequently responds to induction chemotherapy and goes into remission, which is realistic information the nurse can share to support informed treatment decisions. Option b is incorrect because stating that chemotherapy rarely produces results for AML is factually inaccurate and would discourage the patient from pursuing a treatment that has demonstrated effectiveness in achieving remission. Option c is incorrect because nurses are responsible for providing education and reinforcing information about treatment expectations, and sharing general prognostic information is within the nursing scope of practice. Option d is incorrect because while detailed prognosis discussions may be initiated by the oncologist, nurses play a vital role in reinforcing treatment information and supporting patient understanding of realistic outcomes.