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NEW QUESTION 35
The nurse should know that according to current thinking, the most important prognostic factor for a client with breast cancer is:
- A. Tumor size
- B. Axillary node status
- C. Client's level of estrogen-progesterone receptor assays
- D. Client's previous history of disease
Answer: B
Explanation:
Explanation
(A) Although tumor size is a factor in classification of cancer growth, it is not an indicator of lymph node spread. (B) Axillary node status is the most important indicator for predicting how far the cancer has spread. If the lymph nodes are positive for cancer cells, the prognosis is poorer. (C) The client's previous history of cancer puts her at an increased risk for breast cancer recurrence, especially if the cancer occurred in the other breast. It does not predict prognosis, however. (D) The estrogen-progesterone assay test is used to identify present tumors being fedfrom an estrogen site within the body. Some breast cancers grow rapidly as long as there is an estrogen supply such as from the ovaries. The estrogen-progesterone assay test does not indicate the prognosis.
NEW QUESTION 36
A 4 year old has an imaginary playmate, which concerns the mother. The nurse's best response would be:
- A. "Try not to worry because you will just upset your child."
- B. "I understand your concern and will assist you with a referral."
- C. "This is appropriate behavior for a preschooler and should not be a concern."
- D. "Just ignore the behavior and it should disappear by age 8."
Answer: C
Explanation:
(A) This is normal for a preschooler, and a referral is not appropriate. (B) Telling a parent not to worry is unhelpful. This response does not address the mother's concern. (C) This response is incorrect. The behavior is normal and will usually disappear by the time the child enters school. (D) This behavior is normal development for a preschooler.
NEW QUESTION 37
A 32-year-old mother of two was brought to the hospital by her husband. He reported that his wife could no longer manage the house and children. She does not sleep and talks day and night. She has purchased some very expensive clothes. The nurse noted that the client speaks rapidly and changes the subject irrationally. This is an example of:
- A. Hallucinations
- B. Delusions
- C. Flight of ideas
- D. Echolalia
Answer: C
Explanation:
(A) Rapidly moving from one topic to another without following any logical sequence is called flight of ideas. (B) False beliefs are delusions. (C) False sensory perceptions are hallucinations ("hearing voices"). (D) Repeating words is called echolalia.
NEW QUESTION 38
A 3-year-old child was hospitalized for acute laryngotracheobronchitis. During her hospitalization, the child was placed under an oxygen mist tent. The nurse's frequent monitoring of the child's temperature frightened her parents. Which response by the nurse would be most appropriate?
- A. Monitoring the temperature prevents undue chilling.
- B. Taking the child's temperature can prevent airway obstruction.
- C. Checking the temperature will prevent febrile seizures.
- D. Rapid temperature elevations can occur in children.
Answer: A
Explanation:
Explanation
(A) The refrigerated cool mist tent creates a cool, moist environment. The child as well as bedding and clothing may become dampened. Monitoring the temperature of the child will ensure warmth and prevent chilling. (B) Only a low-grade fever is expected in laryngotracheobronchitis. (C) Febrile seizures are not expected with the low-grade fever. (D) Inflammation of the mucosal lining in the respiratory tract can cause airway obstruction. However, monitoring the child's temperature would not prevent airway obstruction.
NEW QUESTION 39
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