1 :

Hint : πŸ’¬Focus on current bowel patterns that may suggest an unresolved problem.

Correct Answers:

  • "l have a bowel movement every 3 to 4 days."

Rationale :

🚨Having a bowel movement every 3–4 days can be within normal limits for some people, but in context, it may indicate chronic constipation, especially if paired with laxative use.

πŸ’©Regular bowel movements vary, but a frequency less than three times per week with straining or discomfort may require further evaluation.

πŸ“ŒOther statements reflect past or controlled conditions, while this one implies a potentially ongoing elimination issue.

🧠This warrants follow-up to prevent complications like impaction or hemorrhoids.

πŸ“ŒCore Message

Always assess bowel frequency for signs of chronic constipation or GI dysfunction.

2 :

Hint : ⚠️Think about medication safety based on known allergies.

Correct Answers:

  • "Avoid this medication if you have an allergy to a sulfa drug."

Rationale :

πŸ’ŠTopiramate has a sulfa moiety, and clients allergic to sulfa drugs may experience serious hypersensitivity reactions.

🚫It is contraindicated in those with sulfa allergies to prevent potential life-threatening effects like anaphylaxis or severe rash.

πŸ’β€β™‚οΈIt's also not safe during pregnancy, but the most direct and immediate precaution is allergy screening.

πŸ“‰Topiramate is not typically linked to blood pressure, so BP checks are unnecessary before each dose.

πŸ“ŒCore Message

Topiramate must be avoided in clients with sulfa drug allergies due to risk of hypersensitivity.

3 :

Hint : 🩺Start with what you observe before taking further steps.

Correct Answers:

  • Assess the client for injuries.

Rationale :

🧠Assessment comes first in any fall situation per the nursing process (ADPIE).

🚨Ensuring the client is not injured or compromised takes priority before any movement or documentation.

πŸ“žCalling for help or reviewing records are important later but do not come before a direct physical evaluation.

🦴Immediate injury detection can guide further actions like imaging or repositioning.

πŸ“ŒCore Message

Always assess the client first after a fall to determine injuries and priorities.

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4 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air.

Wheezing heard on auscultation of the chest. 

Coughs up a small amount of bloody sputum. 

Reports a decreased appetite and having eaten very little in the last 2 weeks

unintentional weight loss of 13.6 kg (30 lb) over the last 3 months. 

Feels weak

fatigues easily

describes experiencing general malaise. 

has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

has recently cut back to less than 1 pack per day.

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

Which of the following findings require immediate follow-up? Select all that apply

Answer Options

Hint : ⏱️Focus on symptoms that threaten ABCs.

Correct Answers:

  • Vital signs
  • Chest pain

Rationale :

πŸ“ˆVital signs show tachypnea (28/min), tachycardia (108 bpm), and low oxygen saturation (90%), indicating acute respiratory distress.

❀️Chest pain rated 6/10 in a lung cancer patient with labored breathing and a central mass may suggest cardiopulmonary compromise.

😴Appetite loss, weight loss, weakness, cough, and smoking history are important, but not emergent compared to the unstable vitals and chest pain.

🚨Immediate follow-up focuses on airway, breathing, and circulation.

πŸ“ŒCore Message

Vital signs and chest pain indicate potential respiratory or cardiovascular compromise and need immediate attention.

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5 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air

Wheezing heard on auscultation of the chest

Coughs up a small amount of bloody sputum

Reports a decreased appetite and having eaten very little in the last 2 weeks,

Unintentional weight loss of 13.6 kg (30 lb) over the last 3 months

Feels weak

fatigues easily, and describes experiencing general malaise

Has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

Has recently cut back to less than 1 pack per day.

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

Which of the following complications is the client at risk for developing? Select all that apply

Answer Options

Hint : πŸ₯Think about structural complications related to central thoracic tumors.

Correct Answers:

  • Pleural effusion
  • Spinal cord compression
  • Superior vena-cava syndrome

Rationale :

πŸ’β€β™‚οΈSmall cell lung cancer commonly leads to superior vena cava (SVC) syndrome, especially when tumors compress major thoracic structures.

🦴Spinal cord compression may result from metastases to vertebrae, causing weakness or neuro deficits.

πŸ’§Pleural effusion is a common complication in advanced lung cancer due to inflammation or lymphatic obstruction.

πŸ§ͺHyperkalemia and pheochromocytoma are unrelated.

🩸Dissecting aortic aneurysm is rare and unrelated to this case's symptoms or diagnosis.

πŸ“ŒCore Message

Lung cancer increases risk for SVC syndrome, spinal compression, and pleural effusion due to tumor location and spread.

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6 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air

Wheezing heard on auscultation of the chest

Coughs up a small amount of bloody sputum

Reports a decreased appetite and having eaten very little in the last 2 weeks

Unintentional weight loss of 13.6 kg (30 lb) over the last 3 months

Feels weak

fatigues easily, and describes experiencing general malaise

Has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

Has recently cut back to less than 1 pack per day

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

For each suggested order, click to specify whether the order would be indicated or not indicated for the care of the client. Note: Each row must have 1 response option selected.

Order Indicated Not indicated
Referral to a dietitian
Insertion of an arterial catheter
Oxygen at 2 L/min via nasal cannula
Therapeutic thoracentesis this evening
Allow the client to sleep in a reclining chair or with HOB elevated

Hint : 🩺Choose supportive care interventions that directly address oxygenation and nutritional issues.

Correct Answers

  • Referral to a dietitian [ Indicated ]
  • Insertion of an arterial catheter [ Not indicated ]
  • Oxygen at 2 L/min via nasal cannula [ Indicated ]
  • Therapeutic thoracentesis this evening [ Not indicated ]
  • Allow the client to sleep in a reclining chair or with HOB elevated [ Indicated ]
Rationale :

πŸ₯—A referral to a dietitian is indicated because the client has unintentional weight loss, decreased appetite, and nutritional deficits. Nutritional support is essential in managing cancer-related cachexia.

πŸ’‰An arterial catheter is not necessary unless the client is critically ill and needs frequent arterial blood gas monitoringβ€”which is not indicated in this case.

πŸ’β€β™‚οΈOxygen therapy at 2 L/min via nasal cannula is appropriate, especially since the client has dyspnea and a SpOβ‚‚ of 90%, which improved with oxygen support.

πŸ’¨A therapeutic thoracentesis is not indicated because the chest x-ray showed no pleural effusion, which is the primary indication for the procedure.

πŸ›ŒSleeping in a reclining position or with the head elevated helps ease dyspnea, improves lung expansion, and promotes oxygenation in lung-compromised clients.

πŸ“ŒCore Message

Care should include nutritional support, oxygen therapy, and positioning for comfort, while avoiding unnecessary invasive procedures.

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7 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air.

Wheezing heard on auscultation of the chest. 

Coughs up a small amount of bloody sputum. 

Reports a decreased appetite and having eaten very little in the last 2 weeks

unintentional weight loss of 13.6 kg (30 lb) over the last 3 months. 

Feels weak

fatigues easily

describes experiencing general malaise. 

has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

has recently cut back to less than 1 pack per day.

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

Complete the following sentence by choosing from the list of options. The nurse should first address the client's _____________.

Answer Options

Hint : πŸ€¦β€β™‚οΈWhen in doubt, prioritize what affects airway and breathing first.

Correct Answers:

  • Respiratory status

Rationale :

πŸ’β€β™‚οΈThe client is experiencing shortness of breath, labored respirations (28 breaths/min), wheezing, and a pulse oximetry reading of 90% on room airβ€”all of which indicate respiratory compromise.

πŸ“‰Addressing respiratory status is the top priority according to ABC principles (Airway, Breathing, Circulation).

πŸ‘‰This must be managed before focusing on less immediate needs.

πŸ’’Although pain, nutrition, and coping are important, they do not pose an immediate life threat compared to impaired gas exchange.

🌬️Prompt intervention to improve oxygenation and ease breathing can prevent respiratory failure or further decompensation.

πŸ“ŒCore Message

The client’s respiratory distress is the most urgent concern and must be addressed before any other issues.

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8 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air.

Wheezing heard on auscultation of the chest. 

Coughs up a small amount of bloody sputum. 

Reports a decreased appetite and having eaten very little in the last 2 weeks

unintentional weight loss of 13.6 kg (30 lb) over the last 3 months. 

Feels weak

fatigues easily

describes experiencing general malaise. 

has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

has recently cut back to less than 1 pack per day.

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

The nurse has reviewed the nurses' notes from 1110 hrs. Which of the following actions should the nurse take first?

Answer Options

Hint : πŸ”¬Prioritize actions that gather critical diagnostic information in clients with respiratory symptoms.

Correct Answers:

  • Obtain a sputum specimen for culture and sensitivity (C & S).

Rationale :

🧫The client has a productive cough with blood-tinged sputum, labored breathing, and wheezing, all of which suggest a possible underlying infection or pulmonary malignancy-related complication.

πŸ“ˆObtaining a sputum culture and sensitivity will help identify pathogens and guide antibiotic therapy, which is a priority in respiratory management.

πŸ₯ͺProviding nutrition and addressing pain or emotional concerns are important, but they are not urgent compared to identifying and treating a possible respiratory infection.

πŸ”Following the nursing process, the first step is assessment or data collectionβ€”in this case, obtaining a diagnostic specimen for evaluation.

πŸ“ŒCore Message

In a client with respiratory distress and sputum production, the first action is to obtain a culture to guide treatment and prevent further pulmonary complications.

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9 :

Day of admission

1100 hrs:

Admitted to the medical unit for 24-hour observation following a transbronchial lung biopsy with findings consistent with small cell lung cancer. Recent physical findings prompting the client to seek medical attention include shortness of breath, generalized aching in chest currently rated 6/10 on the numerical rating scale, a persistent cough for 3 months, and blood-tinged sputum expelled for the last 2 weeks. 

Temperature 37.7Β° C (99.8Β° F)

pulse 108 bpm

respiratory rate 28 breaths per minute and labored

blood pressure 154/88 mmHg

pulse oximetry reading 90% on room air.

Wheezing heard on auscultation of the chest. 

Coughs up a small amount of bloody sputum. 

Reports a decreased appetite and having eaten very little in the last 2 weeks

unintentional weight loss of 13.6 kg (30 lb) over the last 3 months. 

Feels weak

fatigues easily

describes experiencing general malaise. 

has a history of smoking 2 packs of cigarettes per day for 40 years with a long-standing cough

has recently cut back to less than 1 pack per day.

Day of admission

Chest X-ray

0800 hrs:

Mass noted at hilum of lung

no pulmonary or cardiac effusions seen.

The nurse has reviewed the nurses' notes from 1200 hrs. For each of the statements made by the client, click to specify whether the statement indicates an understanding or no understanding of the teaching provided. Note: Each row must have 1 response option selected.

Statement Understanding No understanding
"I should stop smoking."
"I am at risk for experiencing difficulty swallowing."
"My children have a genetic risk for inheriting this disease from me."
"It is good to know that chemotherapy and radiation therapy will cure the cancer."
"I need to reserve the prescribed pain medication for nighttime so that I can sleep."

Hint : πŸ’¬Watch for statements that reflect realistic expectations of disease progression and treatment, not assumptions or misinformation.

Correct Answers

  • "I should stop smoking." [ Understanding ]
  • "I am at risk for experiencing difficulty swallowing." [ Understanding ]
  • "My children have a genetic risk for inheriting this disease from me." [ No understanding ]
  • "It is good to know that chemotherapy and radiation therapy will cure the cancer." [ No understanding ]
  • "I need to reserve the prescribed pain medication for nighttime so that I can sleep." [ No understanding ]
Rationale :

🚬The statement "I should stop smoking" shows an accurate understanding of modifiable risk factors, as continued smoking worsens prognosis and lung function in clients with lung cancer.

πŸ§„The client’s acknowledgment of difficulty swallowing as a potential risk demonstrates understanding, especially considering the tumor's location in the hilum, which may affect surrounding structures including the esophagus.

🧬Saying "my children have a genetic risk" reflects a misunderstandingβ€”small cell lung cancer is most often related to environmental factors, particularly tobacco exposure, and not primarily inherited genetically.

πŸ§ͺThe belief that chemotherapy and radiation will β€œcure” the cancer is incorrect.

πŸ’β€β™‚οΈThese treatments aim to control symptoms, slow progression, or improve quality of life, particularly in small cell lung cancer, which is rarely curable.

πŸ’ŠReserving pain medication only for nighttime reflects a misunderstanding of pain management principles.

😣Pain medications should be taken as prescribed to maintain comfort and prevent escalation, not just for sleep.

πŸ“ŒCore Message

The client demonstrates understanding by acknowledging modifiable risks and clinical symptoms, but shows lack of understanding regarding genetic transmission, cancer curability, and proper pain medication use.

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10 :

Hint : πŸ‘Focus on gentle touch techniques used during early labor on accessible areas.

Correct Answers:

  • Can be used on the abdomen and the thigh.

Rationale :

πŸ–οΈEffleurage is a nonpharmacologic pain management technique involving light, rhythmic stroking of the skin, typically performed on the abdomen, thighs, or lower back during contractions.

🧠It works through gate control theory, where tactile stimulation can interfere with pain signals sent to the brain, providing comfortβ€”not by altering endorphin levels.

⏳It is used during the first stage of labor, not the third stage (delivery of the placenta), when physical discomfort from contractions is most intense.

❌Effleurage does not eliminate labor pain, but it offers a mild distraction and comfort measure that some find helpful during early labor stages.

πŸ“ŒCore Message

Effleurage is a light-touch technique used during early labor to promote comfort, commonly applied to the abdomen or thighs, but it does not eliminate pain or involve endorphins.

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