Question

A client with a history of metastatic lung cancer arrives in the emergency department via ambulance with a complaint of severe back pain and urinary retention. The client states they have had mid-back pain of 9/10 on a 0–10 pain scale for the last two (2) days. The last chemotherapy treatment was one (1) week ago with pemetrexed and carboplatin.

Once a computerized tomography (CT) scan is complete, a diagnosis of cord compression is documented.

The nurse anticipates which intervention(s) will be implemented?

Answer 1

Correct Answers:

External beam radiation

Rationale :

😀Spinal cord compression from metastatic cancer is an emergency because the tumor is pressing directly on the spinal cord, risking permanent neurologic damage.

🧠External beam radiation is a standard treatment to rapidly shrink the tumor mass and relieve pressure on the spinal cord.

🦴This type of radiation is delivered from outside the body, allowing focused treatment to the affected vertebral area without surgery.

🎯While surgery can be used in selected cases, radiation is often the first-line intervention when the compression is due to metastatic disease and the goal is quick decompression and symptom relief.

📌Core Message

In malignant spinal cord compression, external beam radiation is a key treatment because it rapidly shrinks the tumor and relieves pressure on the spinal cord, helping preserve neurologic function.

Answer 2

Correct Answers:

Medication must be tapered, never stop suddenly
Report a fever or sore throat to your health care provider
Avoid crowds and people with infections
Take medication with or soon after a meal

Rationale :

🌟Systemic corticosteroids suppress the hypothalamic–pituitary–adrenal axis, so they must be tapered to allow the adrenal glands to resume normal cortisol production.

🩺Abruptly stopping corticosteroids can cause acute adrenal insufficiency, which may present with hypotension, weakness, and shock.

🛡️Corticosteroids weaken the immune response, so even mild symptoms such as fever or sore throat can signal serious infection that needs prompt reporting.

🍽️Taking dexamethasone with or after food helps decrease gastric irritation and reduces the risk of peptic ulcer and dyspepsia.

🎭Avoiding crowds and people with infections minimizes exposure to pathogens when the client is immunocompromised from steroid therapy.

📌Core Message

Clients on corticosteroids must taper the dose, protect themselves from infection, promptly report signs of illness, and take the drug with food to avoid serious adrenal and GI complications.

Answer 3

Correct Answers:

Remove the client from the day room to decrease stimuli and stay with client.

Rationale :

🚪Clients with moderate Alzheimer’s disease are very sensitive to environmental stimulation, and busy rooms can worsen agitation.

🧩Reducing noise and crowding by moving the client to a quieter area helps lower anxiety and confusion.

😰Remaining physically present with the client provides reassurance and safety, which can de-escalate agitated behaviors.

👂This approach reflects therapeutic dementia care, which emphasizes comfort, minimizing triggers, and avoiding confrontation rather than forcing continued participation in group activities.

📌Core Message

For a client with moderate Alzheimer’s disease who becomes agitated, the priority is to decrease environmental stimulation and stay with them to provide comfort and safety instead of forcing interaction.

Answer 4

Correct Answers:

Insertion site has occlusive dressing in place

Rationale :

🧴A chest tube site should be covered with an occlusive dressing to create an airtight seal and prevent air from entering the pleural space.

🫧Maintaining an airtight seal preserves negative intrapleural pressure, which is essential for lung re-expansion.

📏The dressing also acts as a barrier against microorganisms, lowering the risk of infection at the insertion site.

✍️Findings like vigorous bubbling or complete absence of fluctuation may indicate problems such as air leak or obstruction, and are not considered normal expected findings.

📌Core Message

With a chest tube, an occlusive dressing at the insertion site is an expected and critical finding because it maintains negative pressure, prevents air entry, and helps reduce infection risk.

Answer 5

Correct Answers:

Use of sunblock
Stop smoking
HPV vaccinations
Diet high in fiber and low in fat

Rationale :

🌞Using sunblock is a primary prevention strategy that reduces UV exposure and lowers the risk of skin cancer before it develops.

🚭Stopping smoking removes a major source of carcinogens, which decreases the risk for lung and multiple other cancers at the pre-disease stage.

🧬HPV vaccination prevents infection with high-risk human papillomavirus strains, thereby reducing the risk of cancers such as cervical and oropharyngeal cancers.

🥦A high-fiber, low-fat diet is associated with reduced risk of colorectal cancer and contributes to better overall cancer prevention.

📌Core Message

Primary cancer prevention focuses on avoiding carcinogenic exposures and modifying lifestyle, using strategies like sun protection, smoking cessation, HPV vaccination, and a high-fiber, low-fat diet to prevent cancer from developing.

Answer 6

Correct Answers:

"Symptoms of dementia gradually get worse, so the client will not be independent again."

Rationale :

👵Most common dementias, including Alzheimer’s disease, are progressive and irreversible, meaning cognitive abilities decline over time.

📉As dementia advances, clients lose skills in memory, judgment, and self-care, making long-term independence unrealistic.

⏳Families must be prepared for increasing care needs and supervision, including help with activities of daily living and safety.

🧾Providing an honest explanation that symptoms will gradually worsen supports realistic expectations and appropriate planning for long-term support and resources.

📌Core Message

Because dementia is progressive and irreversible, clients will not regain independence, so families need clear, honest education to plan for ongoing support and safety.

Answer 7

Correct Answers:

Creatinine 2.0 mg/dl.

Rationale :

🚽Benign prostatic hypertrophy can cause chronic urinary retention, leading to prolonged back pressure on the bladder and kidneys.

🧪An elevated serum creatinine reflects impaired renal function, signaling that the kidneys are not adequately clearing waste.

👉A creatinine of 2.0 mg/dL is above normal and suggests postrenal kidney injury due to urinary outflow obstruction.

⚠️Recognizing this elevation is vital because persistent obstruction with rising creatinine can progress to chronic kidney disease and permanent damage if uncorrected.

📌Core Message

In a client with BPH and long-standing urinary retention, an elevated creatinine is a key sign of kidney impairment from chronic obstruction.

Answer 8

Correct Answers:

Infuse a unit of packed red blood cells in less than 4 hours

Rationale :

🩸Packed red blood cells must be infused within 4 hours of removal from controlled storage to limit bacterial growth and hemolysis.

⏱️This time limit is a critical transfusion safety standard that reduces the risk of septic transfusion reactions.

🧊Blood sitting at room temperature for longer periods becomes more susceptible to contamination and cell breakdown.

📋Ensuring each unit is completed in less than 4 hours is a specific nursing responsibility that helps keep transfusions as safe as possible.

📌Core Message

A major safety rule for PRBC transfusion is to complete each unit within 4 hours to minimize risks of infection and hemolysis.

Answer 9

Correct Answers:

Calcium 12 mg/dl

Rationale :

🧫In multiple myeloma, malignant plasma cells stimulate bone resorption, causing breakdown of bone tissue.

🌡️This bone destruction often leads to hypercalcemia, so a calcium level of 12 mg/dL is a typical abnormal finding.

🧂Hypercalcemia contributes to symptoms such as fatigue, confusion, constipation, and polyuria, and can worsen renal impairment.

🧻Recognizing elevated calcium as expected in multiple myeloma helps the nurse monitor for complications and anticipate treatments like hydration and medications to lower calcium.

📌Core Message

Multiple myeloma commonly causes hypercalcemia due to increased bone breakdown, so an elevated serum calcium is an expected but important abnormal lab that needs monitoring.

Answer 10

Correct Answers:

Sympathectomy

Rationale :

🕊️Palliative procedures focus on relieving symptoms and suffering, not on curing the underlying cancer.

💥A sympathectomy interrupts part of the sympathetic nervous system to reduce severe, refractory pain or other distressing symptoms.

🌈This procedure may not alter the course of the disease, but it can significantly improve quality of life by decreasing pain and discomfort.

📚Other procedures listed are more often used with curative or preventive intent, whereas sympathectomy is aimed primarily at comfort.

📌Core Message

A sympathectomy is considered a palliative procedure because its primary purpose is to relieve severe symptoms and improve quality of life, not to eliminate the cancer.

N201E Exam-1

No.

2 :
The nurse is providing discharge education to this client who has been on corticosteroid therapy for the last seven (7) days with dexamethasone. What client teaching should the nurse reinforce?

3 :
A nurse is providing care to a client with the diagnosis of Alzheimer's Disease. Which intervention should the nurse identify as the most appropriate for a client with moderate stage: Alzheimer's Disease who becomes agitated while in the day room during an activity?

4 :
What should a nurse recognize as an expected assessment finding?

5 :
A 45-year-old client presents to the primary healthcare providers office for an annual physical assessment. During this visit, the nurse provides health promotion teaching to this client. What should the nurse educate the client as primary cancer prevention methods? Select all that apply.

6 :
A nurse is educating the adult child of a client with dementia on the disease process and medications. The adult child asks if the client will ever be able to live Independently again. Which should be the most appropriate response for the nurse to use?

7 :
The nurse is taking care of a client with benign prostatic hypertrophy (BPH). Which finding suggests that this client has prolonged chronic urinary retention?

8 :
Two units of packed red blood cells (PRBC) have been prescribed for a client with a hemoglobin of 8.2 cells/mm3 experiencing shortness of breath. What safety measure should the nurse perform when administering packed red blood cells?

9 :
The nurse is caring for a client with multiple myeloma. While reviewing the laboratory results in the electronic health record (EHR), which result should the nurse expect to note related to this disorder?

10 :
Different procedures are used palliatively to relieve suffering and minimize symptoms of cancer in a client. Which procedure does the nurse identify as a palliative procedure?

N201E Exam-1

No.

2 : The nurse is providing discharge education to this client who has been on corticosteroid therapy for the last seven (7) days with dexamethasone. What client teaching should the nurse reinforce?

3 : A nurse is providing care to a client with the diagnosis of Alzheimer's Disease. Which intervention should the nurse identify as the most appropriate for a client with moderate stage: Alzheimer's Disease who becomes agitated while in the day room during an activity?

4 : What should a nurse recognize as an expected assessment finding?

5 : A 45-year-old client presents to the primary healthcare providers office for an annual physical assessment. During this visit, the nurse provides health promotion teaching to this client. What should the nurse educate the client as primary cancer prevention methods? Select all that apply.

6 : A nurse is educating the adult child of a client with dementia on the disease process and medications. The adult child asks if the client will ever be able to live Independently again. Which should be the most appropriate response for the nurse to use?

7 : The nurse is taking care of a client with benign prostatic hypertrophy (BPH). Which finding suggests that this client has prolonged chronic urinary retention?

8 : Two units of packed red blood cells (PRBC) have been prescribed for a client with a hemoglobin of 8.2 cells/mm3 experiencing shortness of breath. What safety measure should the nurse perform when administering packed red blood cells?

9 : The nurse is caring for a client with multiple myeloma. While reviewing the laboratory results in the electronic health record (EHR), which result should the nurse expect to note related to this disorder?

10 : Different procedures are used palliatively to relieve suffering and minimize symptoms of cancer in a client. Which procedure does the nurse identify as a palliative procedure?

2 :
The nurse is providing discharge education to this client who has been on corticosteroid therapy for the last seven (7) days with dexamethasone. What client teaching should the nurse reinforce?

3 :
A nurse is providing care to a client with the diagnosis of Alzheimer's Disease. Which intervention should the nurse identify as the most appropriate for a client with moderate stage: Alzheimer's Disease who becomes agitated while in the day room during an activity?

4 :
What should a nurse recognize as an expected assessment finding?

5 :
A 45-year-old client presents to the primary healthcare providers office for an annual physical assessment. During this visit, the nurse provides health promotion teaching to this client. What should the nurse educate the client as primary cancer prevention methods? Select all that apply.

6 :
A nurse is educating the adult child of a client with dementia on the disease process and medications. The adult child asks if the client will ever be able to live Independently again. Which should be the most appropriate response for the nurse to use?

7 :
The nurse is taking care of a client with benign prostatic hypertrophy (BPH). Which finding suggests that this client has prolonged chronic urinary retention?

8 :
Two units of packed red blood cells (PRBC) have been prescribed for a client with a hemoglobin of 8.2 cells/mm3 experiencing shortness of breath. What safety measure should the nurse perform when administering packed red blood cells?

9 :
The nurse is caring for a client with multiple myeloma. While reviewing the laboratory results in the electronic health record (EHR), which result should the nurse expect to note related to this disorder?

10 :
Different procedures are used palliatively to relieve suffering and minimize symptoms of cancer in a client. Which procedure does the nurse identify as a palliative procedure?