NCLEX-PN : Conditions and Treatments

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

Example Question #51 : Tumors And Cancer

You are the nurse at an oncology practice taking care of an otherwise healthy 22-year old male being treated with chemotherapy and radiation for Hodgkin's lymphoma. His chemotherapy regimen consists of doxorubicin, bleomycin, vinblastine, and dacarbazine. He is not receiving any other medications. He reports feeling well aside from fatigue, and numbness and tingling of his hands and feet. Which of the following is the most likely cause of the hand and foot numbness and tingling?

Possible Answers:

Bleomycin-induced neuropathy

Vinblastine-induced neuropathy

Posterior spinal cord degeneration

Selective serotonin reuptake inhibitor discontinuation syndrome

Diabetic neuropathy

Correct answer:

Vinblastine-induced neuropathy

Explanation:

The correct answer is "Vinblastine-induced neuropathy." 

This is the most likely explanation for this patient's peripheral neuropathy, as the patient is described as being healthy aside from Hodgkin's lymphoma, and on no medications aside from his chemotherapy regimen. As a result, diabetic neuropathy and selective serotonin reuptake inhibitor discontinuation syndrome can each be ruled out as etiologies. Similarly, given that he is otherwise healthy and not complaining of any additional neurological symptoms (and given that he is young and actively receiving chemotherapy) it is unlikely that he is experiencing posterior spinal cord degeneration. 

Thus, in a young patient with lymphoma who is receiving chemotherapy and experiencing peripheral neuropathy, the most likely etiology is one of the chemotherapy medications that he is receiving. In this patient's case, he is receiving doxorubicin, bleomycin, vinblastine, and dacarbazine. Of these medications, vinblastine is the most strongly associated with peripheral neuropathy, as this is a fairly common side effect of vinblastine and other agents in the same class (vinca alkaloids). As such, vinblastine-induced neuropathy is the most likely etiology.

Example Question #51 : Conditions And Treatments

You are a nurse at an oncology clinic taking care of a 65-year old male with stage one non-small cell lung cancer (NSCLC) who is one year removed from a wedge resection and chemotherapy. Which of the following tests would be best to assess treatment response in this patient?

Possible Answers:

Pulmonary function tests

MRI

PET-CT

CT (without PET)

X-ray

Correct answer:

PET-CT

Explanation:

The correct answer is "PET-CT." This is the correct answer because a PET-CT shows not only spatial information from the serial slices taken on CT imaging, which would include the size and location of any potential tumor, scarring, or nodal involvement, but also the FDG-avidity or uptake of the contents of the image, which would help correlate the spatial findings with possible disease activity. Nodules observed on a CT scan can be non-descript, ranging from malignant, to indeterminate, to benign (which may still be infectious or inflammatory). The addition of PET to a CT allows the observer to see which nodules, nodes, or lesions are more likely to be indicative of disease burden, as tumors and infections will have greater FDG uptake since they are more metabolically active than surrounding tissues. 

MRI is not typically used to assess treatment in lung cancer as CT coupled with PET is more commonly used. X-ray does not provide enough resolution to adequately assess response to cancer treatment. Pulmonary function tests, while a useful measure of lung functionality, do not give a specific picture of the lung cancer burden and as such are not the best treatment response assessment tool.

Example Question #1 : Tumor Treatment Follow Up

You are the nurse in an oncology clinic taking care of a patient with a glioblastoma who has been receiving chemotherapy and radiation therapy. You want to assess response to treatment. Which of the following images should would best assess treatment response?

Possible Answers:

X-ray Head

PET-CT

CT Head with contrast

MRI Head

CT Head without contrast

Correct answer:

MRI Head

Explanation:

The correct answer is "MRI Head." This is the correct answer because in evaluating brain parenchyma, which is relatively soft tissue, MRI provides the greatest degree of spatial resolution, which would best allow assessment of any residual, recurrent, or new tumor burden within the brain. CT imaging is commonly used to assess the brain when evaluating for bleeds or fractures, among other conditions, as it is far more expedient than MRI. However, it does not visualize the soft tissue of the brain parenchyma as well as MRI, and treatment response MRI scans are often not emergent, and therefore MRI would be preferred. PET-CT, while often highly useful in oncologic assessments is of limited value in evaluating the brain for cancer response, because the entire brain is highly metabolically active in nearly all patients, and therefore the entire brain typically has a great deal of FDG uptake uniformly, limiting the value of the scan.

Example Question #1 : Respiratory Conditions

A client had just undergone a total right knee replacement and has just returned from the operating room. Later that evening, the client suddenly begins to complain of shortness or breath and chest pain on inspiration. The nurse caring for this client further notes the coughing up of blood and that he is sweating profusely.

Which of the following nursing interventions should the nurse perform first? 

Possible Answers:

Auscultate for breath sounds

Draw blood for arterial blood gasses (ABG's)

Place in Fowler's position

Give oxygen

Assess the client's mental status

Correct answer:

Place in Fowler's position

Explanation:

The priority for this client is to ensure a patent airway by placing him the Fowler's or semi upright seated position. Giving oxygen is warranted but will be given after the client is positioned correctly. ABG's would be helpful in this situation but it not the priority. Auscultation of breath sounds and assessment of mental status are not indicated.

Example Question #1 : Respiratory Conditions

What is the final stage of a pertussis infection?

Possible Answers:

The recovery phase

The post-infectious stage

The convalescent stage

The paroxysmal stage

Correct answer:

The convalescent stage

Explanation:

The final stage of a pertussis infection is known as the convalescent phase. This occurs for 2-6 weeks, after the paroxysmal stage of the disease. During this time coughing decreases, and paroxysms are less severe. The infected individual may experience increased susceptibility to upper and lower respiratory conditions for as much as 6 months after resolution of the infection.

Example Question #1 : Respiratory Conditions

Which of the following organisms causes whooping cough?

Possible Answers:

Bordetella pertussis 

Haemophilus influenzae 

Klebsiella pneumoniae

Human respiratory syncytial virus (RSV)

Correct answer:

Bordetella pertussis 

Explanation:

Whooping cough, a condition that results in severe paroxysmal coughing fits followed by a long wheezing inspiratory gasp (the "whoop") is caused by the bacteria Bordetella pertussis. Haemophilus influenzae and Klebsiella pneumoniae both commonly cause pneumonia, and RSV is a virus that is frequently implicated in lower respiratory infections of infants and children.

Example Question #1 : Respiratory Conditions

In pertussis, what stage follows the incubation (also known as the catarrhal) stage?

Possible Answers:

The acute stage

The whooping stage

The paroxysmal stage

The convalescent stage

Correct answer:

The paroxysmal stage

Explanation:

After the catarrhal stage, an individual with pertussis will progress into the paroxysmal stage. It's during this stage that they will experience uncontrollable fits of 5-15 forceful coughs, followed by a "whoop" or gasp as they struggle to inhale. The force of these coughs can be such that they can result in vomiting, epistaxis, subconjunctival hemorrhage, or even broken ribs. 

Example Question #1 : Respiratory Conditions

How long is the incubation period for pertussis?

Possible Answers:

4-6 weeks

2-7 days

1-3 weeks

2-3 months

Correct answer:

1-3 weeks

Explanation:

The incubation period for pertussis, also known as the catarrhal stage, can last as little as 4 days or as long as 42 days, but a typical period is 1-3 weeks. During this stage the disease looks like a regular upper respiratory infection, with sneezing, mild cough, and runny nose. The infected individual is highly infectious at this time, with bacteria spread by airborne droplets after sneezing or cough. 

Example Question #4 : Respiratory Conditions

You are the nurse taking care of a 40-year old African-American female who complains of fatigue and shortness of breath. Her physical exam is remarkable for erythema nodosum on the bilateral lower extremities. A chest x-ray is performed that demonstrates bilateral hilar infiltrates. She lives and works in a suburb, has not traveled outside of the United States recently, and does not work in a healthcare setting. Which of the following is the most likely diagnosis?

Possible Answers:

Meningitis

Lung cancer

Tuberculosis

Sarcoidosis

Pharyngitis

Correct answer:

Sarcoidosis

Explanation:

The correct answer is "Sarcoidosis." Sarcoidosis is the correct answer as this inflammatory condition is frequently found in African-American women in their 40's who present with fatigue and shortness of breath among other symptoms, who also have erythema nodosum on the lower extremities, and have bilateral hilar infiltrates on chest x-ray. This constellation of findings is highly suggestive of sarcoidosis. Sarcoidosis results in the formation of numerous non-necrotizing granulomas, most commonly found in the lungs, that can play a role in the symptoms experienced by these patients. Other findings suggestive of sarcoidosis include elevated serum calcium levels with normal serum PTH levels.

Tuberculosis can present in a similar manner to sarcoidosis, however given the patient's suburban living environment, lack of a travel history, and lack of healthcare exposure, the likelihood of being exposed to tuberculosis is very low, making sarcoidosis a more likely etiology.

While lung cancer can present as shortness of breath with hilar infiltration in chest x-ray, in a relatively young otherwise healthy patient who also has erythema nodosum and in whom the hilar infiltrates are bilateral, sarcoidosis would be a more likely etiology.

The patient does not have any findings consistent with meningitis (leg rash in meningitis is petechial, not erythema nodosum) or pharyngitis.

Example Question #1 : Causes And Treatments Of Respiratory Conditions

What is the "hygiene hypothesis" in asthma? 

Possible Answers:

Keeping children's hands clean will reduce asthma rates

Dirty water is responsible for many cases of asthma in the developing world

Exposing children to pathogens at a young age will decrease their risk for asthma

Frequent bathing can reduce the severity of asthma attacks

Correct answer:

Exposing children to pathogens at a young age will decrease their risk for asthma

Explanation:

Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response. 

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