A patient who was treated for colorectal cancer last year now has a malignant tumor in the lung. The nurse realizes that this patient is most likely experiencing which phenomenon?
1. Metastasis
2. Contact inhibition
3. Differentiation
4. Hypertrophy
1
Rationale 1: Malignant cells from the primary tumor may travel through the blood or lymph to invade other tissues and organs and form a secondary tumor. This process is called metastasis. Malignant neoplasms can recur after surgical removal of the primary and secondary tumors and after other treatments.
Rationale 2: Contact inhibition is a characteristic of benign neoplasms. It does not describe the phenomenon the patient is experiencing.
Rationale 3: Differentiation is the process whereby cells mature into their intended role. Differentiation is lost in malignant tumors.
Rationale 4: Hypertrophy refers to an increase in a cell's size. There is no way the nurse can tell if this is a characteristic of this tumor.
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A client with diabetes mellitus can effectively monitor the blood sugar at home. The nurse should encourage the client with type 1 diabetes mellitus to monitor:
1. indirect blood glucose monitoring. 2. direct blood glucose monitoring and urine testing for glucose and ketones. 3. hemoglobin A1c testing. 4. home cholesterol testing.
A client was released from the hospital following a lengthy course of IV antibiotics. The home health care nurse assesses that the client has been having new-onset diarrhea. What would the nurse suspect to be the cause of this problem?
a. C. difficile infection b. Contaminated water supply c. Noncompliance with ordered diet d. Not spacing medications properly
The nurse is preparing to write nursing diagnoses for a client. What should the nurse recall about the NANDA label?
1. Must contain three components 2. Describes the health problem for which nursing therapy is given 3. Helps define medical diagnoses for nursing 4. Promotes a taxonomy of nursing
Where do individuals learn their health beliefs and values?
a. in the family b. in school c. from school nurses d. from peers