Cellular Regulation

8. The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (Select all that apply.) a. Hypoxia b. Fever c. Infection d. Bleeding e. Fatigue

a. Hypoxia e. Fatigue

The nurse assesses a client for premalignant skin conditions. Which clinical finding should the nurse recognize can develop into skin cancer over time? Acne vulgaris Actinic keratosis Melasma Psoriasis

Actinic keratosis Rationale: Premalignant skin conditions are lesions that can develop into skin cancers over time. The most common premalignant skin conditions include actinic keratosis and atypical or dysplastic nevi.

The nurse manager and a newly graduated nurse are discussing the purpose of including the oncologist in the plan of care for a client suspected of having breast cancer. Which statement, made by the newly graduated nurse, should the nurse manager question? "An oncologist will only see the client if they need treatment." "Oncologists specialize in diagnosing cancers." "The oncologist can help clients to manage symptoms." "The oncologist will determine the appropriate treatment."

"An oncologist will only see the client if they need treatment." Rationale: Oncologists are specialized providers who assist in diagnosing cancer and can provide education regarding all treatment options. Oncologists also assist in managing symptoms associated with cancer. These providers can prescribe medications, non-pharmacological methods of symptom management, and continue to follow clients throughout the course of treatment. All clients suspected of having breast cancer should be referred to the oncologist because clients will require some form of treatment, whether it be tumor removal, chemotherapy, or radiation.

A client states to the nurse, "My doctor told me I have cervical cancer, but I do not understand what that is exactly." Which is the best response by the nurse? "Cervical cancer is a variation of sarcoma that originates in the cervix." "Cervical cancer is a malignant tumor that originates in the cervix." "Cervical cancer is melanoma that originates in the cervix." "Cervical cancer is a type of lymphoma that originates in the cervix."

"Cervical cancer is a malignant tumor that originates in the cervix." Rationale: Cervical cancer is a malignant tumor that originates in the cervix and is one of the most common types of cancer.

The nurse is caring for a client with breast cancer who has undergone testing for the expression of hormone receptors. The results reveal that the client's human epidermal growth factor receptor 2 (HER2) is higher than normal. Which client statement indicates an understanding of this result? "My cancer will not spread rapidly." "I had breast cancer but it is in remission now." "High levels of HER2 means that there are medications available to treat my specific type of cancer." "High HER2 levels mean that I have an increased risk of ovarian cancer."

"High levels of HER2 means that there are medications available to treat my specific type of cancer." Rationale: Human epidermal growth factor receptor 2 (HER2) is a protein that promotes tissue growth on the outside of breast cells. Clients who have higher than normal HER2 levels are identified as HER2 positive. These cancerous cells tend to grow faster and spread quicker than other cancer cells. However, there are drugs that are designed specifically to target the HER2 protein.

A client is discussing a recent mastectomy and breast cancer diagnosis with the nurse. The nurse identifies Disturbed body image related to surgical procedure as the priority nursing diagnosis. Which client statement supports this nursing diagnosis? "I am planning to have reconstruction surgery soon." "It has taken some time to get used to having one breast." "I wear a special bra, so it looks like I have two breasts." "I feel so unattractive because I am missing a breast."

"I feel so unattractive because I am missing a breast." Rationale: The nursing diagnosis of Disturbed body image is when a client has negative feelings regarding their physical appearance. Physical changes, such as a mastectomy, often precipitate feelings of unattractiveness. Statements of feeling "unattractive" or "ugly" after a mastectomy indicate that clients are experiencing a Disturbed body image.

The nurse educates a newly graduated nurse about ovarian cancer. Which statement should the nurse include? "Ovarian cancer is a malignant cell growth that begins in the ovaries or the fallopian tube." "Ovarian cancer occurs secondary to cervical dysplasia." "Ovarian cancer occurs when the lymphatic system exposes the reproductive system to cancer cells." "Ovarian cancer occurs when uterine tissue grows outside the uterus."

"Ovarian cancer is a malignant cell growth that begins in the ovaries or the fallopian tube." Rationale: Ovarian cancer is a malignant cell growth that begins in the ovaries or the fallopian tubes. It is often bilateral and spreads quickly to nearby organs through direct extension, to abdominal organs through abdominal seeding, and to distant organs through the blood and lymphatic vasculature.

The nurse has provided education to a client scheduled to begin chemotherapy for cervical cancer. Which client statement indicates an understanding of the teaching? "I will perform all of my daily activities in the morning so I can relax the rest of the day." "I will avoid consuming dairy products before my treatment." "I will contact my doctor if I have severe pain." "I will avoid eating or drinking anything for a few hours after my treatment."

"I will contact my doctor if I have severe pain." Rationale: When the nurse is caring for a client receiving chemotherapy for treatment of cervical cancer, there are several topics clients should be educated on. Included in the teaching plan is information about the disease process, the available treatments, and the plan of care. The nurse should emphasize the importance of staying well hydrated and maintaining optimal nutrition during treatment. Also, the nurse should encourage clients to work with the registered dietitian to help them develop an individualized plan to get the calories, protein, and nutrients they need. Teaching also focuses on discussing with the client how to manage symptoms like nausea and vomiting. Managing symptoms of nausea and vomiting include taking prescribed antiemetics as directed, eating smaller, more frequent meals, and eating slowly. Clients should be advised to contact their healthcare provider if vomiting prevents them from keeping food, drinks, or medicines in their stomach. The nurse should also provide clients with suggestions to help them manage pain and fatigue. The nurse should remind them to take their prescribed analgesics as directed, and plan their daily activities so they can space tasks that take a lot of energy throughout the day. The nurse must advise clients to take rest periods between tasks as needed and to get enough sleep each night. Lastly, the nurse should instruct them to contact their healthcare provider right away if the amount of fatigue or pain they are experiencing prevents them from doing their activities of daily living.

The nurse has completed a teaching plan for a client being treated for melanoma. Which statement made by the client indicates further teaching is needed? "I will avoid exposure to the sun between 12:00 PM and 6:00 PM." "I will monitor my incision for redness, swelling, and drainage." "I will keep a body map and take pictures of my other moles." "I will make sure to put on lip balm with SPF before I get in the tanning bed."

"I will make sure to put on lip balm with SPF before I get in the tanning bed." Rationale: When educating clients with melanoma, the nurse should explain that melanoma is a type of aggressive skin cancer usually caused by exposure to ultraviolet (UV) radiation. The nurse should also review the care plan and emphasize the importance of keeping their follow-up appointments and periodic clinical assessment for the development of skin cancer in other parts of their body. The nurse should show clients how to keep their wound site clean and dry and provide instructions on applying any prescribed dressings. Teach them to recognize if infection occurs and instruct them to report to their healthcare provider if they notice increased redness, swelling, or drainage from their wound or develop a fever or chills. Included in the education should be strategies to reduce their risk of skin cancer. Instruct them to avoid tanning beds and limit their exposure to direct sunlight, especially prolonged midday sun, usually around 10:00 AM to 4:00 PM. Teach them to apply a broad-spectrum sunscreen to exposed skin and shield their skin from direct sunlight by wearing a wide-brimmed hat, long-sleeved shirts, and pants. Also, advise clients to wear sunglasses that offer UVA and UVB protection and encourage them to use lip balm with SPF. Then, instruct clients on conducting monthly skin examinations to look for suspicious lesions using the ABCDE of melanoma. Recommend that they perform their self-assessment after a shower or bath, be sure to have plenty of light, a full-length mirror, and a handheld mirror so they can check the entire surface of their skin, including their lips, nose, ears, hands, feet, and between the toes. Encourage clients to keep a body map of any lesions and to use photographs to compare changes over time. Advise clients to contact their healthcare provider if they notice any area of their skin that changes color, size, or shape; becomes raised, itchy or tender; develops oozing, crusting, bleeding, or scaling, and if there is redness and swelling in the surrounding tissues, or if they develop a new lesion.

The nurse has provided discharge teaching to a client receiving chemotherapy after undergoing a lobectomy to treat lung cancer. Which client statement indicates further education is required? "I will avoid using my oxygen near any open flames." "If my pain worsens, I will take my prescribed pain medication." "I will increase my intake of protein in my diet." "I will make sure to use my incentive spirometer hourly when I am awake."

"If my pain worsens, I will take my prescribed pain medication." Rationale: For clients who have had surgical intervention, the nurse should encourage them to cough, take deep breaths, and use the incentive spirometer every hour while awake to prevent atelectasis or pneumonia. Also, the nurse can encourage them to take their prescribed analgesics and other medications, as directed, and advise them to follow up with their healthcare provider if they start to notice symptoms that their condition is worsening. These symptoms include increased shortness of breath, coughing up blood, and new or worsening chest pain.

The nurse has provided discharge education to a client treated for ovarian cancer with a hysterectomy and a bilateral salpingo-oophorectomy. Which client statement indicates an understanding of the teaching? "My husband is now in charge of emptying the cat's litter box." "I will avoid lifting anything heavy for the next two weeks." "I will avoid sexual intercourse for the next two weeks." "I will postpone getting my flu vaccine."

"My husband is now in charge of emptying the cat's litter box." Rationale: Teaching for a client with ovarian cancer after a total abdominal hysterectomy with a bilateral salpingo-oophorectomy includes the review of their diagnosis, treatments, and care plan. The nurse should instruct clients to avoid sexual intercourse for at least six weeks while their incision heals. In addition, they should avoid heavy lifting and any activities that increase pelvic congestion, like dancing or walking swiftly, for at least two months. The nurse should also review the importance of avoiding infection by practicing good hand hygiene, staying away from large crowds, avoiding undercooked foods, and keeping their immunizations up to date. If they have a pet cat, instruct them to have someone else empty the litter box to avoid contracting toxoplasmosis, an illness caused by a parasite in cat feces. Lastly, the nurse should instruct them to immediately seek medical attention if they develop any signs of an infection such as a fever, chills, or sore throat.

The nurse is providing instructions to a client about routine self-breast examinations to detect lumps. Which instructions should the nurse include in the teaching? Elimination tool "If I find a swollen axillary lymph node, I have cancer." "Any mass that is felt during the self-examination is cancerous." "Self-examination of the breasts should be done three to five days after the start of menstruation." "Breast self-exam should be completed once every six to eight months."

"Self-examination of the breasts should be done three to five days after the start of menstruation." Rationale: When providing education regarding breast self-exam, clients should be instructed to perform the exam three to five days after menstruation begins. Post-menopausal clients should complete breast exams on the same day each month due to the absence of menstruation.

A client recently diagnosed with leukemia asks the nurse what caused the disease. Which is the best response by the nurse? "The overproduction of red blood cells by the bone marrow overtakes the number of white blood cells." "Some blood cells have mutations that occur in the genetic material of DNA." "It is caused by sickled blood cells that damage the vessels and produce DNA mutations that are irreversible." "Phagocytes invade the bone marrow, which causes genetic mutations in blood cell production."

"Some blood cells have mutations that occur in the genetic material of DNA." Rationale: The exact cause of leukemia is unknown but it is believed that blood cells that have been exposed to infectious agents, environmental factors, genetic disorders such as Down Syndrome, and certain chemicals such as radiation, smoking, and benzene, which is found in gasoline, contribute to mutations that occur in the DNA.

The oncology nurse is teaching a student nurse about the pathological process of leukemia. Which statement should the nurse include in the teaching? "Leukemia occurs when the bone marrow rapidly produces red blood cells (RBC) due to mutations in the stem cells. As RBC production increases, white blood cell (WBC) production decreases. The reduced WBC production causes clients to become susceptible to infections." "Unregulated growth and destruction of red blood cells triggers an autoimmune response in the body to produce more white blood cells. The cells become mutated and invade body tissues causing the release of toxins." "Red blood cells in clients with leukemia become dehydrated and sickle-shaped. The sickle-shaped blood cells enter the bone marrow, causing the increased production of white blood cells." "Stem cells in the bone marrow produce excessive numbers of white blood cells (WBCs) that are immature, replacing production of effective WBCs, erythrocytes, and thrombocytes."

"Stem cells in the bone marrow produce excessive numbers of white blood cells (WBCs) that are immature, replacing production of effective WBCs, erythrocytes, and thrombocytes." Rationale: Leukemia occurs when the stem cells in the bone marrow begin producing white blood cells that are immature, replacing the production of effective white blood cells (WBCs), red blood cells (RBCs), and platelets. These immature WBCs do not function normally, increasing the risk for infection.

A new nurse on the oncology unit is developing a plan of care for a client with leukemia to include the assistive personnel (AP). Which statement made by the new nurse should the nurse preceptor question? "I can delegate routine vital signs to the assistive personnel." "I will ask the assistive personnel to record daily weights." "The assistive personnel can assist with providing oral hygiene." "The assistive personnel can monitor labs for abnormal values."

"The assistive personnel can monitor labs for abnormal values." Rationale: Assistive personnel can obtain routine vital signs, assist with oral hygiene, and record daily weights for clients with leukemia. Vital signs should be obtained every four hours. Daily weights should be recorded to monitor weight changes that are associated with increased metabolism in clients with leukemia. Oral hygiene prevents infection, which is the leading cause of death in clients with leukemia.

The nurse is preparing a client for a bone marrow biopsy to diagnose leukemia. Which statement, made by the nurse, is appropriate to include in the pre-procedure discussion? "You may feel a brief, sharp pain when the needle enters the bone." "You will be able to walk around immediately after the procedure." "You will need to drink 2 glasses of contrast dye before the exam." "You should not have any tenderness at the site after the exam is completed."

"You may feel a brief, sharp pain when the needle enters the bone." Rationale: A bone marrow exam includes bone marrow aspiration and biopsy. Clients often feel a sharp, but brief, pain when the needle is inserted into the bone. Often, an anesthetic is injected to assist in decreasing pain. The nurse should prepare clients undergoing this procedure about the possibility of pain.

The nurse has reviewed the physiology of the ovaries with a nursing student preparing to care for a client diagnosed with ovarian cancer. Which statement made by the nursing student indicates additional teaching is required? "The ovarian stroma contains embedded ovarian follicles." "The function of the ovaries includes producing luteinizing hormone and follicle-stimulating hormone." "The ovary cortex contains small sacs of oocytes." "Germinal epithelium lines the ovaries and is covered by the tunica albuginea."

"The function of the ovaries includes producing luteinizing hormone and follicle-stimulating hormone." Rationale: The ovaries are paired almond-shaped organs within the pelvic cavity on each side of the uterus. The functions of the ovaries include producing and releasing oocytes through the process of oogenesis and producing estrogen and progesterone, which are responsible for maintaining pregnancy, growth, and development in assigned females at birth. Each ovary is lined by a simple squamous epithelium called the germinal epithelium, which is then covered by a thick connective tissue capsule called the tunica albuginea. The inside of the ovary is divided into two zones, the cortex and medulla. The cortex houses small sacs of oocytes and supporting cells called the ovarian follicles, which are embedded in the outer layer of a unique type of connective tissue called the ovarian stroma.

The oncology nurse is caring for a client who has recently completed chemotherapy and radiation for breast cancer. The client asks the nurse, "How will I know that my treatment has worked?" Which is the best response by the nurse? "The treatment will only be successful if you have a mastectomy, too." "Treatment is successful if you do not have any side effects of the radiation you received." "We consider your treatment to be successful when you are in remission." "Treatment is successful if the cancer is confined to one area and does not spread."

"We consider your treatment to be successful when you are in remission." Rationale: Clients with breast cancer along with their interdisciplinary healthcare team determine what constitutes successful treatment based upon age, stage of cancer, comorbidities, and personal factors. For some clients, successful treatment of cancer is determined by remission. Clients who have successful treatment will be free of malignant cancer cells after chemotherapy and radiation treatments.

The community health nurse is discussing causes of breast cancer with a group of clients at a local health fair. Which statement by the nurse best identifies the most common cause of breast cancer? "Trauma to the breast causes fat necrosis and scarring, leading to the development of breast cancer." "While the cause is not fully understood, breast cancer is believed to be caused by hormonal and hereditary factors." "Being underweight has been linked to the development of malignant cancer cells." "Heart conditions, such as congestive heart failure, disrupt the normal cells of the breast."

"While the cause is not fully understood, breast cancer is believed to be caused by hormonal and hereditary factors." Rationale: The cause of breast cancer is unknown. However, it has been strongly linked to hormones and heredity. BRCA 1 and BRCA 2 genes are known as tumor suppressors and can be inherited from either parent. Clients with breast cancer often have a mutation on these genes. Females are more likely to develop breast cancer due to the high levels of estrogen in the body. Estrogen is responsible for the development of female sex characteristics and regulation of the female reproductive system.

A nurse is assessing a client diagnosed with leukemia who had chemotherapy for treatment. The client asks, "How will I know if the chemotherapy is working?" Which response, made by the nurse, is appropriate? "You should have a rapid rise of potassium and phosphate in your system." "You will have an absence of leukemic cells in your body." "Your blood volume will decrease and become viscous." "A polysomnography (PSG) test will show decreased leukocytes."

"You will have an absence of leukemic cells in your body." rationale: An absence of leukemic cells in the body is an indication that the treatment has been effective, and clients are in remission. Remission is a disease-free period when clients have no signs and/or symptoms.

A student nurse, caring for a client with invasive squamous cell cervical carcinoma, is reviewing how this cancer has developed. Beginning with the development of pathological cellular changes, in which order should the student nurse place the steps of the pathophysiology of cervical cancer? Place the steps in the correct order. All options must be used. Potential Steps Development of Carcinoma in situ Cervical epithelial dysplasia occurs Cervical intraepithelial neoplasia occurs Invasive squamous carcinoma develops Invasive cervical adenocarcinoma occurs

1. Cervical epithelial dysplasia occurs 2. Cervical intraepithelial neoplasia occurs 3. Development of Carcinoma in situ 4. Invasive squamous carcinoma develops 5. Invasive cervical adenocarcinoma occurs Rationale: When the immune system is unable to fight off a human papilloma virus (HPV) infection, the virus inserts itself into the immature squamous cells of the transformation zone, leading to changes in the cell's DNA. As a result, infected cervical epithelial cells undergo dysplasia, or abnormal growth, leading to the formation of a precancerous lesion called cervical intraepithelial neoplasia. Depending on how much of the epithelium is affected by dysplasia, cervical intraepithelial neoplasia can be divided into three grades. The higher the grade, the more likely the lesion will evolve into cancer. Eventually, cervical intraepithelial neoplasia can evolve into carcinoma in situ, affecting the entire epithelium thickness. Finally, carcinoma in situ can progress to invasive squamous cell carcinoma, which is when cancerous cells break through the epithelial basement membrane into the cervical stroma and may even spread or metastasize to neighboring tissues and organs, such as the vagina, uterus, or pelvic wall, as well as to other areas of the body. Less frequently, HPV infects the mucus-secreting columnar cells, giving rise to adenocarcinoma in situ, which may progress to invasive cervical adenocarcinoma.

An older adult client diagnosed with chronic myelogenous leukemia (CML) is prescribed hydroxyurea 15 mg/kg as a single oral dose. Tablets are available in 300 mg formulations. The client's current weight is 88 lbs. How many tablet(s) should the nurse administer?

2 Tablets

The nurse is caring for a client who has just been diagnosed with ovarian cancer involving the lymph nodes. Which treatment should the nurse prepare the client for first? Olaparib therapy 150 mg PO twice daily A total abdominal hysterectomy with bilateral salpingo-oophorectomy Radiation therapy Chemotherapy

A total abdominal hysterectomy with bilateral salpingo-oophorectomy Rationale: The definitive treatment of ovarian cancer is total abdominal hysterectomy with bilateral salpingo-oophorectomy. This type of surgical procedure involves the complete removal of the uterus, in addition to both fallopian tubes and ovaries. In cases of lymph node involvement, the neighboring tissue should also be removed. This surgical procedure is usually followed by chemotherapy and radiation therapy to kill any of the remaining cancer cells. In addition, clients can also be given targeted therapy with medications called poly (ADP-ribose) polymerase (PARP) inhibitors, which block the PARP enzyme that has a role in DNA repair; as a result, PARP inhibitors can prevent cancerous cells from repairing their DNA, ultimately causing these cells to die.

A client newly diagnosed with leukemia is being seen in the office for a routine check-up. The client's daughter asks the nurse, "How did Dad get this disease?" Which response(s) should the nurse include regarding risk factors for leukemia? Select all that apply. A. "Cigarette smoking and exposure to chemicals can increase the risk." B. "African American or Hispanic clients are at greatest risk." C. "Leukemia occurs more frequently in males than females." D. "Having a genetic disorder, such as Bloom syndrome, increases the risk." E. "Previous exposure to ionizing radiation is known to be a risk factor."

A. "Cigarette smoking and exposure to chemicals can increase the risk." C. "Leukemia occurs more frequently in males than females." D. "Having a genetic disorder, such as Bloom syndrome, increases the risk." E. "Previous exposure to ionizing radiation is known to be a risk factor." Rationale: Modifiable risk factors can be changed or modified by clients to prevent the development of leukemia, while non-modifiable risk factors cannot be changed. Modifiable risk factors for the development of leukemia are cigarette smoking and exposure to chemicals. Non-modifiable risk factors include gender, previous exposure to radiation, and having a genetic disorder.

The nurse in the women's health office is gathering data from a client presenting for a routine physical exam. Which question(s) should the nurse ask when screening for risk factor(s) associated with the development of cervical cancer? Select all that apply. A. "Do you have a family history of cancer?" B. "Do you smoke?" C. "Are your menstrual periods regular?" D. "Do you drink alcohol?" E. "At what age did you start having intercourse?" F. "Are you currently using birth control pills?"

A. "Do you have a family history of cancer?" B. "Do you smoke?" E. "At what age did you start having intercourse?" F. "Are you currently using birth control pills?" Rationale: Cervical cancer can arise due to a variety of causes and risk factors. Most cervical cancers are caused by human papillomavirus (HPV). Specifically, high-risk HPV strains such as 16 and 18 are responsible for more than half of all cervical cancers. Since HPV is a sexually transmitted infection, the risk of developing cervical cancer is higher in clients who engage in unprotected sex or have multiple sexual partners. Additional risk factors include having sexual intercourse at an early age, smoking, a compromised immune system, obesity, long-term use of oral contraceptive pills, and a family history of cervical cancer.

The nurse in a primary care office is obtaining the health history from a client with suspected leukemia. Which question(s) should the nurse ask to gather more information about the client's symptoms? Select all that apply. A. "Have you experienced any weight loss or night sweats?" B. "Have you noticed blood in the sink after brushing your teeth?" C. "Do you feel fatigued often or get tired easily?" D. "When doing daily activities, do you feel short of breath?" E. "How frequently do you urinate during the day?"

A. "Have you experienced any weight loss or night sweats?" B. "Have you noticed blood in the sink after brushing your teeth?" C. "Do you feel fatigued often or get tired easily?" D. "When doing daily activities, do you feel short of breath?" E. "How frequently do you urinate during the day?" Rationale: Common manifestations of leukemia include dyspnea on exertion, fatigue, malaise, weakness, decreased urinary output, weight loss, night sweats, and bleeding. Anemia causes the symptoms of fatigue and dyspnea because the body is lacking the blood cells to carry oxygen throughout the body. Bleeding occurs because platelets are decreased and clients are unable to clot effectively.

A client suspected of having breast cancer is discussing their recent self-breast exam with the oncology nurse. Which sign(s) reported by the client support(s) this diagnosis? Select all that apply. A. Hard mass in breast B. Tan-colored areola C. Nipple retraction D. Dimpling of the breast E. Discharge from the nipple

A. Hard mass in breast C. Nipple retraction D. Dimpling of the breast E. Discharge from the nipple Rationale: Clients diagnosed with breast cancer are often asymptomatic at presentation. However, there are some clients who do present with signs and symptoms. Masses may be palpated in the breast tissue of clients with breast cancer. However, in early stages, masses are not detected. The appearance of a mass is an indication that the cancer is advanced. Skin dimpling occurs in clients with breast cancer as well. In addition to edema of the breast, the skin can appear dimpled, resembling an orange peel. Nipple discharge can also occur in clients with breast cancer due to the changes of the ducts in the breast. Clients can experience nipple discharge because the malignant cells have damaged the ducts which are responsible for expressing milk from the breast. Finally, nipple retraction can develop in clients with breast cancer. Nipple retraction can indicate complications such as breast cancer, infection of milk ducts, sudden weight loss, and mastitis.

The nurse is reviewing lab results for a client with suspected leukemia. Which blood test result(s) correlate(s) with this diagnosis? Select all that apply. A. Hemoglobin 9.0 g/dL B. Red blood cells 3.0 million/mm3 C. Platelets 90,000/mm3 D. White blood cell 18,000/mm3 E. Neutrophil 1,000/mm3

A. Hemoglobin 9.0 g/dL B. Red blood cells 3.0 million/mm3 C. Platelets 90,000/mm3 D. White blood cell 18,000/mm3 E. Neutrophil 1,000/mm3 Rationale: Clients with leukemia often present with low platelet counts which increases the risk of bleeding. A normal platelet count is 150,000-400,000/mm3. White blood cells will also be increased in clients with leukemia. Normal white blood cell count is 3,500-12,000/mm3. Clients with leukemia will present with a low red blood cell count. This occurs because the bone marrow neglects the production of red blood cells. Normal red blood cell count for a male is 4.6-6.2 million/mm3, and 4.2-5.4 million/mm3 for females. Leukemia affects the production of blood cells, thereby altering the number of circulating neutrophils. Normal neutrophil count in the body is 3,000-5,800/mm3. Clients undergoing treatment for leukemia may present with low neutrophil counts. Clients with leukemia often present with anemia because bone marrow overproduces white blood cells and neglects red blood cell production. Normal hemoglobin levels are 14.0-18.0 g/dL for males, and 12.0-16.0 g/dL for females.

The community health nurse is preparing a presentation about the risk factors associated with lung cancer for a group of clients. Which environmental risk factor(s) should the nurse teach the clients to avoid? Select all that apply. A. Ionizing radiation B. Pollen C. Asbestos D. Air pollution E. Tobacco smoke F. Coal dust

A. Ionizing radiation C. Asbestos D. Air pollution E. Tobacco smoke F. Coal dust Rationale: Lung cancer occurs when any of the epithelial cells acquire mutations, which can arise due to various risk factors. Environmental risk factors include exposure to toxins like tobacco smoke, air pollution, asbestos, coal dust, radon gas, or ionizing radiation. There are also some genetic risk factors, which is when clients are genetically predisposed to develop lung cancer even without the presence of environmental risk factors .

The nurse summarizes the signs and symptoms of ovarian cancer with a client. Which clinical manifestation(s) should the nurse include? Select all that apply. A. Menstrual changes B. Dyspareuna C. Concave Abdomen D. Urinary frequency E. Weight loss

A. Menstrual changes B. Dyspareuna D. Urinary frequency E. Weight loss Rationale: Initially, clients with ovarian cancer can be completely asymptomatic or experience subtle and non-specific symptoms. Common early symptoms include abdominal distension, bloating, abdominal or pelvic pain, and urinary frequency and urgency. Later on, ovarian tumors can cause unintentional weight loss, abdominal enlargement, bowel obstruction, menstrual changes, and dyspareunia, pain during sexual intercourse. A classic finding is a "sister mary joseph nodule," which happens when it metastasizes to the umbilicus. Awareness and education on these symptoms are essential since early recognition is vital for treatment.

The nurse is assessing a client with leukemia after admission to the oncology unit. The client exhibits hematuria, swollen lymph nodes, and bradycardia. The client also reports a headache and a 5-pound weight loss last week. Which finding(s) support the diagnosis of leukemia? Select all that apply. A. Swollen lymph nodes B. Blood in the urine C. Report of a headache D. Weight loss of 5 pounds in a week E. Heart rate 50/min

A. Swollen lymph nodes B. Blood in the urine C. Report of a headache D. Weight loss of 5 pounds in a week Rationale: Clients with leukemia often experience headaches, hematuria, and swollen lymph nodes. Meningeal infiltration of leukemia causes symptoms of increased intracranial pressure, such as a headache and nausea or vomiting. Infiltration of leukemia into the lymph nodes causes swelling and tenderness. Clients with leukemia often present with bleeding due to decreased platelets. Clients with leukemia will often experience tachycardia and weight loss.

3. You are working with a new graduate and explaining prevention of infection for a child with acute lymphoblastic leukemia. Which statement by this new nurse indicates understanding? A. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer." B. "If blood is drawn, firm pressure should be applied to the area for a minimum of 10 minutes." C. "Having a roommate with a routine surgery would be acceptable for this child." D. "The child should be vaccinated completely to avoid childhood diseases."

A. "Prophylaxis against Pneumocystis pneumonia is routinely given to most children during treatment for cancer."

The nurse caring for a client with breast cancer is reviewing an assessment made by the previous nurse in the electronic medical record (EMR). Which documentation by the nurse supports this diagnosis? A. Hard and immobile mass felt on palpation of the right breast B. Non-palpable right axillary lymph nodes C. Moveable mass with regular borders felt on palpation of the right breast D. Large, soft mass located on the outer aspect of the right breast during palpation.

A. Hard and immobile mass felt on palpation of the right breast Rationale: Documentation for clients diagnosed with breast cancer should include the appearance of the breast and how the mass feels upon palpation. Cancerous masses are immobile and have irregular borders. During palpation of the breast, a cancerous mass will feel hard to the touch and will not move.

The nurse is reviewing the miscellaneous antineoplastic medications prescribed to treat different cancers with a newly graduated nurse on the oncology unit. Which medication(s) should the nurse mention? Select all that apply. A. Irinotecan B. Pegaspargase C. Hydroxyurea D. Azacitidine E. Asparaginase F. Altretamine

A. Irinotecan B. Pegaspargase C. Hydroxyurea D. Azacitidine E. Asparaginase F. Altretamine Rationale: Commonly used antineoplastics include asparaginase and pegaspargase, which are given intramuscularly or intravenously to treat acute lymphoblastic leukemia, as well as altretamine, which is taken orally to treat ovarian cancer. Azacitidine is a medication that can be administered orally, intravenously, or subcutaneously to treat myelodysplastic syndrome or acute myeloid leukemia; hydroxyurea, which is administered orally in clients with chronic myeloid leukemia or head and neck cancer; and irinotecan, which is administered intravenously to clients with metastatic colorectal cancer.

A client who is 5 weeks posttransplant after an allogeneic stem cell transplantation for acute lymphocytic leukemia comes to the clinic with a swollen belly and weight gain. Which additional assessment data support the nurse's suspicion of possible sinusoidal obstructive syndrome (SOS)? Select all that apply. A. Jaundiced skin and sclera B. Platelet count is 28,000/mm3 C. Skin peeling on the hands and feet D. Mixed chimerism by laboratory finding E. Body temperature slightly below normal F. Pain in the upper right abdominal quadrant

A. Jaundiced skin and sclera F. Pain in the upper right abdominal quadrant

The nurse is educating a client newly diagnosed with lung cancer about their condition. Which information should the nurse include in the teaching? A. Lung cancer is a malignant tumor that primarily originates in the lungs or, less often, from another organ. B. Lung cancer is a sarcoma that originates in the lungs but may also spread from another organ. C. Lung cancer is a type of leukemia that can affect the lungs as well as other organs. D. Lung cancer is a type of lymphoma that primarily originates in the lymph nodes of the lungs.

A. Lung cancer is a malignant tumor that primarily originates in the lungs or, less often, from another organ. Rationale: Lung cancer is a malignant tumor that primarily originates in the lungs, or less frequently, can originate in another organ and spread to the lungs through metastasis. Unfortunately, lung cancer is one of the most common and aggressive types of cancer.

4. The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply. A. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. B. Tests include complete blood count, prothrombin time and G6PD, erythropoietin, and sedimentation rate. C. Generally a bone marrow biopsy is done to look for the presence of blast cells. D. The presence of Reed-Sternberg cells is considered diagnostic of Hodgkin disease. E. The presence of a white reflection as opposed to the normal red pupillary reflex in the pupil of a child's eye is a classic sign.

A. The most common finding is enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area. D. The presence of Reed-Sternberg cells is considered diagnostic of Hodgkin disease.

Which teaching will the nurse provide to the client who just underwent a skin biopsy and had sutures placed to close the wound? Select all that apply. A. Use antibiotic ointment as prescribed. B. Return for suture removal in 2 to 3 days. C. Report redness to the health care provider. D. Keep dressing moist so skin does not dry out. E. Use tap water or saline to remove any crusting.

A. Use antibiotic ointment as prescribed. C. Report redness to the health care provider. E. Use tap water or saline to remove any crusting.

The nurse is caring for a group of clients on the oncology unit. Which client is most likely to develop tumor lysis syndrome (TLS)? An 82-year-old client diagnosed with acute leukemia receiving chemotherapy A 17-year-old client in remission for 6-months for lymphoma A 52-year-old client with a history of alcohol abuse diagnosed with skin cancer An 8-year-old client newly diagnosed with stage I bone cancer

An 82-year-old client diagnosed with acute leukemia receiving chemotherapy Tumor Lysis Syndrome (TLS) is caused by a complication during treatment of hematological malignancies, such as leukemia and lymphoma, when chemotherapeutic medications rapidly kill large numbers of tumor cells at once. There are some factors that may put clients at risk of TLS, such as older age and having a large tumor burden, which can be evidenced by the presence of a very high white blood cell count and high lactate dehydrogenase (LDH), as well as bone marrow involvement by the malignancy. Other risk factors include having an underlying renal disease that reduces urinary output, thus promoting the precipitation of uric acid or phosphate-calcium crystals in the renal tubules. Finally, the risk of TLS is also higher with the use of substances that increase the uric acid levels in blood, such as alcohol and medications like thiazide diuretics or levodopa.

After assisting with a bimanual pelvic examination, the health care provider notes that a client has enlarged ovaries. The health care provider says to the nurse, "I suspect ovarian cancer; please inform the client how we'll confirm this diagnosis." Which diagnostic measure should the nurse educate the client on? A positive emission tomography (PET) scan Obtaining bloodwork to evaluate the CA125 level The International Federation of Gynecology and Obstetrics (FIGO) system An exploratory laparotomy with a biopsy

An exploratory laparotomy with a biopsy Rationale: The diagnosis of ovarian cancer starts with the client's history and physical assessment, including a bimanual pelvic examination, which may show enlarged ovaries, followed by additional diagnostic tests like transvaginal ultrasound to observe the tumor. An exploratory laparotomy with biopsy can be done to confirm the diagnosis. Laboratory test results are generally non-specific and may show elevated blood levels of tumor markers like CA125, inhibin, alpha-fetoprotein (AFP), and beta-human chorionic gonadotropin (hCG). Additional imaging tests include computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) that can be used to stage the disease with the TNM classification by defining the "Tumor" location and looking for lymph "Node" involvement or "Metastasis." Ovarian cancer can also be staged using the International Federation of Gynecology and Obstetrics (FIGO) system into stage 0, or carcinoma in situ; stage I, which is confined to the organ of origin; stage II, where the tumor has extended to adjacent organs or tissues; stage III, where cancer has spread to lymph nodes or nearby tissues within the pelvis; and lastly, stage IV, characterized by distant metastasis beyond the pelvis.

The nurse is caring for a client immediately following the surgical removal of a melanoma lesion. Which intervention should the nurse anticipate, including the client's care? Apply topical fluorouracil 5% Obtain a wound culture and sensitivity Remove the surgical sutures Apply mupirocin 2% topically

Apply mupirocin 2% topically After a client's melanoma has been surgically removed, the nurse should assess the incision site for bleeding and drainage and administer antibiotics such as mupirocin and analgesics.The priority nursing goals for clients with skin cancer include early detection of suspicious lesions and providing supportive care during treatment. The nurse should begin by asking clients if they have a family history of skin cancer and talk to them about their history of sun exposure, sunburns, use of tanning beds, and previous exposure to occupational hazards. The nurse should then assess the client's skin, including the palms and the soles of their feet, fingernails, and mucus membranes for moles, birthmarks, or abnormal lesions, and ask them about any changes they may have noticed and report to the healthcare provider any suspicious lesions.

A client newly diagnosed with stage I nonsmall cell lung cancer (NSCLC) who is getting ready for curative surgery asks the nurse whether the oncologist might consider this new drug he has seen on television, pembrolizumab, instead of surgery. What is the nurse's best response? A. "This drug will only work on those lung cancers that have the right target and your tumor does not have it." B. "This drug is approved for use in clients whose lung cancer has metastasized not for early-stage cancers." C. "Why would you want to take a drug for months when you may be cured by surgery alone?" D. "You need to talk about this with your oncologist and your surgeon."

B. "This drug is approved for use in clients whose lung cancer has metastasized not for early-stage cancers."

The nurse is providing discharge education to a client with leukemia. Which statement(s) should the nurse include in the teaching? Select all that apply. A. "Stay in bed as much as possible until you no longer feel tired." B. "Avoid forcefully blowing your nose or straining to have a bowel movement." C. "If you have a cut or scrape, apply pressure to the area for 3 to 5 minutes." D. "Family and friends should not visit you if they are sick." E. "You should avoid eating spicy or highly acidic foods."

B. "Avoid forcefully blowing your nose or straining to have a bowel movement." C. "If you have a cut or scrape, apply pressure to the area for 3 to 5 minutes." D. "Family and friends should not visit you if they are sick." E. "You should avoid eating spicy or highly acidic foods." Rationale: Clients with leukemia should be encouraged to avoid spicy or highly acidic foods to protect the oral mucosa and prevent irritation. The risk of bleeding is high in clients with leukemia and clients should be instructed to place direct pressure on any injuries for 3-5 minutes to promote clotting. Clients should also be educated about the risk of bleeding with straining and forcefully blowing the nose. These activities irritate mucosa and increase the risk of bleeding. Clients with leukemia are at an increased risk of infection and should be educated that family or friends should avoid visitation if they are sick for infection prevention.

The oncology nurse is obtaining a health history on a 65-year-old female client suspected of having breast cancer. Which client statement(s) should the nurse recognize as a non-modifiable risk factor for breast cancer? Select all that apply. A. "I began menopause when I was 50 years old." B. "My infertility issues prevented me from having children." C. "I had radiation treatments on my leg when I was younger." D. "My mother and grandmother both had breast cancer." E. "I started my period when I was 11-years-old."

B. "My infertility issues prevented me from having children." D. "My mother and grandmother both had breast cancer." Rationale: Non-modifiable risk factors for the development of breast cancer occur because clients are unable to modify or change the factor to prevent disease. Non-modifiable risk factors for breast cancer include BRCA 1 and BRCA 2 gene inheritance, menarche before age 12 or menopause after 55-years-old, and radiation treatments to the chest or face. Modifiable risk factors, such as smoking, are factors that can be altered or changed to prevent disease.

he nurse is educating a group of clients about the primary prevention of ovarian cancer. Which modifiable risk factor(s) should the nurse include? Select all that apply. A. Uncontrolled blood pressure B. Pelvic inflammatory disease C. Obesity D. Smoking E. Infertility treatment

B. Pelvic inflammatory disease C. Obesity D. Smoking E. Infertility treatment rationale: Modifiable risk factors for ovarian cancer include smoking, obesity, hormone replacement therapy, and ovarian hyperstimulation from infertility treatments like in vitro fertilization. Additional modifiable risk factors include pelvic inflammatory disease, nulliparity, and first pregnancy at an older age.

A client with leukemia has just been admitted to the oncology unit in an isolation room. The client has a platelet count of 100,000/mm3, neutrophils 2,000/mm3, a history of diabetes and glaucoma. The client asks the nurse, "Am I going to die?" Which nursing diagnosis(es) should the nurse select for this client? Select all that apply. A. Ineffective health maintenance related to hospitalization B. Risk for infection related to neutrophil count C. Social isolation related to isolation precautions D. Anxiety related to fear of death E. Risk for bleeding related to platelet count F. Autonomic dysreflexia related to the disease process

B. Risk for infection related to neutrophil count C. Social isolation related to isolation precautions D. Anxiety related to fear of death E. Risk for bleeding related to platelet count Rationale: Clients with leukemia are at a risk of infection because of the low numbers of neutrophils to fight off infections and a risk of bleeding due to the low number of platelets to initiate clotting. Clients often experience anxiety related to the fear of death and dying. Feelings of social isolation may develop in clients with leukemia, especially when protective isolation is used for treatment.

A 'medically fit' client is scheduled to receive an allogeneic bone marrow transplant for treatment of leukemia. The client asks the nurse, "What happens during the procedure?" Which is an accurate response by the nurse? A. "You will have surgery to remove your bone marrow and receive chemotherapy. Once chemotherapy is complete, they will infuse your bone marrow back into your bones." B. "Chemotherapy is administered first to kill leukemic cells and then you will receive bone marrow from a closely matched donor." C. "Your blood cells will be removed from the peripheral blood. Plasma and white blood cells will be separated and administered through a central venous catheter." D. "You will receive high doses of energy in different forms to destroy any abnormal cell DNA, which will prevent any of the cells in your body from ever mutating again."

B. "Chemotherapy is administered first to kill leukemic cells and then you will receive bone marrow from a closely matched donor." Rationale: An allogeneic bone marrow transplant occurs when clients with leukemia receive bone marrow from an outside donor. The bone marrow is closely matched to the client's bone marrow and is often from a sibling or family member. Chemotherapy and radiation are administered prior to the bone marrow transplant to kill leukemic cells in the body.

The nurse taking care of a 5-year-old cancer patient with ulcerative stomatitis is getting ready to perform mouth care. Which of the following principles should be followed? Select all that apply. A. Due to pain of the stomatitis, viscous lidocaine should be used to swish the mouth three times per day. B. A soft, bland diet, although not the favorite of the child, will help with the pain. C. Lemon glycerine swabs are helpful because they remind children of lemon drops. D. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. E. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

B. A soft, bland diet, although not the favorite of the child, will help with the pain. D. Using a soft sponge-type toothbrush will decrease the tendency for gums to bleed. E. A solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water is helpful for mouth rinse.

The nurse has obtained a baseline assessment and reviewed the laboratory results for a client newly prescribed cisplatin to treat ovarian cancer. Which testing results should the nurse prioritize reviewing before administering treatment? A. Positive emission tomography (PET) B. HCG Quant pregnancy test C. Fluoroscopy D. Serum lipids

B. HCG Quant pregnancy test Rationale: When a client with ovarian cancer is prescribed cisplatin, the nurse should start by performing a baseline assessment, including weight, vital signs, and current symptoms. Symptoms of ovarian cancer may include pelvic or abdominal pain, vaginal bleeding, fatigue, early satiety, and bloating. Next, the nurse should review the most recent laboratory test results, such as a complete blood count (CBC), renal and liver function tests, electrolytes, and confirmation of a negative pregnancy test. Lastly, the nurse should review diagnostic tests, including cancer antigen 125 (CA 125) and transvaginal ultrasound results.

A client states to the nurse, "I understand that a genetic mutation can cause ovarian cancer, but what are the risk factors?" Which risk factor(s) should the nurse review with the client? Select all that apply. A. Type 2 diabetes mellitus (DM) B. Hormone replacement therapy C. Multiparity D. Tobacco smoking E. Late menarche F. Early menopause G. Endometriosis

B. Hormone replacement therapy D. Tobacco Smoking G. Endometriosis Rationale: The exact cause of ovarian cancer is unknown. Still, there is typically a genetic mutation in a cell of the ovary or the fallopian tube, such as a mutation in breast cancer genes 1 and 2, also known as BRCA1 and BRCA2. These mutations may arise from a variety of risk factors. Nonmodifiable risk factors include middle or older age, family history, early menarche, late menopause, a history of polycystic ovarian syndrome (PCOS), endometriosis, and breast or colon cancer. Modifiable risk factors include smoking, obesity, hormone replacement therapy, and ovarian hyperstimulation from infertility treatments like in vitro fertilization, pelvic inflammatory disease, nulliparity, and first pregnancy at an older age.

1. Which nursing intervention is appropriate when caring for a female client who has undergone a mastectomy and will receive chemotherapy? Select all that apply. A. Encourage client to accept her new body image. B. Provide self-care resources to the primary caretaker. C. Teach client about birth control options that are available. D. Refer to support groups for people who have had mastectomy. E. Involve partner in discussions about sexuality if client desires.

B. Provide self-care resources to the primary caretaker. C. Teach client about birth control options that are available. D. Refer to support groups for people who have had mastectomy. E. Involve partner in discussions about sexuality if client desires.

1. How does a mutation in a suppressor gene, such as BRCA1, increase the risk for cancer development? A. Converting a proto-oncogene into an oncogene B. Removing the control over proto-oncogene expression C. Reducing the amount of cyclins produced by the oncogenes D. Inhibiting the recognition of abnormal cells through immunosurveillance

B. Removing the control over proto-oncogene expression

2. Which assessment finding in a client who recently had a right mastectomy 2 days ago will the home health nurse report to the health care provider? A. Temperature of 99°F B. Tingling sensation in the right arm C. Impaired range of motion in the right arm D. Drainage of 20 mL collected over 24 hours

B. Tingling sensation in the right arm

What teaching will the nurse provide to a 30 y/o female client who has never been sexually active about decreasing her risk of developing cervical cancer? Select all that apply. A. "You cannot lower your risk for cervical cancer" B. You cannot receive the Gardasil-9 immunization C. Use condoms when you plan to be sexually active D. OTC oral contraceptive methods can be used to prevent HPV E. Having an annual Pap test will decrease your chances of cervical cancer

B. You cannot receive the Gardasil-9 immunization C. Use condoms when you plan to be sexually active

The oncology nurse is discussing complications of leukemia with a newly hired nurse. Which complication(s) should the oncology nurse include? Select all that apply. A. Glaucoma B. Obesity C. Anemia D. Preeclampsia E. Death F. Hemorrhage

C. Anemia E. Death F. Hemorrhage Rationale: Clients with leukemia often have a low platelet count, which decreases the clotting ability of the body and increases the risk of bleeding and anemia. Clients with leukemia present with anemia due to the decrease in red blood cell production of the body. If treatment for leukemia is not successful, clients will eventually die from the complications associated with leukemia. Infections, anemia, and bleeding can lead to death.

The nurse explains ovarian cancer's pathophysiology to a nursing student. Which information should the nurse include? When the follicle ruptures and releases a mature oocyte, the ovarian cortex becomes inadvertently damaged. A damaged oocyte released from the fallopian tube can start dividing uncontrollably, forming a tumor mass. As the tumor grows, it typically remains in the ovaries Based on the incessant ovulation theory, the risk of ovarian cancer increases with each cycle of ovulation.

Based on the incessant ovulation theory, the risk of ovarian cancer increases with each cycle of ovulation. Rationale: The risk factors for ovarian cancer can lead to dedifferentiation of the surface ovarian epithelium of the fallopian tube epithelium, which the incessant ovulation theory can explain. This theory suggests that the risk of ovarian cancer increases with each cycle of ovulation. During ovulation, the follicle ruptures and releases the mature oocyte, which inadvertently causes damage to the surface epithelium. This damage can lead to the formation of cortical inclusion cysts and invaginations of the ovarian surface epithelium. The epithelial cells of these cysts may then start dividing uncontrollably, forming a tumor mass. As the tumor keeps growing, it can invade neighboring tissues, spread to nearby lymph nodes, or metastasize to distant organs such as the brain. Ovarian cancer can also spread to abdominal organs through abdominal seeding and thoracic organs through transdiaphragmatic passage.

During the admission assessment, the nurse notes the client has a new parenchymal lesion on their left lung documented by the healthcare provider. Which testing should the nurse prepare the client for to confirm the diagnosis? Computed tomography (CT) scan Ultrasound Biopsy Chest x-ray

Biopsy Rationale: Diagnosis of lung cancer involves history, and physical assessment, as well as additional diagnostic tests like imaging. In most cases, chest X-rays show a parenchymal lesion like a poorly defined nodule, called a coin lesion, while a computed tomography (CT) scan can be used to stage the tumor by defining the location and looking for lymph node involvement or metastasis of cancer. A biopsy is needed to confirm the diagnosis once a suspicious lesion is found on imaging.

Which precaution has the highest priority for prevention of harm when the nurse teaches the client about home care after a bone marrow aspiration? A. Clean the suture line daily with soap and water. B. Drink at least 4 L of fluid to ensure adequate hydration. C. Avoid taking any aspirin or aspirin-containing products. D. Stay in bed and get up only to use the bathroom for the next 2 days.

C. Avoid taking any aspirin or aspirin-containing products.

The nurse is developing a teaching plan for a female client prescribed thalidomide for the treatment of skin cancer. Which topic is the most important for the nurse to include in the education? A. Menstruation B. Sexual dysfunction C. Contraception D. Fertility

C. Contraception Rationale: Thalidomide is an angiogenesis inhibitor plant extract chemotherapy agent. Client education should include the purpose of the medication, which is to stop the replication of the cancer cells. Clients should be reminded of weekly appointments for medication administration and use reliable contraception during treatment to prevent pregnancy because thalidomide is a teratogenic medication. Thalidomide causes menstrual disorders and erectile dysfunction. Side effects to include in the education are the increased risk of infection, constipation, impaired renal function, neurotoxicity, and stomatitis.

3. Which statements made by a 62-year-old client alert the nurse to the possibility that he may be at increased genetic risk for cancer development? Select all that apply. A. An older aunt died from a brain tumor while she had breast cancer. B. He had two benign colon polyps removed during his most recent routine colonoscopy. C. His sister died from cancer of the appendix. D. His brother is being treated for breast cancer. E. His 32-year-old daughter has been recently diagnosed with cervical cancer. F. One person in each of the previous three generations of his family died from lung cancer.

C. His sister died from cancer of the appendix. D. His brother is being treated for breast cancer.

A client shows the nurse two pictures of the same lesion, taken 1 month apart. Which assessment finding requires nursing intervention? A. The light pink color of the lesion is the same in both photographs. B. The lesion has almost disappeared by the time of the second photograph. C. The lesion borders have expanded and are shaped differently in the second picture. D. The lesion's well-approximated margins and size look no different in either photograph.

C. The lesion borders have expanded and are shaped differently in the second picture.

he nurse notes a client's Papanicolaou (pap) test results indicate there are abnormal cell changes. Which follow-up testing should the nurse prepare the client for? Computed tomography (CT) scan Colposcopy Pelvic ultrasound Cystoscopy

Colposcopy Rationale: Diagnosis of cervical cancer involves screening with human papilloma virus (HPV) DNA testing, along with a Pap smear (Papanicolaou test), where a sample of cells from the transformation zone is collected with a brush and then examined under a microscope. If the Pap smear shows evidence of abnormal cell changes like dysplasia, it will be followed up with a colposcopy, which is when a magnifying device called a colposcope is used to examine the cervix and then obtain biopsies to confirm the diagnosis. Afterward, imaging tests like a computed tomography (CT) scan or magnetic resonance imaging (MRI) and endoscopic tests like cystoscopy or rectosigmoidoscopy can be performed to look for evidence of metastasis.

The newly graduated nurse is creating a teaching plan for a client prescribed intravenous (IV) doxorubicin for treatment of breast cancer. Which statement should the newly graduated nurse include in the education plan? A. "Avoid sexual intercourse while receiving treatment." B. "The medication will be administered intravenously every 2 weeks for six cycles." C. "Avoid contact with others until the treatment is complete." D. "Schedule your flu shot and be sure it is the inactivated influenza vaccination."

D. "Schedule your flu shot and be sure it is the inactivated influenza vaccination." rationale: The nurse should teach clients prescribed antitumor antibiotics, such as doxorubicin, that the medication will help to stop the growth of the cancer cells. Clients should anticipate that the medication will be administered intravenously every 21 days for 6 cycles. Forty-eight hours after the infusion, clients may experience the harmless side effect of red discoloration of urine and sweat. Side effects like nausea and vomiting may occur, therefore, clients should be advised to eat small, frequent meals and increase fluid intake during treatment. Clients should be cautioned that they are at an increased risk for infection during treatment and should implement infection control practices into their daily routine, such as frequent hand hygiene, avoiding crowds, and contact with people with known infections. Clients should be instructed to avoid live attenuated vaccines, such as the intranasal influenza vaccine. Lastly, clients should use a reliable form of contraception during treatment because the medication has teratogenic effects but they are not required to abstain from sexual activity.

2. A client's cancer is staged as T1, N2, M1 according to the TNM classification system. How does the nurse interpret this report? A. The client has two tumors that are nonresponsive to treatment. B. The client has leukemia confined to the bone marrow. C. The client has a 2-cm tumor with one regional lymph node involved and no distant metastasis. D. The client has a small primary tumor extension into two lymph nodes and one site of distant metastasis.

D. The client has a small primary tumor extension into two lymph nodes and one site of distant metastasis.

The nurse is assessing a client previously diagnosed with breast cancer who had a right-sided radical mastectomy two years ago. Which finding suggests the client may be experiencing a complication of this procedure? Capillary refill less than two seconds on the right hand Bilateral radial pulses 3+ Edema in the right arm and hand Intact peripheral sensation

Edema in the right arm and hand Rationale: A complication of a radical mastectomy to treat breast cancer is lymphedema. Lymphedema is the collection of fluid in the soft tissues of the arm, caused by the damage or removal of lymph nodes. In a radical mastectomy, the entire breast is removed, along with underlying muscle and lymph nodes under the arms.

The nurse is preparing to administer bevacizumab to a client to treat cervical cancer. Which assessment finding should the nurse recognize as a side effect of this medication? Hypotension Epistaxis Myalgia Constipation

Epistaxis Rationale: Angiogenesis inhibitors, such as bevacizumab, can cause side effects like headaches, dizziness, or syncope. Clients may also experience infusion reactions or exfoliative dermatitis. Other common side effects include abdominal pain, anorexia, nausea, vomiting, or diarrhea. The nurse should also plan to monitor for the development of heart failure, hypertension, venous thromboembolism, thrombocytopenia, leukopenia, and increased risk of infections. Additional side effects include dyspnea, epistaxis, hemoptysis, and vaginal bleeding. Finally, bevacizumab can potentially cause gastrointestinal perforation and bleeding, as well as wound dehiscence.

The nurse is monitoring a client receiving a platelet transfusion for treatment of thrombocytopenia secondary to chemotherapy. Which assessment finding should cause the nurse to immediately stop the infusion and notify the healthcare provider? Urinary hesitancy Desquamation Tinnitus Hypotension

Hypotension Rationale: Side effects of blood transfusions include transfusion reactions, which can be life-threatening. One of the most dangerous transfusion reactions is transfusion-associated circulatory overload, referring to a form of pulmonary edema occurring when clients get large product volumes in a short time, and transfusion-related acute lung injury, which can lead to fever, chills, and respiratory distress. Another dangerous reaction is acute hemolytic transfusion reaction which usually occurs when a blood product is given to an incompatible client and manifests as fever, chills, flank pain, leakage from the injection site, and decreased hematocrit. Sepsis can also occur when a transfused product contains a pathogenic microorganism causing fever, chills, and hypotension; and anaphylactic transfusion reactions, which include allergic reactions like angioedema, wheezing, and/or hypotension. Blood products can also cause an urticarial transfusion reaction, referring to hives with no allergic findings; febrile non-hemolytic transfusion reactions, manifesting as generalized fever, sometimes with chills, but no other systemic symptoms; and lastly, primary hypotensive reactions, which is a sudden drop in blood pressure that is caused by the transfusion and returns to normal or baseline when the transfusion is stopped. This mainly occurs during platelet transfusions. Other possible side effects of blood products include diseases transmitted from the donor, such as HIV or hepatitis viruses, and bacterial contamination. In addition, citrate toxicity, or electrolyte imbalances such as hyperkalemia and hypocalcemia, can occur. Finally, some clients, especially those getting a transfusion of multiple units of blood, can develop iron overload.

The nurse is educating a client newly diagnosed with lung cancer about their condition. Which information should the nurse include in the teaching? Lung cancer is a type of lymphoma that primarily originates in the lymph nodes of the lungs. Lung cancer is a malignant tumor that primarily originates in the lungs or, less often, from another organ. Lung cancer is a sarcoma that originates in the lungs but may also spread from another organ. Lung cancer is a type of leukemia that can affect the lungs as well as other organs.

Lung cancer is a malignant tumor that primarily originates in the lungs or, less often, from another organ. Rationale: Lung cancer is a malignant tumor that primarily originates in the lungs, or less frequently, can originate in another organ and spread to the lungs through metastasis. Unfortunately, lung cancer is one of the most common and aggressive types of cancer.

The nurse is performing the assessment of a client diagnosed with leukemia. Which assessment finding should the nurse report to the primary healthcare provider immediately? Weight gain of one pound in one week Heart rate 90/min and pale skin Blood pressure 116/80 mmHg New onset of crackles at the base of the lungs

New onset of crackles at the base of the lungs Rationale: A new onset of crackles at the base of the lungs could indicate infection in the lungs. Clients with leukemia are at an increased risk of respiratory, urinary, or integumentary infections due to the reduction of white blood cells. Clients are placed in neutropenic precautions to prevent infections, so indications of a new infection should be reported to the primary healthcare provider.

The nurse is caring for a client following a cold knife conization procedure for the treatment of cervical cancer. Which of the following symptoms should the nurse prioritize assessing this client for? Pain Fecal incontinence Hematuria Dysuria

Pain rationale: Following a cold knife conization procedure, the nurse should perform a pain assessment, including the onset, quality, severity, location, aggravating or relieving factors, and how frequently they experience pain. The nurse should assist clients into a comfortable position, provide comfort measures, and administer analgesics as prescribed. If the client's pain is unrelieved with medication, report these findings to the healthcare provider.

A client comes to the oncology clinic after having a breast biopsy that confirms breast cancer. Which finding related to breast cancer should the nurse anticipate? Sagging breasts Palpable mass Breast symmetry Low breast density

Palpable Mass Rationale: An expected finding for some clients with breast cancer is a palpable mass. Masses can be found during self-examination of the breast or during a breast examination by a practitioner. In some clients, a palpable mass is the first indication of breast cancer.

The nurse is caring for a client with a small localized tumor in the right lung. Which treatment should the nurse educate the client on? Resection of the nearby lymph nodes Partial lung resection Lobectomy Pneumonectomy

Partial lung resection Rationale: Treatment for lung cancer depends on its aggressiveness and extension. Small, localized tumors can be treated with partial resection, which is when the affected lung area is surgically removed. Clients with larger tumors may require a lobectomy, or removal of the tumor's lung lobe, and perhaps require a pneumonectomy or surgical removal of the entire lung. Also, any involved nearby lymph nodes should be resected. In addition to surgery, clients could be treated with chemotherapy, immunotherapy, or radiotherapy. Finally, metastatic lung cancers cannot be surgically resected, so they are often treated with a combination of therapies and palliative care to decrease their symptoms and improve their quality of life.

The admitting nurse is completing documentation for a client admitted with leukemia. The policy on the unit is to 'chart by exception'. Based on this information, which documentation is an exception that should be charted by the nurse? Bilateral pedal pulses 3+ Equal pupillary reaction to light bilaterally Bilateral capillary refill of less than 2 seconds Petechiae on bilateral arms

Petechiae on bilateral arms Rationale: Petechiae are small, pin-point dots that are visible on the skin in clients with bleeding disorders or leukemia due to low platelet counts and are not findings that are within normal limits. Petechiae should not be identified in a normal skin assessment. Charting by exception means that the nurse should only chart abnormal data.

The oncology nurse is caring for a client newly diagnosed with non-small cell lung cancer who is receiving radiation treatment. Which assessment is the nurse's priority? Respiratory status Characteristic of the sputum Tumor, Node, Metastasis (TNM) classification Pain

Respiratory status Rationale: The priority nursing goals for clients with lung cancer are to optimize oxygenation and respiratory status; provide care related to treatments, and provide comfort and emotional support to promote quality of life. The nurse should first begin by assessing vital signs, including pulse oximetry, and the client's respiratory status, which includes breathing patterns and breath sounds. The nurse should make note of flared nostrils, and the use of accessory breathing muscles. Also, nurses should assess for the presence of a cough and sputum quality and character as well as review the assigned Tumor, Node, Metastasis (TNM) classification of the tumor. Findings to report to the healthcare provider include decreased or absent breath sounds, rapid or shallow breathing, stridor, asymmetric diaphragmatic movement, cyanosis, or hemoptysis. The nurse should assist the client into Fowler's position and provide supplemental oxygen as ordered. Next, the nurse should assess client pain, including the onset, quality, severity, location, aggravating or relieving factors, and how frequently they experience pain. The nurse must report to the healthcare provider if the client reports chest pain, especially occurring with inspiration; a feeling of fullness, tightness, or pressure in the chest. Lastly, the nurse should be sure to provide comfort measures and administer the prescribed analgesics.

The nurse is preparing to provide a client with information about the prevention of lung cancer. Which topic should the nurse include when discussing primary prevention? Smoking cessation Sputum cytology test Chest X-ray Abstinence from alcohol

Smoking cessation Rationale: Primary prevention refers to implementing an intervention before a disease, such as lung cancer, develops. Smoking cessation is an example of primary prevention of a disease. Secondary prevention refers to screening a client to identify an existing disease. Secondary interventions include a sputum cytology test, computed tomography (CT) scan, and chest x-ray.

The nurse is assessing a client before initiating their first chemotherapy treatment for squamous cell lung carcinoma. Which assessment finding indicates their condition is worsening? Weight loss Malaise Night sweats Tightness in the chest

Tightness in the chest Rationale: Clinical manifestations of lung cancer vary based on the size and location of the tumor and whether or not it secretes hormones. Initially, clients can be completely asymptomatic. Over time, the body mounts an immune response to fight the tumor off, so clients may start experiencing unintentional weight loss, fever, malaise, and night sweats. Signs and symptoms of worsening lung cancer include any chest pain, especially occurring with inspiration, or a feeling of fullness, tightness, or pressure in the chest.

The post anesthesia care unit (PACU) nurse is caring for a client who underwent a radical mastectomy of the left breast. Which finding should the nurse immediately report to the healthcare provider? Small amount of serosanguineous drainage on dressing Unequal bilateral arm circumference Blood pressure 122/78 mmHg Oxygen saturation 97% on room air

Unequal bilateral arm circumference Rationale: For clients who are post-operative from a mastectomy, arm circumference should be monitored. An increasing circumference on the affected side may indicate lymphedema or deep vein thrombosis.

The nurse is caring for a client newly diagnosed with melanoma. Which priority treatment should the nurse anticipate reviewing with the client? Immunotherapy Wide surgical excision Application of topical imiquimod Radiation therapy

Wide surgical excision Rationale: The treatment of skin cancer can be grouped into surgical and non-surgical options. The treatment of choice is typically surgical excision of the lesion, which can be done layer by layer or through cryosurgery, curettage, and electrodesiccation. For melanoma, wide surgical excision of the surrounding normal tissue is required to reduce the risk of recurrence. When surgery cannot be performed for any reason, non-surgical therapies can be useful, including topical medications like imiquimod and fluorouracil, as well as chemotherapy, radiation therapy, and immunotherapy.

4. The nurse is monitoring a patient who has received a second course of chemotherapy. Which of these are indications of an oncologic emergency? (Select all that apply.) a. A new and persistent cough b. Constipation c. Bleeding gums d. A swollen tongue e. Nausea and vomiting

a. A new and persistent cough c. Bleeding gums d. A swollen tongue

8. The day before a third round of chemotherapy, the nurse reads that a patient's neutrophil count is 1650 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. The chemotherapy will be started as scheduled. b. The chemotherapy will be given at a lower dosage. c. The oncologist will order a neutrophil transfusion to be given first. d. The chemotherapy will not be given today.

a. The chemotherapy will be started as scheduled.

1. A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? Select all that apply. a. Rinse the mouth with commercial mouthwash twice a day. b. Clean the mouth with a soft-bristle toothbrush and warm saline solution. c. Use lemon-glycerin swabs to keep the mouth moist. d. Keep dentures in the mouth between meals. e. Rinse the mouth with water every 2 hours while awake.

b. Clean the mouth with a soft-bristle toothbrush and warm saline solution. e. Rinse the mouth with water every 2 hours while awake.

6. The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills

b. Fever d. Sore throat e. Chills

2. The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction. b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c. Provide antiemetic medications only upon the request of the patient. d. Hold fluids during chemotherapy to avoid vomiting.

b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins.

4. A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which potential problem is the highest priority at this time? a. Extreme fatigue b. Risk for infection c. Changing body image d. Reduced physical mobility

b. Risk for infection

2. During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity

c. Cardiomyopathy

3. The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for which of these? a. Severe weakness and fatigue b. Elevated body temperature c. Decreased skin turgor d. Excessive bleeding and bruising

d. Excessive bleeding and bruising