Exam 2 Review
Which side effect occurs in patients undergoing radiotherapy and also in patients taking antineoplastic drugs?
alopecia
which are major systemic side effects of antineoplastic drugs? SATA
bone marrow supression N/V Alopecia
A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which vitamin or mineral?
Vitamin B12
Which normal cells are most sensitive to radiation? SATA
digestive and urinary tract linings lymph tissue ovaries testes Hair Follicle Bone Marrow
A patient receiving Adriamycin for treatment of cancer is experiencing signs of cardiomyopathy. Which finding should the nurse report to the health care provider?
dyspnea
The nurse is collecting data from a client who is admitted to the hospital for diagnostic studies to rule out the presence of Hodgkin's disease. Which question would the nurse ask the client to elicit information specifically related to this disease?
"Have you noticed any swollen lymph nodes?"
Which diagnostic procedure is used to detect cancers of the CNS, spinal column, neck bones, and joints?
MRI
The nurse has reinforced discharge instructions regarding home care to a client following a prostatectomy for cancer of the prostate. He is being discharged with an indwelling urinary catheter. Which statement by the client indicates a need for further teaching?
"I should use the leg bag when I am in bed during the night."
Nursing Actions to a Transfusion Reaction?
1. STOP the transfusion 2.Change the IV tubing down to the IV Site 3.Keep the IV open w/ NS 4.Notify the HCP and Blood Bank 5. Do not leave the pt alone (monitor VS and assess)
How often are VS monitored after receiving a blood transfusion?
30min-1hr
What is a normal WBC count?
4,500-11,000/ uL
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The nurse prepares to initiate neutropenic precautions when the nurse notes which laboratory result?
A white blood cell (WBC) count of 2000 cells/mm3.
Which blood type is the universal recipient?
AB
The nurse is reinforcing instructions to a group of adults about the seven warning signs of cancer. The nurse determines that a member of the group needs further teaching if the member states which sign/symptom is a warning sign?
Absence or decreased frequency of menses
A client with sickle cell disease has been admitted to the hospital complaining of a sudden onset of severe pain in the extremities, abdomen, back, and chest. Which interventions would the nurse expect to be included in the care of the client? Select all that apply.
Administer oxygen per nasal cannula. Administer the prescribed opioid analgesic. Encourage the client to keep extremities extended. Hydrate the client with 0.9% normal saline 125 mL/hr intravenously.
The highest rate of death from all cancers occur among?
African Americans
When can the flow of a blood transfusion be increased?
After 15 minutes if no transfusion reaction has occured
When working with a patient who has an internal radiation source, safety precautions include which of the following? SATA
Always wear a lead apron when providing direct care to the patient No pregnant visitors or staff should enter the patients room. The patient must be in a private room
What is the second most common cause of death in the US?
Cancer
Side effects of Procarbazine (Matulane)
May cause HTN if eating foods rich in tyramine
Which test would the nurse expect to have done for a client suspected of having pernicious anemia?
Schilling test
Side effects of Doxorubicin (Adriamycin)
Toxic effects on the heart that may lead to HF
Which blood type is the universal donor?
Type O
The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast?
Under the left shoulder
A client with which type of cancer is at greatest risk for experiencing the complication vena cava syndrome?
lung cancer
Which tumor is malignant?
melanoma
Side effects of Vincristine (Oncovin)
neurotoxicity resulting in numbness and tingling of extremities
Which patient should be placed in a private room?
pt with internal radiation
Regardless of the site treated with radiation therapy, which two common side effects occur?
skin changes fatigue
A treatment likely to be curative when tumors are confined in one area is?
surgery
What is the effect on cells and tissue when DNA of a normal cell is exposed to a carcinogen and irreversible changes occur in the DNA?
the cell appear abnormal but continues to function normally
Stage III Tumor
the tumor is larger or has spread from the site of origin into nearby tissues or both; regional lymph nodes are likely to be involved
Stage II Tumor
there is limited spread of the cancer in the local area, usually to nearby lymph nodes
A patient asks why she is receiving a CSF as part of her cancer treatment. Which replies by the nurse are accurate? SATA
these stimulate the production of WBCs by the bone marrow these reduce the risk of anemia that commonly occur with chemo
Invasive procedures are minimized in patients with?
thrombocytopenia
The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication that may become a chronic problem related to the surgery?
Arm edema on the operative side
The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. Besides treatment of the lung cancer, the nurse anticipates that which interventions may be prescribed to treat the SIADH? Select all that apply.
Initiate safety measures Frequently monitor sodium blood levels Gather data about the neurological status frequently Administer medication that is antagonistic to ADH
A drug that boosts the body's natural defenses to combat malignant cells is?
Interferon
Septicemia s/s
Blood that is contaminated with microorganisms: Rapid onset of chills, high fever, vomiting, diarrhea, hypotension, and shock
What is a normal RBC count?
Females: 4.2-5.2 x 10^6/uL Males: 4.7-6.1 x 10^6/uL
Side effects of Dexamethasone (Decadron)
Fluid retention
The nurse is caring for a client receiving chemotherapy and determines that the client has developed myelosuppression. Which laboratory value would support the client's diagnosis of myelosuppression?
Hemoglobin 9.4 g/dL, hematocrit 26%
Which type of antineoplastic drugs are frequently used in chemotherapy? SATA
Hormones Mitotic Inhibitors alkylating agents antitumor antibiotics biologic response medication
A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?
Malignant proliferation of plasma cells and tumors within the bone
A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?
Monitor the client for bleeding
Which are warning signs of cancer? SATA
Nagging cough and hoarseness change in bowel or bladder habits sores that do not heal change in warts or moles
The nurse is assisting in developing a postoperative plan of care for a client following a right mastectomy. Which interventions will be included in the plan of care? Select all that apply.
Place the right arm on a pillow. Monitor the right arm for edema. Check the incision for approximation. Monitor and measure drainage in the Jackson-Pratt drain. Place a notation: "No intravenous (IVs), blood draws, or blood pressure readings in right arm."
The nurse would monitor for which laboratory result as indicating an adverse reaction in the client who is receiving chemotherapy?
Platelet count 20,000 mm3
The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action? Select all that apply.
Apply pressure on the radiated area to prevent bleeding. Avoid standing within 6 feet of persons under the age of 18 years.
To monitor the patients who are taking antineoplastic drugs, the nurse must be aware that the most dangerous adverse effect is?
Bone marrow suppression
Radiation has immediate and delated effects on cells; the immediate effect is?
Cell death
The nurse is assisting in planning care for a client with Hodgkin's disease who is neutropenic as a result of radiation and chemotherapy. Which actions would be included in the client's plan of care? Select all that apply.
Monitor white blood cell counts daily., Ensure meticulous hand washing before caring for the client., Ask visitors with respiratory infection symptoms to not visit the client.
What is the only thing that can be used in conjunction with blood?
Normal Saline
The nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling. The nurse would take which appropriate action?
Notify the registered nurse immediately.
A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs additional study if the student states that which is an associated characteristic?
Occurs most often in older adults
The nurse is reinforcing instructions to a group of female clients about breast self-examination (BSE). When would the nurse instruct the pre-menopausal client to perform this examination?
One week after menstruation begins
The nurse has conducted dietary teaching with the client diagnosed with iron deficiency anemia. The nurse determines that the client understands the information if the client states the intention to increase intake of which foods? Select all that apply.
Oysters Spinach Kidney beans
The nurse is caring for a client with an internal radiation implant. The nurse would observe which principles? Select all that apply.
Pregnant women are not allowed into the client's room. Wear a lead apron while delivering bedside care to the client.
Benign and Malignant Tumors are alike in that both?
Press on normal tissues and compete with normal cells for nutrients
The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a suprapubic prostatectomy. The nurse would reinforce which discharge instruction? Select all that apply.
Take the prescribed stool softener every day. Avoid lifting objects heavier than 20 pounds for 6 weeks.
A patients blood level of the oncofetal antigen CA125 has continued to rise during 6 months of chemotherapy for ovarian cancer. What is the most likely explanation?
The cancer is continuing to grow despite chemotherapy
Stage I tumor
The malignant cells are confined to the tissue of origin; there is no invasion of other tissues
The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding would the nurse expect to note with this diagnosis?
Increased calcium level
The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy?
Increased uric acid level
The nurse is doing discharge teaching with a client who has sickle cell disease. The nurse reinforces instructions to the client to avoid which factors that could precipitate a sickle cell crisis? Select all that apply.
Infection, emotional stress
Circularly overload s/s
Infusion of blood too rapid for the client to tolerate: cough, dyspnea, CP, headache, hypertension, tachycardia, bounding pulse, distended neck vein, wheezing
The nurse working in an obstetrical-gynecological primary health care provider's office is instructing a small group of premenopausal female clients about breast self-examination (BSE). Which instruction would the nurse reinforce as the first step to begin the BSE?
BSE begins with inspection of the breast standing before a mirror.
Immediate transfusion Reaction s/s?
Chills, diaphoresis, aches, chest pain, rash, hives, itching, swelling, dyspnea, cough, wheezing, or rapid, thready pulse
A patient with cancer is c/o n/v associated with chemotherapy. Which food and beverages should the nurse recommend for this patient? SATA
Clear Broth White Rice Crackers or pretzels Yogurt
The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods? Select all that apply.
Lean beef and chicken liver Clams and mussels
Which of the following describes the action of BRMs?
Promote the bodys natural defenses against cancer cells
A client with lung cancer receiving chemotherapy tells the nurse that the food on the meal tray tastes "funny." Which is the appropriate nursing intervention?
Provide oral hygiene care frequently.
The nurse is caring for a client with thrombocytopenia. Which data would the nurse monitor for related to this condition? Select all that apply.
Pupura Ecchymoses Platelet count less than 150,000mm^3
A client has experienced several episodes of sickle cell crisis. Which reinforced instructions would be included in the client's teaching plan to prevent recurrence? Select all that apply.
Recognize early symptoms of infection and contact the primary health care provider (PHCP). Wear shoes and socks when walking outside to prevent damage to the feet.
Which food sources would the nurse include in the discharge teaching plan of a client with vitamin B12 deficiency anemia? Select all that apply.
Red Meats Eggs Liver
Compromised host precautions may be needed for patients with?
leukopenia
The nurse is caring for a client with a suspected diagnosis of aplastic anemia. Which test would the nurse anticipate to be performed to confirm the diagnosis?
Bone marrow aspiration
A client is admitted to the hospital with vitamin B12 deficiency. When taking the client's history, which symptoms would the nurse expect the client to report? Select all that apply.
Difficulty in walking Numbness in hands Muscle Weakness
A patient is receiving radiation treatment to her head and neck. which is a special problem for this patient, putting her at risk for infections of the gums and teeth?
Dry mouth (xerostomia)
A cancer patient has had the lower abdomen irradiated. Which is a priority nursing activity for this patient?
increase fluid intake and have pt empty bladder often
A client has just been told by the primary health care provider about her diagnosis of breast cancer. The client responds, "Oh no, does this mean I'm going to die?" The nurse interprets which response as the client's initial reaction?
fear
When is the most critical time to monitor the pt after receiving a blood transfusion?
First 15 min
Adverse effects of radiation therapy commonly affect the bone marrow, hair follicles, and GI tract. What makes these tissues especially sensitive to the effects of radiation?
These tissues regenerate rapidly
The nurse is caring for a client with a diagnosis of aplastic anemia. Which are the most likely signs/symptoms associated with aplastic anemia? Select all that apply.
Fatigue Petechiae SOB Infection
The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which signs and symptoms of the client are associated with Hodgkin's disease? Select all that apply.
Fatigue Weakness Night Sweats Enlarged lymph nodes
Due to damage to the most sensitive cells during radiation therapy, which are related side effects of therapy? SATA
Bone marrow supression Alopecia Anorexia N/V
Iron Overload s/s
Complication that occurs in clients who receive multiple blood transfusions: vomiting, diarrhea, hypotension, altered hematological values
The nurse is developing a teaching plan for a client following a radical mastectomy and includes measures that will assist in preventing lymphedema of the affected arm. The nurse would include which interventions when reviewing instructions with the client to prevent this complication? Select all that apply.
Elevate the affected arm on a pillow higher than the heart. Instruct the client to perform simple arm exercises in the affected arm daily. Inspect the arm daily and notify the primary health care provider of redness or swelling.
The nurse is caring for a client after a mastectomy. Which nursing interventions would assist with preventing lymphedema of the affected arm? Select all that apply.
Elevating the affected arm on a pillow above heart level Taking no blood pressure measurements in the affected arm
Signs of Transfusion Reactions
Tachycardia Itching (Uticaria/skin rash) Wheezing, dyspnea, tachypnea Anxiety Flushing/fever Back Pain
Which condition would the nurse identify as the cause of a client's aplastic anemia?
Failure of the bone marrow to produce blood cells
The nurse is teaching a class on healthy living. Select the dietary recommendations believed to reduce the risk of some cancers that should be included in the lesson plan? SATA
Limited alcohol consumption High Fiber, low fat, and low calories A variety of fruits and vegetables Limited smoked and nitrate preserved foods
The licensed practical nurse (LPN) is assisting the registered nurse (RN) to create a teaching plan for the client receiving an antineoplastic medication. The LPN expects which information to be included? Select all that apply.
Maintain oral hygiene and inspect the mouth for sores daily Consult with the PHCP before receiving immunizations Rinse mouth after meals using a soft toothbrush
The nurse is assisting in caring for a client receiving chemotherapy. On review of the morning laboratory results, the nurse notes that the white blood cell count is extremely low, and the client is immediately placed on neutropenic precautions. The client's breakfast tray arrives, and the nurse inspects the meal and prepares to bring the tray into the client's room. Which action would the nurse take before bringing the meal to the client?
Remove the fresh orange from the breakfast tray.
A chemical, viral, or radioactive substance that can cause cancer is called?
carcinogen
