Exam 4
The nurse is reviewing heparin infusion therapy and pertinent laboratory values to monitor with the nursing student. Which statement by the student indicates that teaching has been effective?
"Partial thromboplastin time assesses for therapeutic effect of heparin."
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client?
"You need to consult with the health care provider (HCP) before receiving immunizations."
true teaching facts about osteosarcoma
-"The femur is the most common site of this sarcoma." -"Limping, if a weight-bearing limb is affected, is a clinical manifestation." -x"The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
When assessing a lesion diagnosed as basal cell carcinoma, the nurse most likely expects to note which findings? Select all that apply.
-A pearly papule with a central crater and a waxy border -Location in the bald spot atop the head that is exposed to outdoor sunlight
The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse anticipate the physician to most likely prescribe? Select all that apply.
-Elevation of the right leg -Administration of acetaminophen -Application of moist heat to the right leg -Monitoring for signs of pulmonary embolism
interventions for alopecia
-Excessive brushing and electric appliances on the hair may hasten hair loss once chemotherapy is started -Cutting the hair short before starting the chemotherapy helps the client to gradually adapt to the loss.
rules for cyclophosphamide
-Hemorrhagic cystitis is an adverse effect -drink copious amounts of fluid during the administration of this medication -monitor urine output for hematuria. -taken on an empty stomach, unless gastrointestinal upset occurs. -Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake.
The nurse is teaching the client about risk factors for skin cancer. Which statements by the client indicate that teaching was successful? Select all that apply.
-I have to avoid excessive exposure to sunlight -I am at higher risk for skin cancer because my mother had one
discharge teaching for cancer
-avoid plants/fruits -practice good hygiene -increased protein, calorie, and calcium -return to school 6mos-year
The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply.
-early menarche -Family history of breast cancer -High-dose radiation exposure to chest -Previous cancer of the breast, uterus, or ovaries
The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply.
-easy brushing occurs -gum bleeding occurs -it is hereditary bleeding disorder -treatment and care are similar to hemophilia -the disorder causes platelets to adhere to damaged endothelium
venous insufficiency s/s
-edema of the legs -darkened skin -pain/heaviness -itchy -cramps
The health care provider (HCP) prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply.
-encourage coughing and deep breathing -encourage increased oral intake of water daily -place thigh length elastic stockings on
Hodgkins s/s
-enlarged lymph nodes -reed Sternberg cells
A postpartum client with deep vein thrombosis is being treated with anticoagulant therapy. The nurse teaches the client that the health care provider (HCP) should be contacted for which noted side and adverse effects? Select all that apply.
-epistaxis -hematuria -ecchymosis
The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply.
-facial edema in the morning -serum calcium level of 12 -Numbness and tingling of the lower extremities
febrile reaction
-fever -chills -tachycardia -tachypnea -anxiety
The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record are associated with this diagnosis? Select all that apply.
-fever -weight loss -night sweats -enlarged, painless lymph nodes
◦The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client? Select all that apply.
-four to six small easy to eat meals a day -stop activity if SOB or palpitations occur -allow others to perform care during periods of fatigue -drink small quantities of protein shakes and nutritional supplements daily -take a bath every other day -space activities out every hour
The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply.
-increase in serum calcium level -decrease in LDL levels
what to monitor for after bone marrow is harvested
-infection -bleeding -anesthesia complications
when does decreased platelet aggregation occur
-infectious mononucleosis -idopathic thrombocytopenia purpura -acute leukemia -von willebrands disease
s/s of PE
-inspiratory chest pain -dry cough -hemoptisis -tachycardia -dizziness/syncope -sudden SOB/chest pain
A client returns to the clinic for follow-up treatment following a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that melanoma has which characteristics? Select all that apply.
-lesion is highly metastatic -Lesion is a nevus that has changes in color.
facts about hemophilia A
-males inherit from mom -females inherit carrier status from dad -X chromosome
teaching with doxorubicin/cyclophosphamide
-mouth ulcers may occur -blood in urine contact HCP = hemorrhagic cysts
interventions for warfarin
-no enemas -hard soled shoes -avoid hard foods
interventions for transfusions
-normal saline - blood -4 hours MAX
meds for nausea and vomitting
-odansatron -fenergin
s/s of anemia
-pale -fatigue -beefy tongue -SOB
The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply.
-pathological fracture -urinalysis positive for nitrates -serum creatinine of 2.0
◦The nurse includes which factors in teaching regarding the typical warning signs of cancer? Select all that apply.
-persistant constipation -scab for 6 months -axillary swelling
A 14-year-old child is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. She is receiving a combination chemotherapeutic regimen that includes cyclophosphamide. The nurse plans care understanding that which are associated with this medication? Select all that apply.
-platelet sparing -causes hemorrhagic cystitis -causes bone marrow suppression -increased fluid intake is necessary
risk factors for venous thromboembolism
-prolonged immobility -central venous catheter -surgery -obesity -advanced age -hx of thromboembolism -smokinh -pregnancy -estrogen therapy -heart failure -stroke -cancer
A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote client safety? Select all that apply.
-provide client with a soft toothbrush -instruct client to use an electric razor -monitor all secretions for frank or occult blood
A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply.
-radiation -chemotherapy -Serum sodium level determination -Medication that is antagonistic to antidiuretic hormone
characteristics of Hodgkins disease
-reed Sternberg cells -lymph nodes, spleen and liver are involved -prognosis depends on stage of the disease
when is thrombolytic therapy contraindicated
-risk of uncontrolled bleeding -uncontrolled hypertension
example warning signs of cancer
-scab for 6 mos -axillary swelling -persistant constipation
The nurse is teaching a group of adults about the warning signs of cancer. Which signs and symptoms should the nurse mention to the group? Select all that apply.
-sores that do not heal -nagging cough or hoarseness -indegestion or difficulty swallowing -change in bowel or bladder habits
what to do if an adverse reaction occurs during a transfusion
-stop transfusion always stay in room for first 15m or 50cc of transfusion maintain the line with normal saline
A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method?
-subq -intravenous
signs of PE
-sudden chest pain -SOB -confusion
interventions for pain in babies
-swaddle -distractions -cluster care -skin to skin -pacifier
You're educating a patient's family member about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the family member require you to re-educate them about how this medication works? Select all that apply:
-this medication will dissolve the clot -This medication starts working immediately after the first dose."
virchows triad
-venous stasis -vessel wall damage -hypercoagable state
The nurse is preparing to administer phytonadione to the client. Which laboratory value should the nurse monitor in order to evaluate the effectiveness of the medication?
prothrombin time
The nurse is reviewing the laboratory test results for a client who takes 325 mg of acetylsalicylic acid, or aspirin, daily and has been having frequent nosebleed episodes. What blood level should the nurse review?
prothrombin time
lab test to assess the therapeutic effect for warfarin
prothrombin time (PT)
◦When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
providing oral care with a disposable mouth swab
A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as an indicator that the client is experiencing complications of this therapy?
tarry stools obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood.
◦The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements?
therapy with warfarin is effective when the INR is between 2 and 3
A health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason?
to increase the therapeutic response
A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication?
uric acid level
◦A client with thrombocytopenia is being discharged. Which instruction would the nurse include in a teaching plan for this client?
use a soft bristled toothbrush
•Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include:
using good hand washing
Which statement describes the cause of venous insufficiency?
valves in the veins of the legs become incompetent
Warfarin (Coumadin) is an anticoagulant. What family of anticoagulant medications does this drug belong to?
vitamin K antagonist
The nurse provides instructions regarding home care to the parents of a 3-year-old child hospitalized with hemophilia. Which statement, if made by the parent, indicates a need for further instructions?
we will avoid having our child receive immunizations
when is HIT suspected
whenever platelet count falls below normal <100,000
A client brought to the emergency department states that he has accidentally been taking 2 times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action?
Draw a sample for prothrombin time (PT) and international normalized ratio (INR).
The nurse is providing home care instructions to the client who just had surgery for squamous cell carcinoma. The nurse provides follow-up teaching and explains to the client to watch for which characteristics of this type of skin carcinoma?
Firm, nodular lesion topped with a crust or with a central area of ulceration
A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client?
I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?"
The nurse is providing teaching to a client who will undergo chemotherapy for cancer, and alopecia is expected from the chemotherapeutic agent. Which statement made by the client indicates a need for further teaching?
I cant believe my hair loss will be permanent
The nurse is providing instructions to the mother of a 3-year-old child with hemophilia regarding care of the child. Which statement by the mother indicates a need for further teaching?
I need to cancel the upcoming dental appointment that I made for my child
A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription?
IV infusion of factor VIII
Which statement below BEST describes how Warfarin (Coumadin) works as an anticoagulant?
It stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form."
The nurse is caring for a 9-year-old child with leukemia who is hospitalized for the administration of chemotherapy. The nurse would monitor the child specifically for central nervous system involvement by checking which item?
LOC The central nervous system (CNS) status is monitored in the child with leukemia because of the risk of infiltration of blast cells into the CNS.
rules for timing transfusions
-2-4hrs monitor -vein -volume -age -preexisting conditions might have to infuse slower for heart failure patients
◦The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all that apply.
-avoid beef and processed meats -increase consumption of whole grains -eat colorful fruits and veggies
A client with liver cancer receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse should try to limit which food that is most likely to cause this taste for the client?
-beef -pork
Which interventions are the most appropriatefor a client who is experiencing thrombocytopenia? Select all that apply.
-check secretions for frank or occult blood -encourage fluid intake to avoid constipation -provide oral sponges or a soft toothbrush for oral care -NO MEDS INTRAMUSCULAR/SUBQ
hemolytic reaction
-chest pain -apprehension -lower back pain
teaching for venous thromboembolism
-discontinue birth control -drink a lot of water -regular exercise -graduated compression stockings
•A child is status post-hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.)
-high calcium diet -avoid live fruits/plants -practice good hygiene
allergic reaction
-increased anxiety -itching -rash -decreased BP
The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than how many cells/mm3?
<150,000
heparin induced thrombocytopenia HIT
administer protamine sulfate
A client who has a venous thromboembolism in the upper arm is to be started on oral warfarin (Coumadin) while still receiving an intravenous heparin infusion. What is the nurse's best action?
administer the medications as prescribed
The pediatric nurse educator is providing a teaching session to nursing staff about hemophilia. Which statement should the nurse educator include?
affected prepubescent girls should be counseled concerning menorrhagia, which may be life threatening
The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa. When should the nurse expect to note a therapeutic effect of this medication?
after 2 weeks of therapy
◦The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education?
after this therapy I will not need to have any more
med to prevent clot breakdown
aminocaproic acid
The nurse is caring for a chemotherapy client with a low platelet aggregation level. Which likely caused this decreased platelet production?
bone marrow suppression
myelosuppression
bone marrow suppression
biologics
boost immunity
internal radiation
brachytherapy seeds -sealed vs. unsealed
teaching with vincristine
can cause peripheral neuropathy -cannot give intrathecal route
◦The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
client with chemotherapy induced neutropenia who has just been admitted with an elevated temp
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?
continue to monitor the drainage
seven warning signs of cancer
C - change in bowel or bladder habits A - sore that does not heal U - unusual bleeding/discharge T - thick/lump I - indigestion/difficulty swallowing O - obvious change in wart/mole N - nagging cough/hoarseness
Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy?
Measure the client's current weight and height.
The nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. The nurse should check which diagnostic test noted in the client's record to determine the stage of the disease?
PET scan
◦Which symptom reported by a client who has had a total hip replacement requires emergency action?
SOB and chest pain
The nurse on the pediatric unit is caring for a child with hemophilia who has been in a motor vehicle crash. Which assessment finding, if noted in the child, indicates the need for follow-up?
The child is drowsy and difficult to arouse; previously the child was able to respond to questions effectively.
he nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity?
electrocardiogram changes
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency?
electrocardiographic changes
The nurse is creating a plan of care for a postpartum client who was diagnosed with superficial venous thrombosis. The nurse anticipates that which intervention will be prescribed?
elevation of the affected extremity
After a donor has bone marrow harvested, the nurse should monitor the donor for the following except?
fluid over load
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer?
hematuria
The pediatric nurse educator provides a teaching session to the nursing staff regarding hemophilia. Which statement regarding this disorder should the nurse plan to include in the discussion?
hemophilia A results from deficiency of factor VIII
A client is receiving oral anticoagulant therapy with warfarin. The result of a newly drawn prothrombin time (PT) is 40 seconds. The nurse should anticipate which prescription to be prescribed for this client?
hold the next dose of warfarin
filgrastrim
increased WBC
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder?
increased calcium level
Epoetin alfa
increases RBC
aprelvekin
increases platelets
first round of chemo
induction therapy 1-2wks -high risk for infection -high risk for bleeding
the nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care?
initiate bleeding precautions
A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription?
intravenous infusion of factor VIII
The nurse conducted discharge teaching for the client diagnosed with melanoma. Which statement by a client indicates that education was effective?
it is highly metastatic
•Nursing considerations related to the administration of chemotherapeutic drugs include:
many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates
A 2-year-old boy with a diagnosis of hemophilia is admitted to the hospital with bleeding into the joint of the right knee. Which intervention should the nurse plan to implement with this child?
measure the injured knee joint every shift
Which statement by a client causes the nurse to suspect peripheral venous insufficiency?
my legs swell when I stand for a long time
lab test to assess the therapeutic effect for heparin
partial thromboplastin time (PTT)
The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child?
partial thromboplastin time PTT
The nurse is caring for a client who is taking warfarin. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the health care provider (HCP) and ensures that which prescribed medication is available?
phytonadione (vitamin K)
◦A client is receiving unfractionated heparin (UFH) by infusion. Of which finding does the nurse notify the primary health care provider (PCP)?
platelets 32,000 this is HIT
◦The nurse is explaining the blood component platelets to an 8-year-old child with hemophilia. How should the nurse bestdescribe platelets to this child?
platelets help your body stop bleeding by forming a clot/scab over the bleeding area
The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding?
remove the rectal thermometer from the clients room
A nurse provides dietary instructions to a client who will be taking warfarin sodium. The nurse should tell the client to avoid which food item?
spinach
wilms tumor
starts in the kidneys, better prognosis -do not palpate abdomen or masses
anastrozole
stops the production of estrogen in postmenopausal women
external radiation
teletherapy skin irritation fatigue
The nurse monitors the client for which condition as a complication of polycythemia vera?
thrombosis polycythemia is a disorder that results in excessive production of WBCs, RBCs, and platelets
antidote for warfarin
vitamin K (phytonadione)
normal INR while on warfarin
2-3
A client in the postpartum unit complains of sudden, sharp chest pain. The client is tachycardic, and the respiratory rate is increased. The health care provider diagnoses a pulmonary embolism. Which actions should the nurse plan to take? Select all that apply.
-administer oxygen -assess BP -start IV line -prepare to administer morphine sulfate
transfusion reactions
-allergic -febrile -hemolytic
what anticipatory guidance would be most appropriate in order to help the parents promote their sons growth and development?
-put gate at the top of the steps -put gate at the bottom of the stairs -pad corners of hard tables -make certain that the child is supervised
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action?
Increase fluid intake to 2000 to 3000 mL daily.
The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease?
The disease occurs most often in those older than 75 years of age. ccur at any age but appears to peak in 2 different age groups: in teens and young adults and in adults in their 50s and 60s.
A client has been receiving a series of medications as part of intravenous antineoplastic therapy. The nurse should implement neutropenic precautions after noting which laboratory result for this client?
WBC count of 2,000
◦The nurse is reviewing the medical record of a client with pulmonary embolism (PE). What priority does the nurse set after reviewing the blood gas result below? pH 7.46, PaCO2 30 mm Hg, HCO3- 26 mEq/L (26 mmol/L), PaO2 62 mm Hg
apply oxygen
The nurse is preparing to administer an intramuscular (IM) injection to a client receiving a continuous heparin infusion. Which action should the nurse prepare to do?
apply prolonged pressure to the IM site after the injection
The nurse is performing a change-of-shift assessment on a client. The client had an arterial blood gas specimen drawn during an admission workup on the previous day and has a hematoma at the puncture site. What is the priority nursing intervention?
apply warm compress
Which assessment finding indicates that a client who had a mastectomy is experiencing a complication related to the surgery?
arm edema on the operative side
A pregnant client is seen in the health care clinic. During the prenatal visit, the client informs the nurse that she is experiencing pain in her calf when she walks. Which is the most appropriatenursing action?
assess for signs of venous thrombosis
A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action?
assist the client to shave using an electric razor
A 27-year-old client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time?
before menses
A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication?
broccoli
A client with medullary carcinoma of the thyroid has an excess function of the C cells of the thyroid gland. When reviewing the most recent laboratory results, the nurse should expect which electrolyte abnormality?
calcium
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
calcium level
The nurse is reviewing the laboratory and diagnostic test results of a 5-year-old child scheduled to be seen in the clinic. The nurse notes that the health care provider documented that diagnostic studies revealed the presence of Reed-Sternberg cells. The nurse prepares to assist the health care provider to discuss which initial procedure with the parents?
chemotherapy
A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium. The client's prothrombin time is 20 seconds, with a control of 11 seconds. How should the nurse interpret these results?
client results are within the therapeutic range The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at high risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds; therefore, the result is within the therapeutic range.
The nurse is reviewing the laboratory test results for a client with a diagnosis of thrombocytopenia purpura. The nurse should expect the results for platelet aggregation to be at which level?
decreased Decreased platelet aggregation may occur in persons with infectious mononucleosis, idiopathic thrombocytopenia purpura, acute leukemia, or von Willebrand's disease.
The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy?
decreased uric acid level
The home care nurse is providing safety instructions to the mother of a child with hemophilia. Which instruction should the nurse include to promote a safe environment for the child?
eliminate any toys with sharp edges from the childs play area
The nurse is caring for a client who is on strict bed rest and creates a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing?
encouraging active ROM exercises
The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan?
encouraging fluids
A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note in the client?
enlarged lymph nodes
low molecular weight heparin
enoxaparin
hyperuricemia
especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill.
•A child diagnosed with lymphoma is receiving extensive radiation therapy. The MOST common side effect of this treatment is:
fatigue
The nurse is monitoring a client who is receiving epoetin alfa for adverse effects of the medication. Which finding indicates a side/adverse effect?
hypertension
A client with leukemia is receiving busulfan and allopurinol. The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom?
hyperuricemia
The nurse is providing teaching for a client who will be discharged home to continue therapy with warfarin. Which statement by the client indicates a correct understanding of the teaching?
ill use a soft bristled toothbrush for my teeth
The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)?
inactivity
A client who has been diagnosed with cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason?
increase the destruction of tumor cells
A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. The nurse anticipates that which action is needed?
leaving the rate of the heparin infusion as is
◦The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first?
obtain blood cultures
◦Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?
ondansetron
A client with small cell lung cancer is being treated with etoposide. The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication?
orthostatic hypotension
The nurse is providing home care instructions to the mother of an infant who has just been found to have hemophilia. The nurse should tell the mother that care of the infant should include which appropriate measure?
pad crib rails and table corners
signs of internal hemorrhage
pain -rapid and weak pulse -increased abdominal girth -abdomen guarding change in mental status
The nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes?
painless and movable lymph nodes in the cervical area
The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's history?
pancreatitis
A client is being discharged to home with enoxaparin for short-term therapy. What should the nurse explain to the family about the medication action?
reduces the risk of DVT Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in clients at risk
reThe pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a need for further teaching of the pathophysiology of this disease?
reed sternberd cells are found on biopsy
◦The nurse is assessing several clients who are receiving transfusions of blood components. Which assessment finding requires immediate action by the nurse?
respiratory rate of 36 breaths/min in a client receiving red blood cells
The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse should plan which measure to treat this complication?
rinse the mouth out with diluted baking soda or saline
unsealed brachytherapy
secretions are radioactive
The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child?
swimming
The nurse provides education to the client about the primary purpose of neutrophils. Which statement by the client indicates successful teaching?
they engulf any potential foreign materials
A patient with acute myelogenous leukemia is starting chemotherapy. When teaching the patient about the induction stage of chemotherapy, what is an appropriate statement?
you will be at increased risk for bleeding and infection
A client has been hospitalized for removal of a cervical radiation implant used to treat cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instruction?
"Foul-smelling vaginal discharge is a sign of an infection." foul smelling discharge Is expected
A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response?
"Hair loss may occur, and it will grow back, but it may have a different color or texture."
The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information?
"The child does not experience pain at the primary tumor site."
Which risk factors increase a client's risk for venous thromboembolism that may progress to a pulmonary embolism? Select all that apply.
-age 72 -admission weight of 290lb -presence of a central venous catheter
Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement?
"This medication can be taken to prevent and treat clients with breast cancer."
side effects of chemo
-alopecia -GI disturbances -N/V -chemo brain -smell sensitivity -increased risk of infection -bone marrow suppresion -anorexia
◦The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? Select all that apply
-assess for fever -administer filgrastrim -do not permit fresh flowers or plants in the room -omit raw fruits and veggies from diet
◦The nurse is assessing a client with possible pulmonary embolism (PE). For which symptoms consistent with PE will the nurse assess? Select all that apply.
-dizziness and syncope -inspiratory chest pain -tachycardia
Which patients below are NOT candidates for Warfarin (Coumadin)? Select all that apply:
-A 45-year-old male patient with alcoholism and an active GI ulcer. -A 52-year-old male who needs a liver transplant
The nurse is preparing a client with thrombocytopenia for discharge. Which statement by the client about measures minimizing injury indicates that discharge teaching was effective?Select all that apply.
-I may continue to use an electric shaver -I will not blow my nose if I get a cold -I should use a soft bristled toothbrush to avoid mouth trauma
Warfarin (Coumadin) affects the formation of certain clotting factors. Select below ALL the clotting factors this medication affects:
-II -XII -IX -X
When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply.
-Keeping pregnant women out of the client's room -Placing the client in a private room with a private bath -Wearing a lead shield when providing direct client care
. Your patient was started on Warfarin (Coumadin) a week ago for the treatment of a DVT. Which findings below would indicate an adverse reaction to this medication? Select all that apply:
-Patient reports a severe and sudden headache -Melena -Hematuria -Coffee ground emesis -Bleeding gums
chemo drugs
-doxorubicin -cyclophosphamide -vincristine
moderate neutropenia
1000
normal PT
11-12.5 sec
mild neutropenia
1500
The nurse is monitoring the laboratory test results for a client who is taking warfarin sodium after mechanical heart valve replacement. The nurse should expect the international normalized ratio (INR) for this client to be at what value in order to be therapeutic?
3.0
severe neutropeniia
<500
The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted?
A platelet count of 50,000 mm3 (50 × 109/L)
A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results?
Activated partial thromboplastin time of 60 seconds
A client with chronic kidney disease is receiving epoetin alfa for the past 2 months. What should the nurse determine is an indicator that this therapy is effective?
An increase in serum hematocrit stimulated RBC production
The nurse is caring for a client who is receiving heparin sodium intravenously as a continuous infusion. Which laboratory finding requires immediate nursing intervention?
Platelet count of 100,000 mm3 (100 × 109/L) The platelet count indicates that the client receiving heparin sodium is at risk for heparin-induced thrombocytopenia (HIT). HIT should be suspected whenever platelet counts fall below normal. If severe thrombocytopenia develops (platelet count less than 100,000 mm3 [100 × 109/L]), heparin sodium should be discontinued.
antidote for heparin
protamine sulfate
The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result should the nurse expect in this child?p
prolonged PTT
The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism?
Blood pressure of 198/110 mm Hg Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding,
Enoxaparin sodium is prescribed for a client after hip replacement surgery. Which medication should the nurse anticipate to administer in the event of enoxaparin sodium overdose?
protamine sulfate
A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?
Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
The nurse is reviewing the laboratory test results and notes that the prothrombin time (PT) is 7.0 seconds. The nurse understands that this PT value would be noted in which condition?
DVT
A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding?
Decreased oozing of blood from puncture sites and gums
While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action?
Pick up the implant with long-handled forceps and place it in a lead container.
A child is scheduled for allogeneic bone marrow transplantation (BMT). The parent of the child asks the nurse about the procedure. The nurse should provide which description about the BMT?
Obtaining bone marrow from a donor who matches the child's tissue type
Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia?
Red blood cells that are microcytic and hypochromic
◦The nurse is caring for a group of clients on a medical surgical unit. For which of these individuals does the nurse provide immediate interventions to reduce the risk for pulmonary embolism (PE)?
a client returning from an open reduction and internal fixation of the tibia
the parents ask the nurse to explain the initial treatment for a child with hemophilia when the child gets hurt and has a bleeding episode?
administration of anti hemophilic factor AHF is done, followed by treatment of the specific injury
◦The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered?
allopurinol
A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution?
aminocaproic acid
The nurse is performing a skin assessment on a client diagnosed with malignant melanoma. The nurse should expect to note which characteristic of this type of skin lesion?an irregular
an irregular shaped lesion
The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure should the nurse expect to be prescribed for the child?
application of a bivalved cast for join immobilization
The nurse is caring for a client receiving combination chemotherapy. Which nursing intervention is the most appropriate?
avoid giving agents with the same nadirs and toxicities at the same time Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities.
A home care nurse is visiting a client who was discharged to home with a prescription for continued administration of enoxaparin subcutaneously. What is the nurse's priorityassessment for this client?
bleeding gums or bruising
A child is brought to the emergency department after falling from a high swing and landing on the back. The nurse notes that the client also has hemophilia. Based on the client's history and the nature of the injury, which should the nurse assess for first?
blood in the urine Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in the child with hemophilia
The nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student. Which intervention on the student written plan of care requires correction?
blood transfusion of packed RBCs Blood product transfusion is not the treatment of choice over administering recombinant factors intravenously.
A child is seen in the health care clinic for complaints of fever. On data collection, the nurse notes that the child is pale, tachycardic, and has petechiae. Aplastic anemia is suspected. The nurse should prepare the child to obtain which specimen that will confirm the diagnosis?
bone marrow biopsy
The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored?
bone marrow biopsy
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis?
bone marrow biopsy showing blast cells
Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
protamine sulfate
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment?
palpating the abdomen for a mass
The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child?
partial thromboplastin time (PTT)
◦Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
potential for injury related to sensory and motor deficits
A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data?
presence of hematuria
antidote for enoxaparin
protamine sulfate
allopurinol
decreases uric acid production -indicated in TLS
facts about hemophilia B
deficiency of factor IX
A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a prothrombin time (PT) of 35 seconds and an international normalized ratio (INR) of 3.5. On the basis of these laboratory values, the nurse anticipates which prescription?
holding the next dose of warfarin
The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem?
hyperuricemia
A client is being discharged on warfarin sodium, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided?
if I notice blood tinged urine I will call the HCP
◦The nurse is teaching a young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching?
if I wear pantyhose I won't have to wear the stockings the hospital gives me
when to notify HCP for anticoagulants therapy
if aPTT >70
The nurse is reviewing the laboratory results of a client admitted to the hospital with a diagnosis of venous thrombosis. The nurse expects the platelet aggregation to be reported as which level in this client?
increased Platelets usually aggregate in less than 5 minutes. This test determines abnormalities in the rate and percentage of platelet aggregation. Increased platelet aggregation may occur after surgery or with acute illness, venous thrombosis, and pulmonary embolism.
