Hematological and Oncological Disorders

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? 1. Eat a high-protein diet 2. Avoid exposure to sunlight 3. Wash the skin with a mild soap and pat dry 4. Apply pressure on the radiated area to prevent bleeding

Apply pressure on the radiated area to prevent bleeding

A nurse is taking care of a 72 year old female patient diagnosed with chronic lymphocytic leukemia, the patient requires additional teaching when she states: A) A family history of chronic lymphocytic leukemia. B) "B symptoms" are fevers, night sweats, and weight gain. C) Early treatment does increase survival rate. D) I will have an increased risk of bacterial infections requiring IV antibiotics.

B) "B symptoms" are fevers, night sweats, and weight gain.

A child with a diagnosis of leukemia is being discharged after beginning chemotherapy. Which of the following should be included in the discharge teaching for the parents? Please choose from one of the following options. A. Maintain good oral hygiene by vigorous brushing and flossing B. Take a rectal temperature at the same time every day C. Provide small, bland meals throughout the day D. Serve the child fresh fruits and vegetables with every meal

C.

During the induction phase of chemotherapy for acute lymphoblastic leukemia (ALL) the patient experiences tumor lysis syndrome. Which of the following metabolic disturbances can occur because of tumor lysis syndrome? Please choose from one of the following options. A. Hypercalcemia B. Hypokalemia C. Hyperuricemia D. Hypoglycemia

C.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient's visitors bring in some fresh peaches from home. b. The patient ambulates several times a day in the room. c. The patient uses soap and shampoo to shower every other day. d. The patient cleans with a warm washcloth after having a stool.

A Rationale: Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

In non-Hodgkin's lymphoma, the involved cell in 90% of cases is the A. B lymphocyte. B. T lymphocyte. C. Reed-Sternberg cell. D. neutrophil.

A. B lymphocyte

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 cells/mm^3. On the basis of this laboratory valuem, the nurse should collect which data as a priority? 1. Temperature 2. Lung sounds 3. Status of skin turgor 4. Level of consciousness

Level of consciousness

A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire? a. ""Have you noticed a change in sleeping habits recently?"" b. ""Have you had a respiratory infection in the last 6 months?"" c. ""Have you lost weight recently?"" d. ""Have you noticed changes in your alertness?""

Answer B is correct. The client with leukemia is at risk for infection and has often had recurrent respiratory infections during the previous 6 months. Insomnolence, weight loss, and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections are the primary clinical manifestations; therefore, answers A, C, and D are incorrect.

A patient would need further education about Non Hodgkin's lymphoma by which statement? a. I'm at an increased risk for Non Hodgkin's lymphoma due to exposure of the Epstein Barr Virus b. Reed Sternberg cells are present c. The exact cause is unknown d. Since I am a male I am at a higher risk for Non Hodgkin's lymphoma

Answer: B- Reed Sternberg cells are present Explanation: Reed Sternberg cells are NOT present in Non Hodgkin's lymphoma, they're found in Hodgkin's Lymphoma. You are at an increased risk for Non Hodgkin's lymphoma if you have had exposure to the Epstein Barr Virus, and if you are a male The exact cause of Non Hodgkin's lymphoma is unknown

A patient has been diagnosed with acute lymphoblastic leukemia (ALL). Based on this diagnosis, which of the following will most likely be evident in the patient's history? Please choose from one of the following options. A. Hepatitis C infection B. Down syndrome C. Epstein-Barr virus infection D. Philadelphia chromosome

B.

A client has developed oral mucositis as a result of radiation to the head and neck. The nurse shouls teach the client to incorporate which of the following measures in his or her daily home care routine? a) oral hygiene should be performed in the morning and evening b) high-protein foods, such as peanut butter, should be incorporated in the diet c) a glass of wine per day will not pose any further harm to the oral cavity d) a combination of a weak saline and water solution should be used to rinse the mouth before and after each meal

"2) D Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa as well as provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent."

A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the patient's needs? "1. Encourage activities with other patients in the day room. 2. Isolate him from visitors and patients to avoid infection. 3. Provide a diet high in Vitamin C 4. Provide a quiet environment to promote adequate rest.

"Correct: D. 1. does not meet need for rest 2. no info given about WBC or reverse isolation, on reverse isolation if neutrophil count is less than 500/mm3 3. needed for wound healing and resistance to infection, not best choice 4. primary problem activity intolerance due to fatigue. Correct"

The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis? 1. Night sweats and fever without "chills." 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal.

*1. Clients with Hodgkin's disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early-stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom.* 2. Lymph node enlargement with Hodgkin's disease is in the neck area. 3. Malaise and stomach complaints are not associated with Hodgkin's disease. 4. Pain in the neck area at the site of the cancer occurs in some clients after the ingestion of alcohol. The cause for this is unknown. TEST-TAKING HINT: The test taker must notice the descriptive words, such as "groin" and "fatty," to decide if these options could be correct.

Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? 1) Presence of a mediastinal mass 2) Late CNS leukemia 3) Normal WBC count at diagnosis 4) Disease presents between age 2 and 10

1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer to diagnosis not prognosis.

Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? 1) Presence of a mediastinal mass 2) Late CNS leukemia 3) Normal WBC count at diagnosis 4) Disease presents between age 2 and 10

1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer to diagnosis not prognosis.

A client with carcinoma of the lung develops SIADH as a complication of cancer. The nurse anticipates that the HCP will request which prescriptions? SATA 1) Radiation 2) Chemotherapy 3) Increased fluid intake 4) Decreased oral sodium intake 5) Serum sodium level determination 6) Medication that is antagonistic to antidiuretic hormone

1, 2, 5, 6. CA is a common cause of SIADH, in which excess amts of water are absorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia, and some degree of fluid retention. Syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are closely monitored bc hypernatremia can develop suddenly dt treatment. The immediate institution of appropriate CA therapy, usually radiation or chemo, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

The home health care nurse is caring for a client with cancer who is c/o acute pain. The most appropriate determination of the clients pain should include which assessment? 1) The clients pain rating 2) Nonverbal cues from the client 3) The nurses impression of the clients pain 4) Pain relief after appropriate nursing intervention

1. Clients self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurses impression is not appropriate in determining pain. Assessing pain relief is an important measure, but this option is not r/t the subject of the question.

The nurse is reviewing the lab results of a client dx with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1) Incr Ca levels 2) Incr WBC 3) Decr BUN 4) Decr number of plasma cells in the bone marrow

1. Findings indicative of multiple myeloma are increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by release of Ca from deteriorating bone tissue, and elevated BUN. Incr WBC count may or may not be present, and is not r/t multiple myeloma.

Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin's disease? 1. The client's reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client's menstrual cycle.

1. This is a false promise. Many clients undergo premature menopause as a result of the cancer therapy. *2. The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the cancer can cause cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to be a precursor to leukemia. A developing fetus would be subjected to the internal conditions of the mother.* 3. Some clients—but not all—do become sterile. The client must understand the risks of therapy, but the nurse should give a realistic picture of what the client can expect. It is correct procedure to tell the client the nurse does not know the absolute outcome of therapy. This is the ethical principle of veracity. 4. The therapy may interfere with the client's menses, but it may be temporary. TEST-TAKING HINT: Option "3" can be eliminated on the basis that it says "all" clients; if the test taker can think of one case where "all" does not apply, then the option is incorrect.

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan? A. Fluid overload (overhydration) B. Hemorrhage C. Hypoxia D. Infection

Correct answer D The main objective in caring for a newly diagnosed client with leukemia is protection from infection.

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching? 1. "I will handle this area gently" 2. "I will wear loose-fitting clothing" 3. "I will avoid the use of deodorants" 4. "I will limit sun exposure to 1 hour daily"

I will limit sun exposure to 1 hour daily

A client with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client? A. "Avoid large crowds." B. "Drink at least 2 liters of fluid per day." C. "Elevate your lower extremities when sitting." D. "Use a soft-bristled toothbrush."

Correct answer D Using a soft-bristled toothbrush reduces the risk for bleeding in the client with thrombocytopenia.

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1) Restrict all visitors 2) Restrict fluid intake 3) Teach the client and family about the need for hand hygeine 4) Insert an indwelling urinary catheter to prevent skin breakdown.

3. Meticulous hand hygeine education is implemented for the client, family, visitors and staff in neutropenic clients. Not all visitors are restricted, but client is protected from persons with known infections. Fluids should be encouraged. Invasive measures s/a urinary catheters should be avoided to prevent infections.

The nurse is monitoring a client for s/s r/t SVC syndrome. What is an early sign of this oncological emergency? 1) Cyanosis 2) Arm edema 3) Periorbital edema 4) Mental status change

3. SVC syndrome occurs when the SVC is compressed or obstructed by tumor growth. Early s/s generally occur in the morning and include edema of the face and eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worses, the client experiences edema of the hands and arms. Cyanosis and mental status change are late signs.

As part of chemo education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1) "I should avoid blowing my nose" 2) "I may need a platelet transfusion if my platelet count is too low" 3) "Im going to take aspirin for my headache as soon as I get home" 4) "I will count the number of pads and tampons I use when menstruating"

3. During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000. The correct option describes an incorrect statement by the client. Aspirin and NSAIDs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2 and 4 are correct statements by the client to prevent and monitor bleeding.

A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102 F or higher D. Wheezes or crackles

Correct answer D Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.

When reviewing the laboratory results of a child with leukemia, the healthcare provider notes that the child is also anemic. Which statement provides the best rationale for this problem? Please choose from one of the following options. A. The increased number of lymphocytes is destroying the red blood cells at a rapid rate B. Chemotherapy-induced osteoporosis has caused decreased erythropoiesis C. The overproduction of immature white blood cells occurs at the expense of other cells D. The child has a poor appetite and has not been consuming adequate dietary iron

C.

A client is admitted to the hospital with a suspected diagnosis of Hodgkins disease. Which assessment finding would the nurse expect to note specifically in the client? 1) Fatigue 2) Weakness 3) Weight gain 4) Enlarged lymph nodes

4. Hodgkins disease is a chronic progressive neoplastic disorder of lymphoid tissue c/b painless enlargement of lymph nodes with progression to extralymphatic sites, s/a spleen and liver. Weight loss is more likely to be noted. Fatigue and weakness may occur but are not significantly r/t the disease.

Which of the following description is most consistent with chronic myelogenous leukemia (CML)? Please choose from one of the following options. A. Pronounced splenomegaly and lymphadenopathy B. An increase in reticulocytes C. A translocation between two genes D. 10% blast cells in the bone marrow aspirant

C.

When 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? 1) call the HCP 2) Reinsert the implant into the vagina 3) Pick up the implant with gloved hands and flush it down the toilet 4) Pick up the implant with long-handled forceps and place it in a lead container.

4. If a radiation implant dislodges, the nurse would first encourage the client to lie still until the source has been placed in a safe closed container. The nurse would use a long-handled forceps to place the source in the lead container that should be in the client's room. The nurse should then call the radiation oncologist, document the event and actions taken. Out of scope of practice to reinsert.

The nurse is caring for a client with AML what is the most important information to teach the client and the clients family? 1. Teach the client and the family how to rate pain using the number scale. 2. Teach the client to eat fresh fruits and veggies daily. 3. Teach the client to exercise frequently. 4. Teach the client and the family about the need for hand hygiene.

4. Teach the client and the family about the need for hand hygiene.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? A. Multiple myeloma B. Thrombocytopenia C. Megaloblastic anemia D. Myelodysplastic syndrome

A. Multiple myeloma R: Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

Which clinical manifestations are most consistent with Chronic Myeloid Leukemia? A. Splenomegaly and Lymphadenopathy B. Weight gain and anemia C. Genetic Testing- translocation between two genes no effect on the blast cells D. Sudden onset of SOB and high BP

A. Splenomegaly and Lymphadenopathy An enlarged spleen and lymph nodes are commonly seen with CML due to excess white blood cell storage in these organs. Fatigue and night sweats will also often accompany these manifestations.

A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment? a. The client collects stamps as a hobby. b. The client recently lost his job as a postal worker. c. The client had radiation for treatment of Hodgkin's disease as a teenager. d. The client's brother had leukemia as a child.

Answer C is correct. Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in twins than in siblings.

A nurse begins her shift by reviewing her patient's electrolyte values after receiving report from the previous nurse. Labs: Na = 127 mEq/L Mg = 1.5 mg/dl Cl = 100 mEq/L Ca = 11.3 mg/dl Which electrolyte imbalance is a priority for the nurse to monitor in this patient suspected of having multiple myeloma and why?

Ca = 11.3 mg/dl is hypercalcemia; hypercalcemia can be indicative of bone issues and malignancies

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? A. Leukapheresis B. Attaining remission C. One chemotherapy agent D. Waiting with active supportive care

B. Attaining remission R: Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

What is the gold standard for the diagnosis of Non-Hodgkin's lymphoma? A. CBC - This shows variation in lab values but is not a definitive diagnosis. B. Biopsy - This is the definitive diagnosis and types protein markers. C. CT scan - This can be used to stage the lymphoma. D. History and Physical - This provides information on the patient but does not a guarantee a diagnosis.

B. Biopsy - This is the definitive diagnosis and types protein markers.

A 42 year old male presents to the E.D. following a weekend getaway to Vegas. He states when out at a pool party he has increased pain in his groin, neck, and under arm. He admits to drinking ETOH but denies illicit drug use. He states he has been extremely tired for the past few month and has night sweats. Upon assessment vitals are 124/76 BP, pulse 72, RR 18, 98% spo2 on room air, and a temp of 100.3 degrees Fahrenheit. Physical exam reveals swollen lymph nodes. The nurse would expect a diagnosis of which of the following: A. Human Immunodeficiency Virus infection B. Hodgkin's Lymphoma C. Avian Influenza D. Chlamydia infection

B. Hodgkin's Lymphoma

A nurse is caring for a client with chronic lymphocytic leukaemia, with an elevated WBC and a new prescription for Rituximab (Rituxan). For which of the following adverse effects should the nurse monitor? A.Hypoglycemia B. Hyperglycemia C. Hypercalcemia D. Hyperphosphatemia

B. Hyperglycemia

What are the risk factors for the development of leukemia? Select all that apply. A. Bone marrow hypoplasia B. Chemical exposure C. Down syndrome D. Ionizing radiation E. Multiple blood transfusions F. Prematurity at birth

Correct answers A,B,C,D A. Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. B. Exposure to chemicals through medical need or by environmental events contributes to the development of leukemia. C. Certain genetic factors contribute to the development of leukemia. Down syndrome is one such condition. D. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, contributes to the development of leukemia.

A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? A. Administer prescribed enoxaparin (Lovenox). B. Insert two 18-gauge IV catheters. C. Monitor the patient?s temperature every 2 hours. D. Check stools for presence of frank or occult blood.

D. Check stools for presence of frank or occult blood.

Which finding would you recognize as an indicator of chronic myelogenous leukemia (CML)? A. Presence of an abnormal LE cell B. Numerous immature lymphoblasts C. An elevated white blood cell count D. Presence of the Philadelphia chromosome

D. Presence of the Philadelphia chromosome R: CML is caused by excessive development of mature neoplastic granulocytes in the bone marrow. The excess neoplastic granulocytes move into the peripheral blood in massive numbers and ultimately infiltrate the liver and spleen. These cells contain a distinctive cytogenetic abnormality, the Philadelphia chromosome, which serves as a disease marker and results from translocation of genetic material between chromosomes 9 and 22.

The nurse is explaining treatment options of multiple myeloma to a newly diagnosed patient. Which statement by the patient represents an understanding of the available treatments and outcomes? a. " Chemotherapy and radiation will cure my disease" b. "No treatment is needed if I don't have any symptoms" c. "Stem cell transplants alone will cure me" d. "A combination of therapies will be needed to cure me"

b. "No treatment is needed if I don't have any symptoms" Regular visits with your physician and monitoring of your disease are all that is required if you have no signs or symptoms. Should you develop signs and symptoms, you and your physician may decide to begin treatment.

A nurse is receiving report on a recently admitted 4-year-old male patient with acute lymphocytic leukemia (ALL). Based on the pathophysiology of the cancer, what would the most important nursing diagnosis be while treating this patient? a. Imbalanced Nutrition: Less than body requirements b. Risk for Infection c. Acute pain d. Impaired Skin Integrity

b. Risk for Infection is the most important nursing diagnosis because patients with ALL are at higher risk of infection due to the overproduction of immature WBCs. Immature WBCs are not developed enough to fight off pathogens.

A nurse is assessing a newly admitted client with thrombocytopenia. Which factor needs immediate intervention? A. A nosebleed B. Reports of pain C. Decreased urine output D. Increased temperature

Correct answer A The client with thrombocytopenia has a high risk for bleeding. The nosebleed should be attended to immediately.

The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which is a priority in nursing interventions for the client? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

Encouraging fluids

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which finding should the nurse most likely expect to find documented in the clients record? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes

Enlarged lymph nodes

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding would provide information about the massive cell destruction that occurs with the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

Increased uric acid level

The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)-year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is the same as for the general population. 4. Have the client talk with the family about funeral arrangements.

*1. The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly.* 2. Follow-up appointments should be at least yearly. 3. The client's risk for developing cancer has increased as a result of the therapies undergone for the lymphoma. 4. This client is in remission, and death is not imminent. TEST-TAKING HINT: The test taker should look at the time frames in the answer options. It would be unusual for a client to be told to have a checkup every five (5) years. Option "4" can be eliminated by the stem, which clearly indicates the client is progressing well at the five (5)-year remission mark.

Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hemoglobin of 10 g/L b. WBC count of 1700/µl c. Platelets of 65,000/µl d. Serum creatinine level of 1.2 mg/dl

B Rationale: Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.

The healthcare provider is caring for a patient with acute myelogenous leukemia (AML). Which of the following best describes the characteristics of this type of leukemia? Please choose from one of the following options. A. The function of T-cells and B-cells is adversely affected B. Examination of peripheral blood will show excessive myeloblasts C. Mature leukocytes are transformed into immature cells D. Leukocytes undergo increased differentiation

B.

The client with carcinoma of the lung develops the syndrome of inappropriate intidiuretic hormone (SIADH) as of complication of the cancer. The nurse anticipates that which may be prescribed to treat this complication? Select all that apply 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Serum sodium blood levels 5. Decreased oral sodium intake 6. Medication that is antagonistic to antidiuretic hormone (ADH)

Radiation, Chemotherapy, Serum blood glucose levels, and Medication that is antagonistic to antidiuretic hormone (ADH)

The nurse is assisting with developing a plan of care for a client who is experiencing hematological toxicitiy as a result of chemotherapy. The nurse should suggest including which int he plan of care? 1. Restricting all visitors 2. Restricting fluid intake 3. Restricting fresh fruits and vegetables in the diet 4. Inserting an indwelling urinary catheter to prevent skin breakdown

Restricting fresh fruits and vegetables in the diet

Which statement is correct about the rate of cell growth in relation to chemotherapy? 1. Faster growing cells are less susceptible to chemotherapy. 2. Nondividing cells are more susceptible to chemotherapy. 3. Faster growing cells are more susceptible to chemotherapy. 4. Slower growing cells are more susceptible to chemotherapy.

"Answer 3 The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as the begin active cell division."

Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.

1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes used to monitor the progress of the treatment of Hodgkin's disease, but ESR levels can be elevated in several disease processes. *4. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin's disease.* TEST-TAKING HINT: The test taker can eliminate the first three (3) answer options on the basis these tests give general information on multiple diseases. A biopsy procedure of the involved tissues is the only procedure that provides a definitive diagnosis.

The nurse is caring for a client who is postoperative following a pelvic exenteration and the HCP changes the clients diet from NPO to clear liquids. The nurse should check which priority item before administering the diet? 1) Bowel sounds 2) Ability to ambulate 3) Incision appearance 4) Urine specific gravity

1. Client is NPO until peristalsis returns, usually in 4-6 days. When signs of bowel fx return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. Most important is to assess bowel sounds before feeding. Options 2, 3, 4 unrelated to the data in the question.

The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1) "I change my pouch every week" 2) "I change the appliance in the morning" 3) "I empty the urinary collection bag when it is two-thirds full" 4) "When I'm in the shower I direct the flow of water away from my stoma"

3. The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.

The nurse manager is teaching the nursing staff about s/s r/t hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign of the oncological emergency? 1) headache 2) dysphagia 3) constipation 4) ECG changes

4. Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. ECG changes include shortened ST segment and a wide T wave.

A patient has recently been diagnosed with leukemia. Which of the following symptoms would a health care professional expect to see given this diagnosis? Please choose from one of the following options. A. Bruising, fatigue, and bone pain B. Bradycardia, hypotension, and palpitations C. Paresthesia, facial rash, and abdominal pain D. Dyspnea, malaise, and hypotension

A.

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? A. Petechiae, fever, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

"Answer A is Correct. Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia."

Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder.

1. Long-term steroid use suppresses the immune system and has many side effects, but it is not the highest risk for the development of lymphoma. 2. This client would be considered to be in late-stage breast cancer. Cancers are described by the original cancerous tissue. This client has breast cancer that has metastasized to the lymph system. *3. Clients who have received a transplant must take immunosuppressive medications to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients.* 4. A neurogenic bladder is a benign disease; stent placement would not put a client at risk for cancer. TEST-TAKING HINT: To answer this question, the test taker must be aware of the function of the immune system in the body and of the treatments of the disease processes.

The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes.

1. The scan detects abnormalities in the lymphatic system, not the vascular system. *2. Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days.* 3. Cardiac angiograms are performed through the femoral or brachial arteries and are completed in one session. 4. The test takes 30 minutes to one (1) hour and then is repeated at intervals. TEST-TAKING HINT: The test taker must be aware of diagnostic tests used to diagnose specific diseases. Options "1" and "3" could be eliminated because of the words "vascular" and "cardiac"; these words pertain to the cardiovascular system, not the lymphatic system.

When caring for a client with an internal radiation implant, the nurse should observe which principles? SATA 1) Limiting time with client to 1 hr per shift 2) Keep pregnant women out of client's room 3) Place client in private room with private bath 4) Wearing a lead shield when providing direct client care 5) Removing the dosimeter film badge when entering the client's room 6) Allowing individuals younger than 16yo in the room as long as they are 6ft away from client.

2, 3, 4 The time the nurse spends is 30m per 8 hr shift. The client must be in a private room with a private bath. The nurse should wear a lead shield to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client's room. Children younger than 16 and pregnant women are not allowed in the client's room.

A client is diagnosed with multiple myeloma and the client asks the nurse about the dx. The nurse bases the response on which description of this disorder? 1) Altered RBC production 2) Altered production of lymph nodes 3) Malignant exacerbation in the number of leukocytes 4) Malignant proliferation of plasma cells within the bone

4. Multiple Myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3 describes the leukemic process.

A 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 lack of understanding of the pathophysiology of this disease? 1. Normal bone marrow is replaced by blast cells 2. Red blood cell production is affected 3. the platelet count is decreased 4. the presence of a reed-sternberg cell is found on biopsy

4. Reed-sternberg Cell is found in Hodgkins

Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? a. The NA assists the patient to use dental floss after eating. b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. c. The NA adds baking soda to the patient's saline oral rinses. d. The NA puts fluoride toothpaste on the patient's toothbrush.

A Rationale: Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

The health care provider is assessing a patient undergoing induction chemotherapy for acute myelogeneous leukemia (AML). Which of the following would be the most definitive sign of infection in this patient? Please choose from one of the following options. A. A temperature of 100.5 F B. A left shift noted in the complete blood count (CBC) C. Swollen lymph nodes D. Redness and swelling at the central line insertion site

A.

The patient with a diagnosis of leukemia has been admitted for observation. Which of the following assessments requires immediate intervention? Please choose from one of the following options. A. A temperature of 100.4 F B. Loss of 1 kg (2.2 pounds) over 4 days C. Pale, dry mucous membranes D. A complaint of fatigue

A.

After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Acute confusion related to infiltration of leukemia cells into the central nervous system b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

C Rationale: The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.

A nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? A. "After this therapy, I will not need to have any more." B. "I will need to avoid people with a cold or flu." C. "I will probably lose my hair during this therapy." D. "The goal of this therapy is to put me in remission."

Correct answer A Induction therapy is not a cure for leukemia, it is a treatment.

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks, "What should I say to her?" Which responses does the nurse suggest? Select all that apply. A. "Ask her how she is feeling." B. "Ask her if she needs anything." C. "Tell her to be brave and to not cry." D. "Talk to her as you normally would when you haven't seen her for a long time." E. "Tell her what you know about leukemia."

Correct answers A,B,D A. This is a broad general opening and would be nonthreatening to the client. B. This is a therapeutic communication of offering self and would be considered to be therapeutic and helpful to the client. D. There is no need to act differently with the client. If she wants to offer her feelings, keeping a normal atmosphere facilitates that option. Acting as if things are "different" because she has cancer takes the control of the situation from the client.

A 56-year-old man is admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. He is started on an antiviral agent. What are serious side effects of antiviral agents? Select all that apply. A. Cardiomyopathy B. Nephrotoxicity C. Ototoxicity D. Stroke

Correct answers B,C Antiviral agents, although helpful in combating severe infection, have serious side effects, especially nephrotoxicity and ototoxicity.

After a client with a potential diagnosis of leukemia is admitted to the hospital, the nurse should assess for which of the following? (Select all that apply.) A. Reports of fatigue and weakness B. An elevation in the leukocytes, especially neutrophils C. Signs of bruising easily D. Recent weight gain

"Correct: A, C ANSWER: Reports of fatigue and weakness Signs of bruising easily Rationale: General manifestations of leukemia result from anemia, infection, and bleeding. The client would complain of fatigue and weakness and show signs of bruising. Leukemic cells replace normal hematopoietic elements preventing the formation of mature leukocytes. Neutrophil count would be decreased. Because of an increased metabolism, weight loss may occur. Strategy: It is important to read every word in the question. Do not speed-read."

The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? 1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year.

*1. Up to 90% of clients respond well to standard treatment with chemotherapy and radiation therapy, and those who relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis.* 2. Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's disease because of the expected prognosis with standard therapy. 3. Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred. TEST-TAKING HINT: The test taker must have a basic knowledge of the disease process but could rule out option "2" on the basis of the word "investigational."

The patient receiving chemotherapy is experiencing stomatitis. The healthcare provider should offer the patient: Please choose from one of the following options. A. Frequent oral care with a commercial mouthwash B. Warm saline rinses four times each day C. Hot soup for lunch and dinner D. Plenty of ice chips between meals

B.

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action? 1. Call the health care provider (HCP) 2. Reinsert the implant into the vagina 3. Pick up the implant with gloved hands and flush it down the toilet 4. Pick up the implant with long-handled forceps and place into a lead container

Pick up the implant with long-handled forceps and place into a lead container

The nurse is caring for a client with an internal radiation implant. The nurse would observe which principle? 1. Pregnant women are not allowed into the clients room 2. Limit the time with the client to 1 hour per 8-hour shift 3. Remove the dosimeter badge when entering the clients room 4. Individuals less than 16 years old are allowed in the room if they stay 6 feet away from the client

Pregnant women are not allowed into the clients room

A recently diagnosed Hodgkin's Lymphoma patient is admitted to inpatient surgical unit for scheduled lymphadenectomy. Which of the following assessments requires immediate intervention by the nurse. A. Temperature of 100.3 degrees Fahrenheit (37.9 degrees Celsius) B. Weight loss of 2.2 lbs (1 kg) in 4 days. C. Pale, dry mucous membranes. D. Increased fatigue when mobile.

A. Temperature of 100.3 degrees Fahrenheit (37.9 degrees Celsius)

The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is most appropriate? A. "Why do you say that? Do you think that you could have prevented this?" B. "This must be a difficult time for you and your family. Would you like to talk about how you are feeling?" C. "You shouldn't feel that you could have prevented the cancer. It is not your fault." D. "Many children are diagnosed with cancer. It is not always life-threatening."

"Answer B Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

Priority nursing actions when caring for a hospitalized patient with new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately.

A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately. R: Early identification of an infective organism is a priority, and samples for cultures should be obtained from various sites. In the febrile, neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, and the blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment (or vital signs) requires a call to the physician to order additional cultures, diagnostic tests, and antimicrobial therapies.

A 68- year old male recently diagnosed with Chronic Myeloid Leukemia (CML) calls in to the clinic stating he missed his last dose of his Tyrosine Kinase Inhibitor. What should the nurse instruct the patient to do? A. Double the next dose to make up for the missed medication B. Take the missed dose as soon as possible as long as it isn't almost time for the next dose C. Immediately go to the nearest Emergency Room D. Skip the dose and resume as scheduled tomorrow

B. Take the missed dose as soon as possible as long as it isn't almost time for the next dose. Tyrosine Kinase Inhibitor drugs target the abnormal protein produced by the oncogene found in CML cells, so it is very important for patients to take these exactly as prescribed. Any missed doses should be taken as soon as possible.

A patient comes into the ED with pain and says she was recently diagnosed with cancer but was unsure of the name, she states that she was told that it was a bone marrow cancer that was fast growing and grows in the WBC's. What kind of cancer would you suspect in the patient? A. Chronic Myeloid Leukemia (CML) B. Acute Lymphatic Leukemia (ALL) C. Acute Myeloid Leukemia (AML) D. Chronic Lymphatic Leukemia (CLL)

C. AML

A patient with acute myelogenous leukemia will soon start chemotherapy. When you are teaching the patient about the induction stage of chemotherapy, what is the best explanation? A. The drugs are started slowly to minimize side effects. B. You will develop even greater bone marrow depression with risk for bleeding and infection. C. It will be necessary to have high-dose treatment every day for several months. D. During this time you will regain energy and become more resistant to infection.

C. It will be necessary to have high-dose treatment every day for several months. R: The chemotherapeutic treatment of acute leukemia is often divided into stages. The first stage, induction therapy, is the attempt to induce or bring about a remission. Induction is aggressive treatment that seeks to destroy leukemic cells in the tissues, peripheral blood, and bone marrow in order to eventually restore normal hematopoiesis on bone marrow recovery. During induction therapy a patient may become critically ill because the bone marrow is severely depressed by the chemotherapeutic agents.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care? 1. Monitor closely for signs of infection 2. Monitor the temperature every 4 hours 3. Initate protective isolation precautions 4. Use soft small toothbrush for mouth care

Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care? 1. Monitor closely for signs of infection 2. Monitor the temperature every 4hours 3. Initate prptective isolation precautions 4. Use soft small toothbrush for mouth care

Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

The client is a 56-year-old man admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy? A. Bone marrow suppression B. Liver toxicity C. Nausea D. Stomatitis

Correct answer A This is a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The client is even more at risk for infection than before treatment was begun.

A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow? A. Administers intravenous (IV) corticosteroids before starting the transfusion B. Allows the platelets to stabilize at the client's bedside for 30 minutes C. Infuses the transfusion over a 15- to 30-minute period D. Sets up the infusion with the standard transfusion "Y" tubing.

Correct answer C The volume of platelets-200 or 300 mL (standard amount)-needs to be infused rapidly-over a 15- to 30-minute period.

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client's problem? A. "Ask your doctor to prescribe more medication." B. "It is too soon for additional medication to be given." C. "I'll turn on some soothing classical music for you." D. "Would you like to try some relaxation techniques?"

Correct answer D Because most clients with multiple myeloma have local or generalized bone pain, analgesics and alternative approaches for pain management, such as relaxation techniques, are used for pain relief. This also offers the client a choice.

A 5-year-old patient comes to the emergency room with a high fever, swollen lymph nodes, fatigue and dyspnea. The mother explained that she had brought the child in because she was worried he had the flu based on his symptoms. However, she also explained that the symptoms have been present for about 3 weeks now. Because of this the nurse is concerned that there is a more serious underlying problem such as acute lymphocytic leukemia, especially after finding some bruising on the child's arms. Which of the tests below can be used to diagnose acute lymphocytic leukemia - SELECT ALL THAT APPLY? a. CBC panel b. Bone marrow biopsy and/or aspiration c. Lymph node biopsy d. Uric acid level e. Leukocyte differential f. Bone scan

a, b, d, and e. In patients with ALL, a CBC will show anemia, thrombocytopenia and neutropenia. A bone marrow biopsy and/or aspiration will show proliferation of immature WBCs. It is common that uric acid levels be elevated in patients with ALL. A leukocyte differential can differentiate between the different types of leukocyte cells to determine increased level of immature WBCs.

The nurse is planning care for a client who has leukemia. Which intervention does the nurse include in the plan of care to prevent fatigue? a. Plan care for times when the client has the most energy. b. Schedule for daily physicals and occupational therapy. c. Arrange for a family member to stay with the client. d. Plan all activities to occur in the morning to allow for afternoon naps.

a. Plan care for times when the client has the most energy. R: With leukemia, energy management is needed to help conserve the client's energy. Care should be scheduled when the client has the most energy. This client may not have the most energy in the morning. If the benefit of an activity such as physical or occupational therapy is less than its worsening of fatigue, it may be postponed. The nurse should limit the number of visitors and interruptions by visitors, as appropriate.

The nurse is caring for a 20-year-old man who has Hodgkin's lymphoma in the abdominal and pelvic regions. The client is scheduled for radiation therapy and states, "I want to have children someday, and this procedure will destroy my chances." How does the nurse respond? a. "Adoption is always an option." b. "You have the option to store sperm in a sperm bank." c. "Infertility is not seen with this type of radiation therapy." d. "Sperm production will be permanently disrupted."

b. "You have the option to store sperm in a sperm bank." R: Permanent sterility can occur in male clients receiving radiation in the abdominal and pelvic regions. The client should be informed of this side effect and given the option to store sperm in a sperm bank before treatment. The other options do not appropriately address the client's concerns.

The registered nurse is assigning a practical nurse to care for a client who has leukemia. Which instruction does the registered nurse provide to the practical nurse when delegating this client's care? a. Evaluate the amount of protein the client eats. b. Perform effective hand hygiene frequently. c. Wear a mask when entering the room. d. Assess the client's roommate for symptoms of infection.

b. Perform effective hand hygiene frequently. R: A major objective in caring for the client with leukemia is protection from infection. Frequent handwashing is of the utmost importance. If at all possible, the client should be in a private room. Masks are worn by anyone who has an upper respiratory tract infection. The client may be on a "minimal bacteria diet." Protein is not a factor in this diet.

Mr. Jones goes to see his PCP today because his nagging back pain has suddenly become severe. He indicates that the pain is located on his spine. The PCP suspects that Mr. Jones has multiple myeloma, so he orders blood work and diagnostic tests to confirm what he suspects. Which of following two diagnostic tests confirm a positive result for multiple myeloma? a. Bun and Creatinine b. Urinalysis and Bone Marrow Biopsy c. AST and ALT d. MRI and Cheek Swab

b. Urinalysis and Bone Marrow Biopsy Rational: Urinalysis will show M proteins and the Bone Marrow Biopsy is the hallmark diagnostic criterion when it shows more than 10% plasma cells.

A nursing instructor is teaching students at a community health clinic about cancers that predominantly affect minorities. She classifies the risk based on age, gender and ethnic background. After finishing the lecture, the student nurses should recognize that which group is most at risk for multiple myeloma? a. Caucasian women over age 65 b. Asian men under age 60 c. African-American men over age 60 d. All persons are at an equal risk for Multiple Myeloma

c. African-American men over age 60 Rational: Men have a higher incidence than women, the risk of multiple myeloma increases with age; most people are diagnosed in their mid-60s. African American men are twice as likely to develop multiple myeloma as Caucasian men.

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma

c. hypercalcemia R: Bone degeneration in multiple myeloma causes calcium to be lost from bones, which eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause seizures, coma, and cardiac problems.

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that: a. Hodgkin's lymphoma occurs only in young adults b. Hodgkin's lymphoma is considered potentially curable c. non-Hodgkin's lymphoma can manifest in multiple organs d. non-Hodgkin's lymphoma is treated only with radiation therapy

c. non-Hodgkin's lymphoma can manifest in multiple organs R: Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease.

The nurse is planning discharge teaching for a client who has acute myelogenous leukemia (AML). Which instruction does the nurse include in this client's discharge plan? a. Refrain from intercourse. b. Use aspirin for headaches. c. Apply heat to any bruised areas. d. Avoid contact sports.

d, Avoid contact sports. R: Clients with AML have a low platelet count and are at risk for bleeding. Contact sports can cause bleeding and should be avoided by those with a low platelet count. Anal intercourse should be avoided, but it is not necessary to refrain from all types of intercourse. Ice should be placed on bruised areas instead of heat, and aspirin should not be used by those with a low platelet count.

Multiple myeloma is a form of hematologic cancer. A significant clinical manifestation of this disease is bone destruction. Which of following clinical manifestations can occur as a result of multiple myeloma? a. hypocalcemia b. hyperkalemia c. hypokalemia d. hypercalcemia

d. hypercalcemia (Calcium > 10.2 mg/dl); patient experiences excessive thirst, dehydration, constipation, confusion Rational: extensive bone destruction causes ionized calcium loss

Which of the following laboratory values could indicate that a child has leukemia? 1. WBCs 32,000/mm3 2. Platelets 300,000/mm3 3. Hemoglobin 15g/dL 4. Blood pH of 7.35

"Correct: 1. 1. YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high WBC count is diagnostic and is usually confirmed by a blood smear. 2-4. None of these indicate leukemia,"

The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is most appropriate? A. "Why do you say that? Do you think that you could have prevented this?" B. "This must be a difficult time for you and your family. Would you like to talk about how you are feeling?" C. "You shouldn't feel that you could have prevented the cancer. It is not your fault." D."Many children are diagnosed with cancer. It is not always life-threatening."

"Answer B Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

The nurse writes a nursing problem of "altered nutrition" for a client diagnosed withleukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication prior to meals 2. Monitor the client's serum albumin levels 3. Assess for signs and symptoms of infection 4. Provide skin care to irradiated areas

"Answer: 2 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal medication 2. Serum albumin is a measure of the protein content in the blood that is derived form food eaten; albumin monitors nutritional status 3. Assessment of the nutritional status is indicated for this problem, not assessment of the s/sx of infections. 4. This addresses an altered skin integrity problem"

What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? A. potential for injury B. self-care deficit C. potential for self harm D. alteration in comfort

"Answer: A potential for injury Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects, frequently assess for signs of bleeding, bruising, hemorrhage. "

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? A. advise the client to rest and avoid exertion B. prevent client exposure ot infections C. monitor the blood pressure frequently D. observe for increased bruising

"Answer: B Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding. Objective: Describe the major types of leukemia and the most common treatment modalities and nursing interventions."

When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: a.Discourage the use of stool softeners b.Assess temperature readings every six hours c.Avoid invasive procedures d.Encourage the use of a hard, brittle toothbrush

"Answer: C Rationale: Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to track in this patient"

A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.

"Correct Answer: A The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drug."

A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital for treatment. The nurse should assign the patient: A. To a private room so she will not infect other patients and healthcare workers B. To a private room so she will not be infected by other patients and healthcare workers C. To a semiprivate room so she will have stimulation during her hospitalization D. To a semiprivate room so she will have the opportunity to express her feelings about her illness

"Correct Answer: B A. To a private room so she will not infect other patients and health care workers — poses little or no threat B. To a private room so she will not be infected by other patients and health care workers — CORRECT: protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection C. To a semiprivate room so she will have stimulation during her hospitalization — should be placed in a room alone D. To a semiprivate room so she will have the opportunity to express her feelings about her illness — ensure that patient is provided with opportunities to express feelings about illness"

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

"Correct Answer: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to the foods that a patient will eat. Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading to eating fewer calories. Eating three large meals isn't possible for a patient on chemotherapy due to the decreased taste sensation. Liquid protein supplements should when needed but they lead to less eating during mealtimes due to feeling of satiation."

In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid leukemia (CLL), nursing measures should include: (Select all that apply.) A. Maintaining a clean technique for all invasive procedures. B. Placing the client in protective isolation. C. Limiting visitors who have colds and infections. D. Ensuring meticulous handwashing by all persons coming in contact with the client.

"Correct Answers: B, C, D Rationale: Chronic lymphoid leukemia (CLL) is characterized by a proliferation and accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood, and body tissues. Infections and fever are frequent complications of CLL."

A client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell count differential. 2. A large number of WBCs that decrease after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal.

"Correct answer is 1. 1. A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia."

The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: a. Motivate change in unhealthy lifestyles. b. Educate her about the seven warning signs of cancer. c. Instruct her about healthy stress relief and coping practices. d. Allow her to communicate about the meaning of this experience.

"Correct answer: D Rationale: While the patient is waiting for diagnostic study results, the nurse should be available to actively listen to the patient's concerns and should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears."

The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? 1.) Fever and infections. 2.) Nausea and vomiting. 3.) Excessive energy and high platelet counts. 4.) Cervical lymph node enlargement and positive acid-fast bacillus.

"Correct: 1. 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce WBCs of the number and maturity needed to fight infection (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit #4)."

A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, most appropriately would offer which of the following during this episode of nausea? 1. Cool, clear liquids 2. Low protein foods 3. Low-calorie foods 4. The child's favorite food

"Correct: 1. With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child is nauseated so he doesn't associate if with being sick. Support nutrition with oral supplements and foods high in proteins and calories"

The client diagnosed with leukemia has central nervous system involvement. Whichinstructions should the nurse teach? 1.Sleep with the head of the bed elevated to prevent increased intracranial pressure. 2.Take an analgesic medication for pain only when the pain becomes severe. 3.Explain that radiation therapy to the head may result in permanent hair loss. 4.Discuss end-of-life decisions prior to cognitive deterioration

"Correct: 3 1.Sleeping with the head of the bed elevatedmight relieve some intracranial pressure, but it will not prevent intracranial pressure from occurring.2.Analgesic medications for clients with cancer are given on a scheduled basis with a fast-acting analgesic administered PRN for break-through pain.3.Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. If the radiation therapy destroys the hair follicle, the hair will not grow back.4.Cognitive deterioration does not usually occur"

A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. Which diagnostic study would confirm this diagnosis 1. Platelet count 2. LUmbar puncture 3. bone marrow biopsy 4. wbc count

"Correct: 3. 3 leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or low in leukemia an altered platelet count occurs as a result of the disease but also may occur as a result of chemotherapy and does not confirm the diagnosis"

The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment data warrant immediate intervention? 1.T 99, P 102, R 22, and BP 132/68. 2.Hyperplasia of the gums. 3.Weakness and fatigue. 4.Pain in the left upper quadrant.

"Correct: 4 1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni-toring at intervals, but they do not indicate animmediate need. 2.Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency. 3.Weakness and fatigue are symptoms of thedisease and are expected. 4.Pain is expected, but it is a priority, andpain control measures should be imple-mented."

The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? A. Take the hourly vital signs on a client receiving blood transfusions. B. Monitor the infusion of antineoplastic medications. C. Transcribe the HCP's orders onto the Medication Administration Record. D. Determine the client's reponse to the therapy.

"Correct: A. Explanation: A. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse. B. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. C. This is the responsibility of the word secretary or the nurse, not the unlicensed personnel. D. This represents the evaluation portion of the nursing process and cannot be delegated."

Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic 2. Morphine, a narcotic analgesic 3. Epogen, a biologic response modifier 4. Gleevec, a genetic blocking agent

"Correct: C 1. Because of the ineffective or nonexistent WBCs characteristic of leukemia, the body cannot fight infections, and antibiotics are given to treat infections. 2. Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the drug of choice for most clients with cancer. 3. Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the BCR-ABL protein, preventing the cells from growing and dividing."

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? A. Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary."

"Correct: C 3. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. 1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. 2. Infiltration and extravasations are always a risk, especially with peripheral veins. 4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Level of cognitive ability: Analysis Area of client needs: Physiologic Integrity/Pharmacologic and Parenteral Therapy Integrated process: Teaching/Learning; Nursing Process: Implementation"

Which client statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option? A. "I don't feel strong enough, but my wife said she would help." B. "I was a nurse, so I can take care of myself." C. "I will have lots of medicine to take." D. "We live 5 miles from the hospital."

Correct answer B Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own. The client must be emotionally stable to be a candidate for this type of care.

What intervention most effectively protects a client with thrombocytopenia? A. Avoiding the use of dentures B. Encouraging the use of an electric shaver C. Taking rectal temperatures D. Using warm compresses on trauma sites

Correct answer B The client should be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the HCP's orders onto the Medication Administration Record. 4. Determine the client's response to the therapy.

*1. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse.* 2. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. 3. This is the responsibility of the ward secretary or the nurse, not the unlicensed assistive personnel. 4. This represents the evaluation portion of the nursing process and cannot be delegated. TEST-TAKING HINT: The test taker must decide what is within the realm of duties of a UAP. Three (3) of the options have the UAP doing some action with medications. This could eliminate all of these. Option "1" did not say monitor or evaluate or decide on a nursing action; this option only says the UAP can take vital signs on a client who is presumably stable because the infusion has been going long enough to reach the hourly time span.

The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells.

1. Biopsies are surgical procedures requiring needle aspiration or excision of the area; they are not nuclear medicine scans. 2. The biopsy specimen is sent to the pathology laboratory for the pathologist to determine the type of cell. "Laboratory test" refers to tests of body fluids performed by a laboratory technician. 3. A biopsy is used to determine if the client has cancer and, if so, what kind. However, this response does not answer the client's question. *4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma.* TEST-TAKING HINT: Option "1" can be eliminated if the test taker knows what the word "biopsy" means. Option "3" does not answer the question and can be eliminated for this reason.

The nurse writes the problem of "grieving" for a client diagnosed with non-the lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society's Dialogue group. 4. Have the chaplain visit with the client.

1. Encouraging the client to talk about his or her feelings is an independent nursing intervention. 2. Discussing activities that will make pleasant memories and planning a family outing improve the client's quality of life and assist the family in the grieving process after the client dies, but this is an independent nursing intervention. 3. Nurses can and do refer clients diagnosed with cancer to the American Cancer Society-sponsored groups independently. Dialogue is a group support meeting that focuses on dealing with the feelings associated with a cancer diagnosis. *4. Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions.* TEST-TAKING HINT: The stem of the question asks for a collaborative intervention, which means that another health-care discipline must be involved. Options "1," "2," and "3" are all interventions the nurse can do without another discipline being involved.

Which clinical manifestation of Stage I non-Hodgkin's lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B-cell lymphocytes on the CBC.

1. Enlarged lymph tissue would occur in Stage III or IV Hodgkin's lymphoma. 2. A tender left upper quadrant would indicate spleen infiltration and occurs at a later stage. *3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma.* 4. B-cell lymphocytes are the usual lymphocytes involved in the development of lymphoma, but a serum blood test must be done specifically to detect B cells. They are not tested on a CBC. TEST-TAKING HINT: Most cancers are staged from 0 to IV. Stage 0 is microinvasive and Stage I is minimally invasive, progressing to Stage IV, which is large tumor load or distant disease. If the test taker noted the "Stage I," then choosing the option that presented with the least amount of known disease—option "3"— would be a good choice.

The nurse is developing a POC for the client with multiple myeloma and includes which priority intervention? 1) Encourage fluids 2) Providing frequent oral care 3) Coughing and deep breathing 4) Monitoring RBC count

1. Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. Nurse should administer fluids in adequate amounts to maintain a urine output of 1.5-2L/day. This requires about 3L/day. The fluid is needed to dilute the Ca overload, prevent protein from precipitating in the renal tubules. Others may be components of the POC but are not priority.

The client is a 56-year-old man admitted with a diagnosis of acute myelogenous leukemia (AML). He is prescribed IV cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. He develops an infection. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this client? A. Evaluating the client's liver function tests (LFTs) and serum creatinine levels B. Evaluating the client's white blood cell (WBC) count level C. Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection D. Recognizing that vancomycin (Vancocin) is the drug of choice used to treat all infections in clients with AML

Correct answer C Drug therapy is the main defense against infections that develop in clients undergoing therapy for AML. Agents used depend on the client's sensitivity to various antibiotics for the organism causing the infection.

Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin's disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells.

1. This client is receiving treatments that can have life-threatening side effects; the nurse is not experienced with this type of client. 2. Chemotherapy is administered only by nurses who have received training in chemotherapy medications and their effects on the body and are aware of necessary safety precautions; this nurse is in the first week of orientation. 3. This is expected in a client with leukemia, but it indicates a severely low platelet count; a nurse with more experience should care for this client. *4. This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products.* TEST-TAKING HINT: The key to this question is the fact, although the nurse is an experienced medical-surgical nurse, the nurse is not experienced in oncology. The client who could receive a treatment on a medical-surgical floor should be assigned to the nurse.

A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that hair loss will not be permanent and that the hair will grow back.

B Rationale: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem

A client with leukemia is being discharged from the hospital. After hearing a nurse's instructions to keep regularly scheduled follow-up provider appointments, the client says, "I don't have transportation." How does the nurse respond? A. "A pharmaceutical company might be able to help." B. "I might be able to take you." C. "The local American Cancer Society may be able to help." D. "You can take the bus."

Correct answer C Many local units of the American Cancer Society offer free transportation to clients with cancer, including those with leukemia.

A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrates the client with 1000 mL of IV normal saline B. Initiates the administration of prescribed antibiotics C. Obtains requested cultures D. Places the client on Bleeding Precautions

Correct answer C Obtaining cultures to identify the infectious agent correctly is the priority for this client.