NURS 2207- Oncology Evolve EAQ (Graded)

Place the stages of the grieving process according to Kübler-Ross in the correct order. Depression Denial Anger Bargaining

ANS: 1. Denial 2. Anger 3. Bargaining 4. Depression Rationale: The initial response is shock, disbelief, and denial, and the client seeks additional opinions to negate the diagnosis. When negating the diagnosis is unsuccessful, the client becomes angry and negative. Bargaining for wellness follows in an attempt to prolong life. As the reality of the situation becomes more apparent, depression sets in and the client may become withdrawn.

A client is scheduled for radiation treatments Monday through Friday. The client asks why the treatments will not be given on Saturday and Sunday. Which is the nurse's best response? 1. "This type of schedule gives noncancerous cells time to recover." 2. "The department only operates from Monday through Friday." 3. "Your energy level will be increased greatly by a 5-day schedule." 4. "Side effects are eliminated when treatment is administered for 5 rather than 7 days."

ANS: 1 "This type of schedule gives noncancerous cells time to recover." Rationale: Both malignant and healthy cells are affected by radiation; time between courses of treatment allows normal cells to repair. Staff are available if necessary for a treatment protocol; some facilities operate 7 days a week. Fatigue occurs in either a 5- or 7-day schedule. Some side effects are inevitable, although they vary with each individual; they cannot be eliminated.

Which action would the nurse take for a client with invasive bladder carcinoma who is receiving radiation to the lower abdomen? 1. Observe the feces for the presence of blood. 2. Monitor the blood pressure for hypertension. 3. Administer enemas to remove sloughing tissue. 4. Provide a high-bulk diet to prevent constipation.

ANS: 1 Observe the feces for the presence of blood. Rationale: Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.

A client with an invasive carcinoma of the bladder receives radiation to the lower abdomen in an attempt to shrink the tumor before surgery. Which intervention would the nurse implement to address the potential side effects of radiation? 1. Observe the feces for the presence of blood. 2. Monitor the blood pressure for hypertension. 3. Administer enemas to remove sloughing tissue. 4. Provide a high-bulk diet to prevent constipation.

ANS: 1 Observe the feces for the presence of blood. Rationale: Radiation may damage the bowel mucosa, causing bleeding. Radiation therapy does not affect client blood pressures during treatment. Enemas are contraindicated with lower abdominal radiation because they can damage intestinal mucosa. Diarrhea, not constipation, occurs with lower abdominal radiation.

The nurse observes the student nurse caring for the skin of the client who recently underwent radiation therapy. Which actions made by the student nurse would the nurse correct? Select all that apply. One, some, or all responses may be correct. 1. Using a washcloth for cleaning the radiated site 2. Rinsing soap thoroughly from the skin of the client 3. Drying the irradiated area with rubbing motions 4. Telling the client to wear loose clothing over the skin at the radiation site 5. Removing the ink marks that identify the location of the focused beam of radiation

ANS: 1, 3, 5 Rationale: The nurse should use a hand rather than a washcloth when cleansing the radiated site. This is to provide gentle care to the site. The irradiated area should be dried using patting motions rather than rubbing motions. The ink marks present on the site exactly identify where the location of beam radiation is to be focused. The nurse should take care not to remove these. The skin of the client should be thoroughly rinsed using a mild soap as prescribed by the radiation oncology department. The client's clothing should be loose over the radiation site.

An older adult client who is receiving chemotherapy for cancer has severe nausea and vomiting and becomes dehydrated. The client is admitted to the hospital for rehydration therapy. Which nursing actions have specific gerontological implications the nurse must consider? Select all that apply. One, some, or all responses may be correct. 1. Assessment of skin turgor 2. Documentation of vital signs 3. Assessment of intake and output 4. Administration of antiemetic medications 5. Replacement of fluid and electrolytes

ANS: 1, 4, 5 Rationale: When skin turgor is assessed, the presence of tenting may be related to loss of subcutaneous tissue associated with aging rather than to dehydration; skin over the sternum should be used instead of skin on the arm for checking turgor. Older adults are susceptible to central nervous system side effects, such as confusion, associated with antiemetic medications; dosages must be reduced, and responses must be evaluated closely. Because many older adults have delicate fluid balance and may have cardiac and renal disease, replacement of fluid and electrolytes may result in adverse consequences, such as hypervolemia, pulmonary edema, and electrolyte imbalance. Vital signs can be obtained as with any other adult. Intake and output can be measured accurately in older adults.

A client suffering from cancer is near the end of life. Which action(s) would be performed by the nurse to support the client's family members? Select all that apply. One, some, or all responses may be correct. 1. Helping the family set up hospice 2. Taking time to make sure that the family is comfortable 3. Staying with the client in the absence of family members 4. Giving the family information about the dying process 5. Making sure that the family knows what to do at the time of death

ANS: 1, 4, 5 Rationale: When the client is at the last stage of life, the nurse would help the family set up hospice and other appropriate resources, including grief support. The family members should be informed about the dying process. Make sure that the family knows what to do at the time of death. When the client is hospitalized, take time to make sure that the family is comfortable, and stay with the client in the absence of their family members.

When a client is admitted with thrombocytopenia, which nursing actions would be included in the plan of care? Select all that apply. One, some, or all responses may be correct. 1. Avoid intramuscular injections. 2. Institute neutropenic precautions. 3. Monitor the white blood cell (WBC) count. 4. Administer prescribed anticoagulants. 5. Examine the skin for ecchymotic areas.

ANS: 1, 5 Rationale: Intramuscular injections should be avoided because of the increased risk of bleeding and possible hematoma formation. Decreased platelets increase the risk of bleeding, which leads to ecchymoses. Neutropenic precautions are for clients with decreased WBCs, not platelets. Platelet count, rather than WBC count, will be monitored. Anticoagulants are contraindicated because of the increased bleeding risk.

Which response would the nurse use when a client, who receives radiation therapy for cancer, states, "My family said I will get a radiation burn today." 1. "Your skin blisters will look like have a sunburn to the area." 2. "A localized skin reaction usually occurs about 3 to 6 weeks after beginning treatment." 3. "A daily application of an emollient will prevent a burn and soften the skin." 4. "Your family must have had experience with radiation therapy several years ago."

ANS: 2 "A localized skin reaction usually occurs about 3 to 6 weeks after beginning treatment." Rationale: Radiodermatitis occurs 3 to 6 weeks after the start of treatment. Avoid the use of the word "burn" because it may increase anxiety. Emollients are contraindicated; they may alter the calculated x-ray route and injure healthy tissue. The response about the client's family does not address the client's personal concerns.

Which explanation would the nurse give to the family when an older widow, who is in the terminal stages of lung cancer, exhibits mood changes and anger toward the family? 1. "She is attempting to avoid the reality of the situation." 2. "She is trying to cope with her impending death." 3. "She wants to reduce the family's dependence on her." 4. "She is sad because the family will not take her home to die."

ANS: 2 "She is trying to cope with her impending death." Rationale: Anger is associated with one of the stages of dying; understanding the stages leading to the acceptance of death may help the family accept the client's moods and anger. Avoiding the situation reflects the stage of denial; anger is not common in this stage. The nurse would conduct additional assessment before telling the family that the client is trying to reduce family's dependence on her or that she wants to go home to die.

When a client who has seemed cheerful after a diagnosis of lung cancer and pneumonectomy becomes withdrawn after being discharged home, which action by the home health nurse will be best? 1. Suggest that an antidepressant may be helpful. 2. Ask the client to describe the current emotional state. 3. Reassure the client that depression is a normal reaction. 4. Ask the health care provider to make a mental health referral.

ANS: 2 Ask the client to describe the current emotional state. Rationale: Further assessment of the client is needed before developing a treatment plan. Antidepressant use may be needed, but is not commonly used for grieving and loss after a cancer diagnosis. Although depression is common after a cancer diagnosis, it is not very helpful for the client to know this and further assessment is needed before the nurse knows whether depression is the cause of the client's withdrawal. A mental health referral can be very helpful for some clients with a new cancer diagnosis, but more assessment is needed to determine whether a referral is needed or acceptable to the client.

The health care team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse (RN)? 1. Placing a Foley catheter 2. Assessing the respirations 3. Placing an intravenous (IV) catheter 4. Administering patient-controlled analgesia

ANS: 2 Assessing the respirations Rationale: Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patient-controlled analgesia is within the scope of an RN's practice.

A client receiving chemotherapy also takes a steroid daily. The client's white blood cell count is 3600 per cubic millimeter and red blood cell count is 4.5 million/mm 3. Which instruction would the nurse teach this client? 1. Omit the daily dose of prednisone. 2. Avoid large crowds and persons with infections. 3. Shave with an electric shaver rather than a safety razor. 4. Increase the intake of high-protein foods and red meats.

ANS: 2 Avoid large crowds and persons with infections. Rationale: Moderate leukopenia increases the risk of infection; the client should be taught protective measures. Leukopenia is a side effect of cyclophosphamide, not prednisone. The platelet count has not been provided, so bleeding precautions are not indicated. Increasing the intake of high-protein foods and red meat are measures to correct anemia; protection from infection takes priority.

A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client? 1. Hirsutism 2. Leukopenia 3. Constipation 4. Photosensitivity

ANS: 2 Leukopenia Rationale: Melphalan depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection. Hirsutism occurs with the administration of androgens to women. Diarrhea, not constipation, occurs with melphalan. Photosensitivity occurs with 5-fluorouracil, floxuridine, and methotrexate, not with melphalan.

A client with follicular non-Hodgkin's lymphoma is to be treated with rituximab, a targeted monoclonal antibody. The nurse will monitor the client for which common side effect of rituximab? 1. Polyphagia 2. Leukopenia 3. Constipation 4. Hypertension

ANS: 2 Leukopnia Rationale: Rituximab targets the CD 20 antigen, which regulates cell cycle differentiation and is found on malignant B lymphocytes; as a result, rituximab therapy can cause leukopenia and neutropenia. Anorexia, not polyphagia, may occur with rituximab therapy. Frequent stools and diarrhea, not constipation, may occur with rituximab therapy. Hypotension, not hypertension, may occur as a fatal infusion reaction to rituximab therapy.

When a client who is receiving chemotherapy develops myelosuppression, which information will the nurse include in client teaching? 1. Increase calcium and vitamin D intake. 2. Minimize risk for infection and bleeding. 3. Exercise frequently to improve energy level. 4. Use antiemetics to prevent nausea and vomiting.

ANS: 2 Minimize risk for infection and bleeding. Rationale: Suppression of bone marrow causes decreased number of red blood cells, white blood cells, and platelets and leads to fatigue, increased infection risk, and increased bleeding risk. The client will need to take actions to prevent infection and injuries that might lead to bleeding. Myelosuppression will not increase calcium and vitamin D needs. Anemia caused by myelosuppression causes fatigue and clients will need increased rest to conserve energy. Although chemotherapy may cause nausea, myelosuppression is not a cause of nausea and vomiting.

Which group of clients would the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? 1. Children 2. Older adults 3. Young adults 4. Middle-aged persons

ANS: 2 Older adults Rationale: The incidence of non-Hodgkin lymphoma increases with age; the disease is more common in men and older adults. Younger individuals have a lower incidence of non-Hodgkin lymphomas.

A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct. 1. Deep vein thrombosis 2. Melena 3. Purpura 4. Emboli 5. Hematuria

ANS: 2, 3, 5 Rationale: Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Deep vein thrombosis and emboli are effects of thrombocytosis.

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101°F (38.3°C), and the health care provider prescribes aspirin 650 mg every 4 hours as needed. Which action would the nurse take regarding this new prescription? 1. Express concern about the dosage prescribed. 2. Request a prescription for an antacid. 3. Express concern about the type of antipyretic prescribed. 4. Ask if the frequency should be every 6 hours instead.

ANS: 3 Express concern about the type of antipyretic prescribed. Rationale: Both ALL and methotrexate may cause thrombocytopenia, with resulting bleeding risk. Aspirin is contraindicated with thrombocytopenia because of its inhibitory effect on platelet aggregation, so the nurse should express concern about the type of antipyretic prescribed. The dosage of aspirin prescribed is within the normal range for a client with a normal platelet count. In clients who need to take nonsteroidal anti-inflammatory drugs like aspirin, an antacid may be appropriate, but aspirin should not be administered to this client. Although the frequency is within acceptable limits, aspirin is contraindicated.

After recovery from a modified neck dissection for oropharyngeal cancer, the client receives external radiation to the operative site. Which side effect of radiation would the nurse expect to find? 1. Dry mouth 2. Skin reactions 3. Mucosal edema 4. Bone marrow suppression

ANS: 3 Mucosal edema Rationale: The mucosal lining of the oral cavity, oropharynx, and esophagus is sensitive to the effects of radiation therapy; the inflammatory response causes mucosal edema that may progress to an airway obstruction. A decrease in salivary secretions resulting in dry mouth may interfere with nutritional intake, but it is not life threatening. Erythema of the skin may cause dry or wet desquamation, but it is not life threatening. Radiation to the neck area should not produce as significant bone marrow suppression as radiation to the other sites.

A 20-year-old female client is scheduled to receive pelvic radiation for Hodgkin lymphoma and expresses anxiety about her future ability to conceive a child. The nurse's response will be based on which information about radiation therapy? 1. Radiation used is not radical enough to destroy ovarian function. 2. Intermittent radiation to the area does not cause permanent sterilization. 3. Reproductive ability may be preserved through a variety of interventions. 4. Ovarian function will be destroyed temporarily but will return in about 6 months.

ANS: 3 Reproductive ability may be preserved through a variety of interventions Rationale: Reproductive ability may be preserved through shielding the ovaries or harvesting ova. Radiation can influence or destroy ovarian functioning. Sterilization can occur with radiation to the pelvic area. Once ova are destroyed, they cannot regenerate.

A client diagnosed with invasive cancer of the bladder has brachytherapy scheduled. Which successful therapy outcome would the nurse expect with this client? 1. Decrease in urine output 2. Increase in pulse strength 3. Shrinkage of the tumor when scanned 4. Increase in the quantity of white blood cells (WBCs)

ANS: 3 Shrinkage of the tumor when scanned Rationale: Brachytherapy involves implanting isotope seeds in, or next to, the tumor. The isotope seeds interfere with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary output will increase with successful therapy. With brachytherapy of the bladder, an increase in pulse strength is not a sign of success. The radioactive isotope seeds may affect the client's bone marrow sites, resulting in a reduction of WBCs.

An older adult has undergone chemotherapy. Which agent could be administered to decrease the risk of a potentially contagious common viral infection? 1. Famciclovir 2. Gabapentin 3. Zoster vaccine 4. Herpes simplex virus type 1 (HSV-1) vaccineA

ANS: 3 Zoster vaccine Rationale: Herpes zoster or shingles is the most common viral infection that is potentially contagious to anyone who has not had varicella or who is immunosuppressed, such as clients on chemotherapy. Incidence increases with age mainly for adults 50 years old or older. Administering the zoster vaccine helps in preventing the risk of shingles. Famciclovir is an antiviral medication that helps in reducing the symptoms of the infection. Gabapentin is prescribed to clients suffering from neuralgia caused by shingles. Vaccines for HSV-1 are not available.

Which instruction would the nurse provide to a client receiving brachytherapy for prostate cancer to prevent injury? 1. "Use bleach when doing laundry." 2. "Wear a mask when around others." 3. "Flush the toilet several times after use." 4. "Refrain from close contact with others."

ANS: 4 "Refrain from close contact with others." Rationale: Brachytherapy involves the implantation of radioactive isotopes near the tumor to destroy cancer cells. Clients are radioactive while receiving treatment, making them potentially hazardous to others. Therefore, the nurse will instruct clients to refrain from close contact with others. Using bleach with the laundry and flushing the toilet several times are instructions for clients receiving chemotherapy. Clients who are immunosuppressed will be instructed to wear a face mask to help prevent infections.

Which response would the nurse offer when a client undergoing brachytherapy for breast cancer asks what precautions need to be observed? 1. "There are no restrictions during your brachytherapy." 2. "All body fluid during therapy is treated as radioactive." 3. "You should maintain contact isolation during treatment." 4. "Visitors should be limited, particularly pregnant women and children."

ANS: 4 "Visitors should be limited, particularly pregnant women and children." Rationale: Visitors should be limited, particularly pregnant women and children, during brachytherapy, although the radiation risk is very low. The restriction includes limiting visitors. Body fluid is not radioactive from brachytherapy. Contact isolation is not required with brachytherapy.

Commonly used to treat clients needing immunosuppressant therapy, which medication classification has the potential long-term side effects of neurotoxicity, lymphoma, abnormal glucose control, and hypertension? 1. Corticosteroids 2. Cytotoxic medications 3. Monoclonal antibodies 4. Calcineurin inhibitors

ANS: 4 Calcineurin inhibitors Rationale: Calcineurin inhibitors such as cyclosporine act on T helper cells to prevent production and release of IL-2 and gamma interferon. This class of medications can cause adverse effects such as nephrotoxicity, lymphoma, hypertension, gingival hyperplasia, and hirsutism. Corticosteroids may cause peptic ulcer, osteoporosis, and hyperglycemia. Cytotoxic medications may cause bone marrow suppression, hypertension, diarrhea, and nausea. Monoclonal antibodies may cause pulmonary edema, hypersensitivity reactions, fever/chills, and chest pain.

An adolescent is to begin a chemotherapeutic medication regimen. Which side effect of vincristine is most important for the nurse to prepare the adolescent to expect? 1. Alopecia 2. Constipation 3. Loss of appetite 4. Peripheral neuropathy

ANS: 1 Alopecia Rationale: A side effect of vincristine is alopecia. To adolescents, who are very concerned with identity, hair loss represents a tremendous threat to self-image. Constipation, although very serious, is not as important to the adolescent as a side effect that affects appearance. Although anorexia will be a concern while the adolescent is undergoing chemotherapy, it is not as important before the start of the regimen. Although neurologic side effects are serious, they are not as important to the adolescent before the start of chemotherapy.

A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. Which behaviors indicate the client is emotionally accepting the impending death? 1. Revising the client's will and planning a visit to a friend 2. Alternately crying and talking openly about death 3. Getting second, third, and fourth medical opinions 4. Refusing to follow treatments and stating they won't help anyway

ANS: 1 Revising the client's will and planning a visit to a friend Rationale: Revising the will and planning a visit to a friend are realistic, productive, and constructive ways of using this time. Crying and talking openly about death are signs of depression. Going from health care provider to health care provider demonstrates disbelief, denial, or desperation. Refusing to follow treatments and stating that the client is going to die anyway indicates anger and hopelessness, not acceptance.

A client with a history of hemoptysis and cough for the past 6 months is suspected of having lung cancer. A bronchoscopy is performed. Two hours after the procedure the nurse identifies an increase in the amount of bloody sputum. Which is the nurse's priority? 1. Contact the primary health care provider. 2. Document the amount of sputum. 3. Monitor vital signs every hour. 4. Increase the frequency of cough and deep-breathing exercises.

ANS: 1 Contact the primary health care provider. Rationale: The observation may be indicative of bleeding, and the health care provider should be notified. Overlooking the first signs of hemorrhage may permit the client to go into shock. Continuing to only monitor the client is unsafe. Documenting the amount of sputum is an action to be taken, but not until after contacting the primary health care provider. Vital signs should be monitored, but the priority is to take action to identify and treat bleeding. Increasing the coughing and deep-breathing regimen can precipitate bleeding because of an increase in intrathoracic pressure.

Which prescribed cytokine medication would the nurse administer to treat chemotherapy-induced neutropenia? 1. Filgrastim 2. Oprelvekin 3. Aldesleukin 4. Darbepoetin alfa

ANS: 1 Filgrastim Rationale: Colony-stimulating factors such as filgrastim are administered to treat chemotherapy-induced neutropenia. Oprelvekin is used to prevent thrombocytopenia. Aldesleukin is used to treat metastatic renal cell carcinoma. Darbepoetin alfa is administered to treat anemia related to chronic cancer and kidney disease.

The nurse is caring for a client who underwent surgical resection of an oral cancerous tumor. Which client problem is of highest priority to guide care? 1. Maintain airway. 2. Monitor vital signs. 3. Administer intravenous (IV) fluids. 4. Empty surgical drains.

ANS: 1 Maintain airway. Rationale: The highest priority in planning care for a client who underwent a surgical resection for oral cancer is to maintain the airway and promote gas exchange. Other interventions include monitoring vital signs, administering IV fluids, and empty surgical drains, but these are of lower priority.

A client undergoes surgical implantation of radon seeds for oral cancer. The nurse would observe the client for which side effects? 1. Nausea or vomiting 2. Hematuria or occult blood 3. Hypotension or bradycardia 4. Abdominal cramping or diarrhea

ANS: 1 Nausea or vomiting Rationale: The mucosa of the mouth and the vomiting center in the brain stem may be affected, producing nausea and vomiting. Hematuria, occult blood, hypotension, and bradycardia are not side effects of radiation therapy related to the oral cavity. Neither abdominal cramping nor diarrhea is an expected response because of the distance between the radon seeds and the intestines.

The registered nurse is teaching a nursing student about ways to minimize heat radiation. Which statements made by the nursing student indicate effective learning? Select all that apply. One, some, or all responses may be correct. 1. "I will apply an ice pack to the client." 2. "I will cover the client with dark clothes." 3. "I will instruct the client to remove extra clothes." 4. "I will instruct the client to lie in the fetal position." 5. "I will advise the client to wear sparsely woven clothes."

ANS: 1, 2, 4 Rationale: Applying an ice pack will increase conductive heat loss, which results in minimizing heat radiation. Wearing dark clothes and lying in the fetal position will minimize heat radiation. Removing extra clothes will increase heat radiation. Wearing sparsely woven clothes will enhance heat radiation.

The spouse of a 22-year-old client who is being tested for Hodgkin lymphoma tells the nurse, "Don't you think it is unlikely for someone like my spouse to have cancer?" Which information about Hodgkin lymphoma will the nurse use when responding? 1. More likely to affect women than men 2. Diagnosed during adolescence and young adulthood 3. Primarily a disease of older rather than younger adults 4. More common among populations of Asian heritage

ANS: 2 Diagnosed during adolescence and young adulthood Rationale: Hodgkin lymphoma incidence peaks between the ages of 15 and 35 years and again at age 55 and above. Hodgkin lymphoma is twice as prevalent in men as in women. The incidence of Hodgkin lymphoma is not limited to people in older age groups. Ethnic background is not a risk factor for Hodgkin lymphoma.

When a client with acute myelocytic leukemia who is receiving chemotherapy develops tumor lysis syndrome, the nurse will anticipate a need to implement which collaborative action? 1. Offer analgesics frequently. 2. Infuse large amounts of fluids. 3. Administer antibiotic therapy. 4. Give anticoagulant medication.

ANS: 2 Infuse large amounts of fluids. Rationale: Tumor lysis syndrome occurs when chemotherapy destroys large numbers of abnormal cells quickly, leading to high levels of potassium and uric acid and the risk for hyperkalemia and acute kidney injury. Hydration prevents and manages tumor lysis syndrome by dilution, lowering potassium and uric acid levels, increasing potassium excretion, and preventing kidney stones. More frequent analgesia is will not treat tumor lysis syndrome. Antibiotics are used to treat infection and sepsis associated with leukemia, but are not a treatment for tumor lysis syndrome. Anticoagulant medications are not used to treat tumor lysis syndrome.

Which task can be delegated safely by the registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia? 1. Shaving the client 2. Positioning the client 3. Maintaining oral hygiene 4. Giving intravenous platelet infusions

ANS: 2 Positioning the client Rationale: Clients with thrombocytopenia are at risk of bleeding with slight bruising. Tasks that do not risk bruising may be delegated to the UNP such as carefully positioning the client. The RN would shave the client and maintain oral hygiene. Intravenous infusions should not be administered by a UNP to any client.

Which task can be safely delegated by the registered nurse (RN) to unlicensed assistive personnel (UAP) for a client with thrombocytopenia? 1. Shaving the client 2. Positioning the client 3. Performing oral hygiene 4. Giving intravenous platelet infusions

ANS: 2 Positioning the client Rationale: Clients with thrombocytopenia are at risk of bleeding with slight bruising. Tasks that do not risk bruising the client may be delegated to the UAP. The RN would shave the client and perform oral hygiene. Intravenous infusions would not be administered by UAP to any client.

Which instruction would the nurse provide a client with leukopenia secondary to chemotherapy? 1. "You should avoid exposure to the sun and use a sunscreen." 2. "You should eat high-fiber foods and increase fluid intake." 3. "You should avoid large crowds and people with infections." 4. "You should consume iron supplements and erythropoietin."

ANS: 3 "You should avoid large crowds and people with infections." Rationale: Leukopenia consists of low levels of white blood cells. A leukopenic client should avoid large crowds and people with infection because the client may contract an infection as a result of compromised immunity. The suggestion of avoiding exposure to the sun and using a sunscreen would be beneficial for a client with chemotherapy-induced skin changes. The suggestion of eating high-fiber foods and increasing fluid intake would be beneficial for a client with constipation after chemotherapy. Consuming iron supplements and erythropoietin would be required for a client who developed anemia after chemotherapy.

When a client with lymphoma expresses discouragement during treatment because of chemotherapy side effects, which initial response by the nurse is best? 1. Ask whether the client has considered using antidepressants. 2. Remind the client that positive thoughts can be therapeutic. 3. Acknowledge that the adverse effects of treatment are difficult to endure. 4. Offer information about the effectiveness of chemotherapy for the lymphoma.

ANS: 3 Acknowledge that the adverse effects of treatment are difficult to endure. Rationale: The best initial response by the nurse is to acknowledge the truth of the client's statement that chemotherapy side effects are difficult to endure. This recognizes the client's concern and opens the door to further sharing of concerns by the client. Although antidepressants may be helpful, suggesting antidepressants is premature and may prevent the client from sharing more information about emotional state. Although positive thoughts can sometimes be therapeutic, suggesting that the client be more positive completely fails to acknowledge the client's current feelings. A reminder that chemotherapy is effective does not acknowledge that the side effects are unpleasant.

An adolescent is undergoing radiation for Hodgkin lymphoma. Which important factor would the nurse discuss with the family? 1. Keeping up with schoolwork 2. Accelerated sexual maturation 3. Consistent skin care with lotion 4. Overwhelming fatigue and the need for rest

ANS: 4 Overwhelming fatigue and the need for rest Rationale: The major side effect of radiation therapy is overwhelming fatigue. Lotions can cause irritation if the skin reacts to the radiation. Schoolwork is not a major concern at this time. Accelerated sexual maturation is not an effect of irradiation.

The nurse teaches a client who is scheduled to receive intravenous chemotherapy for ovarian cancer about the use of imagery to maximize the effects of the chemotherapy and reduce the side effects. Which statement would the nurse use regarding this alternative therapy? 1. "Rest your mind while remaining in the present." 2. "Listen to soothing instrumental music during the infusion." 3. "Light a candle with the scent of lavender during the infusion." 4. "Focus on the droplets of chemotherapy attacking the cancer cells."

ANS: 4 "Focus on the droplets of chemotherapy attacking the cancer cells." Rationale: Imagery is the application of the conscious use of the power of imagination with the intention of activating biological, psychological, and spiritual healing. The individual creates mental pictures of the desired outcome from memories, dreams, fantasies, and hopes. Meditation, not imagery, quiets the mind and focuses on the present to release fears, worries, anxieties, and doubts concerning the past and the future. Music therapy, not imagery, aligns the body, mind, and spirit with its own fundamental frequency, which brings about changes in emotions and functioning. Aromatherapy, not imagery, uses essential oils to stimulate the olfactory receptors and ultimately the brain, where many believe the products influence emotions, memory, and a variety of bodily functions such as heart rate, blood pressure, breathing, and immune responses.

When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so sick to my stomach. The medication is useless." Which response by the nurse uses the technique of paraphrasing? 1. "You get sick to your stomach." 2. "Tell me more about how you feel." 3. "I'll get a prescription for an antiemetic." 4. "You don't think the medication is helping you."

ANS: 4 "You don't think the medication is helping you." Rationale: Rewording of the client's statement is paraphrasing, which indicates that the nurse understands the client's concern and helps clarify the concerns. The response "You get sick to your stomach" uses the therapeutic communication technique of restating; this repeats the client's exact words. The response "Tell me more about how you feel" is clarifying, another therapeutic technique. The response "I'll get a prescription for an antiemetic" is not a therapeutic communication technique and does not address the client's concern that the chemotherapy is not effective.

dying client is coping with feelings regarding impending death. During which stage of grieving would the nurse primarily use nonverbal interventions? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

ANS: 4 Acceptance Rationale: Communication and interventions during the acceptance stage are mainly nonverbal (e.g., holding the client's hand). The nurse would be quiet but available. During the anger stage the nurse would accept that the client is angry. The anger stage requires verbal communication. During the denial stage the nurse would accept the client's behavior but not reinforce the denial. The denial stage requires verbal communication. During the bargaining stage the nurse would listen intently but not provide false reassurance. The bargaining stage requires verbal communication.

The client undergoing therapy with an antiproliferative immunosuppressant medication has developed thrombocytopenia. Which medication may have caused the client's condition? 1. Citalopram 2. Daclizumab 3. Methyldopa 4. Azathioprine

ANS: 4 Azathioprine Rationale: Azathioprine is an antiproliferative medication that may cause bone marrow suppression and thrombocytopenia (a decrease in the number of thrombocytes). Citalopram is a selective serotonin reuptake inhibitor used as an antidepressant. Daclizumab may cause anaphylaxis. Methyldopa is used to treat gestational hypertension or pregnancy-induced hypertension.

An adolescent with leukemia is to be given a chemotherapeutic agent. Which time is best for the nurse to administer the prescribed antiemetic? 1. As nausea occurs 2. An hour before meals 3. Just before each meal is eaten 4. Before each dose of chemotherapy

ANS: 4 Before each dose of chemotherapy Rationale: The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.

A client who recently was diagnosed as having myelocytic leukemia discusses the diagnosis by referring to statistics, facts, and figures. The nurse determines that the client is using which defense mechanism? 1. Projection 2. Sublimation 3. Identification 4. Intellectualization

ANS: 4 Intellectualization Rationale: Intellectualization is the use of reasoning and thought processes to avoid the emotional aspects of a situation; this is a defense against anxiety. Projection is denying unacceptable traits and regarding them as belonging to another person. Sublimation is a defense wherein the person redirects the energy of unacceptable impulses into socially acceptable behaviors or activities. Identification is the reduction of anxiety by imitating someone respected or feared.

A 4-year-old child develops thrombocytopenia after vaccination. The nurse would suspect which vaccination may be responsible? 1. Rotavirus vaccine 2. Varicella virus vaccine 3. Human papillomavirus vaccine 4. Measles, mumps, and rubella virus vaccine (MMR)

ANS: 4 Measles, mumps, and rubella virus vaccine (MMR) Rationale: Measles, mumps, and rubella virus vaccine (MMR) may cause transient thrombocytopenia. It is generally benign and occurs only rarely. Rotavirus vaccine carries a small risk for intussusception. Varicella virus vaccine and human papillomavirus vaccine may cause mild effects such as fever and fainting.

A client's laboratory report indicates severe neutropenia and thrombocytopenia. Which medication may have caused this condition? 1. Daclizumab 2. Cyclosporine 3. Methylprednisolone 4. Mycophenolate mofetil

ANS: 4 Mycophenolate mofetil Rationale: Mycophenolate mofetil is a cytotoxic medication (immunosuppressant) that may cause neutropenia and thrombocytopenia. Daclizumab may cause hypersensitivity reaction and anaphylaxis. Cyclosporine may cause neurotoxicity, nephrotoxicity, and hypertension. Methylprednisolone may cause peptic ulcers, osteoporosis, and hyperglycemia.

A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? 1. Diarrhea 2. Alopecia 3. Hemorrhagic cystitis 4. Peripheral neuropathy

ANS: 4 Peripheral neuropathy Rationale: Neurotoxicity is a specific response to vincristine; the child may become numb and ataxic. Vincristine causes adynamic ileus, resulting in constipation; diarrhea occurs with other antineoplastics and radiation therapy. Alopecia is an expected side effect rather than a toxic response; it is not considered serious, and hair will regrow after the treatment is completed. Hemorrhagic cystitis is a toxic response to cyclophosphamide, not vincristine.

The registered nurse is caring for a client who is receiving chemotherapy. Which statement made by the client shows a need for the registered nurse (RN) to delegate unlicensed assistive personnel (UAP) to help the client with activities of daily living (ADLs)? Select all that apply. One, some, or all responses may be correct. 1. "I have severe nausea after my treatments." 2. "I developed a rash after my last chemotherapy treatment." 3. "I am unable to tolerate the pain of chemotherapy." 4. "I am unable to eat by myself because of the intravenous (IV) catheter." 5. "I am unable to get out of bed because I am so weak from the chemotherapy treatment."

ANS: 4, 5 Rationale: UAP are members of the health care team whose scope of practice is limited to feeding, providing basic care, hygiene, and comfort. The client reporting an inability to eat because of the intravenous catheter and an inability to get out of bed because of weakness indicates that he or she can be assisted by the UAP. The RN will be required to report the client's severe nausea to the primary health care provider. The RN will be required to report the pain experienced by the client undergoing chemotherapy. The client's development of a rash after therapy will require the RN to report the side effects of the medication to the primary health care provider.