Oncology Test Bank

A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A)Hyponatremia B)ypophosphatemia C)Hypocalcemia D)Hypokalemia

C - Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A)Do you feel any muscle twitches or spasms? B)Do you feel flushed or sweaty? C)Are you experiencing any dizziness or lightheadedness? D)Are you having any pain that seems to be radiating from your bones?

A - As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurses most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurses best response to this assessment finding? A)Document the presence of normal bile output. B)Irrigate the drainage system with normal saline as ordered. C)Aspirate a sample of the drainage for culture. D)Promptly report this assessment finding to the primary care provider.

A - Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A)Stopping the administration of the drug immediately B)Notifying the patients physician C)Continuing the infusion but decreasing the rate D)Applying a warm compress to the infusion site

A - Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patients physician. Ice can be applied to the site once the drug therapy has stopped.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A)These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies. B)These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer. C)Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy. D)Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.

A - Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and should not be belittled. Radiation destroys both cancerous and normal cells.

You are working in the hospice unit today. One of your patients is a 41-year-old patient with a terminal diagnosis of stage 4 colon cancer. You are updating this patient's care plan. What should you nurse prioritize in your care plan? a) Educating the family on payment options for care b) Prepare the patient and family on expectations of the death and dying process c) Providing ROM exercises to maintain muscle strength d) Encourage the family to plan a COVID friendly social gathering after the patient's death

A - Hospice care focuses on quality of life, but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities.

An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patients most recent blood tests, the nurse should anticipate what imbalance? A)Hypercalcemia B)Hyperproteinemia C)Elevated serum viscosity D)Elevated RBC count

A - Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.

A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient? A)Chew with care to avoid inadvertently biting the tongue. B)Use the oral anesthetic 1 hour prior to meal time. C)Brush teeth before and after eating. D)Swallow slowly and deliberately.

A - If oral anesthetics are used, the patient must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the patient eats if it is used 1 hour prior to meals. There is no specific need to warn the patient about brushing teeth or swallowing slowly because an oral anesthetic has been used.

A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia? A)Monitoring for infection B)Monitoring nutritional status C)Monitor electrolyte levels D)Monitoring liver function

A - In patients with acute leukemia, death typically occurs from infection or bleeding. Compromised nutrition, electrolyte imbalances, and impaired liver function are all plausible, but none is among the most common causes of death in this patient population.

A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care? A)The patient will require an upper endoscopy every 6 months to detect malignant changes. B)Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C)Small amounts of blood are likely to be present in the stools and are not cause for concern. D)Antacids may be discontinued when symptoms of heartburn subside.

A - In the patient with Barretts esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patients care plan? A)Protective isolation and vigilant use of standard precautions B)Provision of a high-calorie, low-texture diet and appropriate oral hygiene C)Including the family in planning the patients activities of daily living D)Monitoring and treating the patients pain

A - Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the patients survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.

An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A)The different leukemias all involve unregulated proliferation of white blood cells. B)The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. C)The different leukemias all result in a decrease in the production of white blood cells. D)The different leukemias all involve the development of cancer in the lymphatic system.

A - Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.

A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer? A)A 65-year-old man with alcoholism who smokes B)A 45-year-old woman who has type 1 diabetes and who wears dentures C)A 32-year-old man who is obese and uses smokeless tobacco D)A 57-year-old man with GERD and dental caries

A - Oral cancers are often associated with the use of alcohol and tobacco, which when used together have a synergistic carcinogenic effect. Most cases of oral cancers occur in people over the age of 60 and a disproportionate number of cases occur in men. Diabetes, dentures, dental caries, and GERD are not risk factors for oral cancer.

You are caring for a patient who has been recently diagnosed with multiple myeloma and is experiencing severe pain. Since admission, the patient has been receiving pain medications on both a scheduled and as needed basis. During your shift, the patient's level of consciousness has declined and she is now unresponsive to your voice. How will you continue to manage the patient's pain control for the rest of your shift? a) The patient's pain control regimen should be continued as scheduled. b) The patient's pain medication dosages should be reduced by 1/2 half. c) Stop IV analgesics and replace with transdermal analgesics. d) Hold all pain control medications until the patient's level of consciousness improves.

A - Pain should be aggressively treated, even if dying patients become unable to verbally report their pain. There is no need to forego the IV route. There is no specific need to discontinue the pain control regiment or to reduce it.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? A)The patient requests that her family bring her makeup and wig. B)The patient begins to discuss the future with her family. C)The patient reports less disruption from pain and discomfort. D)The patient cries openly when discussing her disease.

A - Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem.

The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate? A)The younger you are when you start smoking, the higher your risk of lung cancer. B)The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays. C)The risk for lung cancer is determined mostly by what type of cigarettes you smoke. D)The risk for lung cancer depends primarily on the other risk factors for cancer that you have.

A - Risk is determined by the pack-year history (number of packs of cigarettes used each day, multiplied by the number of years smoked), the age of initiation of smoking, the depth of inhalation, and the tar and nicotine levels in the cigarettes smoked. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer. Risk declines after smoking cessation. The type of cigarettes is a significant variable, but this is not the most important factor.

The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurses assessment should include examination for the signs and symptoms of what complication? A)Tumor lysis syndrome (TLS) B)Syndrome of inappropriate antiduretic hormone (SIADH) C)Disseminated intravascular coagulation (DIC) D)Hypercalcemia

A - TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. DIC, SIADH and hypercalcemia are less likely complications following this treatment and diagnosis.

The hospice nurse has just admitted a new patient to the program. What principle guides hospice care? A)Care addresses the needs of the patient as well as the needs of the family. B)Care is focused on the patient centrally and the family peripherally. C)The focus of all aspects of care is solely on the patient. D)The care team prioritizes the patients physical needs and the family is responsible for the patients emotional needs.

A - The focus of hospice care is on the family as well as the patient. The family is not solely responsible for the patients emotional well-being

A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care? A)Cure of the disease B)Enhancing quality of life C)Controlling symptoms D)Palliation

A - The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure the disease.

The nurse is assessing a patient who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the patient for further assessment? A)Lately, I have this cough that just never seems to go away. B)I find that I dont have nearly the stamina that I used to. C)I seem to get nearly every cold and flu that goes around my workplace. D)I never used to have any allergies, but now I think Im developing allergies to dust and pet hair.

A - The most frequent symptom of lung cancer is cough or change in a chronic cough. People frequently ignore this symptom and attribute it to smoking or a respiratory infection. A new onset of allergies, frequent respiratory infections and fatigue are not characteristic early signs of lung cancer.

A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the patient should adopt what dietary guidelines? A)Eat small, frequent meals with high calorie and vitamin content. B)at frequent meals with an equal balance of fat, carbohydrates, and protein. C)Eat frequent, low-fat meals with high protein content. D)Try to maintain the pre-diagnosis pattern of eating.

A - The nurse encourages the patient to eat small, frequent portions of nonirritating foods to decrease gastric irritation. Food supplements should be high in calories, as well as vitamins A and C and iron, to enhance tissue repair.

A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patients subsequent plan of care? A)Limit the time that visitors spend at the patients bedside. B)Teach the patient to perform all aspects of basic care independently. C)Assign male nurses to the patients care whenever possible. D)Situate the patient in a shared room with other patients receiving brachytherapy.

A - To limit radiation exposure, visitors should generally not spend more than 30 minutes with the patient. Pregnant nurses or visitors should not be near the patient, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the patient and a single room should be used.

You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A)Palliative B)Reconstructive C)Salvage D)Prophylactic

A - When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.

A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which blood tests should be done to further explore this clinical sign? A)Liver function tests (LFTs) B)Complete blood count (CBC) C)Platelet count D)Blood urea nitrogen and creatinine

A - Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.

You are caring for a patient with end stage renal cell carcinoma with metastasis to the lung, bone, and brain. The patient is now experiencing periods of apnea and unconsciousness. You discuss with the physician that the patient and family would benefit from a hospice consult. The physician is reluctant to refer this patient to hospice care. What are contributing factors that are known to underlie his reluctance? Select all that apply. a) Advances in "curative" treatment in late-stage illness b) Financial pressures on health care providers c) Ease of making a terminal diagnosis d) Patient reluctance to accept hospice care e) Strong association of hospice care with prolonging death

A,B,D - Physicians are reluctant to refer patients to hospice, and patients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those patients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible patients.

The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A)Rate of growth B)Ability to cause death C)Size of cells D)Cell contents E)Ability to spread

A,B,E - Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.

You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform? Select all that apply. A)Use a lip lubricant. B)Scrub the tongue with a firm-bristled toothbrush. C)Use dental floss every 24 hours. D)Rinse the mouth with normal saline. E)Eat spicy food to aid in eradicating the yeast.

A,C,D - Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply. A)Perforation into the mediastinum B)Development of an esophageal lesion C)Erosion into the great vessels D)Painful swallowing E)Obstruction of the esophagus

A,C,E - In the later stages of esophageal cancer, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Painful swallowing and the emergence of a lesion are early signs of esophageal cancer.

A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients needs for physical activity? A)Teach the patient about the risks of immobility and the benefits of exercise. B)Assist the patient to a chair during awake times, as tolerated. C)Collaborate with the physical therapist to arrange for stair exercises. D)Teach the patient to perform deep breathing and coughing exercises.

B

The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A)Monthly self-breast exams B)Smoking cessation C)Annual colonoscopies D)Monthly testicular exams

B - Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 570,000 Americans were expected to die from a malignant process in 2011. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer.

The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A)Cognitive deficits B)Impaired wound healing C)Cardiac tamponade D)Tumor lysis syndrome

B - Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis

A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs? A)Administration of parenteral feeds via a peripheral IV B)TPN administered via a peripherally inserted central catheter C)Insertion of an NG tube for administration of feeds D)Maintaining NPO status and IV hydration until treatment completion

B - If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is administered by way of a central line, not a peripheral IV. An NG would be contraindicated for this patient. Long-term NPO status would result in malnutrition.

A nurse, that is working in a local hospice facility, has cared for many patients experiencing the death and dying process. This nurse is becoming overwhelmed with grief. Where is a safe venue this nurse can express their feelings? a) At home with their spouse b) At a staff meeting c) At the funeral home d) On Facebook with a hospice nursing group

B - In hospice settings, where death, grief, and loss are expected outcomes of patient care, interdisciplinary colleagues rely on each other for support, using meeting time to express frustration, sadness, anger, and other emotions; to learn coping skills from each other; and to speak about how they were affected by the lives of those patients who have died since the last meeting. Public settings are inappropriate places to express frustration about the death of a patient. Discussing patient information at home and on social media are a violation of the patient's HIPPA rights and will have consequences.

A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses? A)Activity Intolerance B)Risk for Infection C)Acute Confusion D)Risk for Spiritual Distress

B - Induction therapy places the patient at risk for infection, thus this is the priority nursing diagnosis. During the time of induction therapy, the patient is very ill, with bacterial, fungal, and occasional viral infections; bleeding and severe mucositis, which causes diarrhea; and marked decline in the ability to maintain adequate nutrition. Supportive care consists of administering blood products and promptly treating infections. Immobility, confusion, and spiritual distress are possible, but infection is the patients most acute physiologic threat.

The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response? A)Research has shown that eating a healthy diet can provide all the protection you need against breast cancer. B)Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer. C)Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer. D)Research has shown that there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition.

B - Large-scale breast cancer prevention studies supported by the National Cancer Institute (NCI) indicated that chemoprevention with the medication tamoxifen can reduce the incidence of breast cancer by 50% in women at high risk for breast cancer. A healthy diet and regular exercise are important, but not wholly sufficient preventive measures.

A patients most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patients cancer cells spread? A)Hematologic spread B)Lymphatic circulation C)Invasion D)Angiogenesis

B - Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

The nurses comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages? A)Dull pain radiating to the ears and teeth B)Presence of a painless sore with raised edges C)Areas of tenderness that make chewing difficult D)Diffuse inflammation of the buccal mucosa

B - Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently, and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom.

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A)Pruritis (itching) B)Nausea and vomiting C)Altered glucose metabolism D)Confusion

B - Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Confusion, alterations in glucose metabolism, and pruritis are not common adverse effects.

A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients? A)Encourage several small meals daily. B)Provide skin care to maintain skin integrity. C)Assist the patient with hygiene, as needed. D)Assess the integrity of the patients oral mucosa regularly.

B - Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patients care plan, what potential complication should the nurse address? A)Pancreatitis B)Hemorrhage C)Arteritis D)Liver dysfunction

B - Pancreatitis, arteritis, and liver dysfunction are generally not complications of leukemia. However, the patient faces a high risk of hemorrhage.

The nurse is caring for a 28-year-old woman with a family history of breast cancer. She requested a BRCA tumor marker test. She states if the results come back positive, she wants a bilateral mastectomy. This surgery would be an example of what type of intervention? a) Salvage surgery b) Prophylactic surgery c) Reconstructive surgery d) Palliative surgery

B - Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote? A)Daily performance of weight-bearing exercise to prevent muscle atrophy B)Close monitoring of urine output and kidney function C)Daily administration of warfarin (Coumadin) as ordered D)Safe use of supplementary oxygen in the home setting

B - Renal function must be monitored closely in the patient with multiple myeloma. Excessive weight-bearing can cause pathologic fractures. There is no direct indication for anticoagulation or supplementary oxygen.

The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurses rapid assessment reveals that the patients jugular veins are distended. The nurse should suspect the development of what oncologic emergency? A)Increased intracranial pressure B)Superior vena cava syndrome (SVCS) C)Spinal cord compression D)Metastatic tumor of the neck

B - SVCS occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Increased intracranial pressure may be a part of SVCS, but it is not what is causing the patients symptoms. The scenario does not mention a problem with the patients spinal cord. The scenario says that the cancer has metastasized, but not that it has metastasized to the neck.

A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, They tell me my cancer is malignant, while my coworkers breast tumor was benign. I just dont understand at all. When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type? A)Slow rate of mitosis of cancer cells B)Different proteins in the cell membrane C)Differing size of the cells D)Different molecular structure in the cells

B - The cell membrane of malignant cells also contains proteins called tumor-specific antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.

An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patients wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A)Malignant cells contain more fibronectin than normal body cells. B)Malignant cells contain proteins called tumor-specific antigens. C)Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D)The nuclei of cancer cells are unusually large, but regularly shaped.

B - The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases? A)Persistent fever and cognitive changes B)Abdominal pain and hepatomegaly C)eripheral edema unresponsive to diuresis D)Spontaneous bleeding and jaundice

B - The early manifestations of malignancy of the liver include paina continuous dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.

An adult patients abnormal complete blood count (CBC) and physical assessment have prompted the primary care provider to order a diagnostic workup for Hodgkin lymphoma. The presence of what assessment finding is considered diagnostic of the disease? A)Schwann cells B)Reed-Sternberg cells C)Lewy bodies D)Loops of Henle

B - The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. It is the pathologic hallmark and essential diagnostic criterion. Schwann cells exist in the peripheral nervous system and Lewy bodies are markers of Parkinson disease. Loops of Henle exist in nephrons.

A nurse is caring for a patient who has been diagnosed with leukemia. The nurses most recent assessment reveals the presence of ecchymoseson the patients sacral area and petechiae in her forearms. In addition to informing the patients primary care provider, the nurse should perform what action? A)Initiate measures to prevent venous thromboembolism (VTE). B)Check the patients most recent platelet level. C)Place the patient on protective isolation. D)Ambulate the patient to promote circulatory function.

B - The patients signs are suggestive of thrombocytopenia, thus the nurse should check the patients most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.

A 74-year-old male patient has recently been diagnosed with a Glioblastoma. The patient complains of having a headache that is 8 out of 10 on a 0-10 scale. The nurse can expect to administer which of the following medications? (Select all that apply) a) Zofran b) Gabapentin c) Mannitol d) Ciprofloxacin

B, C - Gabapentin will prevent seizures. Mannitol will decrease fluid content of the brain which will decrease ICP. Zofran and Cipro will not aid in decreasing headache or ICP.

A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patients care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk? A)Labyrinthitis B)Left ventricular hypertrophy C)Decreased bone density D)Hypercoagulation

C - Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Labyrinthitis is uncharacteristic, and patients do not normally experience hypercoagulation or cardiac hypertrophy.

You are caring for a patient s/p total thyroidectomy with a recent diagnosis of thyroid cancer. He is 6 days post-op. When reviewing his chart after you recieve report, you focus on which of the following labs? a) Hbg, Hct, INR, PT/PTT, calcium, TSH b) Serum calcium, serum potassium, free T4, TSH, CBC, BMP c) Serum phosphorus, serum calcium, free T4, TSH d) Free T4 and TSH only

C - Free T4, TSH, serum phosphorous, and serum calcium levels are monitored post op to determine whether thyroid supplementation is needed or is adequate.

The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer? A)Smoked salmon and green beans B)Pork chops and fried green tomatoes C)Baked apricot chicken and steamed broccoli D)Liver, onions, and steamed peas

C - Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.

A patient's most recent CT scan has revealed that her breast cancer has metastasized to her bones and brain. The patient asks how, with treatment, her cancer has spread. What explanation can you give the this patient about the most common way in which the patient's cancer has spread? a) The cancer cells have invaded local areas b) The cancer cells have gotten into the blood's circulation c) The cancer cells have gotten into the lymphatic system d) By the process of angiogenesis

C - Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

You are creating a plan of care for an acute leukemic patient. You determine that the nursing diagnoses that is their number one need is increased risk for infection related to myelosuppression. What intervention should you address that relates to the highest risk of death in this patient? a) Assess the integrity of the patient's oral mucosa daily. b) Encourage consuming all of meals daily. c) Assess and provide skin care to maintain it's integrity. d) Bathe the patient daily.

C - Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia? A)Interrupted sleep pattern B)Hot flashes C)Epistaxis (nose bleed) D)Increased weight

C - Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize? A)Assess ability to clear oral secretions. B)Assess for signs of infection. C)Assess for a patent airway. D)Assess for ability to communicate.

C - Postoperatively, the nurse assesses for a patent airway. The patients ability to manage secretions has a direct bearing on airway patency. However, airway patency is the overarching goal. This immediate physiologic need is prioritized over communication, though this is an important consideration. Infection is not normally a threat in the immediate postoperative period.

An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patients plan of nursing care should prioritize which of the following? A)Assess the patient hourly for signs of compartment syndrome. B)Assess the patients fine motor skills once per shift. C)Assess the patients wound for dehiscence every 4 hours. D)Maintain the patients head of bed at 45 degrees or more at all times.

C - Postoperatively, the nurse assesses the patients responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Fine motor skills are unlikely to be affected by surgery and compartment syndrome is a complication of fracture casting, not abdominal surgery. There is no need to maintain a high head of bed.

Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention? A)Yearly Pap tests B)Testicular self-examination C)Teaching patients to wear sunscreen D)Screening mammograms

C - Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A)Salvage surgery B)Palliative surgery C)Prophylactic surgery D)Reconstructive surgery

C - Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action? A)Tell him that you will give him privacy and leave the room. B)Offer to call pastoral care. C)Ask if he would like you to sit with him while he collects his thoughts. D)Tell him that you can understand how hes feeling.

C - Providing emotional support and discussing the uncertain future are crucial. Leaving is incorrect because leaving the patient doesnt show acceptance of his feelings. Offering to call pastoral care may be helpful for some patients but should be done after the nurse has spent time with the patient. Telling the patient that you understand how hes feeling is inappropriate because it doesnt help him express his feelings.

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A)Disease prophylaxis B)Risk reduction C)Secondary prevention D)Tertiary prevention

C - Secondary prevention involves screening and early detection activities that seek to identify early stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the patient after having been diagnosed with cancer.

A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic? A)Smoking is the reason you are here. B)The doctor left orders for you not to smoke. C)You are anxious about the surgery. Do you see smoking as helping? D)Smoking is OK right now, but after your surgery it is contraindicated.

C - Stating You are anxious about the surgery. Do you see smoking as helping? acknowledges the patients feelings and encourages him to assess his previous behavior. Saying Smoking is the reason you are here belittles the patient. Citing the doctors orders does not address the patients anxiety. Sanctioning smoking would be highly detrimental to this patient.

The nurse is caring for a 46-year-old patient recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating patients with nonsmall cell tumors is what? A)Chemotherapy B)Radiation C)Surgical resection D)Bronchoscopic opening of the airway

C - Surgical resection is the preferred method of treating patients with localized nonsmall cell tumors with no evidence of metastatic spread and adequate cardiopulmonary function. The other listed treatment options may be considered, but surgery is preferred.

Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention? A)Cryosurgery B)Liver transplantation C)Lobectomy D)Laser hyperthermia

C - Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.

A young adult patient has received the news that her treatment for Hodgkin lymphoma has been deemed successful and that no further treatment is necessary at this time. The care team should ensure that the patient receives regular health assessments in the future due to the risk of what complication? A)Iron-deficiency anemia B)Hemophilia C)Hematologic cancers D)Genitourinary cancers

C - Survivors of Hodgkin lymphoma have a high risk of second cancers, with hematologic cancers being the most common. There is no consequent risk of anemia or hemophilia, and hematologic cancers are much more common than GU cancers.

A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patients care, the nurse should be aware of what epidemiologic fact? A)Early diagnosis is associated with good outcomes. B)Five-year survival for older adults is approximately 50%. C)Five-year survival for patients over 75 years old is less than 2%. D)Survival rates are wholly dependent on the patients pre-illness level of health.

C - The 5-year survival rate for patients with AML who are 50 years of age or younger is 43%; it drops to 19% for those between 50 and 64 years, and drops to1.6% for those older than 75 years. Early diagnosis is beneficial, but is nonetheless not associated with good outcomes or high survival rates. Preillness health is significant, but not the most important variable.

The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia? A)Stool softeners are contraindicated. B)Laxatives should be taken daily. C)Consume 2 to 4 L of fluid daily. D)Restrict calcium intake.

C - The nurse should identify patients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the patient and family. The nurse should teach at-risk patients to recognize and report signs and symptoms of hypercalcemia and encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise patients to maintain nutritional intake without restricting normal calcium intake.

The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A)Avoiding direct sun exposure in excess of 15 minutes daily B)Avoiding grapefruit juice and fresh grapefruit C)Avoiding highly crowded public places D)Using an electric shaver rather than a razor

C - The risk of infection is significant for these patients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the patients medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer? A)Promotion of a nutrient-dense, low-fat diet B)Annual screening endoscopy for patients over 50 with a family history of esophageal cancer C)Early diagnosis and treatment of gastroesophageal reflux disease D)Adequate fluid intake and avoidance of spicy foods

C - There are numerous risk factors for esophageal cancer but chronic esophageal irritation or GERD is among the most significant. This is a more significant risk factor than dietary habits. Screening endoscopies are not recommended solely on the basis of family history.

A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurses best response? A)The type of treatment depends on the patients age and health status. B)The type of treatment depends on what the patient wants when given the options. C)The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patients health status. D)The type of treatment depends on the discussion between the patient and the physician of which treatment is best.

C - Treatment of lung cancer depends on the cell type, the stage of the disease, and the patients physiologic status (particularly cardiac and pulmonary status). Treatment does not depend solely on the patients age or the patients preference between the different treatment modes. The decision about treatment does not primarily depend on a discussion between the patient and the physician of which treatment is best, though this discussion will take place.

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply. A)Malignant melanoma B)Brain cancer C)Breast cancer D)Esophageal cancer E)Liver cancer

C,D,E - Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following? A)Daily treatment with targeted therapy medications B)Radiation therapy on a daily basis C)Hematopoietic stem cell transplantation D)An aggressive course of chemotherapy

D - Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies.

An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRFs). The nurse should know that these achieve a therapeutic effect by what means? A)Promoting the synthesis and release of leukocytes B)Focusing the patients immune system exclusively on the tumor C)Potentiating the effects of chemotherapeutic agents and radiation therapy D)Altering the immunologic relationship between the tumor and the patient

D - BRFs alter the immunologic relationship between the tumor and the cancer patient (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRFs do not potentiate radiotherapy and chemotherapy.

A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patients family and friends? A)Your family should likely gather at the bedside in case theres a negative outcome. B)Make sure she doesnt eat any food in the 24 hours before the procedure. C)Wear a hospital gown when you go into the patients room. D)Do not visit if youve had a recent infection.

D - Before HSCT, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the patients contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.

You are performing your rounds following shift change. Your patient complains of burning and tenderness at their IV site. You note that their IV is located in the left forearm and that Carboplatin (a known irritant) is infusing currently. What is your priority of care at this time? a) Apply ice to the IV site and inform the patient to let you know if the pain continues b) Notify the physician immediately c) Slow down the infusion rate of the chemotherapy d) Stop the infusion immediately and then notify the physician of possible extravasation

D - Carboplatin is a chemotherapeutic irritant that can cause severe tissue damage to any vein and should be given in a verified central line for patient safety. Peripheral IV use should only be used for very short amounts of time. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped. Slowing down the drug will allow it to continue to extravasate and cause more patient harm.

An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do? A)Periodically apply ice to the area. B)Keep the area cleanly shaven. C)Apply petroleum jelly to the affected area. D)Avoid using soap on the treatment area.

D - Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies? A)Radiation therapy often results in secondary brain tumors. B)Surgical complications are exceedingly common. C)Diagnosis rarely occurs until the cancer is endstage. D)Metastases are common and respond poorly to treatment.

D - Deaths from malignancies of the head and neck are primarily attributable to local-regional metastasis to the cervical lymph nodes in the neck. This often occurs by way of the lymphatics before the primary lesion has been treated. This local-regional metastasis is not amenable to surgical resection and responds poorly to chemotherapy and radiation therapy. This high mortality rate is not related to surgical complications, late diagnosis, or the development of brain tumors.

A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patients severe bone pain? A)Implementing distraction techniques B)Educating the patient about the effective use of hot and cold packs C)Teaching the patient to use NSAIDs effectively D)Helping the patient manage the opioid analgesic regimen

D - For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain.

The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patients care needs are unable to be met in a home environment. What might you suggest as an alternative? A)Discuss a referral for rehabilitation hospital. B)Panel the patient for a personal care home. C)Discuss a referral for acute care. D)Discuss a referral for hospice care.

D - Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have fewer than 6 months to live. Each of the other listed options would be less appropriate for the patients physical and psychosocial needs.

A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what? A)AML - acute myeloid leukemia B)CML - chronic myeloid leukemia C)MDS - myelodysplastic syndromes D)ALL - acute lymphocytic leukemia

D - In (ALL), manifestations of leukemic cell infiltration into other organs are more common than with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The central nervous system is frequently a site for leukemic cells; thus, patients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. This particular presentation is not closely associated with (AML), (CML), or (MDS).

You are creating a care plan for your oncology patient. One of the nursing diagnoses you develop is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients? a) Encourage 6 small meals a day to promote nutrition b) Bathe your patient daily and as needed c) Assess the integrity of the oral mucosa every other day d) Provide skin care to maintain skin integrity

D - Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

Your newly diagnosed early-stage breast cancer patient is concerned about receiving radiation. You educate her on early effects and late effects of radiation. One key educational point to express about potential late effects of external beam radiation to the breast is? a) Breast erythema b) Menopause c) Weight loss d) Pulmonary fibrosis

D - Pulmonary fibrosis is a common late effect of radiation to the chest. Breast erythema and weight loss are early effects occuring typically within the first 2-4 weeks of radiation. Menopause is not an effect of external beam radiation to the chest.

An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis? A)Apply an ice pack or heating pad PRN to relieve pain and pruritis B)Avoid skin contact with water whenever possible C)Apply phototherapy PRN D)Avoid rubbing or scratching the affected area

D - Rubbing and or scratching will lead to additional skin irritation, damage, and increased risk of infection. Extremes of hot, cold, and light should be avoided. No need to avoid contact with water.

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo? A)Lymphadenectomy B)Needle biopsy C)Open biopsy D)Sentinel node biopsy

D - Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer.

A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurses response? A)The cells in small cell cancer of the lung are not large enough to visualize in surgery. B)Small cell lung cancer is self-limiting in many patients and surgery should be delayed. C)Patients with small cell lung cancer are not normally stable enough to survive surgery. D)Small cell cancer of the lung grows rapidly and metastasizes early and extensively.

D - Surgery is primarily used for NSCLCs, because small cell cancer of the lung grows rapidly and metastasizes early and extensively. Difficult visualization and a patients medical instability are not the limiting factors. Lung cancer is not a self-limiting disease.

A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patients family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage? A)Gastric cancer does not cause signs or symptoms until metastasis has occurred. B)Adherence to screening recommendations for gastric cancer is exceptionally low. C)Early symptoms of gastric cancer are usually attributed to constipation. D)he early symptoms of gastric cancer are usually not alarming or highly unusual.

D - Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation.

A patient presents with a T3 N2 M0 lung cancer and asks the nurse what this means. The nurse's best response is? a) The tumor is less than 3 cm and is only in nearby lymph nodes b) The tumor is greater than 3 cm and is in further lymph nodes on the same side c) The tumor is near the airway, chest, or diaphragm and is in lymph nodes on the opposite side d) The tumor is near the airway, chest, or diaphragm and is in further lymph nodes on the same side

D - TNM is the universal language used in healthcare in regards to staging cancer. T3 means the lesion is any size near an airway, chest, or diaphragm. N2 means the lymph nodes further away are involved, but still on the same side. M0 means there is no metastasis to other organs.

A patient with non-Hodgkins lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurses best response? A)Everyone should do these things because theyre health promotion activities that apply to everyone. B)You dont want to develop a second cancer, do you? C)You need to do this just to be on the safe side. D)Its important to reduce other factors that increase the risk of second cancers.

D - The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The other options do not answer the patients question, and also make light of the patients question.

The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize? A)Adjust the dose to the patients present symptoms. B)Wash hands with an alcohol-based cleanser following administration. C)Use gloves and a lab coat when preparing the medication. D)Dispose of the antineoplastic wastes in the hazardous waste receptacle.

D - The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.

An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? A)Adhering to primary tumor cells B)Inducing mutation of cells of another organ C)Phagocytizing healthy cells D)Invading healthy host tissues

D- Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient? A)Impaired nutritional status B)Cognitive changes C)Diarrhea D)Alopecia

A - Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this patient. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.

A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A)Administer an antiemetic. B)Administer an antimetabolite. C)Administer a tumor antibiotic. D)Administer an anticoagulant.

A - Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

An oncology nurse recognizes a patients risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patients plan of care? Select all that apply. A)Monitoring the patients electrolyte levels B)Monitoring the patients hepatic function C)Measuring the patients weight on a daily basis D)Measuring and recording the patients intake and output E)Auscultating the patients lungs frequently

A, C, D, E - Assessments that relate to fluid balance include monitoring the patients electrolytes, auscultating the patients chest for adventitious sounds, weighing the patient daily, and closely monitoring intake and output. Liver function is not directly relevant to the patients fluid status in most cases.

An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL? A)Increased numbers of blast cells B)Increased lymphocyte levels C)Intractable bone pain D)Thrombocytopenia with no evidence of bleeding

B - An increased lymphocyte count (lymphocytosis) is always present in patients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL.

The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient? A)Fatigue related to altered metabolic processes B)Altered nutrition: less than body requirements related to anorexia C)Risk for infection related to altered immunologic response D)Body image disturbance related to weight loss and anorexia

C - A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patients immunity is suppressed, he or she will be at a high risk for infection. The other listed nursing diagnoses are valid, but they are not as high a priority as is risk for infection.

A patient has undergone surgery for oral cancer and has just been extubated in postanesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient? A)Placing the patient in a left lateral position B)Administering opioids as ordered C)Placing the patient in Fowlers position D)Teaching the patient to use the patient-controlled analgesia (PCA) system

C - After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in Fowlers position to facilitate breathing and promote comfort. Lateral positioning does not facilitate oxygenation or comfort. Medications do not facilitate spontaneous breathing.

An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem? A)Hodgkin disease B)Non-Hodgkin lymphoma C)Multiple myeloma D)Acute thrombocythemia

C - Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older patients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.

A nurse is caring for patient whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment? A)Stomatitis B)Nephropathy C)Cognitive changes D)Peripheral neuropathy

D - A significant toxicity associated with the use of bortezomib for multiple myeloma is peripheral neuropathy. Stomatitis, cognitive changes, and nephropathy are not noted to be adverse effects of this medication.