Unit 4 Breast Cancer, Leukemia and Cellulitis

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement made by the client indicates a need for further instruction regarding home care measures? 1."It is all right to use a straight razor to shave under my arms." 2."I must be sure to use thick potholders when I am cooking." 3."I must be sure not to have blood pressures taken or blood drawn from my right arm." 4."I should inform all of my other health care providers that I have had this surgical procedure."

1 After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1.Encourage the child's parents to stay with the child. 2.Encourage play with other children of the same age. 3.Advise the family to visit only during the scheduled visiting hours. 4.Provide a private room, allowing the child to bring favorite toys from home.

1 Although the preschooler already may be spending some time away from parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection.

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1.Encourage the child's parents to stay with the child. 2.Encourage play with other children of the same age. 3.Advise the family to visit only during the scheduled visiting hours. 4.Provide a private room, allowing the child to bring favorite toys from home

1 Although the preschooler already may be spending some time away from parents at a day-care center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection.

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? 1. "Have you had a fever?" 2. "Have you lost any weight?" 3. "Has diarrhea been a problem?" 4. "Have you noticed any hair loss?"

1 An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? 1. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years 2. Family history of colorectal cancer and consumes a high-fiber diet 3. Limits fat consumption and has regular mammography and Pap screenings 4. Exercises five times every week and does not consume alcoholic beverages

1 Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

A client admitted to the hospital is taking capecitabine for breast cancer. The nurse should monitor the client for which symptom that is a side or adverse effect of the medication? 1.Dyspnea 2.Dizziness 3.Headache 4.Constipation

1 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. Headache, constipation, and dizziness are not adverse effects of this medication.

Capecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? 1.Diarrhea 2.Weakness 3.Irritability 4.Increased appetite

1 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Frequent side effects include diarrhea, nausea, vomiting, stomatitis, hand and foot syndrome (painful palmar-plantar erythema and swelling with paresthesias, tingling, and blistering), fatigue, anorexia, and dermatitis. Weakness, irritability, and increased appetite are not side effects of this medication.

A client who has been diagnosed with breast cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason? 1.Increase the destruction of tumor cells. 2.Prevent the destruction of normal cells. 3.Decrease the risk of the alopecia and stomatitis. 4.Increase the likelihood of erythrocyte and leukocyte recovery.

1 Cisplatin is an alkylatinglike medication, and vincristine is a vinca alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells.

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? 1. Cells are abnormal and moderately differentiated. 2. Cells are very abnormal and poorly differentiated. 3. Cells are immature, primitive, and undifferentiated. 4. Cells differ slightly from normal cells and are well-differentiated.

1 Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1.Initiate bleeding precautions. 2.Monitor closely for signs of infection. 3.Monitor the temperature every 4 hours. 4.Initiate protective isolation precautions.

1 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is has a low platelet count usually less than 50,000 mm3 (50.0 × 109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.

The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? 1.The client looks at the surgical site. 2.The client performs the prescribed arm exercises. 3.The client takes the pain medication as prescribed. 4.The client has read all of the postoperative materials provided by the hospital nurse.

1 Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? 1. A bland, low-fiber diet 2. A high-protein, high-calorie diet 3. A diet high in fresh fruits and vegetables 4. A diet emphasizing whole and organic foods

1 Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

A 50-yr-old patient is preparing to begin breast cancer treatment with tamoxifen. What point should the nurse emphasize when teaching the patient about her new drug regimen? 1. "Report any changes in your vision." 2. "The medication may cause some breast sensitivity." 3. "The drug often alleviates some menopausal symptoms." 4. "Abstain from drinking alcohol after you begin taking tamoxifen."

1 Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary to abstain from alcohol.

The nurse is assessing the intravenous (IV) line of a client who is receiving a chemotherapy infusion. The assessment reveals coolness and swelling around the IV insertion site. What should the nurse do next? 1.Stop the IV infusion. 2.Obtain a prescription for a chest x-ray. 3.Notify the primary health care provider. 4.Apply cold compresses to the insertion site.

1 The assessment indicates that infiltration of the IV solution has occurred, and the infusion must be stopped immediately to prevent further infiltration of the chemotherapy fluid. The nurse next notifies the primary health care provider (PHCP) of the occurrence. The PHCP needs to prescribe the treatment for the insertion site. There is no useful reason for doing a chest x-ray.

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? 1.Elevated on a pillow 2.Level with the right atrium 3.Dependent to the right atrium 4.Elevated above shoulder level

1 The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

The nurse is caring for a client with a diagnosis of breast cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the client's white blood cell count was which value? 1. 2000 mm3 (2.0 × 109/L) 2. 5800 mm3 (5.8 × 109/L) 3. 8400 mm3 (8.4 × 109/L) 4. 11,500 mm3 (11.5 × 109/L)

1 The normal WBC count ranges from 5000 to 10,000 mm3 (5 to 10 × 109/L). The client who has a decrease in the number of circulating WBCs is immunosuppressed. The nurse implements neutropenic precautions when the client's values fall sufficiently below the normal level. The specific value for implementing neutropenic precautions usually is determined by agency policy. The remaining options are normal values.

A woman has just been told by the primary health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response? 1.Fear 2.Rage 3.Denial 4.Anxiety

1 The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement.

The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. 1.Stop the infusion. 2.Prepare to apply ice or heat to the site. 3.Restart the IV at a distal part of the same vein. 4.Notify the primary health care provider (PHCP). 5.Prepare to administer a prescribed antidote into the site. 6.Increase the flow rate of the solution to flush the skin and subcutaneous tissue.

1,2,4,5 Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or heat may be prescribed for application to the site, and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.

A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply. 1.Avoid contact sports. 2.Wash hands frequently. 3.Increase intake of fresh fruits and vegetables. 4.Avoid crowded places such as shopping malls. 5.Treat a sore throat with over-the-counter products. 6.Avoid people who have received live attenuated vaccines.

1,2,4,6 Effective measures should be used to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and hand washing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the primary health care provider.

The nurse prepares to care for a client with acute cellulitis of the lower leg. The nurse anticipates that which interventions will be prescribed for the client? Select all that apply. 1.Antibiotic therapy 2.Cold compresses to the affected area 3.Warm compresses to the affected area 4.Intermittent heat lamp treatments 4 times daily 5.Alternating hot and cold compresses continuously

1,3 Cellulitis is a skin infection into deeper dermal and subcutaneous tissues that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. Warm compresses may be used to decrease the discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics will be initiated. The nurse should provide supportive care as prescribed to manage symptoms such as fatigue, fever, chills, headache, and myalgia. Heat lamps can cause more disruption to already inflamed tissue. Cold compresses and alternating cold and hot compresses are not the best measures.

The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors (select all that apply.)? 1. Nulliparity 2. Age 30 or over 3. Early menarche 4. Late menopause 5. Alcohol consumption 6. Personal history of colon cancer

1,3,4,5,6 Women are at an increased risk for development of breast cancer if they are older than the age of 50 years; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 years or are nulliparous. Alcohol consumption may increase the risk of breast cancer.

The client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states to take which measure? 1.Increase dietary intake of potassium. 2.Increase fluid intake to 2 to 3 L/day. 3.Take the medication with large meals. 4.Decrease dietary intake of magnesium.

2 An adverse effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? 1. Ask the patient if the site hurts. 2. Turn off the chemotherapy infusion. 3. Call the ordering health care provider. 4. Administer sterile saline to the reddened area.

2 Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored? 1.Platelet count 2.Bone marrow biopsy 3.White blood cell count 4.Complete blood cell count

2 Bone marrow aspiration or biopsy allows examination of blast cells and other hypercellular activity. Blood studies will not provide a definitive diagnosis of leukemia

The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session? 1.Older women are more likely to get mammograms. 2.Treatment decisions are based on a woman's overall health. 3.Women younger than age 65 are more likely to get breast cancer. 4.A woman's age is the main factor used to decide which screening methods to use.

2 Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.

A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? 1.Clotting time 2.Uric acid level 3.Potassium level 4.Blood glucose level

2 Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

Capecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the action of the medication. The nurse formulates a response based on which mechanism of action of this medication? 1.Promotes DNA synthesis 2.Interferes with protein synthesis 3.Assists with the processing of RNA 4.Processes enzymes needed for cellular growth

2 Capecitabine is an antimetabolite that inhibits enzymes necessary for the synthesis of essential cellular components. It interferes with DNA synthesis, RNA processing, and protein synthesis. Capecitabine does not promote DNA synthesis, assist with the processing of RNA, or process enzymes needed for cellular growth.

Capecitabine has been prescribed for a client with breast cancer, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further instruction? 1."I need to monitor my temperature." 2."I need to be sure to go to the clinic to receive my yearly flu vaccine." 3."I may have some diarrhea, but if it becomes severe, I will call my health care provider." 4."It's important for me to contact my primary health care provider if I have any fever or other signs of infection."

2 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. The client is instructed to obtain primary health care provider (PHCP) approval before receiving immunizations because the medication lowers the body's resistance to infection. Diarrhea is a frequent side effect of this medication, but the client should contact the PHCP if it becomes severe. The client should monitor his or her temperature and call the PHCP for severe diarrhea or for a fever or other sign of infection.

A client is being admitted to the hospital for treatment of acute cellulitis of the lower left leg. During the admission assessment, the nurse expects to note which finding? 1.An inflammation of the epidermis only 2.A skin infection of the dermis and underlying hypodermis 3.An acute superficial infection of the dermis and lymphatics 4.An epidermal and lymphatic infection caused by Staphylococcus

2 Cellulitis is an infection of the dermis and underlying hypodermis that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. The skin is erythematous, edematous, tender, and sometimes nodular. Erysipelas is an acute, superficial, rapidly spreading inflammation of the dermis and lymphatics. The infection is not superficial and extends deeper than the epidermis

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1.Placing cool compresses on the affected arm 2.Elevating the affected arm on a pillow above heart level 3.Avoiding arm exercises in the immediate postoperative period 4.Maintaining an intravenous site below the antecubital area on the affected side

2 Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia. The nurse notes that the granulocyte count is decreased. The nurse interprets that the client is at risk for which condition? 1.Anemia 2.Infection 3.Bleeding 4.Dehydration

2 Granulocytes are blood cells that destroy bacteria. When granulocytes are decreased from normal, the risk of infection increases significantly. A decreased granulocyte count is not associated with anemia, bleeding, or dehydration.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1.Take the medication with food. 2.Increase fluid intake to 2000 to 3000 mL daily. 3.Decrease sodium intake while taking the medication. 4.Increase potassium intake while taking the medication

2 Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1.Lumbar puncture showing no blast cells 2.Bone marrow biopsy showing blast cells 3.Platelet count of 350,000 mm3 (350 × 109/L) 4.White blood cell count 4500 mm3 (4.5 × 109/L)

2 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease but also may occur as a result of chemotherapy and does not confirm the diagnosis. The white blood cell count may be normal, high, or low in leukemia. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease.

The nurse is assessing a client's peripheral intravenous (IV) site after completion of a vancomycin infusion and notes that the area is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. At this time, which action by the nurse is best? 1.Check for the presence of blood return. 2.Remove the IV site and restart at another site. 3.Document the findings and continue to monitor the IV site. 4.Call the primary health care provider (PHCP) and request that the vancomycin be given orally.

2 Phlebitis at an IV site can be distinguished by client discomfort at the site and by redness, warmth, and swelling proximal to the catheter. If phlebitis occurs, the nurse should remove the IV line and insert a new IV line at a different site, using a vein other than the one that has developed phlebitis. Checking for the presence of blood return should be done before the administration of vancomycin because this medication is a vesicant. Documenting the findings and continuing to monitor the IV site and calling the PHCP and requesting that the vancomycin be given orally do not address the immediate problem. Additionally, there could be indications for the prescription of IV as opposed to oral vancomycin for the client. The PHCP should be notified of the complications with the IV site but not asked for a prescription for oral vancomycin.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1.Glucose level 2.Calcium level 3.Potassium level 4.Prothrombin time

2 Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate? 1.Place the client on bleeding precautions. 2.Place the client on neutropenic precautions. 3.Remove the rectal thermometer from the client's room. 4.Instruct the dietary department to eliminate all proteins from the client's diet.

2 The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the white blood cell count drops, neutropenic precautions need to be implemented. This includes protective isolation techniques to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops below 90,000 to 100,000 mm3 (90 to 100 × 109/L) or per primary health care provider prescription or agency policy. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal clotting time is 8 to 15 minutes, and the normal ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). Removing the rectal thermometer from the client's room would be done if bleeding precautions were initiated. There is no useful reason to eliminate all protein from the diet.

A 27-year-old client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time? 1.After menses 2.Before menses 3.During menses 4.At any time, regardless of the menstrual cycle

2 The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Therefore, the other options are incorrect.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? 1.Remove the fresh flowers from the client's room. 2.Remove the rectal thermometer from the client's room. 3.Instruct family members to wear a mask when entering the client's room. 4.Call the dietary department to report that the client will be on a low-bacteria diet.

2 When the client's platelet count is low, the client is at risk for bleeding. Options 1, 3, and 4 relate to the risk for infection. Rectal temperatures should not be taken on a client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding.

A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? 1. Inappropriate lactation necessitates breast biopsy. 2. Nipple discharge of any type is considered a precursor to cancer. 3. Unexpected nipple discharge of any type warrants medical follow-up. 4. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.

3 Although most cases of nipple discharge are not related to malignancy, further medical assessment is indicated. Other testing would be done for inappropriate lactation before a breast biopsy would be necessary. Galactorrhea is not considered a normal age-related change, nor is it a common perimenopausal symptom

The nurse is monitoring a client with acute lymphocytic leukemia for toxic effects of asparaginase. The nurse should notify the primary health care provider if monitoring reveals which finding? 1.Alopecia 2.Oral ulcerations 3.Prolonged blood clotting times 4.Decreased white blood cell count

3 Asparaginase can cause severe adverse effects; however, they often are different from those of other antineoplastic medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. Signs and symptoms of central nervous system depression ranging from confusion to coma can occur. Nausea and vomiting can be intense and may limit the dose that can be tolerated. In contrast with most antineoplastic medications, asparaginase does not depress the bone marrow, nor does it cause alopecia, oral ulceration, or intestinal ulceration.

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? 1. Use Dial soap to feel clean and fresh. 2. Scented lotion can be used on the area. 3. Avoid heat and cold to the treatment area. 4. Wear the new bra to comfort and support the area.

3 Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication to treat breast cancer. When implementing the plan, the nurse should make which statement to the client? 1."You can take aspirin as needed for headache." 2."You can drink beverages containing alcohol in moderate amounts each evening." 3."You need to consult with the primary health care provider (PHCP) before receiving immunizations." 4."It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."

3 Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? 1. Keep affected arm flat at the patient's side. 2. Apply an elastic bandage on the affected arm. 3. Assess blood pressure only on unaffected arm. 4. Restrict exercise of the affected arm for 1 week

3 Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce fluid volume in the arm.

Capecitabine has been prescribed for a client with breast cancer. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1.Liver function tests 2.Bilirubin level assay 3.Complete blood count (CBC) 4.Triglyceride level determination

3 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Bone marrow depression can occur from the use of this medication, and a CBC and blood chemistry studies should be done periodically. Liver function tests, bilirubin level assay, and triglyceride levels are unnecessary.

The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity? 1.Elevated creatinine 2.Red coloration in the urine 3.Electrocardiogram (ECG) changes 4.Elevated blood urea nitrogen (BUN)

3 Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart, including ECG changes and heart failure. Elevated values on renal function tests are not associated with the use of this medication. A red coloration of the urine may occur with the use of this medication, but this effect is harmless

The nurse performs a breast examination on a 68-yr-old female patient. Which clinical manifestation indicates further evaluation for breast cancer is needed? 1. Bilateral pendulous breasts 2. Right breast is warm, painful to touch 3. Irregular, nontender lump with induration 4. Palpable lump that is tender and movable

3 Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.

The nurse is caring for an obese 67-yr-old woman after a right mastectomy with axillary lymph node dissection. Which discharge instruction should the nurse include? 1. "Arm exercises should not be started for 4 to 6 weeks." 2. "Discontinue arm exercises if you have discomfort or pain." 3. "Special massage therapy can decrease swelling in your arm." 4. "Keep your right arm in a sling to decrease pain and swelling."

3 Decongestive therapy may be used for acute lymphedema and includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The arm exercises should be initiated after surgery and increased gradually. Pain medications should be administered 30 minutes before arm exercises. The operative arm should be kept at the level of the heart but not in a sling; a sling discourages use of the arm

Morphine sulfate, 2.5 mg intravenous piggyback, is prescribed for a child with cancer. The safe pediatric dose is 0.05 to 0.1 mg/kg/dose. The child weighs 50 kg. The nurse determines which concerning the dose prescribed? 1.The dose prescribed is too low. 2.The dose prescribed is too high. 3.The dose prescribed is within the safe dosage range. 4.There is not enough information to determine the safe dosage range.

3 Determine the dosage parameters and the prescribed dosage. The first step is to calculate the lowest and highest amount that the client can receive based on his or her weight. Step 1: 0.05 mg/kg × 50 kg = 2.5 mg (lowest); 1 mg/kg × 50 kg = 5 mg (highest) Step 2: Compare the prescribed dose to the safe dosage range.

The nurse is caring for a 52-yr-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? 1. Observe for alopecia. 2. Determine visual acuity. 3. Monitor cardiac rhythm. 4. Assess mouth and throat.

3 Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and clinical manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1.Anemia 2.Decreased platelets 3.Increased uric acid level 4.Decreased leukocyte count

3 Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1."I have a vase in the utility room, and I will get it for you." 2."I will get the vase and wash it well before you put the flowers in it." 3."The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4."When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room, because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.

The nurse is reviewing the laboratory results for a client with a diagnosis of leukemia and notes that the absolute neutrophil count is decreased. The nurse interprets this to mean that the client is at risk for which problem? 1.Anemia 2.Bleeding 3.Infection 4.Dehydration

3 Neutrophils arise from stem cells and complete the maturation process in the bone marrow. They belong to a class of leukocytes known as granulocytes because of the large number of granules present inside each cell. Neutrophils provide the first internal line of defense, via phagocytosis, against foreign invaders (especially bacteria) in blood and extracellular fluid. If the neutrophil count is low, the client is at risk for infection. The remaining options are not associated with the function of neutrophils.

The nurse in the primary health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint? 1.These sensations are signs of a complication. 2.These sensations probably will be permanent. 3.These sensations dissipate over several months and usually resolve after 1 year. 4.It is nothing to worry about because most women who have this type of surgery experience this problem.

3 Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client? 1."Good job performing your BSE. I am sure that is nothing to be concerned about." 2."Make sure you tell the primary health care provider about your finding at the next regularly scheduled visit." 3."I am glad you called to report this finding. Can you come to the clinic to see your primary health care provider tomorrow?" 4."Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101º F (38.3º C)."

3 Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.

The clinic nurse prepares instructions for a client diagnosed with leukemia who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? 1.Avoid foods and fluids for the next 12 to 24 hours. 2.Swab the mouth with lemon and glycerin 4 times a day. 3.Rinse the mouth with a diluted solution of baking soda or saline. 4.Brush the teeth with a stiff-bristled toothbrush, and use dental floss 3 times a day.

3 Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with a diluted solution of baking soda or saline. Food and fluid are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milkshakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth, particularly with a stiff-bristled toothbrush, and flossing when stomatitis is severe.

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast? 1.Under the left scapula 2.Under the left shoulder 3.Under the right shoulder 4.Under the small of the back

3 The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder and vice versa. Therefore, options 1, 2, and 4 are incorrect.

The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? 1. A 25-yr-old female patient with fibrocystic breast disease 2. A 59-yr-old male patient who has inherited the APC gene 3. A 72-yr-old female patient with a family history of breast cancer Correct 4. A 43-yr-old male patient who is obese and leads a sedentary lifestyle

3 The risk factors most associated with breast cancer are female gender, advancing age, and family history. The incidence of breast cancer increases dramatically after age 60 years. Mutations in BRCA genes may cause 5% to 10% of breast cancers; The APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.

When doing breast self-examination, the female patient should report which findings to her health care provider? 1. Palpable rib margins 2. Denser breast tissue 3. Left nipple deviation 4. Different sized breasts

3 Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings

The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1.Increase in lipase level 2.Increase in blood glucose level 3.Increase in serum calcium level 4.Increase in serum potassium level 5.Decrease in low-density lipoprotein levels

3,5 Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels should be determined. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 1, 2, and 4 are not associated with this medication.

A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? 1."Your friends are correct." 2."You will not lose your hair." 3."Hair loss may occur, but it will grow back just as it is now." 4."Hair loss may occur, and it will grow back, but it may have a different color or texture."

4 Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect.

The nurse is caring for a client who is receiving asparaginase. The nurse should monitor the client for improvement of which condition? 1.Lung cancer 2.Breast cancer 3.Metastatic prostate cancer 4.Acute lymphocytic leukemia

4 Asparaginase is indicated for the treatment of acute lymphocytic leukemia. Lung cancer, breast cancer, and metastatic prostate cancer are treated with other antineoplastic agents.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. Which nursing intervention would be most effective in planning care? 1. Evaluate left arm lymphatic accumulation. 2. Maintain joint flexibility and left arm function. 3. Teach her about chemotherapy and radiation therapy. 4. Assess the patient's response to the diagnosis of breast cancer.

4 Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care. The approach for the care of the left arm and teaching the patient about further therapy will be based the initial assessment.

The nurse is monitoring a client with chronic lymphocytic leukemia (CLL). Which sign should the nurse specifically monitor for and report to the primary health care provider? 1.Anemia 2.Bleeding 3.Pancytopenia 4.Lymphadenopathy

4 CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore, the client will have enlarged and swollen lymph nodes. Options 1 and 2 are clinical manifestations of acute leukemias. Option 3 is a clinical manifestation of hairy cell leukemia.

The primary health care provider (PHCP) writes a prescription for capecitabine for a client with breast cancer who was admitted to the hospital. The nurse should contact the PHCP to verify the prescription if which condition is noted in the assessment data? 1.Myalgia 2.Psoriasis 3.Rheumatoid arthritis 4.Chronic kidney disease

4 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. A contraindication to the use of this medication is severe renal impairment such as that which occurs in chronic kidney disease. Myalgia, psoriasis, and rheumatoid arthritis are not contraindications to this medication.

The nurse is collecting subjective and objective data from a client and notes that the client is taking capecitabine. The nurse determines that this medication has been prescribed to treat which condition? 1.Hypothyroidism 2.Kidney dysfunction 3.Cushing's syndrome 4.Metastatic breast cancer

4 Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. It also is used to treat colon cancer. It is not used to treat hypothyroidism, kidney dysfunction, or Cushing's syndrome.

A client is being admitted to the hospital for treatment of acute cellulitis of the lower left leg, and a nursing student is assigned to provide care for the client. The nursing instructor asks the student to describe this diagnosis. Which answer demonstrates the student's understanding of the diagnosis? 1."It is an acute superficial infection." 2."It is an inflammation of the epidermis." 3."Staphylococcus is the cause of this epidermal infection." 4."This skin infection involves the deep dermis and subcutaneous fat."

4 Cellulitis is a skin infection into deeper dermis and subcutaneous fat that results in deep red erythema without sharp borders and spreads widely through tissue spaces. The skin is erythematous, edematous, tender, and sometimes nodular, and the infection extends beyond the epidermis. It is not a superficial infection, and it is not simply inflammation. Options 1, 2, and 3 are incorrect descriptions.

The nurse is performing assessment of the client who is admitted with left leg cellulitis. What does the nurse anticipate finding on the assessment of the left lower extremity? 1.Pallor 2.Cyanosis 3.Jaundice 4.Erythema

4 Cellulitis presents with erythema (redness), which is localized inflammation. Options 1, 2, and 3 are not signs or symptoms of cellulitis.

The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? 1.Nausea 2.Diarrhea 3.Muscle spasms 4.Hyperuricemia

4 Chemotherapy destroys cells, leading to the release of uric acid into the bloodstream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms.

The nurse is caring for a client diagnosed with breast cancer receiving combination chemotherapy. Which nursing intervention is the most appropriate? 1.Give 2 agents from the same medication class. 2.Give 2 agents with like nadirs at the same time. 3.Test the client's knowledge about each agent's nadir. 4.Avoid giving agents with the same nadirs and toxicities at the same time.

4 Each chemotherapeutic agent has a specific nadir. Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities.

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? 1. "I understand the transplant procedure has no dangerous side effects." 2. "After the transplant, I will feel better and can go home in 5 to 7 days." 3. "My brother will be a 100% match for the cells used during the transplant." 4. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

4 Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than how many cells/mm3? 1.200,000 mm3 (200 × 109/L) 2.180,000 mm3 (180 × 109/L) 3.160,000 mm3 (160× 109/L) 4.150,000 mm3 (150 × 109/L)

4 If a child is thrombocytopenic, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. Additionally, suppositories and rectal temperatures are avoided. The normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L).

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? 1. Metastasis 2. Tumor angiogenesis 3. Immunologic escape 4. Immunologic surveillance

4 Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

A 51-yr-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? 1. Immobilize the patient's right arm until postoperative day 2. Maintain the patient's right arm in a dependent position when at rest. 3. Administer diuretics prophylactically for the prevention of lymphedema. 4. Promote gradually increasing mobility as soon as possible following surgery.

4 Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? 1. Acute pain 2. Hypothermia 3. Powerlessness 4. Risk for infection

4 Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

The nurse teaches a 53-yr-old patient about screening for early detection of breast cancer. Which statement by the patient requires clarification by the nurse? 1. "I should plan to have a mammogram every year." 2. "I will see a health care provider every year for a breast examination." 3. "A breast examination should be done right after my menstrual period." 4. "Self-breast examination is a reliable way to detect breast cancer early."

4 Screening for the early detection of breast cancer includes yearly mammograms starting at age 45 years. Breast self-examination (BSE) has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional, but it should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.

The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention? 1.Document the findings. 2.Administer pain medication. 3.Place a heating pad on the client's back. 4.Notify the primary health care provider (PHCP).

4 Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the PHCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. In addition, a prescription from the PHCP is needed for the use of a heating pad.

The community health nurse is instructing a group of young female clients about breast self-examination. The nurse should instruct the clients to perform the examination at which time? 1.At the onset of menstruation 2.Every month during ovulation 3.Weekly at the same time of day 4.One week after menstruation begins

4 The breast self-examination should be performed regularly, 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? 1.Refusing to look at the wound 2.Reading the postoperative care booklet 3.Asking for pain medication when needed 4.Participating in the care of the surgical drain

4 The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast.

Patients may reduce the risk of developing cancer using health promotion strategies.Identify strategies which can reduce the risk of developing cancer (select all that apply.). Control weight Genetic testing Immunizations Use sunscreen Stop smoking Limit alcohol intake

all of them Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. 1.Multiparity 2.Early menarche 3.Early menopause 4.Family history of breast cancer 5.High-dose radiation exposure to chest 6.Previous cancer of the breast, uterus, or ovaries

2,4,5,6 Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer.

ALL has what % cure rate with chemotherapy

90

what are the most common sites of cell infiltration in leukemia?

CNS and testicles

what do you need to check after a port is instilled?

placement: CXR and auscultating lung sounds to make sure there is no pneumothorax patency: blood return is seen

subcutaneous port

safer with the use of powerful vesicants that can destroy veins and surrounding tissue by evisceration easier access

most common type of leukemia in adults?

Chronic lymphocytic leukemia (CLL)

a port puts the pt at risk for what

infection

segs

mature neutrophils

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. 1.Review side effects of chemotherapy and treatment with the client. 2.Teach the client how to resolve specific concerns of her personal life. 3.Teach the client to pace activities with rest so as to maintain strength. 4.Offer information on available counseling services and support groups. 5.Tell the client about some other clients who have had breast cancer treatment. 6.Inquire how the cancer diagnosis and treatment affect the client's normal routine

1,3,4,6 It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available (e.g., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1.Maintain the child in a semiprivate room. 2.Reduce exposure to environmental organisms. 3.Use strict aseptic technique for all procedures. 4.Ensure that anyone entering the child's room wears a mask. 5.Apply firm pressure to a needle-stick area for at least 10 minutes.

2,3,4 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle-stick area for at least 10 minutes is a measure to prevent bleeding.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1."This medication can be used only to treat breast cancer." 2."Yes, your family member can take this medication for bladder cancer as well." 3."This medication can be taken to prevent and treat clients with breast cancer." 4."This medication can be taken by anyone with cancer as long as their health care provider approves it."

3 Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

The home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching? 1.Empties the drain to prevent infection 2.Elevates the arm when lying and sitting 3.Applies lotion to the area after the incision heals 4.Performs full range-of-motion exercises to the upper arm

4 The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed.

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care? 1.Keep suction drains fully inflated to provide adequate suction. 2.Perform venipunctures and blood pressures on the operative side only. 3.Inform the client that drains will be removed on the second postoperative day. 4.Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.

4 The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

most common type of leukemia in children?

Acute lymphocytic leukemia (ALL)

what do you assess in a pt with a fever who had high dose chemo?

Infection! check port heart and lung sounds I/O NVD? U/A AxO? S+S of septic shock

clinical manifestations of leukemia

anemia: weakness, pallor immunosuppression: infection, fever thrombocytopenia: petechiae, bruising, purpura cells infiltrate outside bone marrow

priority interventions for pt with fever after high dose chemo

antipyretics antibiotics neutropenic precautions thrombocytopenic precautions

bone marrow aspiration and biopsy is obtained from where?

iliac crest

bands

immature white blood cells (granulocytes)

other sites of cell infiltration?

lymph nodes, spleen, brain, liver, joints

tylenol suppository is not appropriate for a pt with what?

thrombocytopenia

Absolute Neutrophil Count (ANC)

total number of WBC's x bands+segs / 100

When caring for female patients, the nurse should be aware that most cancers occur where on the breast?

upper outer quadrant

The nurse expects to note which prescription for a client with a skin infection that extends into the dermis? 1.Applying warm compresses to the affected area 2.Placing iced compresses to the affected area every 4 hours 3.Alternating the application of hot and iced compresses every 2 hours 4.Placing antibiotic ointment on the affected site followed by continuous heat lamp application

1 Warm compresses may be prescribed to decrease the discomfort, erythema, and edema associated with a skin infection that is characteristic of cellulitis. The nurse should also provide supportive care as prescribed to manage associated symptoms such as fever or chills. After tissue and blood are obtained for culture, antibiotics are initiated. Heat lamps can cause more disruption to already inflamed tissue. Iced compresses are not prescribed because they can damage tissue.

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

1 When the child is nauseated, offering cool, clear liquids is best because they are soothing and better tolerated. Supportive nutritional measures should include oral supplements with high-protein and high-calorie foods. The nurse should not offer favorite foods when the child is nauseated because foods eaten during times of nausea will be associated with being sick.

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? 1. Firm-bristle toothbrush 2. Hydrogen peroxide rinse 3. Alcohol-based mouthwash 4. 1 tsp salt in 1 L water mouth rinse

4 A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

The nurse is giving client instructions over the telephone about preparing for a mammography. The nurse should make which statement to the client? 1."Wear metal jewelry as desired." 2."Consume clear liquids only on the day of the test." 3."Use only lanolin-based skin lotions on the day of the test." 4."If possible, avoid using underarm deodorant on the day of the test."

4 The client should avoid the use of lotions or underarm deodorant on the day of mammography because this can affect breast and axilla positioning and obtaining clear mammography pictures. At the mammography suite, the client may also be asked to clean the underarms with the provided wipes. Mammography is a type of radiographic procedure. Therefore, the client is advised not to wear jewelry or metal objects on the day of the test. No special dietary preparation is needed.