220 - chapter 1 recap
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which patient statement indicates that the nurse's teaching about management of the skin reaction has been effective? A) "I can buy some aloe vera gel to use on the area." B) "I will expose the treatment area to a sun lamp daily." C) "I can use ice packs to relieve itching in the treatment area." D) "I will scrub the area with warm water to remove the scales."
A) "I can buy some aloe vera gel to use on the area."
Which nursing action will be included in the plan of care for a patient admitted with multiple myeloma? A) Monitor fluid intake and output. B) Administer calcium supplements. C) Assess lymph nodes for enlargement. D) Limit weight-bearing and ambulation.
A) Monitor fluid intake and output.
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to A) enhance the patient's immunologic response to tumor cells. B) stimulate malignant cells in the resting phase to enter mitosis. C) prevent the bone marrow depression caused by chemotherapy. D) protect normal cells from the harmful effects of chemotherapy.
A) enhance the patient's immunologic response to tumor cells.
A side effect common to biologic therapies is A) flu like syndrome B) bone marrow suppression C) central nervous system deficits D) nausea, vomiting, anorexia, and diarrhea
A) flu like syndrome
The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? A) "I have frequent muscle aches and pains." B) "I rarely have the energy to get out of bed." C) "I experience chills after I inject the interferon." D) "I take acetaminophen (Tylenol) every 4 hours."
B) "I rarely have the energy to get out of bed."
Which nursing intervention will be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)? A) Assign the patient to a private room. B) Avoid intramuscular (IM) injections. C) Use rinses rather than a toothbrush for oral care. D) Restrict activity to passive and active range of motion.
B) Avoid intramuscular (IM) injections.
After the nurse has finished teaching a patient who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the patient indicates that the teaching has been effective? A) Fresh fruit salad B) Roasted chicken C) Whole wheat toast D) Cream of potato soup
B) Roasted chicken
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? A) The patient ambulates several times a day in the room. B) The patient's visitors bring in some fresh peaches from home. C) The patient cleans with a warm washcloth after having a stool. D) The patient uses soap and shampoo to shower every other day.
B) The patient's visitors bring in some fresh peaches from home.
A patient with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the A) platelet count. B) bleeding time. C) thrombin time. D) prothrombin time.
B) bleeding time.
A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, the nurse will plan to teach the patient about A) packed red blood cells (PRBCs) transfusion. B) bone marrow biopsy. C) filgrastim (Neupogen) administration. D) erythropoietin (Epogen) administration.
B) bone marrow biopsy.
A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to A) suggest that the patient limit social contacts until regrowth of the hair occurs. B) encourage the patient to purchase a wig or hat and wear it once hair loss begins. C) have the patient wash the hair gently with a mild shampoo to minimize hair loss. D) inform the patient that the hair will grow back once the chemotherapy is complete.
B) encourage the patient to purchase a wig or hat and wear it once hair loss begins.
The primary use of biologic therapy in cancer treatment is to A) prevent the fatigue associated with chemotherapy and high-dose radiation B) enhance or supplement the effects of the host's immune responses to tumor cells C) depress the immune system and circulating lymphocytes, as well as increasing a sense of well-being D) protect normal rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy.
B) enhance or supplement the effects of the host's immune responses to tumor cells
During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be A) establishing ECG monitoring B) increasing urine output with hydration therapy C) administering a bisphophonate such as pamidronate (aredia) D) restricting fluids and administering hypertonic sodium chloride solution.
B) increasing urine output with hydration therapy
The nurse assesses a patient receiving nilotinib (Tasigna). It is most important for the nurse to ask which of the following questions? A) "Have you noticed any hair loss?" B) "Have you lost any weight?" C) "Have you had a fever?" D) "Has diarrhea been a problem?"
C) "Have you had a fever?"
When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include? A) Limit fluids to 2 to 3 quarts a day. B) Take a daily multivitamin with iron. C) Avoid exposure to crowds as much as possible. D) Drink only one or two caffeinated beverages daily.
C) Avoid exposure to crowds as much as possible.
The nurse in the outpatient clinic is caring for a 50-year-old who smokes heavily. To reduce the patient's risk of dying from lung cancer, which action will be best for the nurse to take? A) Educate the patient about the seven warning signs of cancer. B) Plan to monitor the patient's carcinoembryonic antigen (CEA) level. C) Discuss the risks associated with cigarettes during every patient encounter. D) Teach the patient about the use of annual chest x-rays for lung cancer screening.
C) Discuss the risks associated with cigarettes during every patient encounter.
A patient is receiving radiation to the head and neck and complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A) Cleanse the mouth every 2 to 4 hours with hydrogen peroxide B) Apply palifermin (Kepivance) as a topical anesthetic. C) Provide high-protein and high-calorie, soft foods every 2 hours. D) Weigh the patient every month to monitor for weight loss.
C) Provide high-protein and high-calorie, soft foods every 2 hours.
A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." An appropriate intervention for the nurse to plan with the patient is to A) minimize activity until the treatment is completed. B) exercise vigorously when fatigue is not as noticeable. C) establish a time to take a short walk almost every day. D) consult with a psychiatrist for treatment of depression.
C) establish a time to take a short walk almost every day.
While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for the nursing diagnosis of A) diarrhea B) grieving C) risk for infection D) imbalanced nutrition: less than body requirements
C) risk for infection
The nurse is teaching a postmenopausal patient with stage III breast cancer about the expected outcomes of her cancer treatment. Which patient statement indicates that the teaching has been effective? A) "After cancer has not recurred for 5 years, it is considered cured." B) "The cancer will be cured if the entire tumor is surgically removed." C) "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." D) "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."
D) "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."
Which nursing action will be most effective in improving oral intake for a patient with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers? A) Offer the patient frequent small snacks between meals. B) Assist the patient to choose favorite foods from the menu. C) Provide education about the importance of nutritional intake. D) Apply the ordered anesthetic gel to oral lesions before meals.
D) Apply the ordered anesthetic gel to oral lesions before meals.
Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action by the nurse? A) Generalized muscle aches B) Complaints of nausea and anorexia C) Oral temperature of 100.6° F (38.1° C) D) Crackles heard at the lower scapular border
D) Crackles heard at the lower scapular border
Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I will call my health care provider if my stools turn black." b. "I will take a stool softener if I feel constipated occasionally." c. "I should take the iron with orange juice about an hour before eating." d. "I should increase my fluid and fiber intake while I am taking iron tablets."
a. "I will call my health care provider if my stools turn black."
The nurse determines that teaching about pernicious anemia has been effective when the patient says a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." b. "My symptoms can be completely reversed if I take cobalamin (vitamin B12) supplements." c. "If my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high incobalamin."
a. "This condition can kill me unless I take injections of the vitamin for the rest of my life."
Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains
a. A patient with chronic heart failure
In a severely anemic patient, the nurse would expect to find a. Dyspnea and tachycardia b. Cyanosis and pulmonary edema c. Cardio eagle and pulmonary fibrosis d. Ventricular dysrhythmias and wheezing
a. Dyspnea and tachycardia
What is the most important method for identifying the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood and sputum cultures c. Assessing for redness and swelling d. Monitoring white blood cell (WBC) count
a. Frequent temperature monitoring
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates malignant cells in the resting phase to enter mitosis.
a. IL-2 enhances the body's immunologic response to tumor cells.
Patient-Centered Care: To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not
a. Implement a walking program
When teaching the patient about a new prescription for oral iron supplements, what does the nurse instruct the patient to do? a. Increase fluid and dietary fiber intake b. Take the iron preparations with meals c. Use enteric-coated preparations taken with orange juice d. Report the presence of black stools to the health care provider
a. Increase fluid and dietary fiber intake
During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Obtain more information about the family history. b. Schedule a sigmoidoscopy to provide baseline data. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood.
a. Obtain more information about the family history.
The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)
a. Shortness of breath
While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2°F (39°C). What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline. b. Notify the health care provider and the blood bank. c. Add a leukocyte reduction filter to the blood administration set. d. Recognize this as a mild allergic transfusion reaction and slow the transfusion.
a. Stop the transfusion and instill normal saline.
A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/uL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.
a. The platelet count is 42,000/uL.
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.
a. check all stools for occult blood.
The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will a. immobilize the joint. b. apply heat to the knee. c. assist the patient with light weight bearing. d. perform passive range of motion to the knee.
a. immobilize the joint.
During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to a. increase urine output with hydration therapy. b. establish electrocardiographic (ECG) monitoring. c. administer a bisphosphonate such as pamidronate (Aredia). d. restrict fluids and administer hypertonic sodium chloride solution.
a. increase urine output with hydration therapy.
The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the MOST important preventive action for both women and men? a. smoking cessation b. routine colonoscopies c. frequent imaging tests d. regular examination of reproductive organs
a. smoking cessation
A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."
b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."
Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 44-year-old with sickle cell anemia who says "my eyes always look sort of yellow" b. 23-year-old with no previous health problems who has a nontender lump in the axilla c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement
b. 23-year-old with no previous health problems who has a nontender lump in the axilla
After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue
b. 33-year-old with a fever of 100.8° F (38.2° C)
A patient with thrombocytopenia with active bleeding is to receive two units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs every 15 minutes during the procedure. d. Refrigerate the second unit until the first unit has transfused.
b. Agitate the bag periodically during the transfusion.
Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease
b. Aplastic anemia
Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.
b. Check temperature every 4 hours.
The nurse is counseling a group of individuals over the age of 50 with average risk for cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal exam
b. Colonoscopy every 10 years
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about a. Folic acid intake b. Dietary intake of iron c. A history of gastric surgery d. A history of sickle cell anemia
b. Dietary intake of iron
When teaching the patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety. b. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects. c. Assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening. d. Inform the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong useof wigs.
b. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects.
Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure
b. Hemorrhage and infection
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.
b. Hospitalization is required for several weeks after the stem cell transplant.
A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid venipunctures. b. Notify the patient's physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.
b. Notify the patient's physician.
A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing intervention for the patient? a. Wrapping the knee with an elastic bandage b. Placing the patient on bed rest and applying ice to the joint c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions
b. Placing the patient on bed rest and applying ice to the joint
Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema
b. Potential complication: infection
In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which activity? a. Maintaining protective isolation b. Promoting leg exercises and ambulation c. Protecting the patient from injury or falls d. Promoting hydration with a large oral fluid intake
b. Promoting leg exercises and ambulation
When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression
b. Secondary malignancies
A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.
b. Teach the patient to administer filgrastim (Neupogen) injections.
When a patient is undergoing brachytherapy, what is it important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment. b. The patient is a source of radiation and personnel must wear film badges during care. c. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.
b. The patient is a source of radiation and personnel must wear film badges during care.
Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.
b. The patient is difficult to arouse.
Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted
b. The patient with neutropenia who has a temperature of 101.8° F
A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens in the blood d. CT or positron emission tomography (PET) scan
b. Tissue biopsy
An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.
b. alternate periods of rest and activity.
The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. stool occult blood test. d. gastric analysis testing.
b. bilirubin level.
It is important for the nurse providing care for a patient with sickle cell crisis to a. limit the patient's intake of oral and IV fluids. b. evaluate the effectiveness of opioid analgesics. c. encourage the patient to ambulate as much as tolerated. d. teach the patient about high-protein, high-calorie foods.
b. evaluate the effectiveness of opioid analgesics.
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron. b. folic acid. c. cobalamin (vitamin B12). d. ascorbic acid (vitamin C).
b. folic acid.
In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of a. folic acid. b. intrinsic factor. c. extrinsic factor. d. cobalamin intake.
b. intrinsic factor.
The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful to you in the past when coping with stressful events?" d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"
c. "Can you tell me what has been helpful to you in the past when coping with stressful events?"
A patient with acute myelogenous leukemia is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient? a. "Your bone marrow is destroyed by radiation and new bone marrow cells from a matched donor are injected into your bones." b. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse." c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused." d. "During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be giventransfusions of red blood cells and platelets to prevent complications."
c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused."
A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."
c. "Malignant tumors may spread to other tissues or organs."
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."
c. "The biopsy will help decide the treatment for my enlarged prostate."
A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.
c. Administer prescribed antiemetics 1 hour before the treatments.
Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family
c. Administering subcutaneous filgrastim (Neupogen) injection
A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action would address the cause of the patient problem? a. Add protein powder to foods such as casseroles. b. Tell the patient to eat foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add spices to enhance the flavor of foods that are served.
c. Avoid giving the patient foods that are strongly disliked.
Which normal tissues manifest early, acute responses to pelvic radiation therapy? a. Spleen and liver b. Kidney and nervous tissue c. Bone marrow and gastrointestinal (GI) mucosa d. Hollow organs such as the stomach and bladder
c. Bone marrow and gastrointestinal (GI) mucosa
External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.
c. Clean the perianal area carefully after every bowel movement.
A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Relief of pressure in the stomach will promote better nutrition. c. Decreasing the tumor size will improve the effects of other therapy. d. Tumor growth will be controlled by the removal of malignant tissue.
c. Decreasing the tumor size will improve the effects of other therapy.
What describes a primary use of immunotherapy therapy in cancer treatment? a. Protect normal, rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy b. Prevent the fatigue associated with chemotherapy and high-dose radiation as seen with bone marrow depression c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. Depress the immune system and circulating lymphocytes as well as increase a sense of well-being by replacing central nervous system deficits
c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms
A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush four times a day
c. Monitoring the patient for headaches, vertigo, or confusion
During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux
c. Paresthesia of the hands and feet
After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time
c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)
An allogenic hematopoietic stem cell transplant is considered as treatment for a patient with acute myelogenous leukemia. What information should the nurse include when teaching the patient about this procedure? a. There is no risk for graft-versus-host disease because the donated marrow is treated to remove cancer cells. b. The patient's bone marrow will be removed, treated, stored, and then reinfused after intensive chemotherapy. c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen(HLA) match with the patient. d. There is no need for posttransplant protective isolation because the stem cells are infused directly into the blood.
c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen(HLA) match with the patient.
A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.
c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.
c. ask the patient whether there are any questions or concerns about HSCT.
In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find? a. An absence of factor IX b. A decreased platelet count c. A prolonged bleeding time d. A prolonged partial thromboplastin time (PTT)
d. A prolonged partial thromboplastin time (PTT)
Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count
d. Absolute neutrophil count
Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time
d. Activated partial thromboplastin time
What is a nursing intervention that is indicated for the patient during a sickle cell crisis? a. Frequent ambulation b. Application of antiembolism hose c. Restriction of sodium and oral fluids d. Administration of large doses of continuous opioid analgesics
d. Administration of large doses of continuous opioid analgesics
The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Moisturize skin with lotion b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area
d. Avoid extreme temperatures to the area
A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Administer the warfarin (Coumadin) at the scheduled time. c. Teach the patient about the purpose of platelet transfusions. d. Discontinue heparin and flush intermittent IV lines using normal saline.
d. Discontinue heparin and flush intermittent IV lines using normal saline.
A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members
d. Dysfunctional family processes related to effect of illness on family members
A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. Which type of anemia is this patient most at risk for? a. Aplastic anemia b. Hemolytic anemia c. Iron-deficiency anemia d. Folic acid deficiency anemia
d. Folic acid deficiency anemia
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a. Frequent loose stools b. Nausea and vomiting c. Elevated white blood count (WBC) d. Increased carcinoembryonic antigen (CEA)
d. Increased carcinoembryonic antigen (CEA)
What factor differentiates a malignant tumor from a benign tumor? a. It causes death. b. It grows at a faster rate. c. It is often encapsulated. d. It invades and metastasizes.
d. It invades and metastasizes.
The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the first thing the nurse should do for this patient? a. Administer a nonsteroidal antiinflammatory drug b. Assess the patient's vital signs and behavior to determine the medication to use. c. Have the patient keep a pain diary to better assess the patient's potential addiction. d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain.
d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain.
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis
d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis
During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do? a. Limit fluid intake b. Avoid humid weather c. Eliminate exercise from the lifestyle d. Seek early medical intervention for upper respiratory infections
d. Seek early medical intervention for upper respiratory infections
Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.
d. Suggest use of a daily planner and encourage adequate rest and sleep.
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/µL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/µL
d. White blood cells (WBC) 2700/µL
A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to includea. a hematocrit (Hct) of 38%. b. an RBC count of 4,500,000/mL. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).
d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).
A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.
d. disconnect the transfusion and infuse normal saline.
A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.
d. monitor fluid intake and output.
