Chapter 48- Hematological and Oncological Disorders

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

3

The nurse is monitor a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this emergency? A. cyanosis B. arm edema C. periorbital edema D. ECG changes

3 All others are late signs of SVC

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indication of possible oncological emergency? (select all that apply) A. Facial edema in the morning B. Weight loss of 20 lbs in a month C. Serum Ca of 12 D. Serum K of 3.4 Numbness and tingling of the lower extremities

A,C,D

A gastrectomy is performed on a client with gastric cancer. In the immediate post-op period, the nurse should take which most appropriate action? A. Measure abdominal girth B. Irrigate the nasogastric tube C. Continue to monitor the drainage D. Notify HCP

C Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours post-op changes to brown tinged, and is then yellow or clear, Because the bloody drainage is expected in the immediate port-op period the nurse should continue to monitor the drainage

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

1,2,5,6 In SIADH excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia, and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone.

The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign of symptom of this type of cancer? A. Dysuria B. Hematuria C. Urgency on urination D. Frequency of urination

2

The nurse is conducting a history and monitoring lab values on a client when multiple myeloma. What assessment finding should the nurse expect to note? Select all that apply A. Pathological fracture B. Urinalysis positive for nitrate C. Hemoglobin level of 15.5 D. Calcium level of 8.6 E. Serum Creatinine level of 2.0

A, B. E

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment findings indicates that the colostomy is beginning to function? A. The passage of flatus B. Absent bowel sounds C. The client's ability to tolerate food D. Bloody drainage from the colostomy

A.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? A. Age younger than 50 B. Hx of colorectal polyps C. Family Hx of colorectal cancer D. Chronic inflammatory bowel disease

A.

The nurse is caring for a client who is post-op following a pelvic exenteration and the health care provider changes the client's diet from NPO to clear liquids. The nurse should check which priority item before administering diet? A. Bowel sounds B.Ability to ambulate C.Incision appearance D. Urine specific gravity

A. Bowel sounds

The home health nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? A. Client's pain rating B. Nonverbal cues from the client C. The nurse's impression of the pain D. Pain relief after appropriate nursing intervention

A. Clients pain rating

The nurse us reviewing the lab results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? A. increased Ca levels B. Increased WBCs C.Decreased BUN level D.Decreased number of plasma cells in the bone marrow

A. Increased number of plasma cells in the bone marrow, anemia, hypercalcemia are caused by the release fo calcium from the deteriorating bone tissue, and an elevated BUN level

The nurse is creating a plan of care for the client with multiple myeloma and included which PRIORITY intervention in the plan? A. encouraging fluid B. providing frequent oral care C. coughing and deep breathing D. monitoring the RBC count

A. encourage fluid

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets the at the client is experiencing which condition? A. Rupture of the bladder B. The development of a Vesicovaginal fistula C. Extreme stress caused by the diagnosis of cancer D. Altered perineal sensation as a side effect of radiation therapy

B

The nurse is caring for a client following a mastectomy, Which nursing intervention would assist in preventing lymphedema of the affected arm? A. Placing cool compresses on the affected arm B. Elevating the affected arm on a pillow above heart level C. Avoiding arm exercises in the immediate post-op period D. Maintaining an intravenous site below the antecubital area on the affected side

B

The nurse is instructing a client to perform a testicular self-examination. The nurse should provide the client with which information about the procedure? A. to examine the testicle while laying down B. that the best time for the examination is after a shower C. to gently feel the testicle with 1 finger to feel for a growth D. that TSEs should be done at least every 6 months

B TSE Is recommended montly after a warm bath or shower when the scrotal skin is relaxed. Client is to use both hands

A client is diagnosed as having bowel tumor. The nurse should monitor the client for which complication of this type of tumor? select all that apply A. Flatulence B. Peritonitis C. Hemorrhage D. fistula formation E.Bowel perforation F. Lactose intolerance

B, C, D, E

When caring for a client with an internal radiation implant, the nurse should observe which principles? (select all that apply) A. Limit the time with the client to 1 hour per shift B. Keeping pregnant women out of the client's room C. Placing the client on a private room with a private bath D.Wearing a lead shield when providing direct client care E. Removing the dosimeter film badge when entering the client'd room F. Allowing individuals younger than 16 years old in the room as long as they are 6 feet apart

B,C,D

The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? A. Clamp the surgical drain B. Change the dressing as prescribed C.Notify HCO D. Remove and replace the perineal packing

B.

The nurse is assessing a client who has a new urererostomy. Which statement by the client indicated the need for more education about urinary stoma care? A. I change my pouch every week B. i change the application in the morning C. I empty the urinary collection bag when it is 2/3 full D. When I'm in the shower I direct the flow of water away from the stoma

C. Should be changed when 1/3 full

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result from chemotherapy? A. Restrict all visitors B. Restrict fluid intake C. Teach the client and family about the need for hand hygiene D. Insert an indwelling urinary catheter to prevent skin breakdown

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

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? A. at the onset of menstruation B. every month during ovulation C. Weekly at the same time of day D. 1 week after menstruation begins

D

The nurse manager is teaching nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this emergency? A. headache B. dysphagia C. constipation D. ECG changes

D

During the admission assessment of a client with ovarian cancer, the nurse recognized which manifestation as typical of the disease? A.Diarrhea B. Hypermenorrhea C. Abnormal Bleeding D. Abdominal distention

D Abdominal distension

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? A.fatigue B. weakness C. weight gain D. enlarged lymph nodes

D. Enlarged lymph nodes Hodgkins is a chronic progressive neoplastic disorder of lymphoid tissue characterized by enlarged lymph nodes with progression to spleen and liver

While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which INITIAL action? A. Call the HCP B. Reinsert he implant into the vagina C.Pick up the implant with gloved hands and flush it down the toilet D. Pick up the implant with long-handled forceps and place it in a lead container

D. Pick up the implant with long-handled forceps and place it in a lead container