CPHON B practice questions
Specialty nursing practice guidelines There are three components to these standards: standards of professional practice, standards of professional performance, and specialty practice quidelines.
Which of the following is a component of the standards of nursing care?
Syndrome of inappropriate antidiuretic hormone Patients receiving cyclophosphamide have a risk for developing syndrome of antidiuretic hormone (SIADH). Polydipsia is an early sign of SIADH
A patient receiving cyclophosphamide reports extreme thirst. The nurse is concerned that the patient is exhibiting early signs of:
Transient radiation myelopathy myelopathy clinical manisfestation symptoms are characterized by momentary, electrical shock-like paresthesias or numbness radiating from the neck to the extremities occurring after neck flexion. It typically occurs 2-4 months after spinal cord exposure to radiation therapy.
A 10-year-old patient who received mantle radiation therapy four months ago presents with shock-like sensations moving down both arms after bending his neck forward. What is the patient experiencing?
saying up to six words - Normal language development for a 15-month-old child includes saying four to six words, gesturing, pointing, and understanding simple words.
A 15-month-old patient with cancer is at the nurses' station cooing at all the people who walk by. The nurse is concerned because the patient's language should include:
Disseminated intravascular coagulation - DIC is caused by an alteration in clotting factors in the blood stream. Clinical presentation may include: petechiae, ecchymosis, purpuric rash, prolonged/uncontrolled bleeding, abnormal PT/PTT
A patient comes to clinic with a temperature of 101.7°F (38.7°C), blood pressure 110/65 mmHg, platelet count 19,000/mm3, diffuse petechiae, and oozing at the port site. Which of the following is most likely the cause?
"I feel overwhelmed with all of my new responsibilities." - Family members should be given adequate time and instruction to develop and begin implementing a coordinated plan of care for discharge.
A patient is being discharged following a hematopoietic stem cell transplant. Which statement made by the parent indicates that more teaching is required?
Fidelity - The ethical principle of fidelity applies to keeping the patient's best interests first when providing care.
A patient requests pain medication which the nurse administers, despite the parents requests to hold the medication. What ethical principle is the nurse demonstrating?
Azoospermia - Radiation doses greater than 600cGy can cause permanent azoospermia
A patient who received 600cGy testicular radiation will most likely experience which of the following?
Non-Hodgkin lymphoma - Children with Wiskott-Aldrich syndrome, ataxia-telangiectasis, and other inherited or acquired immunodeficiency syndromes are at increased risk for non- Hodgkin lymphoma.
A patient with Wiskott-Aldrich syndrome has an increased risk for developing which of the following types of cancer?
Obtain baseline laboratory studies, including blood cultures - Baseline laboratory studies must be obtained. This includes blood cultures, complete blood count, electrolytes, blood urea nitrogen, creatinine, liver function tests.
A patient with acute lymphoblastic leukemia presents to the emergency department with a fever of 102 degrees Fahrenheit (38.9 degrees Celsius). What initial order should the nurse expect?
Urinary function - Symptoms of spinal cord compression are dependent on the location of the tumor and may include back pain, weakness, ataxia, paralysis, bowel or bladder dysfunction, paresthesia.
A school-age child with metastatic Ewing sarcoma reports lower back pain during a clinic visit. What should the nurse further assess?
Perform frequent clinical assessments - Decreased respiratory rate and decreased oxygen saturation are late signs of an opioid overdose. Baseline assessment of a patient's level of consciousness is the most reliable way to remain alert to excessive sedation and prevent respiratory depression.
An 18-year-old patient receiving a continuous infusion of morphine has a respiratory rate of 16 breaths per minute while sleeping. What is the most appropriate nursing action?
Hyperleukocytosis - The clinical presentation of hyperleukocytosis includes shortness of breath, tachypnea, cyanosis, blurred vision, headaches, seizures, papilledema, agitation, ataxia, confusion, delirium, and stupor. Hyperleukocytosis is a condition when white blood cell count is greater than 100,000/mm3.
An adolescent male presents with irritability, headache, and blurred vision. Laboratory data includes white blood count 275,000/mm3, hemoglobin 7 g/dL, and platelet count 20,000/mm3. These clinical presentations are indicative of which oncologic emergency?
evidence-based practice - Most models of EBP incorporate five main activities which are often referred to with the acronym the five A's (ask, acquire, appraise, apply and assess.)
Ask, acquire, appraise, apply and assess are activities incorporated into most models of:
0.04 - CML accounts for less than 5% of pediatric cancers
Chronic myeloid leukemia accounts for approximately what percentage of childhood cancers?
6 months - Chronic pain is persistent pain that lasts for more than 6 months.
Chronic pain is defined as persistent pain that lasts for more than:
Venous irritation - Cladribine is an irritant and symptoms of venous irritation include sensations of aching and tightening along a peripheral vein, above the administration site during the infusion.
Cladribine is being administered peripherally to a patient who reports aching and tightness along the vein. What does the nurse suspect the patient is experiencing?
At the time of diagnosis - Palliative care begins at the time of diagnosis with a life-threatening or life- limiting disease.
Members of the healthcare team should begin discussing palliative care:
the first of three consecutive days with an absolute neutrophil count higher than 500. The standard definition of myeloid engraftment as defined by the Center for International Blood and Bone Marrow Transplant Research and FACT is the first 3 consecutive days with and ANC of greater than 500.
Myeloid engraftment is defined as:
Pulmonary edema is increased capillary permeability that causes fluid to leak into the lungs. Clinical features include weight gain, fluid retention, ascites, cough, and shortness of breath.
One week after an allogeneic transplant, a patient receiving multiple blood products develops a cough and shortness of breath. What is the most likely cause for the patient's oxygen saturation of 91%, respiratory rate of 28, and rales?
Myocarditis - High doses of cyclophosphamide given in short doses and in conjunction with total body irradiation can induce acute or chronic myopericarditis that has been associated with pericardial tamponade, hemorrhagic myocardial necrosis, or PEA
Patients who have received high- dose cyclophosphamide in conjunction with radiation are monitored for which of the following complications?
2-6 months - Posterior fossa syndrome usually presents within 24 - 48 hours after posterior fossa surgery and can last for approximately 2 -6 months
Posterior fossa syndrome can last approximately how long?
Reduce hospital-acquired infections Protective isolation measures such as positive-pressure single rooms, low- microbial diets, and strict hand-washing should be used for children requiring allogeneic transplant.
Protective isolation with positive- pressure air flow designed to do which of the following?
Temozolamide is an alkylating agent
Temozolamide is classified as an:
tolerated dose and shortest possible interval between doses Chemotherapy should be administered at maximum dose intensity maximum tolerated dose and shortest possible interval between doses.
The definition of maximum dose intensity is the maximum?
Pulmonary fibrosis - Bleomycin is most commonly associated with pulmonary toxicity, specifically pulmonary fibrosis.
The long term side-effects of bleomycin include which of the following?
Mantle radiation - Contemporary Hodgkin therapy now attempts to avoid exposing female patients to chest radiation whenever possible.
Treatment plans for females with Hodgkin lymphoma often avoid the use of which of the following treatments?
The only know side effect of the administration of immunizations is soreness at the injection site
What is a known side effect of the HPV immunization?
blue-green - Mitoxantrone is dark blue in color and may turn urine blue/green
What is important to explain to a patient who is receiving mitoxantrone? The color of his urine may be:
Provide teaching about the use of contraception - An appropriate nursing intervention for sexually active patients is to provide education regarding the use of contraceptive methods to prevent unwanted pregnancy and sexually transmitted
What is the most appropriate nursing intervention for a sexually active female adolescent currently being treated with chemotherapy who reports having unprotected sex?
Hyaluronidase is the suggested antidote for vincristine
What is the recommended antidote for a vincristine extravasation?
Hyponatremia The early clinical presentation of syndrome of inappropriate antidiuretic: hormone includes serum sodium levels less than 130 mEgL with thirst, anorexia, headache, muscle cramps, weakness, and lethargy.
What is the syndrome of inappropriate antidiuretic hormone manifested by?
Angiogenesis is the proliferation of new capillaries.
What is the term used to describe the process when tumors form their own blood supply to continue to grow?
it is not what you say, but rather how you say it - Parents need to be cognizent of verbal and nonverbal cues when discussing death with children. Information should be appropriately delivered in a factual but sensitive manner.
When discussing death with children who have cancer it is most important to remember:
Dexamethasone - Metoclopramide should be administered with dexamethasone or benadryl due to the side effects it may cause in children, most notably the extrapyramidal reactions
Which medication should be given concurrently with metoclopramide to help eliminate extrapyramidal reactions in pediatric patients?
Encouraging open communication - Engaging in open communication allows the nurse to assess the family and promotes a trusting relationship.
Which of the following actions by the nurse promotes effective coping for families dealing with a cancer diagnosis?
talks about beginning to plan family activities without the child who has died - Rebuilding a life with the living family members demonstrates a healthy acceptance of the loss of a child.
Which of the following actions demonstrates a parent's healthy response to the death of a child? The parent:
Malnutrition - Risk factors for sepsis include prolonged neutropenia, mucositis, malnutrition, asplenia, and the use of invasive devices,
Which of the following co- morbidities increases a patient's risk for developing sepsis?
Reacting to medications - Skin breakdown may be exacerbated by hypersensitivity reactions to medications.
Which of the following factors can contribute to impaired skin integrity for a patient receiving treatment for cancer?
Trisomy 21 is considered a favorable prognostic indicator for patient diagnosed with both acute lymphoblastic leukemia and acute myeloid leukemia.
Which of the following genetic factors is associated with a favorable outcome in patients diagnosed with acute myeloid leukemia?
A hospital conducts interdisciplinary meetings to discuss a patient's and parents' treatment decision - Strategies for addressing moral distress include healthcare institutions providing open discussions with staff regarding specific clinical decisions that have occurred with patients and families and developing policies and procedures to address situation that cause moral distress.
Which of the following is a positive strategy for addressing moral distress?
The student's death should be discussed in an open and honest manner - Teachers should be open and honest with classmates regarding a students death from cancer.
Which of the following is an appropriate action for a teacher to take with the classmates of a student who has died from cancer?
Beckwith-Wiedemann syndrome - Hepatoblastoma is associated with Beckwith-Wiedemann syndrome, Li- Fraumeni syndrome, and chromosomal abnormalities.
Which of the following is an inherited condition that is associated with hepatoblastoma?
Debulking is done when it is not possible to remove more than 90% of the tumor.
Which of the following is considered criteria for debulking surgery?
Vincristine is a plant derivative. Their mechanism of action causes an arrest during mitosis
Which of the following medications causes cellular arrest?
Demonstrate the dressing change on a doll - Preschoolers need to explore pretend situations before they experience them. Nurses should facilitate opportunities for imaginary play to meet the developmental needs of a preschool age child.
Which of the following nursing actions is the most appropriate prior to a first time central line dressing change for a four-year old?
4-year-old with medulloblastoma receiving 4,000 cGy of whole-brain radiation with a posterior fossa boost dose - Patients receiving whole-brain radiation have the greatest risk of developing neurocognitive impairment.
Which patient is at greatest risk for developing neurocognitive impairment following treatment?
Stage III lymphoma involvement is on both side of diaphragm.
Which stage of Hodgkin lymphoma involves lymph node regions on both sides of the diaphragm?
Stage 4 mucositis is characterized by ulcerations
Which stage of mucositis is characterized by ulcerations of the oral mucosa?
providing only essential information - Teaching materials should be focused on relevant and essential information for caregivers. Materials should be at the appropriate education level and learning preference of the learner.
While teaching parents of a child who was recently diagnosed with cancer, the nurse avoids overwhelming the parents by: