EXAM4: ONCOLOGY
Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?
50mL (110/2.2= 50)
A client has a diagnosis of rheumatoid arthritis and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address what potential adverse effect? A. Bone marrow suppression B. Acute confusion C. Sedation D. Malignant hyperthermia
A
A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? A. TMP-SMZ B. Cephalexin C. Azithromycin D. Garamycin
A
A client reports dyspnea, fatigue, and having had a persistent productive cough for the last few months, which the client attributes to a bout with the flu. The nurse suspects that this client may have: A. lung cancer. B. pleurisy. C. pleural effusion. D. lung abscess.
A
A client with stage II breast cancer has received her treatment plan that includes radiation therapy. The nurse knows that the client understands radiation treatment when she makes which statement? A. "Radiation therapy will reduce the chance of breast cancer recurrence." B. "Radiation and a modified radical mastectomy will cure my breast cancer." C. "I will receive my first radiation treatment before I leave the hospital." D. "I will plan on radiation treatments once a week for 5 weeks."
A
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis? A. Risk for infection related to inadequate defenses B. Fatigue related to deficient blood cells C. Activity intolerance related to side effects of chemotherapy D. Anxiety related to change in role function
A
Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________. A. 1 hour; 72 hours; 4 weeks B. 4 days; 7 days; 2 weeks C. 1 week; 3 weeks; 3 months D. 1 month; 2 months; 6 months
A
The nurse is caring for a client who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A. Palliative B. Reconstructive C. Salvage D. Prophylactic
A
The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse? A. The client has converted from HIV infection to AIDS. B. The client has advanced HIV infection. C. The client's T4-cell count has decreased due to the Pneumocystis pneumonia. D. The client has another infection present that is causing a decrease in the T4-cell count.
A
Which of the following is a characteristic of a malignant tumor? A. It gains access to the blood and lymphatic channels. B. It demonstrates cells that are well differentiated. C. It is usually slow growing. D. It grows by expansion.
A
A nurse is performing the admission assessment of a client who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A. Current medication regimen B. Identification of client's support system C. Immune system function D. Genetic risk factors for HIV E. History of sexual practices
A, B, C, E
The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. A. Safe exercise B. Narcotic safety C. Medication dosages and side effects D. Dressing changes E. Assistive devices
A, C, E
A client is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? A. Promoting appropriate use of complementary therapies B. Addressing possible barriers to adherence C. Educating the client about the pathophysiology of HIV D. Teaching the client about the need for follow-up blood work
B
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept? A. Histology of tissue B. Staging of disease C. Involvement of lymph nodes D. Total blood cell count
B
A client with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the client's care in the knowledge of potential complications. What assessment should the nurse prioritize? A. Close monitoring of temperature B. Frequent abdominal auscultation C. Assessment of hemoglobin, hematocrit, and red blood cell levels D. Palpation of peripheral pulses and leg girth
B
A client with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location rules out the use of enteral feeding. What intervention will best meet this client's nutritional needs? A. Administration of parenteral feeds via a peripheral IV B. Parenteral nutrition given via a peripherally inserted central catheter C. Insertion of an NG tube for administration of feeds D. Maintaining NPO status and IV hydration until treatment completion
B
A nurse is planning patient education for a client being discharged home with a diagnosis of rheumatoid arthritis. The client has been prescribed antimalarials for treatment, so the nurse knows to teach the client to self-monitor for what adverse effect? A. Tinnitus B. Visual changes C. Stomatitis D. Hirsutism
B
A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? A. "It allows time for you to cope with the treatment." B. "It will allow time for the repair of healthy tissue." C. "It will decrease the incidence of leukopenia and thrombocytopenia." D. "It is not really understood why you have to go for 6 weeks of treatment."
B
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? A. No further treatment is indicated. B. Adjuvant therapy is likely. C. Palliative care is likely. D. Repeat biopsy is needed before treatment begins.
B
The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A. Cognitive deficits B. Impaired wound healing C. Cardiac tamponade D. Tumor lysis syndrome
B
The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session? A. Copious sputum production B. Coughing C. Dyspnea D. Severe pain
B
What test will the nurse assess to determine the client's response to antiretroviral therapy? A. Western blotting B. Viral load C. Enzyme immunoassay D. Complete blood count
B
Which condition is an early manifestation of HIV encephalopathy? A. Hyperreflexia B. Headache C. Vacant stare D. Hallucinations
B
Which is the most common presenting symptom of colon cancer? A. Fatigue B. Change in bowel habits C. Anorexia D. Weight loss
B
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, what will the nurse assess for? A. Adventitious lung sounds B. Hair loss C. Diarrheal stools D. Laryngeal edema
C
A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? A. Crackles B. Rhonchi C. Decreased breath sounds D. Wheezes
C
A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: A. breast self-examination. B. mammography. C. fine needle aspiration. D. chest X-ray.
C
A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? A. 24 hours B. 2 to 4 days C. 7 to 14 days D. 21 to 28 days
C
The clinical nurse educator is presenting health promotion education to a client who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A. Avoiding direct sun exposure in excess of 15 minutes daily B. Avoiding grapefruit juice and fresh grapefruit C. Avoiding highly crowded public places D. Using an electric shaver rather than a razor
C
The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action? A. Assess the client for additional signs and symptoms of Kaposi sarcoma. B. Review the client's most recent viral load and CD4+ count. C. Place the client on respiratory isolation and inform the physician. D. Perform oral suctioning to reduce the client's risk for aspiration.
C
The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder? A. Kidney stone formation B. Proteinuria C. Chronic kidney disease D. Neurogenic bladder
C
The nurse is caring for a client with breast cancer and removal of axillary lymph nodes. Which assessment finding is documented and brought to the physician's attention as potential lymphedema? A. A reddened area around the breast B. Fluid accumulation under in the axilla C. Enlargement of the arm or hand D. Drainage from the areola
C
The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? A. First thing in the morning when the client wakes B. After cool compresses have been applied to the hands C. After the client has had a warm paraffin hand bath D. After the client has a diagnostic test
C
The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer? A. Smoked salmon and green beans B. Pork chops and fried green tomatoes C. Baked apricot chicken and steamed broccoli D. Liver, onions, and steamed peas
C
There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS? A. Sharing the diagnosis with a support group B. Caring for a client who can kill other people C. Disclosure of the client's condition D. Caring for a client with an infectious terminal disease
C
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo? A. Lymphadenectomy B. Needle biopsy C. Open biopsy D. Sentinel node biopsy
D
A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? A. "Removing the tumor is a primary treatment for colon cancer." B. "This surgery will prevent further tumor growth." C. "Once the tumor is removed, cell pathology can be determined." D. "Tumor removal will promote comfort."
D
A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result? A. It is diagnostic for Sjögren's syndrome. B. It is diagnostic for systemic lupus erythematosus. C. It is specific for rheumatoid arthritis. D. It is suggestive of rheumatoid arthritis.
D
A community health nurse is performing a visit to the home of a client who has a history of rheumatoid arthritis (RA). On what aspect of the client's health should the nurse focus most closely during the visit? A. The client's understanding of rheumatoid arthritis B. The client's risk for cardiopulmonary complications C. The client's social support system D. The client's functional status
D
An adult woman's mother died of left breast cancer. If the client and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A. More aggressive chemotherapy B. Left mastectomy C. Radiation therapy D. Bilateral mastectomy
D
The nurse is caring for a client who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. The client reports a new onset of weakness with abdominal pain and further assessment suggests that the client likely has a fluid volume deficit. The nurse should recognize that this client may be experiencing what electrolyte imbalance? A. Hypernatremia B. Hypomagnesemia C. Hypophosphatemia D. Hypercalcemia
D
The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis? A. "Once the colon tumor is removed, I will be fine." B. "I will be happy once all the cancer is cut out." C. "How could I be so unlucky to get cancer twice?" D. "My cancer has now spread to my liver."
D
The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? A. Less than 200/mm3 B. Between 200 to 350/mm3 C. Between 350 to 499/mm3 D. Greater than 500/mm3
D
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? A. Time, distance, and shielding B. The use of disposable utensils and wash cloths C. Avoid showering or washing over skin markings. D. Inspect the skin frequently.
D