Oncology

"A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which of the following is the appropriate and supportive response to the mother? "1. I'm not sure. I'll discuss it with the physician. 2. The child is too young to have radiation therapy. 3. It's very costly, and chemotherapy works just as well. 4. The physician would prefer that you discuss the treatment options with the oncologist."

"ANSWER: 2 Rationale: Radiation therapy is usually delayed until a child is 8 years of age, if posssible, to prevent retardation of bone growth and soft tissue development. Options 1,3, and 4 are inappropriate responses to the mother."

Which of the following manifestations would be directly associated with Hodgkin's disease? "a. bone pain b. generalized edema c. petechiae and purpura d. painless, enlarged lymph nodes"

"Correct answer: D Rationale: Hodgkin's disease usually presents as painless enlarged lymph nodes. The diagnosis is made by lymph node biopsy."

The nurse and licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? "1.The client newly diagnosed with chronic lymphocytic leukemia. 2.The client who is four (4) hours post-procedure bone marrow biopsy. 3.The client who received two (2) units of PRBCs on the previous shift. 4.The client who is receiving multiple intravenous piggyback medications"

(CORRECT: 1) The newly diagnosed client will need to betaught about the disease and about treat-ment options. The registered nurse cannot delegate teaching to a an LPN.

A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? 1. Administer prescribed enoxaparin (Lovenox). 2. Insert two 18-gauge IV catheters. 3. Monitor the patient?s temperature every 2 hours. 4. Check stools for presence of frank or occult blood.

3. Check stools for presence of frank or occult blood. a. A platelet count

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

7. d. Folic acid deficiency megaloblastic anemia is related to dietary deficiency as seen in anorexia and with the use of oral contraceptives and antiseizure medications. The other anemias are unrelated to this patient's history.

The patient with a diagnosis of leukemia has been admitted for observation. Which of the following assessments requires immediate intervention? Please choose from one of the following options. A. A temperature of 100.4 F B. Loss of 1 kg (2.2 pounds) over 4 days C. Pale, dry mucous membranes D. A complaint of fatigue

A.

The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression. A. Client with hemoglobin of 7.4 and hematocrit of 21.8 B. Client with diarrhea and potassium level of 2.9 mEq/L C. Client with 250,000 platelets D. Client with 5000 white blood cells/mm3

A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.

Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

ANS: A Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.

A patient has been diagnosed with acute lymphoblastic leukemia (ALL). Based on this diagnosis, which of the following will most likely be evident in the patient's history? Please choose from one of the following options. A. Hepatitis C infection B. Down syndrome C. Epstein-Barr virus infection D. Philadelphia chromosome

B.

The nurse teaches the client that intraperitoneal chemotherapy will be delivered where? A. Into the veins of the legs B. Into the lung C. Into the heart D. Into the abdominal cavity

D. Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.

The nurse receives report on a client with a glioblastoma. Recognizing that cancers are classified by their tissue of origin, the nurse begins to plan care for a client with which type of cancer? A. Liver B. Smooth muscle C. Fatty tissue D. Brain

D. The prefix "glio-" is used when cancers of the brain are named.

1) The RN knows to monitor for tumor lysis syndrome how long after treatment?: a)24 hrs. b)12-24 hrs. c)36 hrs. d)48-72 hrs.

The answer is D. rationale: The onset for tumor lysis syndrome is often seen in 48-72 hours and it does not usually occur spontaneously. 12,24, and 36 hours are simply not enough time for this to develop in most cases.

1. A nurse is receiving report on a recently admitted 4-year-old male patient with acute lymphocytic leukemia (ALL). Based on the pathophysiology of the cancer, what would the most important nursing diagnosis be while treating this patient? a. Imbalanced Nutrition: Less than body requirements b. Risk for Infection c. Acute pain d. Impaired Skin Integrity

b. Risk for Infection is the most important nursing diagnosis because patients with ALL are at higher risk of infection due to the overproduction of immature WBCs. Immature WBCs are not developed enough to fight off pathogens.

The most common type of leukemia in older adults is a. acute myelocytic leukemia. b. acute lymphocytic leukemia. c. chronic myelocytic leukemia. d. chronic lymphocytic leukemia.

d

mucositis

frequent gentle oral care soft toothbrush or if counts are low sponge tipped applicators rinse with saline or saline and baking soda or prescribed solutions perineal and rectal care

A client has developed oral mucositis as a result of radiation to the head and neck. The nurse shouls teach the client to incorporate which of the following measures in his or her daily home care routine? a) oral hygiene should be performed in the morning and evening b) high-protein foods, such as peanut butter, should be incorporated in the diet c) a glass of wine per day will not pose any further harm to the oral cavity d) a combination of a weak saline and water solution should be used to rinse the mouth before and after each meal"

"2) D Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa as well as provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent."

"Which statement is correct about the rate of cell growth in relation to chemotherapy? "1. Faster growing cells are less susceptible to chemotherapy. 2. Nondividing cells are more susceptible to chemotherapy. 3. Faster growing cells are more susceptible to chemotherapy. 4. Slower growing cells are more susceptible to chemotherapy."

"Answer 3 The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as the begin active cell division."

"The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? "A. Petechiae, fever, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion"

"Answer A is Correct. Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia."

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate? "A. Why do you say that? Do you think that you could have prevented this?"" B. ""This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"" C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" D.""Many children are diagnosed with cancer. It is not always life-threatening."""

"Answer B Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

"The nurse writes a nursing problem of "altered nutrition" for a client diagnosed withleukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? "1. Administer an antidiarrheal medication prior to meals 2. Monitor the client's serum albumin levels 3. Assess for signs and symptoms of infection 4. Provide skin care to irradiated areas"

"Answer: 2 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal medication 2. Serum albumin is a measure of the protein content in the blood that is derived form food eaten; albumin monitors nutritional status 3. Assessment of the nutritional status is indicated for this problem, not assessment of the s/sx of infections. 4. This addresses an altered skin integrity problem"

"What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? "A. potential for injury B. self-care deficit C. potential for self harm D. alteration in comfort"

"Answer: A potential for injury Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects, frequently assess for signs of bleeding, bruising, hemorrhage. "

"After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following?" "A. advise the client to rest and avoid exertion B. prevent client exposure ot infections C. monitor the blood pressure frequently D. observe for increased bruising"

"Answer: B Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding. Objective: Describe the major types of leukemia and the most common treatment modalities and nursing interventions."

During history taking of a client admitted with newly diagnosed Hodgkin's disease, which of the following would the nurse expect the client to report? "a) weight gain B) night sweats C) Severe lymph node pain D) Headache with minor visual changes"

"B - Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes, fever, malaise, and night sweats. Weight loss may be present if metastatic disease occurs. Headache and visual changes may occur if brain metastasis is present."

"The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? "1.Survival for Hodgkin's disease is relatively good with standard therapy. 2.Survival depends on becoming involved in an investigational therapy program. 3.Survival is poor, with more than 50% of clients dying within six (6) months. 4.Survival is fine for primary Hodgkin's, but secondary cancers occur within a year."

"Correct Answer: 1. 1.Up to 90% of clients responds well to standard treatment with chemotherapy and radiation therapy, and those that relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis. 2.Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's because of the expected prognosis with standard therapy. 3.Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4.Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred."

"A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? "A. malaise B. seizures C. neuropathy D. lymphadenopathy"

"Correct Answer: A 1. Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers. 2. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. 3. Neuropathy is a side effect of certain chemotherapeutic agents. 4. Lymphadenopathy is one of the findings of lymphoma."

"A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that "a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection."

"Correct Answer: A The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drug."

"A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital for treatment. The nurse should assign the patient: "A. To a private room so she will not infect other patients and healthcare workers B. To a private room so she will not be infected by other patients and healthcare workers C. To a semiprivate room so she will have stimulation during her hospitalization D. To a semiprivate room so she will have the opportunity to express her feelings about her illness"

"Correct Answer: B A. To a private room so she will not infect other patients and health care workers — poses little or no threat B. To a private room so she will not be infected by other patients and health care workers — CORRECT: protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection C. To a semiprivate room so she will have stimulation during her hospitalization — should be placed in a room alone D. To a semiprivate room so she will have the opportunity to express her feelings about her illness — ensure that patient is provided with opportunities to express feelings about illness"

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? "A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods."

"Correct Answer: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to the foods that a patient will eat. Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading to eating fewer calories. Eating three large meals isn't possible for a patient on chemotherapy due to the decreased taste sensation. Liquid protein supplements should when needed but they lead to less eating during mealtimes due to feeling of satiation."

"In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid leukemia (CLL), nursing measures should include: (Select all that apply.) "A. Maintaining a clean technique for all invasive procedures. B. Placing the client in protective isolation. C. Limiting visitors who have colds and infections. D. Ensuring meticulous handwashing by all persons coming in contact with the client."

"Correct Answers: B, C, D Rationale: Chronic lymphoid leukemia (CLL) is characterized by a proliferation and accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood, and body tissues. Infections and fever are frequent complications of CLL."

"A client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell count differential. 2. A large number of WBCs that decrease after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells that are larger than normal."

"Correct answer is 1. 1. A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia."

"A diagnosis of Hodgkin's disease is suspected in a 12 year old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test results confirm the diagnosis of Hodgkin's disease? "1. Elevated vanillylmandelic acid urinary levels. 2. The presence of blast cells in the bone marrow. 3. The presence of Epstein-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes"

"Correct answer: #4 Hodgkin's disease is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-sternberg cells) is the classic characteristic of this disease. The presence of blast cells in the bone marrow indicates leukemia. Epstein Barr virus is associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma."

"Multiple drugs are often used in combinations to treat leukemia and lymphoma because: "a. there are fewer toxic and side effects b. the chance that one drug will be effective is increased c. the drugs are more effective without causing side effects d. the drugs work by different mechanisms to maximize killing of malignant cells"

"Correct answer: D Combination therapy is the mainstay of treatment for leukemia. The three purposes for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the patient by using multiple drugs with varying toxicities, and (3) interrupt cell growth at multiple points in the cell cycle."

"The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: "a. Motivate change in unhealthy lifestyles. b. Educate her about the seven warning signs of cancer. c. Instruct her about healthy stress relief and coping practices. d. Allow her to communicate about the meaning of this experience."

"Correct answer: D Rationale: While the patient is waiting for diagnostic study results, the nurse should be available to actively listen to the patient's concerns and should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears."

The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? "1.) Fever and infections. 2.) Nausea and vomiting. 3.) Excessive energy and high platelet counts. 4.) Cervical lymph node enlargement and positive acid-fast bacillus."

"Correct: 1. 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce WBCs of the number and maturity needed to fight infection (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit #4)."

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

"Correct: 1. With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child is nauseated so he doesn't associate if with being sick. Support nutrition with oral supplements and foods high in proteins and calories"

"The client diagnosed with leukemia has central nervous system involvement. Whichinstructions should the nurse teach? "1.Sleep with the head of the bed elevated to prevent increased intracranial pressure. 2.Take an analgesic medication for pain only when the pain becomes severe. 3.Explain that radiation therapy to the head may result in permanent hair loss. 4.Discuss end-of-life decisions prior to cognitive deterioration"

"Correct: 3 1.Sleeping with the head of the bed elevatedmight relieve some intracranial pressure, but it will not prevent intracranial pressure from occurring.2.Analgesic medications for clients with cancer are given on a scheduled basis with a fast-acting analgesic administered PRN for break-through pain.3.Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. If the radiation therapy destroys the hair follicle, the hair will not grow back.4.Cognitive deterioration does not usually occur"

A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. Which diagnostic study would confirm this diagnosis "1. Platelet count 2. LUmbar puncture 3. bone marrow biopsy 4. wbc count"

"Correct: 3. 3 leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or low in leukemia 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 nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment data warrant immediate intervention? 1.T 99, P 102, R 22, and BP 132/68. 2.Hyperplasia of the gums. 3.Weakness and fatigue. 4.Pain in the left upper quadrant."

"Correct: 4 1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni-toring at intervals, but they do not indicate animmediate need. 2.Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency. 3.Weakness and fatigue are symptoms of thedisease and are expected. 4.Pain is expected, but it is a priority, andpain control measures should be imple-mented."

"Which test is considered diagnostic for Hodgkin's lymphoma? "1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes."

"Correct: 4. 1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes usedto monitor the progress of the treatmentof Hodgkin's disease, but ESR levels canbe elevated in several disease processes. 4. Cancers of all types are definitively diagnosed through biopsy procedures.The pathologist must identify ReedSternberg cells for a diagnosis ofHodgkin's disease (correct)"

"After a client with a potential diagnosis of leukemia is admitted to the hospital, the nurse should assess for which of the following? (Select all that apply.)" " A. Reports of fatigue and weakness B. An elevation in the leukocytes especially neutrophils C. Signs of bruising easily D. Recent weight gain"

"Correct: A, C ANSWER: Reports of fatigue and weakness Signs of bruising easily Rationale: General manifestations of leukemia result from anemia, infection, and bleeding. The client would complain of fatigue and weakness and show signs of bruising. Leukemic cells replace normal hematopoietic elements preventing the formation of mature leukocytes. Neutrophil count would be decreased. Because of an increased metabolism, weight loss may occur. Strategy: It is important to read every word in the question. Do not speed-read."

"The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? "A. Appropriate use of sunscreen decreases the risk of skin cancer. B. Repeated exposure to the sun causes premature aging of the skin. C. A child's skin is delicate, and burns easily. D. In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer."

"Correct: A. Appropriate use of sunscreen decreases the risk of skin cancer. While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer is the best response. Nursing Process: Implementation Category of Client Need: Health Promotion and Maintenance Cognitive Level: Application"

"The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? "A. Take the hourly vital signs on a client receiving blood transfusions. B. Monitor the infusion of antineoplastic medications. C. Transcribe the HCP's orders onto the Medication Administration Record. D. Determine the client's reponse to the therapy."

"Correct: A. Explanation: A. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse. B. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. C. This is the responsibility of the word secretary or the nurse, not the unlicensed personnel. D. This represents the evaluation portion of the nursing process and cannot be delegated."

"Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic 2. Morphine, a narcotic analgesic 3. Epogen, a biologic response modifier 4. Gleevec, a genetic blocking agent"

"Correct: C 1. Because of the ineffective or nonexistent WBCs characteristic of leukemia, the body cannot fight infections, and antibiotics are given to treat infections. 2. Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the drug of choice for most clients with cancer. 3. Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the BCR-ABL protein, preventing the cells from growing and dividing."

"Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? "A. Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary."

"Correct: C 3. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. 1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. 2. Infiltration and extravasations are always a risk, especially with peripheral veins. 4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Level of cognitive ability: Analysis Area of client needs: Physiologic Integrity/Pharmacologic and Parenteral Therapy Integrated process: Teaching/Learning; Nursing Process: Implementation"

"A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the patient's needs? "1. Encourage activities with other patients in the day room. 2. Isolate him from visitors and patients to avoid infection. 3. Provide a diet high in Vitamin C 4. Provide a quiet environment to promote adequate rest."

"Correct: D. 1. does not meet need for rest 2. no info given about WBC or reverse isolation, on reverse isolation if neutrophil count is less than 500/mm3 3. needed for wound healing and resistance to infection, not best choice 4. primary problem activity intolerance due to fatigue. Correct"

The 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 - Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease."

"The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin'sdisease from a biopsy?" The nurse's answer is based on which scientific rationale? "A.Biopsies are nuclear medicine scans that can detect cancer. B.A biopsy is a laboratory test that detects cancer cells. C.It determines which kind of cancer the client has. D.The HCP takes a small piece out of the tumor and looks at the cells."

"D-COrrect: A biopsy is the removal of cells from a massand examination of the tissue under amicroscope to determine if the cells arecancerous. Reed-Sternberg cells are diag-nostic for Hodgkin's disease. If these cellsare not found in the biopsy, the HCP can rebiopsy to make sure the specimen pro- vided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma"

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? "When your hair grows back it will be patchy." "Don't use your curling iron and that will slow down the loss." "You can get a wig now to match your hair so you will not look different." "You should contact "Look Good, Feel Better" to figure out what to do about this."

"You can get a wig now to match your hair so you will not look different." Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

23. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the HCP's orders onto the Medication Administration Record. 4. Determine the client's response to the therapy.

*1. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse.* 2. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, competent nurse. 3. This is the responsibility of the ward secretary or the nurse, not the unlicensed assistive personnel. 4. This represents the evaluation portion of the nursing process and cannot be delegated. TEST-TAKING HINT: The test taker must decide what is within the realm of duties of a UAP. Three (3) of the options have the UAP doing some action with medications. This could eliminate all of these. Option "1" did not say monitor or evaluate or decide on a nursing action; this option only says the UAP can take vital signs on a client who is presumably stable because the infusion has been going long enough to reach the hourly time span.

15. The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis? 1. Night sweats and fever without "chills." 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal.

*1. Clients with Hodgkin's disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early-stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom.* 2. Lymph node enlargement with Hodgkin's disease is in the neck area. 3. Malaise and stomach complaints are not associated with Hodgkin's disease. 4. Pain in the neck area at the site of the cancer occurs in some clients after the ingestion of alcohol. The cause for this is unknown. TEST-TAKING HINT: The test taker must notice the descriptive words, such as "groin" and "fatty," to decide if these options could be correct.

24. The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)-year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is the same as for the general population. 4. Have the client talk with the family about funeral arrangements.

*1. The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly.* 2. Follow-up appointments should be at least yearly. 3. The client's risk for developing cancer has increased as a result of the therapies undergone for the lymphoma. 4. This client is in remission, and death is not imminent. TEST-TAKING HINT: The test taker should look at the time frames in the answer options. It would be unusual for a client to be told to have a checkup every five (5) years. Option "4" can be eliminated by the stem, which clearly indicates the client is progressing well at the five (5)-year remission mark.

17. The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? 1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year.

*1. Up to 90% of clients respond well to standard treatment with chemotherapy and radiation therapy, and those who relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis.* 2. Investigational therapy regimens would not be recommended for clients initially diagnosed with Hodgkin's disease because of the expected prognosis with standard therapy. 3. Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred. TEST-TAKING HINT: The test taker must have a basic knowledge of the disease process but could rule out option "2" on the basis of the word "investigational."

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? - "Where is the pain?" - "Is the pain getting worse?" - "What does the pain feel like?" - "Do you use medications to relieve the pain?"

- "What does the pain feel like?" The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? - It is delivered via an Ommaya reservoir and extension catheter. - It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. - A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. - The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

- A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? - It will recur. - It has metastasized. - It is probably benign. - It is probably malignant.

- It is probably benign. Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? - Maintain hope. - Exhibit a caring attitude. - Plan realistic long-term goals. - Give them antianxiety medications. - Be available to listen to fears and concerns. - Teach them about all the types of cancer that could be diagnosed.

- Maintain hope. - Exhibit a caring attitude. - Be available to listen to fears and concerns. Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? - The medications the patient is taking - The nutritional supplements that will help the patient - How much time is needed to provide the patient's care - The time the nurse spends at what distance from the patient

- The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

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

- Turn off the chemotherapy infusion. 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.

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? - Firm-bristle toothbrush - Hydrogen peroxide rinse - Alcohol-based mouthwash - 1 tsp salt in 1 L water mouth rinse

1 tsp salt in 1 L water mouth rinse 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.

19. Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.

1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes used to monitor the progress of the treatment of Hodgkin's disease, but ESR levels can be elevated in several disease processes. *4. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin's disease.* TEST-TAKING HINT: The test taker can eliminate the first three (3) answer options on the basis these tests give general information on multiple diseases. A biopsy procedure of the involved tissues is the only procedure that provides a definitive diagnosis.

14. The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells.

1. Biopsies are surgical procedures requiring needle aspiration or excision of the area; they are not nuclear medicine scans. 2. The biopsy specimen is sent to the pathology laboratory for the pathologist to determine the type of cell. "Laboratory test" refers to tests of body fluids performed by a laboratory technician. 3. A biopsy is used to determine if the client has cancer and, if so, what kind. However, this response does not answer the client's question. *4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma.* TEST-TAKING HINT: Option "1" can be eliminated if the test taker knows what the word "biopsy" means. Option "3" does not answer the question and can be eliminated for this reason.

A 36-year-old mother of two children has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this woman? 1. Plan for 30 minutes of rest before and after every meal. 2. Encourage foods high in protein, iron, vitamin C, and folate. 3. Instruct the patient to select soft, bland, and nonacidic foods. 4. Give the patient a list of medications that inhibit iron absorption.

1. Encourage foods high in protein, iron, vitamin C, and folate. a. Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.

18. The nurse writes the problem of "grieving" for a client diagnosed with non-the lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society's Dialogue group. 4. Have the chaplain visit with the client.

1. Encouraging the client to talk about his or her feelings is an independent nursing intervention. 2. Discussing activities that will make pleasant memories and planning a family outing improve the client's quality of life and assist the family in the grieving process after the client dies, but this is an independent nursing intervention. 3. Nurses can and do refer clients diagnosed with cancer to the American Cancer Society-sponsored groups independently. Dialogue is a group support meeting that focuses on dealing with the feelings associated with a cancer diagnosis. *4. Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions.* TEST-TAKING HINT: The stem of the question asks for a collaborative intervention, which means that another health-care discipline must be involved. Options "1," "2," and "3" are all interventions the nurse can do without another discipline being involved.

22. Which clinical manifestation of Stage I non-Hodgkin's lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B-cell lymphocytes on the CBC.

1. Enlarged lymph tissue would occur in Stage III or IV Hodgkin's lymphoma. 2. A tender left upper quadrant would indicate spleen infiltration and occurs at a later stage. *3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma.* 4. B-cell lymphocytes are the usual lymphocytes involved in the development of lymphoma, but a serum blood test must be done specifically to detect B cells. They are not tested on a CBC. TEST-TAKING HINT: Most cancers are staged from 0 to IV. Stage 0 is microinvasive and Stage I is minimally invasive, progressing to Stage IV, which is large tumor load or distant disease. If the test taker noted the "Stage I," then choosing the option that presented with the least amount of known disease—option "3"— would be a good choice.

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? 1. Thirst 2. Fatigue 3. Headache 4. Abdominal pain

1. Fatigue a. The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

16. Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder.

1. Long-term steroid use suppresses the immune system and has many side effects, but it is not the highest risk for the development of lymphoma. 2. This client would be considered to be in late-stage breast cancer. Cancers are described by the original cancerous tissue. This client has breast cancer that has metastasized to the lymph system. *3. Clients who have received a transplant must take immunosuppressive medications to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients.* 4. A neurogenic bladder is a benign disease; stent placement would not put a client at risk for cancer. TEST-TAKING HINT: To answer this question, the test taker must be aware of the function of the immune system in the body and of the treatments of the disease processes.

13. The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes.

1. The scan detects abnormalities in the lymphatic system, not the vascular system. *2. Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days.* 3. Cardiac angiograms are performed through the femoral or brachial arteries and are completed in one session. 4. The test takes 30 minutes to one (1) hour and then is repeated at intervals. TEST-TAKING HINT: The test taker must be aware of diagnostic tests used to diagnose specific diseases. Options "1" and "3" could be eliminated because of the words "vascular" and "cardiac"; these words pertain to the cardiovascular system, not the lymphatic system.

20. Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin's disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells.

1. This client is receiving treatments that can have life-threatening side effects; the nurse is not experienced with this type of client. 2. Chemotherapy is administered only by nurses who have received training in chemotherapy medications and their effects on the body and are aware of necessary safety precautions; this nurse is in the first week of orientation. 3. This is expected in a client with leukemia, but it indicates a severely low platelet count; a nurse with more experience should care for this client. *4. This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products.* TEST-TAKING HINT: The key to this question is the fact, although the nurse is an experienced medical-surgical nurse, the nurse is not experienced in oncology. The client who could receive a treatment on a medical-surgical floor should be assigned to the nurse.

21. Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin's disease? 1. The client's reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client's menstrual cycle.

1. This is a false promise. Many clients undergo premature menopause as a result of the cancer therapy. *2. The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the cancer can cause cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to be a precursor to leukemia. A developing fetus would be subjected to the internal conditions of the mother.* 3. Some clients—but not all—do become sterile. The client must understand the risks of therapy, but the nurse should give a realistic picture of what the client can expect. It is correct procedure to tell the client the nurse does not know the absolute outcome of therapy. This is the ethical principle of veracity. 4. The therapy may interfere with the client's menses, but it may be temporary. TEST-TAKING HINT: Option "3" can be eliminated on the basis that it says "all" clients; if the test taker can think of one case where "all" does not apply, then the option is incorrect.

What will caring for a patient with a diagnosis of polycythemia vera likely require the nurse to do? 1. Encourage deep breathing and coughing. 2. Assist with or perform phlebotomy at the bedside. 3. Teach the patient how to maintain a low-activity lifestyle. 4. Perform thorough and regularly scheduled neurologic assessments.

10. Assist with or perform phlebotomy at the bedside. a. Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.

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.

10. b. Pernicious anemia is a type of cobalamin (vitamin B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Folic acid deficiency may contribute to folic acid deficiency anemia, not pernicious anemia. Extrinsic factor may be a factor in some cobalamin deficiencies but not in pernicious anemia. Lack of cobalamin intake can cause cobalamin deficiency but not pernicious anemia. Increasing cobalamin intake cannot improve pernicious anemia without intrinsic factor to aid its absorption.

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

11. c. Neurologic manifestations of weakness, paresthesias of the feet and hands, and impaired thought processes are characteristic of cobalamin deficiency and pernicious anemia. Hepatomegaly and jaundice often occur with hemolytic anemia and the patient with cobalamin deficiency often has achlorhydria or decreased stomach acidity and would not experience effects of gastric hyperacidity.

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. What should be the emergency nurse's immediate response to this? 1. Immediate transfusion of platelets 2. Resting the patient's knee to prevent hemarthroses 3. Assistance with intracapsular injection of corticosteroids 4. Range-of-motion exercises to prevent thrombus formation

12. Resting the patient's knee to prevent hemarthroses a. In patients with hemophilia, joint bleeding requires resting of the joint in order to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

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 in cobalamin."

12. a. Without cobalamin replacement individuals with pernicious anemia will die in 1 to 3 years but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reversed with therapy but long-standing neuromuscular complications might not be reversed. Because pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.

An older patient relates that she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if she has microcytic, hypochromic anemia? 1. Take enteric-coated iron with each meal. 2. Take cobalamin with green leafy vegetables. 3. Take the iron with orange juice one hour before meals. 4. Decrease the intake of the antiseizure medications to improve.

13. Take the iron with orange juice one hour before meals. a. With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help RBC maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? 1. Elevated D-dimers 2. Elevated fibrinogen 3. Reduced prothrombin time (PT) 4. Reduced fibrin degradation products (FDPs)

14. Elevated D-dimers a. The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

After the diagnosis of disseminated intravascular coagulation (DIC), what is the first priority of collaborative care? 1. Administer heparin. 2. Administer whole blood. 3. Treat the causative problem. 4. Administer fresh frozen plasma.

15. Treat the causative problem. a. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? 1. Strict hand washing 2. Daily nasal swabs for culture 3. Monitor temperature every hour. 4. Daily skin care and oral hygiene 5. Encourage eating all foods to increase nutrients. 6. Private room with a high-efficiency particulate air (HEPA) filter

16. Strict hand washing; Daily skin care and oral hygiene; Private room with a high-efficiency particulate air (HEPA) filter a. Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice. d. Clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss. e. A patient who has acute blood loss may have postural hypotension and increased heart rate.

16. a, d, e. With rapid blood loss, hypovolemic shock may occur. Clinical manifestations will be more reliable, as they reflect the body's attempt to meet oxygen requirements. As the percentage of blood loss increases, clinical manifestations worsen. Blood transfusions will first be used, then iron, vitamin B12, and folic acid supplements may be used.

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? 1. Leukapheresis 2. Attaining remission 3. One chemotherapy agent 4. Waiting with active supportive care

17. Attaining remission a. Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? 1. Prevent patient infection. 2. Avoid abnormal bleeding. 3. Give pneumococcal vaccine. 4. Provide companionship while isolated.

18. Prevent patient infection. a. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient? a. Sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy. b. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling. c. The primary problem during a sickle cell crisis is destruction of the abnormal cells, resulting in fewer RBCs to carry oxygen. d. Oxygen therapy does not alter the shape of the abnormal erythrocytes but only allows for increased oxygen concentration in hemoglobin.

18. b. During a sickle cell crisis, the sickling cells clog small capillaries and the resulting hemostasis promotes a self perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may help to control further sickling but additional oxygen does not reach areas of local hypoxia caused by occluded vessels.

The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? 1. "When I take a vacation, I should not go to the mountains." 2. "I should avoid contact with anyone who has a respiratory infection." 3. "When my vision is blurred, I will close my eyes and rest for an hour." 4. "I may experience severe pain during a crisis and need narcotic analgesics."

2. "When my vision is blurred, I will close my eyes and rest for an hour." a. Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? 1. Unit secretary 2. A physician's assistant 3. Another registered nurse 4. An unlicensed assistive personnel

2. Another registered nurse a. Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? 1. Skin care that will be needed 2. Method of obtaining the treatment 3. Gastrointestinal tract effects of treatment 4. Treatment type and expected side effects

20. Treatment type and expected side effects a. The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

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

20. d. The patient with sickle cell disease is particularly prone to upper respiratory infection and infection can precipitate a sickle cell crisis. Patients should seek medical attention quickly to counteract upper respiratory infections because pneumonia is the most common infection of patients with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis, and moderate activity is permitted. Dehydration in hot weather may precipitate a sickling episode but humid weather alone will not do so.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? 1. Multiple myeloma 2. Thrombocytopenia 3. Megaloblastic anemia 4. Myelodysplastic syndrome

21. Multiple myeloma a. Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination of the patient is ecchymosis.

21. a, c, d. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP) has decreased platelets and RBCs with enhanced agglutination of the platelets. Platelet deficiencies lead to superficial site bleeding. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? 1. Start IV fluids. 2. Maintain oxygenation. 3. Maintain distal warmth. 4. Check peripheral pulses.

22. Maintain oxygenation. a. Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? 1. Trauma or splenic sequestration crisis 2. Abnormal hemoglobin or enzyme deficiency 3. Macroangiopathic or microangiopathic factors 4. Chronic diseases or medications and chemicals

23. Macroangiopathic or microangiopathic factors a. Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of RBC precursors which reduce RBC production.

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

23. b. Thrombus and embolization are the major complications of polycythemia vera because of increased hypervolemia and hyperviscosity. Active or passive leg exercises and ambulation should be implemented to prevent thrombus formation. Hydration therapy is important to decrease blood viscosity. However, because the patient already has hypervolemia, a careful balance of intake and output must be maintained and fluids are not increased injudiciously.

A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy

24. b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy.

Priority Decision: 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

25. c. The major complication of thrombocytopenia is hemorrhage and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.

Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? 1. 5 2. 15 3. 30 4. 60

3. 15 a. As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.

Priority Decision: A 76-year-old woman has an Hgb of 7.3 g/dL (73 g/L) and is experiencing ataxia and confusion on admission to the hospital. What is a priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient. c. Keep top bedside rails up and call bell in close reach d. Question the patient about possible causes of anemia

3. c. In the older adult, confusion, ataxia, and fatigue are common manifestations of anemia and place the patient at risk for injury. Nursing interventions should include safety precautions to prevent falls and injury when these symptoms are present. The nurse, not the patient's family, is responsible for the patient and although a quiet room may promote rest, it is not as important as protection of the patient.

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. a. Does the patient have leukopenia? b. What is the patient's neutrophil count? c. Does the patient have neutropenia? d. Is the patient at risk for developing a bacterial infection? If so, why?

32. a. Yes, as the WBC count is below 4000/μL. b. The neutrophil count is 2300 × 40% = 920/μL. c. Yes, as the neutrophil count is less than 1000/μL. d. Yes, the patient is at moderate risk of infection with opportunistic pathogens and nonpathogenic organisms from normal body flora.

Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of granulocytes? a. Acute lymphocytic leukemia (ALL) b. Chronic lymphocytic leukemia (CLL) c. Acute myelogenous leukemia (AML) d. Chronic myelogenous leukemia (CML)

36. c. Acute myelogenous leukemia (AML) is seen in 80% of adults with acute leukemia and is characterized by hyperplasia of the bone marrow with uncontrolled proliferation of myeloblasts, the precursors of granulocytes. Acute lymphocytic leukemia (ALL), the other acute leukemia, is most common in children and is characterized by small, immature lymphocytes, primarily of B-cell origin, proliferated in the bone marrow. Fever, bleeding, and central nervous system manifestations are also common with ALL. The other two leukemias are chronic in onset and the maturity of WBCs.

Which statements accurately describe chronic lymphocytic leukemia (select all that apply)? a. Most common leukemia of adults b. Only cure is bone marrow transplant c. Neoplasm of activated B lymphocytes d. Increased incidence in survivors of atomic bombs e. Philadelphia chromosome is a diagnostic hallmark f. Mature-appearing but functionally inactive lymphocytes

37. a, c, f. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It is a neoplasm of activated B lymphocytes that are mature appearing but functionally inactive. As it progresses, pressure on nerves from enlarged lymph nodes causes pain and paralysis. Mediastinal node enlargement leads to pulmonary symptoms. The other characteristics are related to chronic myelogenous leukemia (CML).

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? 1. Lactated Ringer's 2. 5% dextrose in water 3. 0.9% sodium chloride 4. 0.45% sodium chloride

4. 0.9% sodium chloride a. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood as they will cause RBC hemolysis.

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? 1. A 60-year-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL 2. A 50-year-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer 3. A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL 4. A 30-year-old patient with a pulse of 112 beats/minute and a white blood cell count of 14,000/µL

4. A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL a. A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

A pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a lack of understanding of the pathophysiology of this disease? " 1. Normal bone marrow is replaced by blast cells 2. Red blood cell production is affected 3. the platelet count is decreased 4. the presence of a reed-sternberg cell is found on biopsy"

4. Reed-sternberg Cell is found in Hodgkins

During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest

4. d. Dyspnea at rest indicates that the patient is making an effort to provide adequate amounts of oxygen to the tissues. If oxygen needs are not met, angina, myocardial infarction, heart failure, and pulmonary and systemic congestion can occur. The other manifestations are present in severe anemia but they do not reflect hypoxemia, a priority problem.

What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Nursing management of the patient undergoing treatment for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.

41. b. The patient is monitored for infection as leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.

Following a splenectomy for the treatment of ITP, the nurse would expect the patient's laboratory test results to reveal which of the following? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulins

42. c. Splenectomy may be indicated for treatment for ITP and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.

The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 1. 11:45 AM 2. 12:00 noon 3. 12:30 PM 4. 3:30 PM

5. 12:00 noon a. The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.

A 50-year-old man with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? 1. Confirm the IV solution is 0.9% saline. 2. Obtain the vital signs before the transfusion is initiated. 3. Monitor the patient for shortness of breath and back pain. 4. Double check the patient identity and verify the blood product.

5. Obtain the vital signs before the transfusion is initiated. a. The registered nurse (RN) may delegate tasks such as taking vital signs to unlicensed assistive personnel (UAP). Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. Verification of the patient's identity and the blood product data must be completed by a licensed nurse.

Bridge Nclex

6. Correct answer: a Rationale: Patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed. Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used.

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? 1. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. 2. Hang the fresh frozen plasma as a piggyback to the primary IV solution. 3. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. 4. Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

6. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. a. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in Factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum

6. c, d, f. Iron-deficiency anemia is the most common type of anemia and occurs with chronic blood loss or malabsorption in the duodenum so it may occur with duodenal removal. The other options are associated with cobalamin deficiency.

Before beginning a transfusion of RBCs, which action by the nurse would be of highest priority to avoid an error during this procedure? 1. Check the identifying information on the unit of blood against the patient's ID bracelet. 2. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. 3. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. 4. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

7. Check the identifying information on the unit of blood against the patient's ID bracelet. a. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? 1. Immediately pick up both units of blood from the blood bank. 2. Infuse the blood slowly for the first 15 minutes of the transfusion. 3. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. 4. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

8. Infuse the blood slowly for the first 15 minutes of the transfusion. a. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within 4 hours, and cannot be hung with dextrose.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? 1. A 59-year-old man whose alcoholism has precipitated folic acid deficiency 2. A 23-year-old African American man who has a diagnosis of sickle cell disease 3. A 30-year-old woman with a history of "heavy periods" accompanied by anemia 4. A 3-year-old child whose impaired growth and development is attributable to thalassemi

9. A 23-year-old African American man who has a diagnosis of sickle cell disease a. A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

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

A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy and/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.- ineffective tissue perfusion. The most important consideration with this child is to ensure there is adequate tissue perfusion. Impaired urinary elimination, risk for deficient volume, and impaired physical mobility are accurate nursing diagnoses, but not the priority in the acute phase of DIC. Test Taking Tip - Use the ABCs to determine priority. Note the vascular problem with DIC. This is a clue that there would be a perfusion problem, thus eliminate options B and D. Eliminate option C because an actual problem (tissue perfusion) would be a priority over a potential problem (risk).

A nurse is caring for a 5 year old child with secondary burns over 40% of the body. The child has just been diagnosed with disseminated intravascular coagulation (DIC). Which is the priority nursing diagnosis based on the most recent condition? a. Ineffective tissue perfusion Impaired urinary elimination Risk for deficient fluid volume Impaired physical mobility

The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A) Cells are abnormal and moderately differentiated. B) Cells are very abnormal and poorly differentiated. C) Cells are immature, primitive, and undifferentiated. D) Cells differ slightly from normal cells and are well-differentiated.

A) Cells are abnormal and moderately differentiated. 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 patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? A) Maintain hope. B) Exhibit a caring attitude. C) Plan realistic long-term goals. D) Give them antianxiety medications. E) Be available to listen to fears and concerns. F) Teach them about all the types of cancer that could be diagnosed.

A) Maintain hope. B) Exhibit a caring attitude. E) Be available to listen to fears and concerns. Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? A) Strict hand washing B) Daily nasal swabs for culture C) Monitor temperature every hour. D) Daily skin care and oral hygiene E) Encourage eating all foods to increase nutrients. F) Private room with a high-efficiency particulate air (HEPA) filter

A) Strict hand washing D) Daily skin care and oral hygiene F) Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

The nurse should teach a patient who is taking which drug to avoid prolonged sun exposure? A) Tetracycline B) Ipratropium C) Morphine sulfate D) Oral contraceptives

A) Tetracycline Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

Which intervention should the nurse perform in the acute care of a patient with autonomic dysreflexia? A) Urinary catheterization B) Administration of benzodiazepines C) Suctioning of the patient's upper airway D) Placement of the patient in the Trendelenburg position

A) Urinary catheterization Because the most common cause of autonomic dysreflexia is bladder irritation, immediate catheterization to relieve bladder distention may be necessary. Benzodiazepines are contraindicated, and suctioning is likely unnecessary. The patient should be positioned upright.

Nursing interventions for a patient with severe anemia related to peptic ulcer disease would include (select all that apply): A. monitoring stools for guaiac B. instruction for a high iron diet C. taking vital signs every 8 hours D. teaching self injection of erythropoietin E. administration of cobalamin (vit B12) injections

A, B

Priority nursing actions when caring for a hospitalized patient with a new onset temperature of 102.2*F and severe neurtopenia include: (check all that apply): A. administering the prescribed antibiotic STAT B. drawing peripheral and ventral line blood cultured C. ongoing monitoring of the patient's vitals for signs of septic shock D. taking a full set of vital signs and notifying the physician immediately E. administering infusions of WBCs treated to decrease immunogenicity

A, B, C, D

The nursing management of a patient of a patient is sickle cell crisis includes (select all that apply): A. monitoring CBC B. blood transfusion if required and iron chelation C. optimal pain management and oxygen therapy D. rest as needed and DVT prophylaxis E. administration of IV iron and diet high in iron content

A, B, C, D

A graduate nurse is getting ready for the NLCEX. While studying, the graduate comes across a question regarding triggers of the DIC process. Of the following, which are considered conditions that trigger DIC? Select all that apply: A. A gunshot wound B. Cancer C. CHF D. Sepsis E. Parasitic infection

A, B, D, E— Frazier states that DIC results secondary to tissue damage, vessel damage, and infections. As result, any trauma (gunshot, MVA, burn), cancer, or infection can trigger the DIC process.

The RN is caring for a patient who was admitted to the unit with high risk for DIC, Disseminated Intravascular Coagulation. What clinical manifestations would the RN be assessing the patient for? Select all that apply: A. Petechiae B. Decreased blood pressure C. Elevated blood pressure D. Pruritus E. Severe hemorrhaging

A, B, E— DIC is defined as an inappropriate activation of clotting cascade—leading to hypercoagulation and then bleeding (Frazier, 2014). The decrease in blood pressure is related to the bleeding.

The client with prostate cancer asks the nurse for more information and counseling. Which resources will the nurse suggest? Select all that apply. A. American Cancer Society's Man to Man program. B. Us TOO International. C. American Prostate Cancer Society. D. National Prostate Cancer Coalition. E. The client's church, synagogue, or place of worship.

A,B,D,E: American Cancer Society's Man to Man program helps the client and partner cope with prostate cancer. This program provides one-on-one education, personal visits, educations presentations, and the opportunity to engage in open and candid discussions. Us TOO International is a prostate cancer support group that is sponsored by the Prostate Cancer Education and Support Network. The National Prostate Cancer Coalition provides prostate cancer information.The client's church, synagogue or place of worship is a community support service that may be important for many clients.

The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.

A,C,D,F: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms, as well as Flowers and plants. Thrombocytopenia cause bleeding, not low neutrophils.The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

The client with benign prostatic hyperplasia (BPH) is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? Select all that apply. A. Avoid drugs used to treat erection problems. B. Be careful when changing positions. C. Keep all appointments for follow-up laboratory testing. D. Hearing tests will need to be conducted periodically. E. Take the medication in the afternoon.

A-C: Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension, can cause liver damage, do not affect hearing and should be taken in the evening to decrease the risk of problems related to hypotension.

The health care provider is assessing a patient undergoing induction chemotherapy for acute myelogeneous leukemia (AML). Which of the following would be the most definitive sign of infection in this patient? Please choose from one of the following options. A. A temperature of 100.5 F B. A left shift noted in the complete blood count (CBC) C. Swollen lymph nodes D. Redness and swelling at the central line insertion site

A.

In non-Hodgkin's lymphoma, the involved cell in 90% of cases is the A. B lymphocyte. B. T lymphocyte. C. Reed-Sternberg cell. D. neutrophil.

A. B lymphocyte

A client newly diagnosed with acute leukemia asks why he is at such extreme risk for infection when his white blood cell count is so high. What is the nurse's best response? A. "Even though you have many white blood cells, they are too immature to fight infection." B. "For now, your risk is low; however, when the chemotherapy begins, your risk for infection will be high." C. "These white blood cells are cancerous and live longer than normal white blood cells, so they are too old to fight infection." D. "It is not the white blood cells that provide protection; it is the red blood cells, which are very low in your blood right now."

A. For clients who understand that white blood cells are a great protection against infection, being at great risk for infection even when WBC counts are sometimes ten times normal is confusing. These are leukemic cells that overgrow at a very immature level. Therefore even though there can be huge numbers of circulating WBCs, these cells are so immature that they are nonfunctional. In addition, the heavy production of immature leukemic cells prevents normal WBCs, RBCs, and platelets from forming and maturing into functional cells.

Which assessment is most important for the nurse to perform for the client receiving one unit of packed red blood cells from an autologous donation? A. Temperature B. Blood pressure C. Oxygen saturation D. IV site for hives

A. In an autologous blood transfusion, the client receives his or her own blood components. Therefore the chances for an incompatibility type reaction do not exist. The main problems that can come from autologous transfusion are fluid overload and infection from blood contamination during the collection, storage, or infusion processes. Fluid overload is very unlikely when only one unit is being transfused. Contamination and infection are just as likely with an autologous transfusion as they are with a transfusion of donated blood products. The most important assessment is for signs of infection, including temperature.

The client is receiving chemotherapy treatment for breast cancer and asks for additional support for managing the associated nausea and vomiting. Which complementary therapy will the nurse suggest? A. Ginger B. Journaling C. Meditation D. Yoga

A. It has long been believed that ginger helps alleviate nausea and vomiting. Current studies are being done on the effect of ginger on chemotherapy-induced nausea.

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. A client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. A client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. A client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

A. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

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

A client has undergone a lymph node biopsy. The nurse anticipates that the report will reveal which result if the client has Hodgkin's Lymphoma? A. Reed-Sternberg cells B. Philadelphia chromosome C. Epstein-barr virus D. Herpes simplex virus

A. Reed-Sternberg Cells Rational: Histologic isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia-chromosome is attributed to chronic myelogenous leukemia. Viruses are much smaller than can be visualized with cytology.

A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client? a. Sexual dysfunction related to radiation therapy b. Anticipatory grieving related to terminal illness c. Tissue integrity related to prolonged bed rest d. Fatigue related to chemotherapy

A. Sexual dysfunction r/t radiation therapy. Radiation therapy often causes sterility in male clients and would be of primary importance to this client. The psychosocial needs of the client are important to address in light of the age and life choices. Hodgkin's disease, however, has a good prognosis when diagnosed early.

A recently diagnosed Hodgkin's Lymphoma patient is admitted to inpatient surgical unit for scheduled lymphadenectomy. Which of the following assessments requires immediate intervention by the nurse. A. Temperature of 100.3 degrees Fahrenheit (37.9 degrees Celsius) B. Weight loss of 2.2 lbs (1 kg) in 4 days. C. Pale, dry mucous membranes. D. Increased fatigue when mobile.

A. Temperature of 100.3 degrees Fahrenheit (37.9 degrees Celsius)

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements

A. Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.

14. The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? Elevated D-dimers Elevated fibrinogen Reduced prothrombin time (PT) Reduced fibrin degradation products (FDPs)

A. The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

Which information must the organ transplant nurse emphasize before each client is discharged? A. Taking immune suppressant medications increases your risk for cancer and the need for screenings. B. You are at increased risk for cancer when you reach 60 years of age. C. Immunosuppressant medications will decrease your risk for developing cancers. D. After 6 months, you may stop immune suppressant medications, and your risk for cancer will be the same as that of the general population.

A. Use of immune suppressant medications to prevent organ rejection increases the risk for cancer. Immune suppressant medications must be taken for the life of the organ; the risk for developing cancer remains.

Priority nursing actions when caring for a hospitalized patient with new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately.

A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately. R: Early identification of an infective organism is a priority, and samples for cultures should be obtained from various sites. In the febrile, neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, and the blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment (or vital signs) requires a call to the physician to order additional cultures, diagnostic tests, and antimicrobial therapies.

16. The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)? Strict hand washing Daily nasal swabs for culture Monitor temperature every hour. Daily skin care and oral hygiene Encourage eating all foods to increase nutrients. Private room with a high-efficiency particulate air (HEPA) filter

A. d, E. Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

24. Which action will the nurse include in the plan of care for a 72-year-old woman 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.

ANS: A A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.

6. 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."

ANS: A It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the doctor about this. The other patient statements are correct.

33. 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/L. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.

ANS: A Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/L unless the patient is actively bleeding. Therefore the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate.

32. 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

ANS: B A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient.

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

ANS: B Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.

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.

ANS: B Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported but would not be unusual in a patient with thrombocytopenia.

14. Which intervention will be included in the nursing 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 soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.

ANS: B IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.

11. 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.

ANS: B Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC) hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia.

3. 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).

ANS: B Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.

5. 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.

ANS: B Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

8. 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.

ANS: B Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.

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.

ANS: B The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 500/µL), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment.

38. 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

ANS: B The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.

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.

ANS: B The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly.

21. 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."

ANS: B This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information.

10. Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis? a. Take a daily multivitamin with iron. b. Limit fluids to 2 to 3 quarts per day. c. Avoid exposure to crowds when possible. d. Drink only two caffeinated beverages daily.

ANS: C Exposure to crowds increases the patient's risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended

23. 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.

ANS: C Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision.

42. Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/L

ANS: C The calf swelling and pain suggest that the patient may have developed a deep vein thrombosis, which will require diagnosis and treatment to avoid complications such as pulmonary embolus. The other findings will also be reported to the health care provider but are expected in a patient with this diagnosis.

36. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.

ANS: C The patient's blood pressure indicates hypovolemia caused by blood loss and should be addressed immediately to improve perfusion to vital organs. The other actions also are appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient.

12. 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.

ANS: D All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.

20. 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

ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.

13. 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.

ANS: D Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.

15. 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

ANS: D Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.

1. 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 include a. a hematocrit (Hct) of 38%. b. an RBC count of 4,500,000/L. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

ANS: D The patient's clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.

30. 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.

ANS: D The patient's symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority.

. A nurse is preparing to discharge a patient. Which statement would indicate a need for further teaching? a. House cleaning is a good way to de-stress. b. I will avoid all smoking and secondhand smoke. c. I will refrain from gardening for 12 months. d. I will not empty my cat's litter box for 6 month

ANSWER: A. RATIONALE: The patient should avoid cat litter, smoking and second hand smoke, house cleaning and gardening due to the risk for infection.

2. A stem cell recipient asks why he is admitted to the hospital for 4-7 days before a transplant. What should the nurses response be? a. "You have a need for fluid replacement prior to the procedure." b. "Total body irradiation needs to take place before the transplant." c. "Assessing sleeping patterns is vital to the success of treatment." d. "Blood transfusions are needed in order to avoid anemia post transplant."

ANSWER: B RATIONALE: The patient needs to eradicate lingering malignant cells, severely suppress the immune system to prevent graft rejection and create space in the bone marrow for the stem cells to engraft.

A nurse is providing teaching for a patient newly diagnosed with Febrile Nutropenia. The nurse includes in the teaching that the patient should avoid which of the following dietary options: SELECT ALL THAT APPLY a. Cooked vegetables b.Salad bars c. Shell fish d. Lightly cooked eggs e. Yogurt

ANSWERS are B, C, D, and E- The pt. should avoid salad bars, shell fish, lightly cooked eggs, and yogurt so they do not introduce potential bacteria into the GI tract that the body may not respond well to.

When teaching a pt about G-CSF, the RN knows the benefits to this therapy are: SELECT ALL THAT APPLY a. Reduces the incidence of Febrile Neutropenia-associated hospitalizations b. Minimize chemotherapy dose reduction and delays that could compromise treatment outcomes c. Cures cancer d. This is a placebo effect and has no real advantages e. This allows the pt. to eat any foods they wish

ANSWERS: A and B- There is no evidence that this therapy cures cancer or allows the patient to eat outside of dietary restrictions. Studies have shown there to be a decreased amount of FN related hospitalizations and minimizes chemotherapy outcome complications

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? Morphine sulfate Ibuprofen (Advil) Ondansetron (Zofran) Acetaminophen (Tylenol)

Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? - Increase intake of liquids at mealtime to stimulate the appetite. -Serve three large meals per day plus snacks between each meal. - Avoid the use of liquid protein supplements to encourage eating at mealtime. - Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client? "a. Sexual dysfunction related to radiation therapy b. Anticipatory grieving related to terminal illness c. Tissue integrity related to prolonged bed rest d. Fatigue related to chemotherapy"

Answer A is correct. Radiation therapy often causes sterility in male clients and would be of primary importance to this client. The psychosocial needs of the client are important to address in light of the age and life choices. Hodgkin's disease, however, has a good prognosis when diagnosed early. Answers B, C, and D are incorrect because they are of lesser priority

"A client with acute leukemia is admitted to the oncology unit. Which of the following would be most important for the nurse to inquire? "a. ""Have you noticed a change in sleeping habits recently?"" b. ""Have you had a respiratory infection in the last 6 months?"" c. ""Have you lost weight recently?"" d. ""Have you noticed changes in your alertness?"""

Answer B is correct. The client with leukemia is at risk for infection and has often had recurrent respiratory infections during the previous 6 months. Insomnolence, weight loss, and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections are the primary clinical manifestations; therefore, answers A, C, and D are incorrect.

"A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment? "a. The client collects stamps as a hobby. b. The client recently lost his job as a postal worker. c. The client had radiation for treatment of Hodgkin's disease as a teenager. d. The client's brother had leukemia as a child."

Answer C is correct. Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in twins than in siblings.

A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use? " a. Body temperature of 99°F or less b. Toes moved in active range of motion c. Sensation reported when soles of feet are touched d. Capillary refill of < 3 seconds"

Answer D is correct. It is important to assess the extremities for blood vessel occlusion in the client with sickle cell anemia because a change in capillary refill would indicate a change in circulation. Body temperature, motion, and sensation would not give information regarding peripheral circulation; therefore, answers A, B, and C are incorrect.

Question #2, Knowledge Question. 2) An RN is caring for a patient who just received a round of cancer treatment, how long should the nurse closely observe them for signs of Tumor Lysis Syndrome? A) 48-72 hours B) 1-4 hours C) 12-18 hours D) 24-32 hours

Answer: A, 48-72 hours. Rationale: 1-4 hours is too sudden after a treatment for the full effects of TLS to take effect yet. 12-18 hours is also too soon for development. 24-32 hours may not have any signs of TLS, because it can take awhile for TLS to build up and take effect. 48-72 hours is the common time frame for TLS to take effect and an RN must know to check electrolytes, uric acid, creatine, and BUN every six to eight hours for the first 48-72 hours after treatment.

A patient comes into the ED with DIC. Which clinical manifestations would the nurse expect the patient to present with? (select all that apply) a. Petechiae b. Spontaneous bruising c. Low blood pressure d. Bleeding from only one site e. Decline in organ function f. High blood pressure

Answer: A, B, C, E Rationale: With DIC the patient would present with bleeding from more than one site and a low blood pressure not a high blood pressure.

1. An RN is treating a patient with acute lymphoma, which medications would the nurse utilize to prevent an episode of Tumor Lysis Syndrome? Select All That Apply: A) Furosemide B) Ciprofloxacin C) Allopurinol D) Rasburicase E) Cytosin

Answer: A, C, D, Furosemide, Allopurinol and Rasburicase. Rationale: Furosemide is a diuretic used to decrease fluid retention and aid in excreting intracellular contents of malignant cells. Allopurinol inhibits enzyme xanthine oxidase which blocks conversion of enzymes to uric acid. Rasburicase converts acid to allantoin, which is more filtered in urine than uric acid. Cytosine is a drug that predisposes patients to TLS. Ciprofloxacin is an antibiotic that helps fight bacteria within the body.

A patient would need further education about Non Hodgkin's lymphoma by which statement? a. I'm at an increased risk for Non Hodgkin's lymphoma due to exposure of the Epstein Barr Virus b. Reed Sternberg cells are present c. The exact cause is unknown d. Since I am a male I am at a higher risk for Non Hodgkin's lymphoma

Answer: B- Reed Sternberg cells are present Explanation: Reed Sternberg cells are NOT present in Non Hodgkin's lymphoma, they're found in Hodgkin's Lymphoma. You are at an increased risk for Non Hodgkin's lymphoma if you have had exposure to the Epstein Barr Virus, and if you are a male The exact cause of Non Hodgkin's lymphoma is unknown

A nurse knows that a patient hospitalized for febrile neutropenia is more likely to suffer from: A). recurrence of cancer B). bone fractures C). nosocomial infection D). chemotherapy urgency (needing to receive treatment right away)

Answer: C). nosocomial infection Nosocomial infection is a risk of hospitalization, especially when the patient has decreased neutrophils and has longer and/or more frequent hospital stays. There is no indication that the patient's cancer was in remission and recurrence doesn't result from febrile neutropenia, neither does bone fractures. Hospitalization for febrile neutropenia DELAYS chemotherapy treatment.

A patient comes in with suspected DIC. Which nursing intervention is not a priority? a. Assess Airway b. Assess Breathing c. Assess Circulation d. Pulse oximetry e. ABGs f. Assess Skin Turgor

Answer: F Rationale: Assessing skin turgor is not a priority in this high emergency situation. The nurse would first want to assess ABCs

Labs that would confirm DIC would be, Select all that apply: a. INR 3.0 b. Platelet count 40,000 c. Calcium 20mg/dL d. WBS 1,500 e. D-dimer 550ng/mL

Answer: a,b,e Rationale, a higher than normal INR due to low clotting factors. Low platelet levels indicate the abundant use of platelets in the clotting process. An elevated D-dimer indicates excessive fibrinolysis.

A nurse is providing discharge teaching to the family of a pediatric patient with neutropenia. Which should the nurse include in the teaching for the prevention of febrile neutropenia? Select all that apply. A. Ensure family receives live vaccines B. Avoid remodeling in the home C. Child should continue going to school D. Avoid reheated food E. Include high iron foods such as shellfish and liver

Answers: B, C, D Rationale: the patient and family should not receive live vaccines, but should receive inactivated vaccines. Remodeling in the home involves the release of spores from brick and cement dust which contain aspergillus spores. Children should continue going to school so as not to be isolated and maintain psychosocial wellness. Reheated food can contain bacteria which puts the child at risk for infection. The patient in fact should avoid shellfish and liver as may harbor bacteria and is considered a high-risk food.

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

. A nurse is taking care of a 72 year old female patient diagnosed with chronic lymphocytic leukemia, the patient requires additional teaching when she states: A) A family history of chronic lymphocytic leukemia. B) "B symptoms" are fevers, night sweats, and weight gain. C) Early treatment does increase survival rate. D) I will have an increased risk of bacterial infections requiring IV antibiotics.

B) "B symptoms" are fevers, night sweats, and weight gain.

The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A) A woman who obtains regular cancer screenings and consumes a high-fiber diet B) A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C) A woman who exercises five times every week and does not consume alcoholic beverages D) A woman who limits fat consumption and has regular mammography and Pap screenings

B) A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years 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).

While on a mission trip, the nurse is caring for a patient diagnosed with tetanus. The patient has been given tetanus immune globulin (TIG). What should be the focus of collaborative care (select all that apply)? A) Administration of penicillin B) Tracheostomy for mechanical ventilation C) Administration of polyvalent antitoxin D) Teach correct processing of canned foods. E) Control of spasms with diazepam (Valium)

B) Tracheostomy for mechanical ventilation E) Control of spasms with diazepam (Valium) Control of the spasms of tetanus is essential because the laryngeal and respiratory system spasms cause apnea and anoxia. A tracheostomy is performed early so mechanical ventilation may be done to maintain ventilation. Penicillin is administered for neurosyphilis. Use of polyvalent antitoxin and teaching the correct canning process is done for botulism.

When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply. A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns

B,D,E

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all the apply. A. Limit sodium intake. B. Avoid beef and processed meats. C. Increase consumption of whole grains. D. Eat "colorful fruits and vegetables," including greens. E. Avoid gas-producing vegetables such as cabbage.

B-D. Eating cruciferous vegetables such as broccoli, cauliflower, brussels sprouts, and cabbage may reduce cancer risk.

The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills

B. Allergy is the most common side effect. Although fever & chills are side effect of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? A. Leukapheresis B. Attaining remission C. One chemotherapy agent D. Waiting with active supportive care

B. Attaining remission R: Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

7. A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? Leukapheresis Attaining remission One chemotherapy agent Waiting with active supportive care

B. Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

Which precaution is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination? A. Take antibiotics exactly as prescribed. B. Perform mouth care three times daily. C. Avoid the use of pepper and raw foods. D. Report any burning on urination immediately.

B. Autocontamination is the overgrowth of the client's own normal flora or the translocation of his or her normal flora from its normal location to a different one. Performing frequent mouth care can reduce the number of normal flora organisms in the mouth and decrease the risk for developing an infection from autocontamination. Taking antibiotics does not prevent autocontamination, nor does reporting symptoms of an infection. Avoiding exposure to environmental organisms does not prevent autocontamination.

The client with prostate cancer asks why he must have surgery instead of radiation, even if it is the least invasive type. What is the nurse's best response? A."It is because your cancer growth is large." B. "Surgery is the most common intervention to cure the disease." C. "Surgery slows the spread of cancer." D. "The surgery is to promote urination."

B. Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure.

What is the gold standard for the diagnosis of Non-Hodgkin's lymphoma? A. CBC - This shows variation in lab values but is not a definitive diagnosis. B. Biopsy - This is the definitive diagnosis and types protein markers. C. CT scan - This can be used to stage the lymphoma. D. History and Physical - This provides information on the patient but does not a guarantee a diagnosis.

B. Biopsy - This is the definitive diagnosis and types protein markers.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain

B. Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.

A 42 year old male presents to the E.D. following a weekend getaway to Vegas. He states when out at a pool party he has increased pain in his groin, neck, and under arm. He admits to drinking ETOH but denies illicit drug use. He states he has been extremely tired for the past few month and has night sweats. Upon assessment vitals are 124/76 BP, pulse 72, RR 18, 98% spo2 on room air, and a temp of 100.3 degrees Fahrenheit. Physical exam reveals swollen lymph nodes. The nurse would expect a diagnosis of which of the following: A. Human Immunodeficiency Virus infection B. Hodgkin's Lymphoma C. Avian Influenza D. Chlamydia infection

B. Hodgkin's Lymphoma

A nurse is caring for a client with chronic lymphocytic leukaemia, with an elevated WBC and a new prescription for Rituximab (Rituxan). For which of the following adverse effects should the nurse monitor? A.Hypoglycemia B. Hyperglycemia C. Hypercalcemia D. Hyperphosphatemia

B. Hyperglycemia

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.

Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual (Pap) smears

B. Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. all the other options are secondary levels of prevention.

The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

B. T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia

B. TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

A 68- year old male recently diagnosed with Chronic Myeloid Leukemia (CML) calls in to the clinic stating he missed his last dose of his Tyrosine Kinase Inhibitor. What should the nurse instruct the patient to do? A. Double the next dose to make up for the missed medication B. Take the missed dose as soon as possible as long as it isn't almost time for the next dose C. Immediately go to the nearest Emergency Room D. Skip the dose and resume as scheduled tomorrow

B. Take the missed dose as soon as possible as long as it isn't almost time for the next dose. Tyrosine Kinase Inhibitor drugs target the abnormal protein produced by the oncogene found in CML cells, so it is very important for patients to take these exactly as prescribed. Any missed doses should be taken as soon as possible.

Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time

B. The focus of palliative surgery is to improve quality of life during the survival time.

Lewis CH. 31 Nclex 1.When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What should the nurse place highest priority on initiating interventions to reduce? Thirst Fatigue Headache Abdominal pain

B. The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

19. A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? Brentuximab vedotin (Adcetris) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

B. The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.

The registered nurse is teaching a group of nursing students about malignant transformation. Which statement about the process of malignant transformation is true? A. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. B. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. C. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.

B. These promoters increase cell division. If cell division is halted, this does not lead to cancer development in the initiation phase.In the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latent phase occurs between initiation and tumor formation. promotion phase consists of progression when the blood supply changes from diffusion to TAF.

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B. When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO.

Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A) Proto-oncogenes B) Cell differentiation C) Dynamic equilibrium D) Activation of oncogenes

C) Dynamic equilibrium Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.

A 42-year-old man is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. The physician orders include IV Sandoglobulin. What is important for the nurse to assess for before administration? A) Elevated fasting blood glucose and serum albumin B) Elevated activated partial thromboplastin time (aPTT) C) Elevated serum creatinine and blood urea nitrogen (BUN) D) Elevated aspartate aminotransferase and alanine aminotransferase

C) Elevated serum creatinine and blood urea nitrogen (BUN) Patients receiving IV administration of high-dose immunoglobulin (Sandoglobulin) need to be well hydrated and have adequate renal function. Elevated serum creatinine and blood urea nitrogen indicate impaired renal function.

A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/µL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/µL. Based on the CBC results, what is the most serious clinical finding? A) Cough, rhinitis, and sore throat B) Fatigue, nausea, and skin redness at site of radiation C) Temperature of 101.9° F, fatigue, and shortness of breath D) Skin redness at site of radiation, headache, and constipation

C) Temperature of 101.9° F, fatigue, and shortness of breath Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.

When reviewing the laboratory results of a child with leukemia, the healthcare provider notes that the child is also anemic. Which statement provides the best rationale for this problem? Please choose from one of the following options. A. The increased number of lymphocytes is destroying the red blood cells at a rapid rate B. Chemotherapy-induced osteoporosis has caused decreased erythropoiesis C. The overproduction of immature white blood cells occurs at the expense of other cells D. The child has a poor appetite and has not been consuming adequate dietary iron

C.

Which of the following description is most consistent with chronic myelogenous leukemia (CML)? Please choose from one of the following options. A. Pronounced splenomegaly and lymphadenopathy B. An increase in reticulocytes C. A translocation between two genes D. 10% blast cells in the bone marrow aspirant

C.

Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day

C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia.

Which teaching is most appropriate for a client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.

C. A high-fiber diet will assist with constipation due to neuropathy. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns

With which male client will the nurse conduct prostate screening and education? A. Young adult with a history of urinary tract infections. B. Client who has sustained an injury to the external genitalia. C. Adult who is older than 50 years. D. Sexually active client.

C. A man who is 50 years or older is at higher risk for prostate cancer.

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

C. A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow. the other options are too complex

A patient comes into the ED with pain and says she was recently diagnosed with cancer but was unsure of the name, she states that she was told that it was a bone marrow cancer that was fast growing and grows in the WBC's. What kind of cancer would you suspect in the patient? A. Chronic Myeloid Leukemia (CML) B. Acute Lymphatic Leukemia (ALL) C. Acute Myeloid Leukemia (AML) D. Chronic Lymphatic Leukemia (CLL)

C. AML

Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."

C. Brachytherapy refers to short-term insertion of a radiation source.

A patient with acute myelogenous leukemia will soon start chemotherapy. When you are teaching the patient about the induction stage of chemotherapy, what is the best explanation? A. The drugs are started slowly to minimize side effects. B. You will develop even greater bone marrow depression with risk for bleeding and infection. C. It will be necessary to have high-dose treatment every day for several months. D. During this time you will regain energy and become more resistant to infection.

C. It will be necessary to have high-dose treatment every day for several months. R: The chemotherapeutic treatment of acute leukemia is often divided into stages. The first stage, induction therapy, is the attempt to induce or bring about a remission. Induction is aggressive treatment that seeks to destroy leukemic cells in the tissues, peripheral blood, and bone marrow in order to eventually restore normal hematopoiesis on bone marrow recovery. During induction therapy a patient may become critically ill because the bone marrow is severely depressed by the chemotherapeutic agents.

Which intervention will be most helpful for the client with mucositis? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Mouth swabs are soft and disposable and therefore clean. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa.

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults b. Hodgkin's lymphoma is considered potentially curable c. Non-Hodgkin's lymphoma can manifest in multiple organs d. Non-Hodgkin's lymphoma is treated only with radiation therapy

C. Non-Hodgkin's lymphoma can manifest in multiple organs. Rationale: Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease. Test plan: Physiological Integrity-Physiological Adaptation

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."

C. Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.

Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back.

C. Radiation therapy that is directed in or around the oral cavity has a variety of actions that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are affected, which changes the composition of the person's saliva and often causes "dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In addition, the radiation damages the integrity of the enamel and also damages some of the living cells in the tooth. All contribute to an increased risk for dental infections and cavities.

Which intervention will be most helpful in preventing disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest

C. Sepsis is a major cause of DIC, especially in the oncology client. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer A. Is in situ. B. Has metastasized. C. Has spread locally. D. Has spread extensively.

C. Stage II cancer is associated with local spread. Stage 0 denotes cancer in situ; stage III denotes extensive regional spread, and stage V denotes metastasis.

The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.

Six weeks after hematopoietic stem cell transplantation for leukemia, the client's white blood cell (WBC) count is 8200/mm3. What is the nurse's best action in view of this laboratory result? A. Notify the health care provider immediately. B. Assess the client for other symptoms of infection. C. Document the laboratory report as the only action. D. Remind the client to avoid crowds and people who are ill.

C. The WBC count is now within the normal range (5000 to 10,000/mm3) and is an indicator of successful engraftment. The client is not at any particular risk for infection at this time, nor is there reason to believe an infection is present. (At any post-transplantation check-up, the client is assessed for infection.)

A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm

C. The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.

The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period? A. Peak B. Trough C. Nadir D. Adjuvant

C. The lowest point of bone marrow function is referred to as the nadir. The peak of bone marrow function occurs when the client's blood levels are at their highest.Trough, which means low, is typically used in reference to drug levels.

a client has undergone a lymph node biopsy. the nurse anticipates that the report will reveal which result if the client has Hodgkin's lymphoma? "1. Reed-Sternberg cells. 2. Philadelphia chromosome. 3. Epstein-Barr virus. 4. Herpes simplex virus."

CORRECT #1. RATIONALE: histological isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia chromosome is attribted to chronic myelogenous leukemia. viruses are much smaller than can be visualized with cytology. STRATEGY: the core issue of the question is knowledge of characteristic findings in the diagnosis of lymphoma. use nursing knowledge and the process of elimination to make a selection.

The nurse knows that stem cells can be collected for transplant from: a.) Bone marrow b.) Saphenous vein c.) Circulating peripheral blood d.) Placenta e.) Umbilical cord

Correct answers: A, C, & E Rationale: Stem cells may be collected from three sources including bone marrow, circulating peripheral blood, and umbilical cord blood. Bone marrow is the traditional source for stem cells, and the marrow of the long bones, vertebrae, sternum, and ribs is the main site of stem cell production from birth until a person reaches about age 18. Circulating peripheral blood normally has few stem cells, but the number can be increased by using recombinant growth factors. And umbilical cord blood use is on the rise but is still relatively low compared with the other two sources. Stem cells are not taken from the placenta or saphenous vein.

"The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. Which of the following describes the involvement of the disease? "1. Involvement of a single lymph node. 2. Involvement of two or more lymph nodes on the same side of the diaphragm. 3. Involvement of lymph node regions on both sides of the diaphragm. 4. Diffuse disease of one or more extralymphatic organs."

Correct: 1. In the staging process, the designations A and B signify, respectively, that symptoms were or were not present when Hodgkin's disease was found. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs.

A pregnant woman arrives at the emergency department (ED) with abruption of the placenta at 34 weeks' gestation. The RN knows she's at risk for which of the following blood dyscrasias? A. Thrombocytopenia B. Idiopathic thrombocytopenic purpura (ITP). C. Disseminated intravascular coagulation (DIC). D. Heparin-associated thrombosis and thrombocytopenia (HATT).

C— Abruption placentae is a cause of DIC because it activates the clotting cascade after hemorrhage. Thrombocytopenia results from decreased production of platelets, ITP doesn't have a definitive cause, and a patient with abruption placentae wouldn't get heparin (Rnpedia.com, n.d.).

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: A. hyperkalemia B. hyperuricemia C. hypercalcemia D. CNS myeloma

D

Because myelodysplastic syndrome arises from pluripotent hematopoietic stem cells in the bone marrow, laboratory results the nurse would expect to find include: A. an excess of T cells B. an excess of platelets C. a deficiency of granulocytes D. a deficiency of all cellular blood components

D

Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are A. chills and hemolysis B. leukostasis and neutrophilia C. fluid overload and pulmonary edema D. transmission of cytomegalovirus and fever

D

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? A) Metastasis B) Tumor angiogenesis C) Immunologic escape D) Immunologic surveillance

D) Immunologic surveillance Immunologic surveillance is the process where 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.

During routine assessment of a patient with Guillain-Barré syndrome, the nurse finds the patient is short of breath. The patient's respiratory distress is caused by A) elevated protein levels in the CSF. B) immobility resulting from ascending paralysis. C) degeneration of motor neurons in the brainstem and spinal cord. D) paralysis ascending to the nerves that stimulate the thoracic area.

D) paralysis ascending to the nerves that stimulate the thoracic area. Guillain-Barré syndrome is characterized by ascending, symmetric paralysis that usually affects cranial nerves and the peripheral nervous system. The most serious complication of this syndrome is respiratory failure, which occurs as the paralysis progresses to the nerves that innervate the thoracic area.

The issue that is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse is the alteration of which factor? A. Comfort because of surgical pain. B. Mobility because of treatment. C. Nutrition because of radiation treatment. D. Sexual function after treatment.

D. : Altered sexual function is one of the biggest concerns of men after cancer treatment.

4. The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? A 60-year-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL A 50-year-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL A 30-year-old patient with a pulse of 112 beats/minute and a white blood cell count of 14,000/µL

D. A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

Lewis Pre-TEst 3.A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? Administer prescribed enoxaparin (Lovenox). Insert two 18-gauge IV catheters. Monitor the patient?s temperature every 2 hours. Check stools for presence of frank or occult blood.

D. A platelet count

Which of the following items 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? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse

D. 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 client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Encourage the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.

D. Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.

A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? A. Administer prescribed enoxaparin (Lovenox). B. Insert two 18-gauge IV catheters. C. Monitor the patient?s temperature every 2 hours. D. Check stools for presence of frank or occult blood.

D. Check stools for presence of frank or occult blood.

The home health RN is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment data would be most important to communicate to the transplant team? A. The temperature is 96.6° F. B. The client reports joint pain. C. The oral mucosa appears pink and dry. D. A lump is palpable in the client's axilla.

D. Clients taking immune suppressive drugs to prevent rejection are at increased risk for development of cancer; any lump should be reported to the physician.

The nurse understands that hormone treatment for prostate cancer works by which action? A. Decreases blood flow to the tumor. B. Destroys the tumor. C. Shrinks the tumor. D. Suppresses growth of the tumor.

D. Hormone therapy, particularly anti-androgen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Anti-androgens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation).

The outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light

D. Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties. Drugs should be stored according to the recommendations, but this is not the primary concern for this client. The client will be homebound for 1 to 3 months after the treatment and should not go outside.

Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection

D. 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.

Which finding would you recognize as an indicator of chronic myelogenous leukemia (CML)? A. Presence of an abnormal LE cell B. Numerous immature lymphoblasts C. An elevated white blood cell count D. Presence of the Philadelphia chromosome

D. Presence of the Philadelphia chromosome R: CML is caused by excessive development of mature neoplastic granulocytes in the bone marrow. The excess neoplastic granulocytes move into the peripheral blood in massive numbers and ultimately infiltrate the liver and spleen. These cells contain a distinctive cytogenetic abnormality, the Philadelphia chromosome, which serves as a disease marker and results from translocation of genetic material between chromosomes 9 and 22.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat.

20. The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? Skin care that will be needed Method of obtaining the treatment Gastrointestinal tract effects of treatment Treatment type and expected side effects

D. The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.

D. Tobacco is the single most important source of preventable carcinogenesis.

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill.

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? - Metastasis - Tumor angiogenesis - Immunologic escape - Immunologic surveillance

Immunologic surveillance Immunologic surveillance is the process where 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.

Which of the following are nursing implications for educating a client who is a recent stem cell transplant recipient? Select All That Apply a. Running the shower for two minutes before getting in b. Have another person change your cat's litter for at least 12 months. c. Don't garden or mow your lawn for at least 6 months. d. You will not feel "back to normal" for at least one year. e. Wash your clothes in temperatures of 30 degrees Celsius or higher to rid of bacteria.

Rationale: a, c, d. Shower water should be run for at least two minutes prior to getting into the shower to rid of bacteria and microbes within the shower hose. Cat litter can be changed by the stem cell transplant recipient at a minimum of six months post transplant. Gardening or mowing the lawn can be done by the stem cell transplant recipient no sooner than 6-12 months post transplant due to the risk of aspergillus infection. The stem cell transplant recipient will not feel back to normal for at least one year. Clothes should be washed in temperatures of at least 40 degrees Celsius to rid of bacteria.

2) Possible electrolyte imbalances that the RN needs to watch for with tumor lysis would be: (select all that apply) a)decreased uric acid b)hypercalcemia c)Increased phosphatemia d)hyperkalemia

The answer is C and D rationale: intracellular contents such as potassium and phosphorus release into the blood stream when cells die. This puts the patient at higher risk for developing hyperkalemia and phosphatemia. You would see increased uric acid and hypocalcemia with tumor lysis syndrome. The four most common signs of tumor lysis syndrome are hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.

d. DIC is a clinical syndrome that develops as a complication of a wide variety of other disorders, with sepsis being the most common cause of DIC. Abruption placenta, not placenta previa is a condition that can trigger DIC. Pulmonary embolus and hemodialysis do not trigger DIC.

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? a. A 35 year old pregnant client with placenta previa b. A 42 year old client with a pulmonary embolus c. A 60 year old client receiving hemodialysis 3 days a week d. A 78 year old client with septicemia

A complication of the hyperviscosity of polycythemia is a. thrombis. b. cardiomyopathy. c. pulmonary edema. d. disseminated intravascular coagulation (DIC).

a

In a severely anemic patient, the nurse would expect to find a. dyspnea and tachycardia. b. cyanosis and pulmonary edema. c. cardiomegaly and pulmonary edema. d. ventricular dysrhythmias and wheezing.

a

Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply) a. monitoring stools for guaiac. b. instructions for high-iron diet. c. taking vital signs every 8 hours. d. teaching self-injection of erythropoietin. e. administering of cobalamin (vitamin B12) injections.

a

21. The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? Multiple myeloma Thrombocytopenia Megaloblastic anemia Myelodysplastic syndrome

a Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

lymphoma

a group of blood cancers that develop in the lymphatic system involving the lymphocytes. can progress to spleen, GI, liver and bone marrow hodgkins and non hodgkins

Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2 F and severe neutropenia include (select all that apply) a. administering the prescribed antibiotic STAT. b. drawing peripheral and central line blood cultures. c. ongoing monitoring of the patient's vital signs for septic shock. d. taking a full set of vital signs and notifying the physician immediately. e. administering transfusions of WBCs treated to decrease immunogenicity.

a, b, c, d

2. A 5-year-old patient comes to the emergency room with a high fever, swollen lymph nodes, fatigue and dyspnea. The mother explained that she had brought the child in because she was worried he had the flu based on his symptoms. However, she also explained that the symptoms have been present for about 3 weeks now. Because of this the nurse is concerned that there is a more serious underlying problem such as acute lymphocytic leukemia, especially after finding some bruising on the child's arms. Which of the tests below can be used to diagnose acute lymphocytic leukemia - SELECT ALL THAT APPLY? a. CBC panel b. Bone marrow biopsy and/or aspiration c. Lymph node biopsy d. Uric acid level e. Leukocyte differential f. Bone scan

a, b, d, and e. In patients with ALL, a CBC will show anemia, thrombocytopenia and neutropenia. A bone marrow biopsy and/or aspiration will show proliferation of immature WBCs. It is common that uric acid levels be elevated in patients with ALL. A leukocyte differential can differentiate between the different types of leukocyte cells to determine increased level of immature WBCs.

When caring for a client with suspected SIADH, the nurse reviews the medical record to uncover which signs and symptoms consistent with this syndrome? (select all that apply) A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness

a,b,e: ADH is secreted or produced ectopically, resulting in water retention and sodium dilution which causes confusion and changes in mental status and weakness. Tachycardia may result from fluid volume excess.

Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? select all that apply. A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing

a,c,d,e: Radiation therapy to any site produces fatigue,may cause clients to report changes in taste. Radiation side effects are site specific; the larynx is in this area, therefore changes in the skin may occur and dysphagia may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair.

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. Constipation is a common side effect of oral iron supplementation and increased fluids and fiber should be consumed to prevent this effect. Because iron can be bound in the gastrointestinal (GI) tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.

The nurse is planning care for a client who has leukemia. Which intervention does the nurse include in the plan of care to prevent fatigue? a. Plan care for times when the client has the most energy. b. Schedule for daily physicals and occupational therapy. c. Arrange for a family member to stay with the client. d. Plan all activities to occur in the morning to allow for afternoon naps.

a. Plan care for times when the client has the most energy. R: With leukemia, energy management is needed to help conserve the client's energy. Care should be scheduled when the client has the most energy. This client may not have the most energy in the morning. If the benefit of an activity such as physical or occupational therapy is less than its worsening of fatigue, it may be postponed. The nurse should limit the number of visitors and interruptions by visitors, as appropriate.

Which of the following nursing interventions and client instructions are appropriate in caring for a client with pancytopenia? Select all that apply. a. restrict fresh fruits and vegetables in the diet b. restrict all visitors c. insert a Foley to monitor I&O d. restrict fluids e. report low-grade temperature f. hold firm pressure for 5 min following necessary venipunctures g. report an ANC (absolute neutrophil count) of 2,500/mm3 h. administer epoetin alfa (Procrit) as prescribed

a. restrict fresh fruit and vegetables in the diet *these pose a risk for introduction of bacteria into the GI system. Client's with low WBC counts need to follow a low-bacteria diet e. report low-grade fever *may represent an immune response to an infection due to client's immunosuppression f. hold firm pressure for 5 min following necessary venipunctures *low platelet counts puts the client at increased risk for bleeding h. administer epoetin alfa (Procrit) as prescribed *administration of a colony stimulating factor can be vital in RBC production to counter disease-induced anemai

The nurse is explaining treatment options of multiple myeloma to a newly diagnosed patient. Which statement by the patient represents an understanding of the available treatments and outcomes? a. " Chemotherapy and radiation will cure my disease" b. "No treatment is needed if I don't have any symptoms" c. "Stem cell transplants alone will cure me" d. "A combination of therapies will be needed to cure me"

b. "No treatment is needed if I don't have any symptoms" Regular visits with your physician and monitoring of your disease are all that is required if you have no signs or symptoms. Should you develop signs and symptoms, you and your physician may decide to begin treatment.

he nurse is caring for a 20-year-old man who has Hodgkin's lymphoma in the abdominal and pelvic regions. The client is scheduled for radiation therapy and states, "I want to have children someday, and this procedure will destroy my chances." How does the nurse respond? a. "Adoption is always an option." b. "You have the option to store sperm in a sperm bank." c. "Infertility is not seen with this type of radiation therapy." d. "Sperm production will be permanently disrupted."

b. "You have the option to store sperm in a sperm bank." R: Permanent sterility can occur in male clients receiving radiation in the abdominal and pelvic regions. The client should be informed of this side effect and given the option to store sperm in a sperm bank before treatment. The other options do not appropriately address the client's concerns.

The registered nurse is assigning a practical nurse to care for a client who has leukemia. Which instruction does the registered nurse provide to the practical nurse when delegating this client's care? a. Evaluate the amount of protein the client eats. b. Perform effective hand hygiene frequently. c. Wear a mask when entering the room. d. Assess the client's roommate for symptoms of infection.

b. Perform effective hand hygiene frequently. R: A major objective in caring for the client with leukemia is protection from infection. Frequent handwashing is of the utmost importance. If at all possible, the client should be in a private room. Masks are worn by anyone who has an upper respiratory tract infection. The client may be on a "minimal bacteria diet." Protein is not a factor in this diet.

. Mr. Jones goes to see his PCP today because his nagging back pain has suddenly become severe. He indicates that the pain is located on his spine. The PCP suspects that Mr. Jones has multiple myeloma, so he orders blood work and diagnostic tests to confirm what he suspects. Which of following two diagnostic tests confirm a positive result for multiple myeloma? a. Bun and Creatinine b. Urinalysis and Bone Marrow Biopsy c. AST and ALT d. MRI and Cheek Swab

b. Urinalysis and Bone Marrow Biopsy Rational: Urinalysis will show M proteins and the Bone Marrow Biopsy is the hallmark diagnostic criterion when it shows more than 10% plasma cells.

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnositc resutls that indicate a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma

c

DIC is a disorder in which a. the coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels. b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts. c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage. d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature.

c

A nursing instructor is teaching students at a community health clinic about cancers that predominantly affect minorities. She classifies the risk based on age, gender and ethnic background. After finishing the lecture, the student nurses should recognize that which group is most at risk for multiple myeloma? a. Caucasian women over age 65 b. Asian men under age 60 c. African-American men over age 60 d. All persons are at an equal risk for Multiple Myeloma

c. African-American men over age 60 Rational: Men have a higher incidence than women, the risk of multiple myeloma increases with age; most people are diagnosed in their mid-60s. African American men are twice as likely to develop multiple myeloma as Caucasian men.

What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia? a. The development of infection at these sites b. Increased compensatory production of blood cells by these organs c. Infiltration of the organs by increased numbers of WBCs in the blood d. Normal hypertrophy of the organs in an attempt to destroy abnormal cells

c. Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and central nervous system by excessive WBCs in the blood.

A client with a diagnosis of MI reports that dyspnea began 2 weeks ago. Which of the following cardiac enzymes should the nurse assess to determine if the infarction occurred 14 days ago? a. CK-MB b. Troponin I c. Troponin T d. Myoglobin

c. Troponin T * Troponin T level disappears after 14-21 days CK-MB disappears after 3 days Toponin I disappears after 7 days Myoglobin levels disappear after 24 hr

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma

c. hypercalcemia R: Bone degeneration in multiple myeloma causes calcium to be lost from bones, which eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause seizures, coma, and cardiac problems.

A client with leukemia develops thrombocytopenia following chemotherapy. Based on this specific finding, which of the following nursing interventions is the highest priority? a. encourage the client to turn, cough, and deep breathe every 2 hrs b. monitor the client's temperature every 4 hrs c. monitor the client's platelet counts d. encourage the client to ambulate several times a day

c. monitor the client's platelet counts *Thrombocytopenia is a decrease in platelet counts with a risk of bleeding. Bleeding precautions are generally implemented for counts less than 50,000/mm3

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that: a. Hodgkin's lymphoma occurs only in young adults b. Hodgkin's lymphoma is considered potentially curable c. non-Hodgkin's lymphoma can manifest in multiple organs d. non-Hodgkin's lymphoma is treated only with radiation therapy

c. non-Hodgkin's lymphoma can manifest in multiple organs R: Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease.

A client with angina reports not being able to make all of the lifestyle changes recommended. Which of the following changes should the nurse suggest the client work on first? a. diet modification b. relaxation exercises c. smoking cessation d. taking omega-3 capsules

c. smoking cessation *Nicotine causes vasoconstriction, elevating BP and narrowing coronary arteries

Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and side effects. b. the chance that one drug will be effective is increased. c. the drugs are more effective without causing side effects. d. the drugs work by different mechanisms to maximize killing of malignant cells.

d

The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and a. thrombin. b. factor VI. c. factor VII. d. factor VIII.

d

The nurse is planning discharge teaching for a client who has acute myelogenous leukemia (AML). Which instruction does the nurse include in this client's discharge plan? a. Refrain from intercourse. b. Use aspirin for headaches. c. Apply heat to any bruised areas. d. Avoid contact sports.

d, Avoid contact sports. R: Clients with AML have a low platelet count and are at risk for bleeding. Contact sports can cause bleeding and should be avoided by those with a low platelet count. Anal intercourse should be avoided, but it is not necessary to refrain from all types of intercourse. Ice should be placed on bruised areas instead of heat, and aspirin should not be used by those with a low platelet count.

1. Multiple myeloma is a form of hematologic cancer. A significant clinical manifestation of this disease is bone destruction. Which of following clinical manifestations can occur as a result of multiple myeloma? a. hypocalcemia b. hyperkalemia c. hypokalemia d. hypercalcemia

d. hypercalcemia (Calcium > 10.2 mg/dl); patient experiences excessive thirst, dehydration, constipation, confusion Rational: extensive bone destruction causes ionized calcium loss

multiple myeloma

destruction of bone=bone pain malignant disease of plasma cells in the bone marrow with destruction of bone 5yr survival dx bone marrow biopsy, mri, protein electrophoresis (serum and urine) + for M protein and Bencce- jones protein most common sign is bone pain, osteoporosis, fracture, elevated serum protein, hypercalcemia, renal damage, renal failure, anemia symptoms, fatigue, weak, increased serum viscosity and increased risk of bleeding and infection no cure- palliative chemo, corticosteroids, radiation help relive bone pain

non hodgkins

lymphoid tissue becomes largely infiltrated with malignant cells, spread is unpredicatable and localized. disease is rare increased risk with age prognosis vary treatment may include interferon, chemo, and or radiation swollen painful nodes, fatigue, sweat

leukemia

malignancy of the bone marrow resulting in unregulated proliferation and differentiation in stem cells caused by genetic and viral links or bone marrow related to bone marrow suppression acute myeloid leukemia (AML) chronic myeloid leukemia (CML) slower growing acute lymphocytic leukemia (ALL) Chronic lymphocytic leukemia (CLL) slower

chronic lymphocytic leukemia

most common in older men 3-15 yr survival malignant b lymphocytes, most are maure, may escape apoptosis, resulting in excess accumulation of cells- keep growing manifestations- lymphadenopathy (pain) hepatomegaly, splenomegaly, in later stages anemia and thrombocytopenia; autoimmune complications with ES destroying RBCs and platelets B symptoms include fever, sweats, weightloss early stage may require no treatment, chemo, monoclonal antibody therapy

acute myeloid leukemia

most common non lymphocyic leukemia, defect in stem cells that differentiate myeloid cells affect all ages with peak at 60 SS fever, infection, bleeding, weakness, fatigue, pain from enlarged liver or spleen, hyperplasia of gums, bone pain treament aggressive chemo (induction therapy) kill the bone marrow absolute neutrophil count is zero. risk infection. then retransfuse

improving nutrition

oral care before and after meals analgesia before meals appropriate treatment of nausea small frequent feeding soft foods moderate temp low microbial diet nutrition supplement

chronic myeloid leukemia

uncommon in people under 20 life expectancy 3-5 years acquired mutation in myeloid sem ccells (BCR ABL gene releases protein causing abn proliferation) marrow expands bone, spleen or liver initial may be asymptomatic, malaise, anorexia, weight loss, confusion, SOB due to leukostasis, bone pain treat imatinib mestylate (gleevec) block signals in leukemic cells that express BCR-ABL protein, halt proliferation BMT or PBSCT may cure chemo as palliative

acute lymphocytic /lymphoid leukemia

uncontrolled proliferation of immature cells from lymphoid stem cell: B Lymph (75%) T lymph 25% impeding myeloid cell most common under 15 more in boys manifested by leukemic cell infiltration, symptoms of meningeal involvement and liver, spleen and bone marrow pain treat chemo (induction and corticosteroids) CNS irradiation imatinib mestylate if Philadelphia chromosome positive BMT or PBSCT monoclonal antibody therapy

Multiple drugs are often used in combination to treat leukemia and lymphoma because: A. there are fewer toxic side effects B. the chance that one drug will be effective is increased C. the drugs work more effectively without causing side effects D. the drugs work by different mechanisms to maximize killing of malignant cells

D

Which of the following manifestations would be directly associated with Hodgkin's disease? a. bone pain b. generalized edema c. petechiae and purpura d. painless, enlarged lymph nodes"

D. Painless, enlarged lymph nodes. Rationale: Hodgkin's disease usually presents as painless enlarged lymph nodes. The diagnosis is made by lymph node biopsy. Test plan: Physiological Integrity-Physiological adaptation

A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102 deg. F or higher D. Wheezes or crackles

D. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.

The most common type of leukemia in older adults is: A. acute myelocytic leukemia B. acute lymphocytic leukemia C. chronic myelocytic leukemia D. chronic lymphocytic leukemia

D. chronic lymphocytic leukemia

Which cellular dysfunction in the process of cancer development allows defective cell proliferation? - Proto-oncogenes - Cell differentiation - Dynamic equilibrium - Activation of oncogenes

Dynamic equilibrium Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? - Bacteria - Sun exposure - Most chemicals - Epstein-Barr virus

Epstein-Barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

Match the following: Hodgkin's lymphoma Acute myelocytic leukemia (AML) Chronic lymphocytic leukemia (CLL) a. most common leukemia in adults b. most cases are in adults over the age of 60 c. Reed-Sternberg cells

Hodgkin's lymphoma - c AML - a CLL - b

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? - It is in situ. - It has metastasized. - It has spread locally. - It has spread extensively.

It has spread locally. Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? - Acute pain - Hypothermia - Powerlessness - Risk for infection

Risk for infection 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.

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? -Teach the patient to exercise daily. -Teach the patient promoting factors to avoid. -Tell the patient to have the cancer surgically removed now. -Teach the patient which vitamins will improve the immune system.

Teach the patient promoting factors to avoid. The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.

When caring for a patient with thrombocytopenia, the nurse instructs the patient to a. dab his or her nose instead of blowing. b. be careful when shaving with a safety razor. c. continue with physical activities to stimulate thrombopoiesis. d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia.

a

The nursing management of a patient in sickle cell crisis includes (select all that apply) a. monitoring CBC. b. optimal pain management and O2 therapy. c. blood transfusions if required and iron chelation. d. rest as needed and deep vein thrombosis prophylaxis. e. administration of IV iron and diet high in iron content.

a, b, c, d

A client asks why one aspirin per day has been prescribed. Which of the following is the nurse's best response? a. aspirin reduces the formation of blood clots that could cause a heart attack b. aspirin will decrease any pain due to myocardial ischemia c. aspirin will dissolve any clots that are forming in your coronary artery d. aspiring will relieve any headaches that are caused by your other medications

a. aspirin reduces the formation of blood clots that could cause a heart attack

A client's platelet count is 10,000/mm3. based on this laboratory value, which of the following is the priority nursing assessment? a. level of consciousness b. skin turgor c. bowel sounds d. breath sounds

a. level of counsciousness *the client is at a high risk for spontaneous bleeding, including risk for a fatal cerebral bleed, due to a platelet count less than 20,000/mm3. A change in LOC can be an early sign of cerebral hemorrhage

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

A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. At this severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold

b. The patient's hemoglobin (Hgb) level indicates a moderate anemia and at this severity additional findings usually include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hgb level is below 6 g/dL (60 g/L).

hodgkins

classic presence of malignant cells called reed Stenberg (viral etiology cure rate good) painless lymph node enlargement, puritis, fever, sweat, fatigue, weight loss

Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect fo find include a(n) a. excess of T cells. b. excess of platelets. c. deficiency of granulocytes. d. deficiency of all cellular blood components.

d

Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are a. chills and hemolysis. b. leukostasis and neutrophilia. c. fluid overload and pulmonary edema. d. transmission of cytomegalovirus and fever.

d

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults. b. Hodgkin's lymphoma is considered potentially curable. c. non-Hodgkin's lymphoma can manifest in multiple organs. d. non-Hodgkin's lymphoma is treated only with radiation therapy.

c

When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find a. leukopenia. b. RBC abnormalities. c. decreased hemoglobin. d. increased platelet count.

d

A nurse is assessing a client newly diagnosed with Stage I Hodgkin's lymphoma. Which area of the body would the nurse most likely find involved? "1. Back 2. Chest 3. Groin 4. Neck"

"(4. Neck is correct) At the time of diagnosis of stage I Hodgkin's lymphoma, a painless cervical lesion is often present. The back, chest, and groin areas may be involved in later stages."

"When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: "a.Discourage the use of stool softeners b.Assess temperature readings every six hours c.Avoid invasive procedures d.Encourage the use of a hard, brittle toothbrush "

"Answer: C Rationale: Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to track in this patient"

Which of the following laboratory values could indicate that a child has leukemia? "1. WBCs 32,000/mm3 2. Platelets 300,000/mm3 3. Hemoglobin 15g/dL 4. Blood pH of 7.35"

"Correct: 1. 1. YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high WBC count is diagnostic and is usually confirmed by a blood smear. 2-4. None of these indicate leukemia,"

Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? " 1) Presence of a mediastinal mass 2) Late CNS leukemia 3) Normal WBC count at diagnosis 4) Disease presents between age 2 and 10"

1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer to diagnosis not prognosis.

What nursing intervention should be the priority in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? 1. Administration of packed red blood cells 2. Administration of oral or IV corticosteroids 3. Administration of clotting factors VIII and IX 4. Maintenance of reverse isolation and application of standard precautions

11. Administration of oral or IV corticosteroids a. Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? 1. Brentuximab vedotin (Adcetris) 2. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine 3. Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine 4. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

19. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine a. The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.

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

19. d. Because pain usually accompanies a sickle cell crisis and may last for 4 to 6 days, pain control is an important part of treatment. Rest is indicated to reduce metabolic needs and fluids and electrolytes are administered to reduce blood viscosity and maintain renal function. Although thrombosis does occur in capillaries, elastic stockings that primarily affect venous circulation are not indicated; anticoagulants are used instead.

The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia

d. Because red meats are the primary dietary sources of cobalamin, a strict vegetarian is most at risk for cobalamin deficiency anemia. Meats are also an important source of iron and folic acid but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.

Number in sequence the events that occur in disseminated intravascular coagulation (DIC). a. Activation of fibrinolytic system b. Uncompensated hemorrhage c. Widespread fibrin and platelet deposition in capillaries and arterioles d. Release of fibrin-split products e. Fibrinogen converted to fibrin f. Inhibition of normal blood clotting g. Production of intravascular thrombin h. Depletion of platelets and coagulation factors

31. a. 5; b. 8; c. 3; d. 6; e. 2; f. 7; g. 1; h. 4

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

33. a. An elevated temperature is of most significance in recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response to injury. When the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temperature is elevated but are not used to monitor for infection.

What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High-efficiency particulate air (HEPA) filtration rooms d. Strict hand washing by all persons in contact with the patient

34. d. Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may be used prophylactically in some neutropenic patients. High-efficiency particulate air (HEPA) filtration and laminar airflow (LAF) rooms may reduce the number of aerosolized pathogens but they are expensive and LAF use is controversial.

The nurse is caring for a client with AML what is the most important information to teach the client and the clients family? 1. Teach the client and the family how to rate pain using the number scale. 2. Teach the client to eat fresh fruits and veggies daily. 3. Teach the client to exercise frequently. 4. Teach the client and the family about the need for hand hygiene.

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

A complication of the hyperviscosity of polycythemia is: A. thrombosis B. cardiomyopathy C. pulmonary edema D. disseminated intravascular coagulation (DIC)

A

When providing care for a patient with thrombocyopenia, the nurse instructs the patient to: A. dab his or her nose instead of blowing B. be careful when shaving with a safety razor C. continue with physical activities to stimulate thrombopoiesis D. avoid t aspirin because it may mask the fever that occurs with thrombocytopenia

A

Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply. A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A,C,D: Fever is a sign of infection secondary to neutropenia.Pallor is a sign of anemia.

A patient has recently been diagnosed with leukemia. Which of the following symptoms would a health care professional expect to see given this diagnosis? Please choose from one of the following options. A. Bruising, fatigue, and bone pain B. Bradycardia, hypotension, and palpitations C. Paresthesia, facial rash, and abdominal pain D. Dyspnea, malaise, and hypotension

A.

18. A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? Prevent patient infection. Avoid abnormal bleeding. Give pneumococcal vaccine. Provide companionship while isolated.

A. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

The client has undergone transurethral resection of the prostate (TURP). Which intervention will the nurse incorporate in this client's postoperative care? A. Administer antispasmodic medications. B. Encourage the client to urinate around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place the client in a supine position, with his knees flexed.

A. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur after TURP.

When caring for a client with cachexia, the nurse expects to note which symptom? A. Weight loss B. Anemia C. Bleeding tendencies D. Motor deficits

A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? A. Multiple myeloma B. Thrombocytopenia C. Megaloblastic anemia D. Myelodysplastic syndrome

A. Multiple myeloma R: Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

Which clinical manifestations are most consistent with Chronic Myeloid Leukemia? A. Splenomegaly and Lymphadenopathy B. Weight gain and anemia C. Genetic Testing- translocation between two genes no effect on the blast cells D. Sudden onset of SOB and high BP

A. Splenomegaly and Lymphadenopathy An enlarged spleen and lymph nodes are commonly seen with CML due to excess white blood cell storage in these organs. Fatigue and night sweats will also often accompany these manifestations.

In severely anemic patients, the nurse would expect to find: A. dyspnea and tachycardia B. cyanosis and pulmonary edema C. cardiomegaly and pulmonary fibrosis D. ventricular dysrhythmia and wheezing

A. dyspnea and tachycardia

25. 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.

ANS: A Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.

45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.

ANS: A Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be addressed quickly. The other patient findings will also be discussed with the health care provider, but are not life threatening.

19. 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.

ANS: B The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed.

A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I a. need to start eating more red meat and liver." b. will stop having a glass of wine with dinner." c. could choose nasal spray rather than injections of vitamin B12." d. will need to take a proton pump inhibitor like omeprazole (Prilosec)."

ANS: C Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.

9. Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis? a. "Home oxygen therapy is frequently used to decrease sickling." b. "There are no effective medications that can help prevent sickling." c. "Routine continuous dosage narcotics are prescribed to prevent a crisis." d. "Risk for a crisis is decreased by having an annual influenza vaccination."

ANS: D Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.

The 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? Use Dial soap to feel clean and fresh. Scented lotion can be used on the area. Avoid heat and cold to the treatment area. Wear the new bra to comfort and support the area.

Avoid heat and cold to the treatment area. 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.

The healthcare provider is caring for a patient with acute myelogenous leukemia (AML). Which of the following best describes the characteristics of this type of leukemia? Please choose from one of the following options. A. The function of T-cells and B-cells is adversely affected B. Examination of peripheral blood will show excessive myeloblasts C. Mature leukocytes are transformed into immature cells D. Leukocytes undergo increased differentiation

B.

The patient receiving chemotherapy is experiencing stomatitis. The healthcare provider should offer the patient: Please choose from one of the following options. A. Frequent oral care with a commercial mouthwash B. Warm saline rinses four times each day C. Hot soup for lunch and dinner D. Plenty of ice chips between meals

B.

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Risk for Injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction

B. The highest priority is safety.

The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)? A.Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine 131

B. Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS.

DIC is a disorder in which: A. the coagulation pathway is generally altered, leading to thrombus formation in all major blood vessels B. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts C. a disease process stimulates coagulation process with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage D. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature

C

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is: A. Hodgkin's lymphoma only occurs in young adults B. Hodgkin's lymphoma is considered potentially curable C. non-Hodgkin's lymphoma can manifest in multiple organs D. non-Hodgkin's lymphoma is treated only with radiation therapy

C

The nurse is providing care for a patient who has been diagnosed with Guillain-Barré syndrome. Which assessment should be the nurse's priority? A) Pain assessment B) Glasgow Coma Scale C) Respiratory assessment D) Musculoskeletal assessment

C) Respiratory assessment Although all of the assessments are necessary in the care of patients with Guillain-Barré syndrome, the acute risk of respiratory failure necessitates vigilant monitoring of the patient's respiratory status.

A child with a diagnosis of leukemia is being discharged after beginning chemotherapy. Which of the following should be included in the discharge teaching for the parents? Please choose from one of the following options. A. Maintain good oral hygiene by vigorous brushing and flossing B. Take a rectal temperature at the same time every day C. Provide small, bland meals throughout the day D. Serve the child fresh fruits and vegetables with every meal

C.

During the induction phase of chemotherapy for acute lymphoblastic leukemia (ALL) the patient experiences tumor lysis syndrome. Which of the following metabolic disturbances can occur because of tumor lysis syndrome? Please choose from one of the following options. A. Hypercalcemia B. Hypokalemia C. Hyperuricemia D. Hypoglycemia

C.

The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about side effects of doxorubicin (Adriamycin). Which side effect will the nurse instruct the client to report to the physician? A. Diaphoresis B. Dysphagia C. Edema D. Hearing loss

C. Doxorubicin (Adriamycin) is an anthracycline, and clients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue.

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)

C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.

Which of the following conditions is not a complication of Hodgkin's disease? a. Anemia b. Infection c. Myocardial Infarction d. Nausea

C. Myocardial Infarction Rationale: Complications of Hodgkin's are pancytopenia, nausea, and infection. Cardiac involvement usually doesn't occur. Test plan: Physiological Integrity-Physiological adaptation

A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrates the client with 1000 mL of IV normal saline B. Initiates the administration of prescribed antibiotics C. Obtains requested cultures D. Places the client on Bleeding Precautions

C. Obtaining cultures to identify the infectious agent correctly is the priority for this client.

A nurse begins her shift by reviewing her patient's electrolyte values after receiving report from the previous nurse. Labs: Na = 127 mEq/L, Mg = 1.5 mg/dl, Cl = 100 mEq/L, Ca = 11.3 mg/dl Which electrolyte imbalance is a priority for the nurse to monitor in this patient suspected of having multiple myeloma and why?

Ca = 11.3 mg/dl is hypercalcemia; hypercalcemia can be indicative of bone issues and malignancies

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

Cells are abnormal and moderately differentiated. 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 20,000/ul. Based on the laboratry result, which intervention will the nurse document in the plan of care? 1 Mointor closely for signs of infection 2. Mointor the temperature every 4hours 3. Initate prptective isolation precautions 4. Use soft small toothbrush for mouth care

Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding

A, B, C: These results are expected results for a sepsis patient. The nurse would expect an abnormal platelet count

7 year old is admitted 1-week post chemo with signs of sepsis. Which lab values does the nurse anticipate? (Select all that apply) Positive blood culture WBC count of 3,500 High Lactic acid level Platelet count of 175

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? -Hypokalemia -Hypouricemia -Hypocalcemia -Hypophosphatemia

Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

b Patients and family should refrain from receiving live virus because the spores can be excreted and passed on to the patient. The patient should not receive a live vaccine because of the risk of contracting the disease from the live antigen.

A nurse has gone through the teaching about how to prevent infection for a 5 year old cancer patient, which response from the mother indicates the need for further teaching? Eat a well balanced diet and plenty of fluids Patient and family should receive varicella vaccine Patient and family should receive an inactive influenza vaccine Patient should be getting sufficient amounts of sleep and rest

Answer: A, C, D Rationale: A -> GVHD can cause a rash that start on palms & soles of feet and potential spread to the rest of the body B -> Ascites is not a sign of GVHD C -> jaundice is not a sign of GVHD D -> nausea & vomiting is a sign of GVHD E-> clammy skin is not a sign of GVHD F-> Dry eyes are a sign of GVHD

A patient recently had a stem cell transplant. The nurse knows that immediate action is needed when the patient starts showing what signs of graft vs. host disease? (select all that apply) a. Rash on palms & soles of feet b. Ascites c. Jaundice d. Nausea & vomiting e. Clammy skin f. Watery eyes

B. Rationale: TLS causes a build up of uric acid which inundates the kidneys causing crystals to form in the renal tubules leading to acute kidney failure which has the symptom so flank pain and oliguria. TLS is most likely to occur 48-72 hours after chemotherapy treatment and is most common in aggressive forms of cancer

A patient with metastatic breast cancer who received chemotherapy treatment 2 days ago presents back to the hospital with flank pain and oliguria. Which acute disorder does the nurse suspect the patient has? A. Disseminated Intravascular Coagulation B. Tumor lysis syndrome C. Graft vs. Host disease D. Sepsis

D. Allopurinol is used to decrease uric acid levels. BUN, Potassium and phosphate levels are increased in TLS but are not affected by allopurinol therapy

A patient with tumor lysis syndrome is taking allopurinol. Which laboratory value should the nurse monitor to determine the effectiveness of this medication? A. BUN B. Serum Phosphate C. Serum Potassium D. Uric Acid Levels

The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A) "Have you had a fever?" B) "Have you lost any weight?" C) "Has diarrhea been a problem?" D) "Have you noticed any hair loss?"

A) "Have you had a fever?" An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.

The nurse performs discharge teaching for a 34-year-old male patient with a T2 spinal cord injury resulting from a construction accident. Which statement, if made by the patient to the nurse, indicates that teaching about recognition and management of autonomic dysreflexia is successful? A) "I will perform self-catheterization at least six times per day." B) "A reflex erection may cause an unsafe drop in blood pressure." C) "If I develop a severe headache, I will lie down for 15 to 20 minutes." D) "I can avoid this problem by taking medications to prevent leg spasms."

A) "I will perform self-catheterization at least six times per day." Autonomic dysreflexia is usually caused by a distended bladder. Performing self-catheterization five or six times a day prevents bladder distention. Signs and symptoms of autonomic dysreflexia include a severe headache. Patients should raise the head of the bed to 45 to 90 degrees. This action helps to relieve hypertension (systolic pressure up to 300 mm Hg) that occurs with autonomic dysreflexia.

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

A) A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy and/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.

Which patient would be more likely to have the highest risk of developing malignant melanoma? A) A fair-skinned woman who uses a tanning booth regularly B) An African American patient with a family history of cancer C) An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia D) A Hispanic male with a history of psoriasis and eczema that responded poorly to treatment

A) A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

Which clinical manifestation would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury? A) Bradycardia B) Hypertension C) Neurogenic spasticity D) Bounding pedal pulses

A) Bradycardia Neurogenic shock is due to the loss of vasomotor tone caused by injury and is characterized by bradycardia and hypotension. Loss of sympathetic innervations causes peripheral vasodilation, venous pooling, and a decreased cardiac output. Thus hypertension, neurogenic spasticity, and bounding pedal pulses are not seen in neurogenic shock.

What features of cancer cells distinguish them from normal cells (select all that apply)? A) Cells lack contact inhibition. B) Cells return to a previous undifferentiated state. C) Oncogenes maintain normal cell expression. D) Proliferation occurs when there is a need for more cells. E) New proteins characteristic of embryonic stage emerge on cell membrane.

A) Cells lack contact inhibition. B) Cells return to a previous undifferentiated state. E) New proteins characteristic of embryonic stage emerge on cell membrane. Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.

Which manifestations in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia? A) Headache and rising blood pressure B) Irregular respirations and shortness of breath C) Decreased level of consciousness or hallucinations D) Abdominal distention and absence of bowel sounds

A) Headache and rising blood pressure Manifestations of autonomic dysreflexia are hypertension (up to 300 mm Hg systolic), a throbbing headache, bradycardia, and diaphoresis. Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic manifestations.

A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by? A) Hypercalcemia B) Tumor lysis syndrome C) Spinal cord compression D) Superior vena cava syndrome

A) Hypercalcemia Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? A) Multiple myeloma B) Thrombocytopenia C) Megaloblastic anemia D) Myelodysplastic syndrome

A) Multiple myeloma Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) A) administering the prescribed antibiotic STAT. B) drawing peripheral and central line blood cultures. C) ongoing monitoring of the patient's vital signs for septic shock. D) taking a full set of vital signs and notifying the physician immediately. E) administering transfusions of WBCs treated to decrease immunogenicity.

A) administering the prescribed antibiotic STAT. B) drawing peripheral and central line blood cultures. C) ongoing monitoring of the patient's vital signs for septic shock. D) taking a full set of vital signs and notifying the physician immediately. Early identification of an infective organism is a priority, and cultures should be obtained from various sites. Serial blood cultures (at least two) or one from a peripheral site and one from a venous access device should be obtained promptly. In a febrile neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, and blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment findings (or vital signs) necessitates a call to the physician for additional cultures, diagnostic tests, addition of antimicrobial therapies, or a combination of these.

When caring for a patient with thrombocytopenia, the nurse instructs the patient to A) dab his or her nose instead of blowing. B) be careful when shaving with a safety razor. C) continue with physical activities to stimulate thrombopoiesis. D) avoid aspirin because it may mask the fever that occurs with thrombocytopenia

A) dab his or her nose instead of blowing. Patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed. Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used.

In a severely anemic patient, the nurse would expect to find A) dyspnea and tachycardia. B) cyanosis and pulmonary edema. C) cardiomegaly and pulmonary fibrosis. D) ventricular dysrhythmias and wheezing.

A) dyspnea and tachycardia. Patients with severe anemia (hemoglobin level, less than 6 g/dL) exhibit the following cardiovascular and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction, tachypnea, orthopnea, and dyspnea at rest.

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply) A) inspect all aspects of the mouth and teeth. B) assess the gag reflex and respiratory rate and depth. C) lightly palpate the affected side of the face for edema. D) test for temperature and sensation perception on the face. E) ask the patient to describe factors that initiate an episode.

A) inspect all aspects of the mouth and teeth. D) test for temperature and sensation perception on the face. E) ask the patient to describe factors that initiate an episode. Assessment of the attacks, including the triggering factors, characteristics, frequency, and pain management techniques, helps the nurse plan for patient care. Painful episodes are usually triggered by light cutaneous stimulation at a specific point (i.e., trigger zone) along the distribution of the nerve branches. Precipitating stimuli include chewing, tooth brushing, a hot or cold blast of air on the face, washing the face, yawning, or talking. Touch and tickle seem to predominate as causative triggers, rather than pain or changes in ambient temperature. The nursing assessment should include the patient's nutritional status, hygiene (especially oral), and behavior (including withdrawal). As a result of the attacks, the patient may eat improperly, neglect hygienic practices, wear a cloth over the face, and withdraw from interaction with others.

The nursing management of a patient in sickle cell crisis includes (select all that apply) A) monitoring CBC. B) optimal pain management and O2 therapy. C) blood transfusions if required and iron chelation. D) rest as needed and deep vein thrombosis prophylaxis. E) administration of IV iron and diet high in iron content.

A) monitoring CBC. B) optimal pain management and O2 therapy. C) blood transfusions if required and iron chelation. D) rest as needed and deep vein thrombosis prophylaxis. Complete blood count (CBC) is monitored. Infections are common with elevated white blood cell counts, and anemia may occur with low hemoglobin levels and low RBC counts. Oxygen may be administered to treat hypoxia and control sickling. Rest may be instituted to reduce metabolic requirements, and prophylaxis for deep vein thrombosis (with anticoagulants) is prescribed. Transfusion therapy is indicated when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce transfusion-produced iron overload. Pain occurring during an acute crisis is usually undertreated; patients should have optimal pain control with opioid analgesics, nonsteroidal antiinflammatory agents, antineuropathic pain medications, local anesthetics, or nerve blocks.

The primary protective role of the immune system related to malignant cells is A) surveillance for cells with tumor-associated antigens. B) binding with free antigen released by malignant cells. C) production of blocking factors that immobilize cancer cells. D) responding to a new set of antigenic determinants on cancer cells.

A) surveillance for cells with tumor-associated antigens. Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.

In teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on A) the thickness of the lesion. B) the degree of asymmetry in the lesion. C) the amount of ulceration in the lesion. D) how much the lesion has spread superficially.

A) the thickness of the lesion. The most important prognostic factor is tumor thickness at the time of diagnosis. Two methods are used to determine thickness. The Breslow measurement indicates the depth of the tumor in millimeters, and the Clark level indicates the depth of invasion of the tumor. The higher the number, the deeper the melanoma.

A. Rationale: One of the main symptoms of tumor lysis syndrome is hyperuricemia (a build up of uric acid). Hypermagnesemia and buffalo hump are not symptoms associated with TLS. TLS is most likely to cause HYPERphosphatemia not HYPOphosphatemia

A. Rationale: One of the main symptoms of tumor lysis syndrome is hyperuricemia (a build up of uric acid). Hypermagnesemia and buffalo hump are not symptoms associated with TLS. TLS is most likely to cause HYPERphosphatemia not HYPOphosphatemia

The nurse cares for a 63-year-old woman taking prednisone (Deltasone) and acyclovir (Zovirax) for Bell's palsy. It is most important for the nurse to follow up on which patient statement? A) "I can take both medications with food or milk." B) "I will take these medications for 2 to 3 months." C) "I can take acetaminophen with the prescribed medications." D) "Chances of a full recovery are good if I take the medications."

B) "I will take these medications for 2 to 3 months." Prednisone and acyclovir will usually be prescribed for 10 days. Prednisone will be tapered over the last 4 days of treatment. Oral prednisone and acyclovir may be taken with food or milk to decrease gastrointestinal upset. Patients with Bell's palsy usually begin recovery in 2 to 3 weeks, and most patients have complete recovery in 2 to 3 months. Patients have the best chance for full recovery if prednisone is initiated before complete paralysis occurs. There are no serious drug interactions among prednisone, acyclovir, and acetaminophen.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A) A 59-year-old man whose alcoholism has precipitated folic acid deficiency B) A 23-year-old African American man who has a diagnosis of sickle cell disease C) A 30-year-old woman with a history of "heavy periods" accompanied by anemia D) A 3-year-old child whose impaired growth and development is attributable to thalassemi

B) A 23-year-old African American man who has a diagnosis of sickle cell disease A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

The nurse should recognize which patient as likely to have the poorest prognosis? A) A 60-year-old diagnosed with nodular ulcerative basal cell carcinoma B) A 59-year-old man who is being treated for stage IV malignant melanoma C) A 70-year-old woman who has been diagnosed with late squamous cell carcinoma D) A 51-year-old woman whose biopsy has revealed superficial squamous cell carcinoma

B) A 59-year-old man who is being treated for stage IV malignant melanoma Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late squamous cell carcinoma (SCC) has worse outcomes than superficial SCC, these are both exceeded in mortality by late-stage malignant melanoma.

What nursing intervention should be the priority in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? A) Administration of packed red blood cells B) Administration of oral or IV corticosteroids C) Administration of clotting factors VIII and IX D) Maintenance of reverse isolation and application of standard precautions

B) Administration of oral or IV corticosteroids Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what? A) Leukapheresis B) Attaining remission C) One chemotherapy agent D) Waiting with active supportive care

B) Attaining remission Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

A 68-year-old patient with a spinal cord injury has a neurogenic bowel. Beyond the use of bisacodyl (Dulcolax) suppositories and digital stimulation, which measures should the nurse teach the patient and the caregiver to assist the patient with bowel evacuation (select all that apply)? A) Drink more milk. B) Eat 20-30 g of fiber per day. C) Use oral laxatives every day. D) Drink 1800 to 2800 mL of water or juice. E) Establish bowel evacuation time at bedtime.

B) Eat 20-30 g of fiber per day. D) Drink 1800 to 2800 mL of water or juice. The patient with a spinal cord injury and neurogenic bowel should eat 20-30 g of fiber and drink 1800 to 2800 mL of water or juice each day. Milk may cause constipation. Daily oral laxatives may cause diarrhea and are avoided unless necessary. Bowel evacuation time is usually established 30 minutes after the first meal of the day to take advantage of the gastrocolic reflex induced by eating.

The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following? A) Central cord syndrome B) Spinal shock syndrome C) Anterior cord syndrome D) Brown-Séquard syndrome

B) Spinal shock syndrome About 50% of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as spinal shock. Central cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. Anterior cord syndrome results in motor and sensory loss but not reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function.

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A) Teach the patient to exercise daily. B) Teach the patient promoting factors to avoid. C) Tell the patient to have the cancer surgically removed now. D) Teach the patient which vitamins will improve the immune system.

B) Teach the patient promoting factors to avoid. The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.

Which assessment finding of a 70-year-old male patient's skin should the nurse prioritize? A) The patient's complaint of dry skin that is frequently itchy B) The presence of an irregularly shaped mole that the patient states is new C) The presence of veins on the back of the patient's leg that are blue and tortuous D) The presence of a rash on the patient's hand and forearm to which the patient applies a corticosteroid ointment

B) The presence of an irregularly shaped mole that the patient states is new Although all of the noted assessment findings are significant, the presence of an irregular mole that is new is suggestive of a neoplasm and warrants immediate follow-up.

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

B) Turn off the chemotherapy infusion. 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.

A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A) Brentuximab vedotin (Adcetris) B) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine C) Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine D) BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

B) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.

To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with A) aspirin. B) acetaminophen. C) sodium bicarbonate. D) meperidine (Demerol).

B) acetaminophen. Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

The most common early symptom of a spinal cord tumor is A) urinary incontinence. B) back pain that worsens with activity. C) paralysis below the level of involvement. D) impaired sensation of pain, temperature, and light touch.

B) back pain that worsens with activity. The most common early symptom of a spinal cord tumor outside the cord is pain in the back, with radicular pain simulating intercostal neuralgia, angina, or herpes zoster. The location of the pain depends on the level of compression. The pain worsens with activity, coughing, straining, and lying down.

Goals of rehabilitation for the patient with an injury at the C6 level include (select all that apply) A) stand erect with leg brace. B) feed self with hand devices. C) assist with transfer activities. D) drive adapted van from wheelchair. E) push a wheelchair on a flat surface.

B) feed self with hand devices. C) assist with transfer activities. D) drive adapted van from wheelchair. E) push a wheelchair on a flat surface. Rehabilitation goals for a patient with a spinal cord injury at the C6 level include the ability to assist with transfer and perform some self-care; feed self with hand devices; push a wheelchair on smooth, flat surfaces; drive an adapted van from a wheelchair; independent computer use with adaptive equipment; and need for attendant care for only 6 hours per day.

The nurse explains to a patient undergoing brachytherapy of the cervix that she A) must undergo simulation to locate the treatment area. B) requires the use of radioactive precautions during nursing care. C) may experience desquamation of the skin on the abdomen and upper legs. D) requires shielding of the ovaries during treatment to prevent ovarian damage.

B) requires the use of radioactive precautions during nursing care. Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A) "Where is the pain?" B) "Is the pain getting worse?" C) "What does the pain feel like?" D) "Do you use medications to relieve the pain?"

C) "What does the pain feel like?" The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? A) "When I take a vacation, I should not go to the mountains." B) "I should avoid contact with anyone who has a respiratory infection." C) "When my vision is blurred, I will close my eyes and rest for an hour." D) "I may experience severe pain during a crisis and need narcotic analgesics."

C) "When my vision is blurred, I will close my eyes and rest for an hour." Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A) "When your hair grows back it will be patchy." B) "Don't use your curling iron and that will slow down the loss." C) "You can get a wig now to match your hair so you will not look different." D) "You should contact "Look Good, Feel Better" to figure out what to do about this."

C) "You can get a wig now to match your hair so you will not look different." Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? A) A 60-year-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL B) A 50-year-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer C) A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL D) A 30-year-old patient with a pulse of 112 beats/minute and a white blood cell count of 14,000/µL

C) A 40-year-old patient with a temperature of 100.8o F (38.2o C) and a neutrophil count of 256/µL A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

The nurse is teaching about skin cancer prevention at the community center. Which individual is most at risk for developing skin cancer? A) A 67-year-old bald-headed man with psoriasis and type 2 diabetes mellitus B) A 76-year-old Hispanic man who has a latex allergy and numerous acrochordons C) A 55-year-old woman with fair skin and red hair who has a family history of skin cancer D) A 62-year-old woman with chronic kidney disease who has blond hair with dry, pale skin and pruritus

C) A 55-year-old woman with fair skin and red hair who has a family history of skin cancer Risk factors for skin cancer include having fair skin (with red hair) and a family history of skin cancer. Allergies, acrochordons (skin tags), psoriasis, type 2 diabetes mellitus, and chronic kidney disease are not risk factors associated with the development of skin cancer.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A) It is delivered via an Ommaya reservoir and extension catheter. B) It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C) A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D) The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

C) A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

The patient with peripheral facial paresis on the left side of her face is diagnosed with Bell's palsy. What should the nurse include in teaching the patient about self-care (select all that apply)? A) Administration of antiseizure medications B) Preparing for a nerve block to relieve pain C) Administration of corticosteroid medications D) Dark glasses and artificial tears to protect the eyes E) Surgeries available if conservative therapy is not effective

C) Administration of corticosteroid medications D) Dark glasses and artificial tears to protect the eyes Self-care for Bell's palsy includes corticosteroid medications to decrease inflammation of the facial nerve (CNVII) and protecting the cornea from drying out because of the inability to close the eyelid. Antiseizure medications, a nerve block, or surgeries are used for trigeminal neuralgia.

A 22-year-old female with paraplegia after a spinal cord injury tells the home care nurse that bowel incontinence occurs two or three times each day. Which action by the nurse is most appropriate? A) Take magnesium citrate (Citroma) every morning with breakfast. B) Teach the patient to gradually increase intake of high-fiber foods. C) Assess bowel movements for frequency, consistency, and volume. D) Instruct the patient to avoid all caffeinated and carbonated beverages.

C) Assess bowel movements for frequency, consistency, and volume. The nurse should establish baseline bowel function and explore the patient's current knowledge of an appropriate bowel management program after spinal cord injury. To prevent constipation, caffeine intake should be limited, but not eliminated. Oral saline laxatives such as magnesium citrate are not indicated for long-term management of bowel elimination. Instruction on high-fiber foods is indicated if the patient has a knowledge deficit.

The 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? A) Use Dial soap to feel clean and fresh. B) Scented lotion can be used on the area. C) Avoid heat and cold to the treatment area. D) Wear the new bra to comfort and support the area.

C) Avoid heat and cold to the treatment area. 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 25-year-old male patient who is a professional motocross racer has anterior spinal cord syndrome at T10. His history is significant for tobacco, alcohol, and marijuana use. What is the nurse's priority during rehabilitation? A) Prevent urinary tract infections. B) Monitor the patient every 15 minutes. C) Encourage him to verbalize his feelings. D) Teach him about using the gastrocolic reflex.

C) Encourage him to verbalize his feelings. To help him with his coping and prevent self-harm, the nurse should create a therapeutic patient environment that encourages his self-expression and verbalization of thoughts and feelings. This patient is at high risk for depression and self-injury because he is likely to lose function below the umbilicus involving lost motor and sensory function. In addition, he is a young adult male patient who is likely to need a wheelchair, have impaired sexual function, and is unlikely to resume his racing career. Because the patient uses tobacco, alcohol, and marijuana frequently, hospitalization is likely to result in a loss of these habits that can make coping especially difficult for him. Prevention of urinary tract infections and facilitating bowel evacuation with the gastrocolic reflex will be important but not as important as helping him cope. In rehabilitation, monitoring every 15 minutes is not needed unless he is on a suicide watch.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A) Hypokalemia B) Hypouricemia C) Hypocalcemia D) Hypophosphatemia

C) Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A) It will recur. B) It has metastasized. C) It is probably benign. D) It is probably malignant.

C) It is probably benign. Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A) Weigh the patient every month to monitor for weight loss. B) Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C) Provide high-protein and high-calorie, soft foods every 2 hours. D) Apply palifermin (Kepivance) liberally to the affected oral mucosa.

C) Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.

The goals of cancer treatment are based on the principle that A) surgery is the single most effective treatment for cancer. B) initial treatment is always directed toward cure of the cancer. C) a combination of treatment modalities is effective for controlling many cancers. D) although cancer cure is rare, quality of life can be increased with treatment modalities.

C) a combination of treatment modalities is effective for controlling many cancers. The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).

The nurse counsels the patient receiving radiation therapy or chemotherapy that A) effective birth control methods should be used for the rest of the patient's life. B) if nausea and vomiting occur during treatment, the treatment plan will be modified. C) after successful treatment, a return to the person's previous functional level can be expected. D) the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.

C) after successful treatment, a return to the person's previous functional level can be expected. Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20.

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate A) hyperkalemia. B) hyperuricemia. C) hypercalcemia. D) CNS myeloma.

C) hypercalcemia. Bone degeneration in multiple myeloma causes calcium to be lost from bones, which eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause seizures, coma, and cardiac problems.

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that A) Hodgkin's lymphoma occurs only in young adults. B) Hodgkin's lymphoma is considered potentially curable. C) non-Hodgkin's lymphoma can manifest in multiple organs. D) non-Hodgkin's lymphoma is treated only with radiation therapy.

C) non-Hodgkin's lymphoma can manifest in multiple organs. Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease.

A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the flu because he has a bad headache and nausea. The nurse's first priority is to A) call the physician. B) check the patient's temperature. C) take the patient's blood pressure. D) elevate the head of the bed to 90 degrees.

C) take the patient's blood pressure. Autonomic dysreflexia is a massive, uncompensated cardiovascular reaction mediated by the sympathetic nervous system. Manifestations include hypertension (up to 300 mm Hg systolic), throbbing headache, marked diaphoresis above the level of the injury, bradycardia (30 to 40 beats/min), piloerection, flushing of the skin above the level of the injury, blurred vision or spots in the visual fields, nasal congestion, anxiety, and nausea. It is important to measure blood pressure when a patient with a spinal cord injury complains of headache. Other nursing interventions in this serious emergency are elevation of the head of the bed 45 degrees or sitting the patient upright, notification of the physician, and assessment to determine the cause. Table 61-8 lists the causes and symptoms of autonomic dysreflexia. The nurse must monitor blood pressure frequently during the episode. An α-adrenergic blocker or an arteriolar vasodilator may be administered.

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

D) "Before the transplant I will have chemotherapy and possibly full body radiation." 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.

After learning about rehabilitation for his spinal cord tumor, which statement shows the patient understands what rehabilitation is and can do for him? A) "I want to be rehabilitated for my daughter's wedding in 2 weeks." B) "Rehabilitation will be more work done by me alone to try to get better." C) "I will be able to do all my normal activities after I go through rehabilitation." D) "With rehabilitation, I will be able to function at my highest level of wellness."

D) "With rehabilitation, I will be able to function at my highest level of wellness." Rehabilitation is an interdisciplinary endeavor carried out with a team approach to teach and enable the patient to function at the patient's highest level of wellness and adjustment. It will be a lot of work for all involved and take longer than 2 weeks. With neurologic dysfunction, the patient will not be able to do all the normal activities in the same way as before the lesion, so this statement should be discussed.

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? A) Firm-bristle toothbrush B) Hydrogen peroxide rinse C) Alcohol-based mouthwash D) 1 tsp salt in 1 L water mouth rinse

D) 1 tsp salt in 1 L water mouth rinse 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 patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A) Morphine sulfate B) Ibuprofen (Advil) C) Ondansetron (Zofran) D) Acetaminophen (Tylenol)

D) Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A) Increase intake of liquids at mealtime to stimulate the appetite. B) Serve three large meals per day plus snacks between each meal. C) Avoid the use of liquid protein supplements to encourage eating at mealtime. D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority? A) Advise the patient to eat foods that are fatty, fried, or high in calories. B) Discuss with the physician the need for parenteral or enteral feedings. C) Advise the patient to drink a nutritional supplement beverage at least three times a day. D) Advise the patient to experiment with spices and seasonings to enhance the flavor of food.

D) Advise the patient to experiment with spices and seasonings to enhance the flavor of food. Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables.

What practice should the nurse teach a patient to follow when the patient is applying topical medication? A) Avoid applying medications directly on to dressings. B) Use a tongue blade whenever the patient's skin integrity allows. C) Avoid covering skin regions that have topical medication in place. D) Apply a layer of medication that is just thick enough to ensure coverage.

D) Apply a layer of medication that is just thick enough to ensure coverage. Patients should be directed to avoid applying topical medications too thickly. Medications may be applied directly on to dressings, and regions with medications may be covered. A tongue blade is not normally used for the application of a thin coat.

A 64-year-old man with leukemia admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? A) Administer prescribed enoxaparin (Lovenox). B) Insert two 18-gauge IV catheters. C) Monitor the patient?s temperature every 2 hours. D) Check stools for presence of frank or occult blood.

D) Check stools for presence of frank or occult blood. A platelet count

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A) Bacteria B) Sun exposure C) Most chemicals D) Epstein-Barr virus

D) Epstein-Barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

When planning care for a patient with a C5 spinal cord injury, which nursing diagnosis has the highest priority? A) Risk for impairment of tissue integrity caused by paralysis B) Altered patterns of urinary elimination caused by tetraplegia C) Altered family and individual coping caused by the extent of trauma D) Ineffective airway clearance caused by high cervical spinal cord injury

D) Ineffective airway clearance caused by high cervical spinal cord injury Maintaining a patent airway is the most important goal for a patient with a high cervical fracture. Although all of these are appropriate nursing diagnoses for a patient with a spinal cord injury, respiratory needs are always the highest priority. Remember the ABCs.

A 19-year-old man is admitted to the emergency department with a C6 spinal cord injury after a motorcycle crash. Which medication should the nurse anticipate that she will administer first? A) Enoxaparin (Lovenox) B) Metoclopramide (Reglan) C) IV immunoglobulin (Sandoglobulin) D) Methylprednisolone sodium succinate (Solu-Medrol)

D) Methylprednisolone sodium succinate (Solu-Medrol) Methylprednisolone (MP) blocks lipid peroxidation by-products and improves blood flow and reduces edema in the spinal cord. High-dose MP should be administered within 8 hours of injury. Enoxaparin is a low-molecular-weight heparin used to prevent deep vein thrombosis. Metoclopramide is used to treat delayed gastric emptying. IV immunoglobulin (Sandoglobulin) is used to treat Guillain-Barré syndrome.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A) Acute pain B) Hypothermia C) Powerlessness D) Risk for infection

D) Risk for infection 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 patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A) The medications the patient is taking B) The nutritional supplements that will help the patient C) How much time is needed to provide the patient's care D) The time the nurse spends at what distance from the patient

D) The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? A) Skin care that will be needed B) Method of obtaining the treatment C) Gastrointestinal tract effects of treatment D) Treatment type and expected side effects

D) Treatment type and expected side effects The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to A) motivate change in an unhealthy lifestyle. B) teach her about the seven warning signs of cancer. C) instruct her about healthy stress relief and coping practices. D) allow her to communicate about the meaning of this experience.

D) allow her to communicate about the meaning of this experience. While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.

The primary difference between benign and malignant neoplasms is the A) rate of cell proliferation. B) site of malignant tumor. C) requirements for cell nutrients. D) characteristic of tissue invasiveness.

D) characteristic of tissue invasiveness. The ability of malignant cells to invade and metastasize is the major difference between benign and malignant neoplasms. Other differences between benign and malignant neoplasms are presented in Table 16-3.

The most common type of leukemia in older adults is A) acute myelocytic leukemia. B) acute lymphocytic leukemia. C) chronic myelocytic leukemia. D) chronic lymphocytic leukemia.

D) chronic lymphocytic leukemia. Chronic lymphocytic leukemia is a disease primarily of older adults.

A patient is admitted to the ICU with a C7 spinal cord injury and diagnosed with Brown-Séquard syndrome. On physical examination, the nurse would most likely find A) upper extremity weakness only. B) complete motor and sensory loss below C7. C) loss of position sense and vibration in both lower extremities. D) ipsilateral motor loss and contralateral sensory loss below C7.

D) ipsilateral motor loss and contralateral sensory loss below C7. Brown-Séquard syndrome is a result of damage to one half of the spinal cord. This syndrome is characterized by a loss of motor function, position sense, and vibratory sense, as well as by vasomotor paralysis on the same side (ipsilateral) as the injury. The opposite (contralateral) side has loss of pain and temperature sensation below the level of the injury.

A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient's BP is 84/50 mm Hg, his pulse is 38 beats/minute, and he remains orally intubated. The nurse determines that this pathophysiologic response is caused by A) increased vasomotor tone after injury. B) a temporary loss of sensation and flaccid paralysis below the level of injury. C) loss of parasympathetic nervous system innervation resulting in vasoconstriction. D) loss of sympathetic nervous system innervation resulting in peripheral vasodilation.

D) loss of sympathetic nervous system innervation resulting in peripheral vasodilation. Neurogenic shock results from loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia. Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and a decrease in cardiac output. These effects are usually associated with a cervical or high thoracic injury (T6 or higher).

A characteristic of the stage of progression in the development of cancer is A) oncogenic viral transformation of target cells. B) a reversible steady growth facilitated by carcinogens. C) a period of latency before clinical detection of cancer. D) proliferation of cancer cells in spite of host control mechanisms.

D) proliferation of cancer cells in spite of host control mechanisms. Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

Multiple drugs are often used in combinations to treat leukemia and lymphoma because A) there are fewer toxic and side effects. B) the chance that one drug will be effective is increased. C) the drugs are more effective without causing side effects. D) the drugs work by different mechanisms to maximize killing of malignant cells.

D) the drugs work by different mechanisms to maximize killing of malignant cells. Combination therapy is the mainstay of treatment for leukemia. The three purposes for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the patient by using multiple drugs with varying toxic effects, and (3) interrupt cell growth at multiple points in the cell cycle.

The most effective method of administering a chemotherapy agent that is a vesicant is to A) give it orally. B) give it intraarterially. C) use an Ommaya reservoir. D) use a central venous access device.

D) use a central venous access device. If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

B, D, A, E, C. This is the order listed

Place the sequence of DIC in the correct order 1. ___ A. Widespread clotting occurs within the microvasculature. 2. ___ B. Damage to endothelial, tissue factors, or toxins stimulate the clotting cascade 3. ___ C. Clotting factors and platelets are consumed faster than can be replaced 4. ___ D. Excess thrombin within the circulation overwhelms naturally occurring anticoagulant 5. ___ E. thrombi and emboli impair tissue perfusion leading to ischemia, infarction, and necrosis

C. TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are HYPERuricemia, HYPERphosphatemia, HYPERkalemia, and HYPOcalcemia.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia

Answer: D Rationale: A side effect of taking neupogen in preparation for a stem cell "donation" is bone pain due to the development of new white blood cells in the bone marrow, which can create pressure and pain with the excess of WBCs being created. Abdominal pain is not a concern. You need to take neupogen until your neutrophil count is high enough for them to extract. Neupogen does not decrease the risk for rejection.

The nurse is taking care of a patient who is preparing to donate stem cells, the nurse knows the patient understands the side effects of taking neupogen before the procedure when they state I may have abdominal pain as a result of taking neupogen for this procedure I will only have to take neupogen for 3 days before the procedure There will be a decreased risk of rejection as a result of taking neupogen for this procedure I may have bone pain as a result of receiving neupogen for this procedure

A and B Rationale: The nurse is not supposed to assure safety at all costs due to the potential for complications. Long periods of isolation may be necessary post-op to prevent infections.

The role of the nurse working with a stem cell transplant patient post-op includes (Select all that apply): a. support the patient by helping them identify and answer questions regarding treatment b. make sure the patient understands and can consent to treatment c. relieve anxiety by assuring safety of treatment without complications. d. encourage family visits as much as possible

a, b, d Rational: Aseptic conditions should be maintained in the case where a patient is at risk for infection. They should not eat poultry, eggs and cheese as they are considered "high risk" foods and can bring with them bacteria that is harmful to immunosuppressant patients

The student nurse's teaching has been effective when they can identify ways to prevent risk for infection in febrile neutropenia. Select all that apply: I need to perform good hand hygiene I need to maintain protective isolation I should include a diet that includes poultry eggs and cheese My family should limit any household constructiona, b, d Rational: Aseptic conditions should be maintained in the case where a patient is at risk for infection. They should not eat poultry, eggs and cheese as they are considered "high risk" foods and can bring with them bacteria that is harmful to immunosuppressant patients

B, C, D Rationale: Transplants take between 30-60 minutes.

When teaching a student nurse about stem cell transplant, the nurse manager knows the teaching is successful when the student nurse states... (Select all that apply) a. the transplant can take up to 2 hours b. engraftment of stem cells can take up to 14-25 days c. acute GVHD can occur within 100 days after the stem cell transplant d. chronic GVHD can occur after 100 days from the stem cell transplant

ABD. Shortness of breath and fruity breath are not signs and symptoms of DIC or bleeding problems.

You are the nurse evaluating a patient with suspected DIC. What assessment findings are consistent with this diagnosis? (select all that apply) A. petechiae B. low blood pressure C. shortness of breath D. spontaneous bruising E. fruity breath