PrepU Oncology Guta WK 2
A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching?
"I'll use hats to protect my head from the sun when my hair falls out." The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete. Chapter 15: Management of Patients with Oncologic Disorders - Page 340
A client has multiple myeloma. Prior to starting treatment with thalidomide, what it is most important action for the nurse to take?
Contract with the client regarding birth-control methods. Thalidomide (Thalomid) may cause birth defects. Prior to taking this drug, the client must agree to use approved methods of birth control. The question is asking about thalidomide and not multiple myeloma. The other options relate to the effects of multiple myeloma. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 988
A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client?
Fear Fear of the unknown is probably the major concern for this client. Fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time. Chapter 15: Management of Patients with Oncologic Disorders - Page 375
A client diagnosed with cancer has the tumor staged and graded based on what?
How the tumor tends to grow and the cell type Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer. Chapter 15: Management of Patients with Oncologic Disorders - Page 333
The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to
Limit alcohol ingestion to one drink per day. Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women. Smoking is strongly associated with certain cancers, and tobacco may act synergistically with other substances. Even decreasing use of tobacco still places one at risk for cancer. Recommendation by the U.S. Department of Agriculture for fruits and vegetables is 4 1/2 cups per day and for protein is 5 1/2 ounces per day with low-fat or lean meat and poultry and/or other proteins such as fish, beans, peas, nuts, and seeds. Chapter 15: Management of Patients with Oncologic Disorders - Page 331
Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy?
fever The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment. Chapter 15: Management of Patients with Oncologic Disorders - Page 345
A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply.
"It helps to strengthen the bone." "It helps to decrease bone pain." Radiation therapy is useful in strengthening the bone at a specific lesion, particularly a bone at risk for fracture or spinal cord compression. It is also extremely useful in relieving bone pain. Radiation therapy is not effective in decreasing bone malignancy, decreasing excess calcium, or activating an immune response. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 996
Following bone marrow aspiration of a client, analysis reveals more than 20% immature blast cells. Platelet counts are 9000/mm³. What nursing interventions should the nurse employ for the care of this client? Select all that apply.
-Administer prescribed docusate daily. -Assess for mental state changes. The client has leukemia with immature blast cells and an extremely low platelet count. The client is at increased risk for bleeding. Interventions that would address bleeding include assessing for mental status changes (because bleeding could occur in the brain) and administering stool softeners to prevent constipation (which would increase the risk of bleeding from the rectum). Oral contraceptives would be administered to induce amenorrhea. Ibuprofen would be avoided because this medication inhibits platelet function. The nurse is to apply pressure to venipuncture sites for 5 minutes. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 982
The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a negative biopsy report?
A wide excision of lump will be performed. The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors. Chapter 15: Management of Patients with Oncologic Disorders - Page 336
An oncology nurse is contributing to the care of a client who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). The nurse should know that these achieve a therapeutic effect by what means?
Altering the immunologic relationship between the tumor and the client BRMs alter the immunologic relationship between the tumor and the cancer client (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRMs do not potentiate radiotherapy and chemotherapy. Chapter 15: Management of Patients with Oncologic Disorders - Page 352
A client has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The client states, "They tell me my cancer is malignant, while my coworker's breast tumor was benign. I just don't understand at all." When preparing a response to this client, the nurse should be aware of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?
Different proteins in the cell membrane The cell membrane of malignant cells also contains proteins called tumor-associated antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type. Chapter 15: Management of Patients with Oncologic Disorders - Page 326
A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply.
Encourage ambulation Encourage hydration Muscle cramping can be alleviated or reduced by encouraging hydration and ambulation. Warning the client to avoid abrupt position change best supports the client with postural hypotension. Paresthesias (tingling) can best be mediated with range of motion exercises. Clients experiencing hypoesthesia should be warned to avoid extremes in temperatures. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 998
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells? Select all that apply.
Erythrocytes Granulocytes Monocytes Platelets AML results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets. Islet cells are associated with the pancreas. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 971
The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends
Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days The American Cancer Society recommendations are for adolescents to engage in at least 60 minutes of moderate to vigorous physical activity at least 5 days per week. The MyPyramid recommendations include 4 1/2 cups of fruits and vegetables every day. People who have a body mass index less than 24 are at increased risk for problems associated with poor nutritional status. Ingesting more protein will not necessarily build more muscle mass and is not recommended for normal healthy individuals. Chapter 15: Management of Patients with Oncologic Disorders - Page 329
A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Indigestion Indigestion is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer. Chapter 15: Management of Patients with Oncologic Disorders - Page 333
The nursing instructor is discussing the diagnosis of cancer with their nursing class. The instructor tells her students that scientists have predicted that gene therapy will one day play a large role in the prediction, diagnosis, and treatment of cancer. What cancer is gene therapy currently being investigated in the treatment of?
Melanoma Scientists predict that gene therapy will play a significant role in the future prediction, diagnosis, and treatment of cancer. It is currently being investigated in the treatment of brain tumors, melanoma, and renal, breast, ovarian, lung, and colon cancers.
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. Which of the following is the most common complication of the pathology resulting from this process?
Pathologic fractures Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.
Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure?
Psychological status During the BMT procedure, the nurse assesses the patient's psychological status. Patients experience many mood swings and need emotional support and help throughout this process. Assessing the patient's blood pressure, urine gravity, and electrolyte levels is important for patients undergoing chemotherapy. Chapter 15: Management of Patients with Oncologic Disorders - Page 350
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo?
Sentinel node biopsy Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer. Chapter 15: Management of Patients with Oncologic Disorders - Page 335
The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. Why?
Trauma and microabrasions may contribute to anemia. In a client with leukemia who is at risk for hemorrhage, the nurse handles the client gently when assisting and encourages the client to use electric razors. Trauma and microabrasions from razors may contribute to anemia from bleeding. Fragile tissues and altered clotting mechanisms may result in hemorrhage even after minor trauma. Therefore, the nurse inspects the skin for signs of bruising and petechiae and reports melena, hematuria, or epistaxis (nosebleeds). The risks for spontaneous and uncontrolled bleeding or infection from microorganisms are not addressed by the use of electric razors.
A client returns to the surgeon's office for a report on a diagnostic procedure to determine the cell composition of the client's abdominal neoplasm. Which term is significant to indicate the likelihood of the tumor spreading?
benign Tumors are classified according to their cell of origin and whether their growth is benign, meaning not invasive or spreading; or malignant, meaning invasive and capable of spreading. New growths of abnormal tissue are called neoplasms or tumors. The term 'primary site' may be used in reference to the origins of an initial tumor if metastasis, or the development of a secondary tumor from the primary tumor at a distant location. A lesion generally appears on the skin and looks like a mole. Chapter 15: Management of Patients with Oncologic Disorders - Page 326
A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with?
normal cellular processes during the S phase of the cell cycle Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction. Chapter 15: Management of Patients with Oncologic Disorders - Page 343
A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply.
-"This type of leukemia primarily impacts older adults." -"This type of leukemia is rarely seen in certain ethnicities." Chronic lymphocytic leukemia (CLL) is a common malignancy of older adults and primarily impacts older adults and has a strong familial predisposition. This type of leukemia rarely impacts Native Americans and infrequently individuals of Asian descent. While many clients will have a normal life expectancy, others will have a very short life expectancy due to the aggressive nature of the disease. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 976
The nurse is teaching a client who is undergoing diagnostic tests for multiple myeloma. What clinical findings support the client's diagnosis of multiple myeloma?
serum albumin level of 2.0 g/dL Albumin is a protein found in the blood and low levels can be seen in myeloma. Normal albumin level is 3.4 to 5.4 g/dL. Serum creatinine level may be increased (above 1.2 mg/dL in men and 0.9 mg/dL in women). Serum calcium levels exceed 10.2 mg/dL in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 994
A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?
"I'll only need chemotherapy treatment before receiving my bone marrow transplant." This client demonstrates understanding about treatment when she states that she'll need chemotherapy before receiving a bone marrow transplant. Most clients receive chemotherapy before undergoing bone marrow transplantation. Most women older than age 26 can't bear children after undergoing treatment because they experience the early onset of menopause. Clients who undergo chemotherapy or radiation must avoid all fresh fruits and vegetables, and all foods should be cooked to avoid bacterial contamination. Clients who undergo bone marrow transplantation typically remain hospitalized for 20 to 25 days. Chapter 15: Management of Patients with Oncologic Disorders - Page 350
The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply.
Ability to cause death Ability to spread Rate of growth Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently. Chapter 15: Management of Patients with Oncologic Disorders - Page 326
After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply.
Administer allopurinol. Increase hydration. Administer rasburicase. Increased uric acid and phosphorus concentrations after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Rasburicase is an enzyme that can also decrease uric acid. Administration of potassium is not indicated, as concentrations are elevated after chemotherapy. Exercise is not initially encouraged because the client could have weakness and cramping during this time. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 973
A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse should identify what main goal of care?
Cure of the disease The goal in the treatment of Hodgkin lymphoma is cure. Palliation is thus not normally necessary. Quality of life and symptom control are vital, but the overarching goal is the cure of the disease. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 990
Which assessment findings support the client's diagnosis of acute myeloid leukemia? Select all that apply.
Petechiae Bone pain Weakness and fatigue Enlarged lymph nodes Clients with AML may present with petechiae, enlarged lymph nodes, weakness, fatigue, and bone pain. An enlarged heart is not a typical finding with this disorder. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 972
A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping?
Refer client for professional counseling. Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping. Chapter 15: Management of Patients with Oncologic Disorders - Page 368
When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.
muscle weakness loss of balance and coordination cramps and spasms in the legs Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign. Chapter 15: Management of Patients with Oncologic Disorders - Page 346
A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this client's care, the nurse should be aware of what epidemiologic fact?
Five-year survival for clients over 75 years old is less than 2%. The 5-year survival rate for clients with AML who are 50 years of age or younger is 43%; it drops to 19% for those between 50 and 64 years, and drops to1.6% for those older than 75 years. Early diagnosis is beneficial, but is nonetheless not associated with good outcomes or high survival rates. Pre-illness health is significant, but not the most important variable. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 972
A client diagnosed with cancer has his tumor staged and graded based on what factors?
How they tend to grow and the cell type Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer. Chapter 15: Management of Patients with Oncologic Disorders - Page 333
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.
Hyperphosphatemia Hyperuricemia Hyperkalemia When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur. Chapter 15: Management of Patients with Oncologic Disorders - Page 383
The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply.
dietary substances environmental factors viruses defective genes chemical agents Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy. Chapter 15: Management of Patients with Oncologic Disorders - Page 327
A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.
tumor markers client history risk factors The health care provider, using information obtained during the history and physical examination, selects tests that help to establish a diagnosis. Specific cancers alter the chemical composition of blood and other body fluids. Specialized tests have been developed for specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The use of sunscreen would be part of a skin cancer diagnosis. Chapter 15: Management of Patients with Oncologic Disorders - Page 333
The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply.
-Rinse the mouth with normal saline. -Use dental floss every 24 hours. -Use a lip lubricant. Stomatitis is an inflammation of the oral cavity. The client should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided. Chapter 15: Management of Patients with Oncologic Disorders - Page 355
You are doing client teaching in the oncology clinic. One of your clients will undergo sealed radiation therapy. What should you teach this client and their family?
Clients must avoid contact with other people for at least 2 months after the implant. Sealed brachytherapy sources include interstitial and intracavitary implants. Clients generally go home if they have permanent implants. Clients must stay away from other people for a few days when the radiation is most active. They must restrict close contact with children or pregnant women to 5 minutes and be no closer to them than 6 feet for 2 months after the implant. Maintaining a vegetarian diet will not help clients minimize radiation.
The hospice nurse is caring for a client with cancer who is living at home. The nurse has explained to the client and the family that the client is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this client and family to do to reduce the client's risk of hypercalcemia?
Consume 2 to 4 L of fluid daily. The nurse should identify clients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the client and family. The nurse should teach at-risk clients to recognize and report signs and symptoms of hypercalcemia and encourage clients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise clients to maintain nutritional intake without restricting normal calcium intake. Chapter 15: Management of Patients with Oncologic Disorders - Page 381
The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the client, she admits that she drinks around 600 mL (20 oz) of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.
Liver cancer Esophageal cancer Breast cancer Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast. Chapter 15: Management of Patients with Oncologic Disorders - Page 329
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply.
Sloughing tissue Effectiveness of the antidote Tissue necrosis Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote. Chapter 15: Management of Patients with Oncologic Disorders - Page 329
The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line
With a soft, plastic catheter Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle. Chapter 15: Management of Patients with Oncologic Disorders - Page 342
The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart?
Integrative medicine Integrative medicine is the use of therapies in conjunction with conventional medicine. This is also known as complementary medicine. Alternative therapies are used instead of conventional medicine. Chapter 15: Management of Patients with Oncologic Disorders - Page 343
The client has a body surface area of 2.05 m². He is prescribed vincristine (Oncovin) 1.4 mg/m². Vincristine is available as 1 mg/1 mL. How many mL will the nurse administer? Round your answer to the nearest tenth.
2.9 The dose ordered is 1.4 mg for each 1 m² of the client's body surface area, which is 2.05. 1.4 mg/m² x 2.05 m² = 2.87 mg. The dose available is 1 mg for each 1 mL. 1 mg/1 mL x 2.87 mg = 2.87 mL. Rounding your answer to 1 decimal place would be 2.9 mL. Chapter 15: Management of Patients with Oncologic Disorders - Page 342
Which of the following are true statements about effective radiation therapy? Select all that apply.
-Slower-growing tissues at rest (muscle) are more radioresistant. -Tumors that are small in size and dividing rapidly are more sensitive. -Tumors that are well oxygenated are more sensitive to radiation. All of the statements are true except for A. Cells are most vulnerable during DNA synthesis and mitosis. Tissues that experience frequent cellular division are most sensitive to radiation. Chapter 15: Management of Patients with Oncologic Disorders - Page 338
A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. The client has a single lumen central venous catheter in place and the health care provider has ordered the nurse to administer imipenem cilastatin 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products?
Platelets, imipenem cilastatin, amphotericin B, packed RBCs Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts the client at risk for spontaneous hemorrhage. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, the client currently asymptomatic. The absence of clinical manifestations makes the need for a transfusion less urgent. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 972-973
The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.
-Egg white omelet with spinach and mushrooms -Turkey breast on whole wheat bread -Steamed broccoli and carrots Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese. Chapter 15: Management of Patients with Oncologic Disorders - Page 331
A nurse prepares teaching for a group of clients with chronic myeloid leukemia (CML). When planning the teaching on medication adherence, which factors associated with lower oral therapy adherence will the nurse keep in mind? Select all that apply.
-Taking medication independent of meals -Low socioeconomic status -Living alone -Not participating in a clinical trial Adherence to the oral medication therapeutic regimen is critical to optimal client outcomes. Various factors lead to lower adherence rates to the oral medication therapeutic regimen. These may include: living alone, low socioeconomic status, not participating in a clinical trial, and taking medication independent of meals. A higher self-report of functional status Chapter 34: Management of Patients With Hematologic Neoplasms - Page 975
A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)
-avoids shaving the irradiated skin -assesses the client for any sun exposure The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage. Chapter 15: Management of Patients with Oncologic Disorders - Page 359
A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.
-instructs the client to discontinue calcium -asks about nausea and vomiting -teaches the client to report abdominal or bone pain The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea. Chapter 15: Management of Patients with Oncologic Disorders - Page 382