UNRS 312 Exam 2
P.R. has completed her 7 days of high-dose chemotherapy and is now on Day 10. At the beginning of your shift she says, "I am so bored sitting around here. I feel great except for just a little tiredness. Why can't I just go home?" Why is it important that A.R. remains in the hospital?
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A nurse is teaching a group of women about the risk factors for the development of breast cancer. Which statement is true regarding breast cancer risk?
Women who have never had biological children have a greater risk of breast cancer than women who have biological children
The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful?
"I will avoid reaching over the stove with my left hand."
A patient with acute myelogenous leukemia is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient?
"Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation, and new bone marrow cells from a donor are infused."
P.R. immediately had a bone marrow biopsy to identify underlying disease. Initial pathology report revealed presence of >25% myeloblasts. This result confirms the diagnosis of acute myeloblastic leukemia. P.R. tells the nurse that she is confused about what the oncologist meant by "blasts in her blood and bone marrow". She asks, "What does that have to do with my pain and bleeding?" How would you explain the underlying diagnosis and relate it to pain and bleeding?
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Chemotherapy, targeted therapy and immunotherapy are used to treat cancer. Discuss how each therapy works.
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A patient who is being treated for advanced prostate cancer tells the nurse about new-onset back pain. Which action should the nurse take first?
Assess for sensation and strength in the legs.
A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first?
Assess the patency of the catheter
The nurse would be most concerned when the patient's breast examination reveals which finding?
An immobile, hard, nontender lesion in the upper outer quadrant.
A 50-year-old man with no risk factors asks the nurse about the recommended frequency for prostate cancer screening. What should the nurse tell him is the recommended interval?
Annually, beginning at 50 years old
During the immediate postoperative period following a modified radical mastectomy, the nurse initially institutes which exercises for the affected arm?
Ask the patient to flex and extend the fingers and wrist of the operative side.
The nurse is caring for a patient who was admitted to the hospital for metastatic breast cancer to the brain, liver and lung, List two possible clinical manifestations for each site of metastases.
Brain: altered mental status, headaches liver: jaundice, thrombocytopenic lung: tachycardic, shortness of breath, diminished lung sounds
A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing?
CA 15-3 level testing
The following tumor markers are measured during diagnosis of testicular cancer except:
CA-125
A patient who has received high-dose chemotherapy has been unable to tolerate any oral intake. List pharmacological and non-pharmacological interventions to control nausea and improve oral intake.
Pharmacological interventions: zofran, reglan, pantoprazole, famotidine, colace Non-pharmacological interventions: exercise, TV (distraction method)
A patient is being worked-up for probable non-Hodgkins lymphoma. What clinical manifestation indicates a poor prognosis?
Fever, night sweats, weight loss
The UAP reports that the patient in 522 is complaining of feeling cold and is chilling. Knowing that the patient is neutropenic and anemic what should the nurse do?
Go to the room immediately to assess the patient.
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
Hematuria
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?
Hospitalization will be required for several weeks after the stem cell transplant procedure is performed.
What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia?
Infiltrates of the organs by increased numbers of WBCs in the blood.
A patient who is scheduled for a right breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?
Malignant tumors may spread to other tissues or organs."
P.R. is a 20-yo female who presented to the ED with history of increasing fatigue, SOB, and heavy menstrual period for 14 days. She reports that she had to drop out of college and return home a month ago because she was experiencing severe neck, shoulder, and back pain that has not resolved with multiple treatments. CBC results: WBC 2.8, x 10(3)/mcL, Hgb 4.9 gm/dL, RBC 1.35 x 10(6)/mcL, platelets 38 x 10(3)/mcL. Peripheral differential noted a large percentage of abnormal cells that were confirmed by pathophysiology to be blasts, ANC 0.4 x 10(3)/mcL. She received 2 units of PRBC and 2 platelet transfusions in ED. She was admitted for supportive therapy and clinical workup for a possible hematological disease. (The next four questions relate to this Patient Scenario.) Based on P. R. signs/symptoms and CBC results what would be the patient's admitting diagnosis?
Pancytopenia
The nurse initiates a blood transfusion and monitors the patient for signs of a transfusion reaction. Five minutes into the transfusion, which would be a cause for concern?
Patient complains of flank pain and chills
What is the most common cause of death in patients with a hematological cancer?
Sepsis
A patient with a breast biopsy positive for cancer tells the nurse that she read about tamoxifen on the Internet and asks about its use. The best response by the nurse includes which information?
Tamoxifen is the treatment of choice if the tumor has receptors for estrogen on its cells.
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?
Teach the patient to administer filgrastim (Neupogen) injections.
Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patient's skin rash?
The donor T cells are attacking the patient's skin cells.
A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?
The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure?
Tumor size will decrease and this will improve the effects of other therapy.
The nurse would expect that a lumbar puncture may be ordered to rule out central nervous system involvement in what hematological diseases. (check all that apply)
acute lymphoblastic leukemia, lymphoma
"Bone demineralization in multiple myeloma can lead to
anemia, fractures, bone pain
In cancer, corticosteroids are used in combination with other drugs to: (check all that apply)
decrease swelling and inflammation, treat cancer, prevent and control nausea
Patient Profile: RM is a 58 year-old African American male who was recently been diagnosed with metastatic lung cancer to the bone. He is status-post initial treatment with chemotherapy through a peripherally inserted central venous catheter and is currently Day 7 of Cycle 1 of chemotherapy. He has returned to the outpatient clinic for his first follow-up appointment. Subjective data States he has almost continuous nausea, which becomes severe and causes vomiting following his cycle of chemotherapy. States he has no appetite and feels hot. States no one at home to help with food preparation. Expresses no hope that the chemotherapy will be beneficial. Reports fatigue/malaise Objective data Temp: 100.9 o F (38.3 o C) BP: 98/58; RR: 20/min; HR: 94 beats/min WBC count: 2800/μL (2.8 x 109/L) ANC: 500/μL (0.5 x109/L) Skin warm with decreased turgor What are two probable problems that need to be further assessed and immediately addressed?
dehydration, neutropenic fever
A patient asks the nurse about screening tests for colon cancer. The nurse explains that beginning at 45-50 years old, persons who have an average risk of colon cancer should have a colonoscopy. How often is a colonoscopy recommended for this population?
every 10 years
Post stem-cell transplant patients receive many medications to prevent possible complications. Match the drug name with the possible complication.
fluconzole (fungal infection), acyclovir (herpes simplex), Sulfamethoazole trimethoprim (pneumocystis), ursodiol (veno-occlusive), allopurinol (tumor lysis syndrome), tacrolimus (graft vs host), mycophenolate mofetil (graft vs host), sirolimusi (graft vs host)
List four possible clinical manifestations of pancreatic cancer.
fluid and electrolyte imbalance, respiratory problems, abdominal pain, constipation
What is the most common type of lung cancer and what treatment options are available for this cancer?
non-small cell lung cancer, chemo, radiation, surgery
A patient is being worked-up for probable acute myeloid leukemia and is being prepped for a bone marrow biopsy. What lab test result would indicate that it is not safe to perform the procedure?
platelet count 38/ul
"Post stem-cell transplant patients often need supportive therapy in the form of
psychosocial, spiritual, and ethical care
List two major risk factors for esophageal cancer?
smoking, excessive alcohol consumption
A student nurse is speaking to a group of teenagers patient about skin cancer (melanoma). What information is important to include for prevention and early detection?
sunscreen education, early detection of melanoma (abnomral skin patterns)
