CH 48 Hematological and Oncological Disorders

The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1. "i change my pouch every week" 2. "i change the appliance in the morning" 3. "i empty the urinary collection bag when it is two-thirds full" 4. "when i'm in the shower i direct the flow of water away from my stoma"

3. "i empty the urinary collection bag when it is two-thirds full"

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. "i should avoid blowing my nose" 2. "i may need a platelet transfusion if my platelet count is too low" 3. "im going to take aspirin for my headache as soon as i get home" 4. "i will count the number of pads and tampons i use when menstruating"

3. "im going to take aspirin for my headache as soon as i get home"

While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action? 1. call the HCP 2. reinsert the implant into the vagina 3. pick up the implant with gloved hands and flush it down the toilet 4. pick up the implant with long-handled forceps and place it in a lead container

4. pick up the implant with long-handled forceps and place it in a lead container

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? 1. age younger than 50 years 2. history of colorectal polyps 3. family history of colorectal cancer 4. chronic inflammatory bowel disease

1. age younger than 50 years

The nurse is caring for a client who is postoperative following a pelvic exenteration and the HCP changes the clients diet from NPO status to clear liquids. The nurse should check which priority item before administering the diet? 1. bowel sounds 2. ability to ambulate 3. incision appearance 4. urine specific gravity

1. bowel sounds

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. encouraging fluids 2. providing frequent oral care 3. coughing and deep breathing 4. monitoring the RBC count

1. encouraging fluids

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1. facial edema in the morning 2. weight loss of 20 lb in 1 month 3. serum calcium level of 12 mg/dL 4. serum sodium level of 136 mg/dL 5. serum potassium level of 3.4 mg/dL 6. numbness and tingling of the lower extremities

1. facial edema in the morning 3. serum calcium level of 12 mg/dL 6. numbness and tingling of the lower extremities

The nurse is reviewing the lab results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. increased calcium level 2. increased WBCs 3. decreased BUN level 4. decreased number of plasma cells in the bone marrow

1. increased calcium level

The nurse is conducting a history and monitoring lab values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply. 1. pathological fracture 2. urinalysis positive for nitrites 3. hemoglobin level of 15.5 g/dL 4. calcium level of 8.6 mg/dL 5. serum creatinine level of 2.0 mg/dL

1. pathological fracture 2. urinalysis positive for nitrites 5. serum creatinine level of 2.0 mg/dL

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the HCP will request which prescriptions? Select all that apply. 1. radiation 2. chemotherapy 3. increased fluid intake 4. decreased oral sodium intake 5. serum sodium level determination 6. medication that is antagonistic to antidiuretic hormone

1. radiation 2. chemotherapy 5. serum sodium level determination 6. medication that is antagonistic to antidiuretic hormone

The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. the client's pain rating 2. nonverbal cues from the client 3. the nurse's impression of the client's pain 4. pain relief after appropriate interventions

1. the client's pain rating

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? 1. the passage of fluids 2. absent bowel sounds 3. the client's ability to tolerate food 4. bloody drainage from the colostomy

1. the passage of fluids

The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? 1. clamp the surgical drain 2. change the dressing as prescribed 3. notify the HCP 4. remove and replace the perineal packing

2. change the dressing as prescribed

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. placing cool compresses on the affected arm 2. elevating the affected arm on a pillow above heart level 3. avoiding arm exercises in the immediate postoperative period 4. maintaining an intravenous site below the antecubital area on the affected side

2. elevating the affected arm on a pillow above heart level

The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? 1. dysuria 2. hematuria 3. urgency on urination 4. frequency of urination

2. hematuria

When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply. 1. limiting the time with the client to 1 hour per shift 2. keeping pregnant women out of the client's room 3. placing the client in a private room with a private bath 4. wearing a lead shield when providing direct client care 5. removing the dosimeter film badge when entering the client's room 6. allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client

2. keeping pregnant women out of the client's room 3. placing the client in a private room with a private bath 4. wearing a lead shield when providing direct client care

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply. 1. flatulence 2. peritonitis 3. hemorrhage 4. fistula formation 5. bowel perforation 6. lactose intolerance

2. peritonitis 3. hemorrhage 4. fistula formation 5. bowel perforation

The nurse is instructing a client to perform a testicular self exam (TSE). The nurse should provide the client with which information about the procedure? 1. to examine the testicles while lying down 2. that the best time for the exam is after a shower 3. to gently feel the testicle with 1 finger to feel for a growth 4. that TSEs should be done at least every 6 minutes

2. that the best time for the exam is after a shower

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? 1. rupture of the bladder 2. the development of a vesicovaginal fistula 3. extreme stress caused by the diagnosis of cancer 4. altered perineal sensation as a side effect of radiation therapy

2. the development of a vesicovaginal fistula

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action? 1. measure abdominal girth 2. irrigate the nasogastric tube 3. continue to monitor the drainage 4. notify the HCP

3. continue to monitor the drainage

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. cyanosis 2. arm edema 3. periorbital edema 4. mental status changes

3. periorbital edema

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. restrict all visitors 2. restrict fluid intake 3. teach the client and family about the need for hand hygiene 4. insert an indwelling urinary catheter to prevent skin breakdown

3. teach the client and family about the need for hand hygiene

The community health nurse is instructing a group of young female clients about breast self exams. The nurse should instruct the clients to perform the exam at which time? 1. at the onset of menstruation 2. every month during ovulation 3. weekly at the same time of day 4. 1 week after menstruation begin

4. 1 week after menstruation begin

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? 1. diarrhea 2. hypermenorrhea 3. abnormal bleeding 4. abdominal distention

4. abdominal distention

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? 1. headache 2. dysphagia 3. constipation 4. electrocardiographic changes

4. electrocardiographic changes

A 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? 1. fatigue 2. weakness 3. weight gain 4. enlarged lymph nodes

4. enlarged lymph nodes