Chapter #15 & 33
You are caring for an 87-year-old female who has been admitted to your unit with iron-deficiency anemia. What would you suspect?
Blood loss from the gastrointestinal or genitourinary tract Explanation: If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tract is suspected. This is because iron deficiency anemia is unusual in older adults as the body does not eliminate excessive iron, causing total body iron stores to increase with age.
The nurse is providing education to a patient with cancer radiation treatment options. The nurse determines that the patient understands when he or she states that which of the following types of radiation is aimed at protecting healthy tissue during the treatment?
Brachytherapy Explanation: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body by use of an implant. With this type of therapy, the further the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
Which of the following vitamins enhance the absorption of iron?
C Explanation: Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.
Which of the following is true about a malignant tumor?
Gains access to the blood and lymphatic channels By gaining access to blood and lymphatic channels, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:
Increase her intake of calcium-rich foods. Explanation: One of the major side effects of Aromasin is hypercalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?
Liver Explanation: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
A patient with sickle cell disease comes to the emergency department complaining of severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide?
Start an intravenous line with dextrose 5% in 0.25 normal saline Adequate hydration is important during a painful sickling episode. Oral hydration is acceptable if the patient can maintain adequate fluid intake; IV hydration with dextrose 5% in water (D5W) or dextrose 5% in 0.25 normal saline solution (3 L/m2/24 h) may be required for a sickle crisis. Supplemental oxygen may also be needed.
A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?
7 to 14 days Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that a common feature of all leukemias is which of the following?
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation: The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?
Vitamin K Explanation: Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?
Osteoporosis Explanation: Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
Pallor, tachycardia, and a sore tongue Explanation: Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet.
A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms? Stomatitis
The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
Following a BMT the patient should be monitored for at least
You Selected: 3 months. After a BMT, the nurse closely monitors the patient for at least 3 months because complications related to the transplant are still possible, and infections are very common.
Which of the following is a sign or symptoms of septic shock?
You Selected: Altered mental status Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply.
Family members should stand about 6 feet from the patient. Lead aprons should be worn to buffer the exposure. Visitors may stay for 30 minutes or less. Exposure for the nurse, health care provider or visitors should be limited to 30 minutes/8-hour shift. As time increases, exposure to radiation increases. The goal is to deliver safe, efficient care in the shortest amount of time.
Which of the following is true about a malignant tumor?
Gains access to the blood and lymphatic channels Explanation: By gaining access to blood and lymphatic channels, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.
A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms?
The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
Which type of surgery is utilized in an attempt to relieve complications of cancer? You Selected: Palliative
Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing non-vital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?
You Selected: Adjuvant therapy is likely T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care.
A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?
"I guess the doctor could not remove the entire tumor." Explanation: Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.
The nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. The nurse states:
"You may choose to discontinue this test." Explanation: The American Cancer Society recommendations for women 70 years or older, who have had normal Pap tests for 10 years, and who have had a total hysterectomy may choose to stop cervical cancer screening as in a Pap test.
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?
A hemolytic allergic reaction caused by an antigen reaction Explanation: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnoea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhoea, abdominal cramps and, possibly, shock.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? You Selected: Wear disposable gloves and protective clothing.
A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.
A 5-year-old client has just received stem cell transplantation as treatment for his leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?
Closely monitor the client for at least 3 months. Explanation: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
The client is receiving a vesicant anti neo plastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Extra vasation Explanation: The nurse needs to monitor IV administration of anti neo plastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
An 82-year-old client has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia?
Intrinsic factor
Which of the following terms refers to a form of white blood cell involved in immune response?
Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis?
Risk for infection related to inadequate defenses Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.
A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately You Selected: Stops the chemotherapeutic infusion
The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.
An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an): You Selected: Platelet count of 60,000/mm3.
Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3.
The physician is attending to a 72-year-old patient with a malignant brain tumor. The physician recommends immediate radiation therapy. Which of the following is a reason for the physician's recommendation?
To prevent the formation of new cancer cells Explanation: Radiation therapy helps in preventing cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used for analyzing the lymph nodes or for destroying the surrounding tissues around the tumor.
Question 2 See full question The nurse evaluates teaching as effective when a female client states that she will Use sunscreen when outdoors.
Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.
Which of the following would be consistent with a benign neoplasm?
Usually progressive and slow Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to
Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.
A client being treated for iron deficiency anemia with ferrous sulfate (Ferasol) continues to be anemic despite treatment. The nurse should assess the client for use of which medication?
Aluminum hydroxide (Maalox) Explanation: The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption.
What are considered carcinogens?
Dietary substances Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered Explanation: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?
Avoiding using soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.
Which of the following is a symptom of Cooley's anemia?
Bronzing of the skin Explanation: Patients with Cooley's anemia exhibit symptoms of severe anemia and a bronzing of the skin, which is caused by hemolysis of erythrocytes. Dyspnea, stomatitis (inflammation of the mouth), and glossitis (inflammation of the tongue) are symptoms of pernicious anemia.
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?
Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.
The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? You Selected: Malignant tumor
Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.
Which of the following is a growth-based classification of tumors?
You Selected: Malignant Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias. Tumors classified on the basis of growth are described as benign or malignant.
A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? (Select all that apply.)
Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in African American men remain substantially higher than those among Caucasian men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, you find evidence of petechiae and ecchymoses. You note that the spleen appears enlarged. What would you suspect is wrong with this client?
Aplastic anemia Explanation: Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.
A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following:
Asks the client to open his mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin (Mycostatin) Explanation: The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.
The drug interleukin-2 is an example of which type of biologic response modifier?
Cytokine Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? You Selected: Stage 3 pressure ulcer on the left heel
Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.
Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?
Lamb and peaches Explanation: Iron-rich foods include lamb and peaches.
Jeremiah, a 10-year-old boy with hemophilia, is a patient on the pediatric unit where you practice nursing. Jeremiah was admitted to your floor via the ED after sustaining an injury while playing outdoors with friends. Initially, he presented with severe bleeding but has since stabilized. Which of the following interventions will the nurse include in her care plan for Jeremiah? Select all that apply.
Support painful joints on pillows. Encourage client to use a soft toothbrush and rinse the mouth with warm water between and after meals. Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Interventions are implemented to reduce pain and discomfort and to prevent further bleeding episodes. NSAIDs and aspirin are eliminated because these drugs can increase bleeding tendencies. The nurse takes the temperature over the temporal artery or tympanically to avoid oral or rectal injuries and checks the urine and stools for signs of bleeding.
The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome?
The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.
A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through:
inhalation of aerosols. Explanation: Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won't absorb chemicals through an intact gown, protective gloves, or goggles.
A serum sodium level lower than 110 mEq/L is associated with
seizure. Explanation: Serum sodium levels lower than 110 mEq/L is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium levels lower than 120 mEq/L.
A serum sodium level lower than 110 mEq/L is associated with
seizure. Explanation: Serum sodium levels lower than 110 mEq/L is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium levels lower than 120 mEq/L.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is which of the following? You Selected: No evidence of primary tumor
Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
The most common cause of iron deficiency anemia in men and postmenopausal women is
The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease or GI tumors. Menorrhagia is the most common cause in premenopausal women. Iron malabsorption is another cause, which is seen in patients with celiac disease. Patients with chronic alcoholism often have chronic blood loss from the GI tract.
The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the:
father is HbA and the mother is HbS. Explanation: If the father has normal hemoglobin (HbA) and the mother has sickle cell anemia (HbS), the couple has a 0% chance of having a child with sickle cell anemia. If both parents have sickle cell anemia, the couple has a 100% chance of having a child with sickle cell anemia. If the father has sickle cell anemia and the mother has sickle cell trait (HbAS), the couple has a 50% chance of having a child with sickle cell anemia. If both parents have sickle cell trait, the couple has a 25% chance of having a child with sickle cell anemia.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA). Such damage results from multiple factors. Which of the following is a carcinogen?
Dietary substances Environmental factors Viruses Chemical agents Defective genes Medically prescribed interventions Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
You Selected: Control The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.
Which of the following classes of antineoplastic agents is cell cycle-specific?
Antimetabolites (5-FU) Explanation: Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics are cell cycle-nonspecific. Alkylating agents are cell-cycle nonspecific. Nitrosoureas are cell cycle-nonspecific.
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse
Checks the clients's BUN and creatinine Explanation: Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.
A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply.
Family members should stand about 6 feet from the patient. Visitors may stay for 30 minutes or less. Lead aprons should be worn to buffer the exposure.
A 15-year-old client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding?
Fresh frozen plasma Explanation: Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid (Amicar) that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hespan, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about?
Inhaled nitric oxide is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
It lowers serum and uric acid levels. Explanation: Adequate hydration, diuresis, alkalinization of the acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity.
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 (Protonix) for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. The nurse does the following interventions: (Select all that apply.) Correct response: 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.
Which of the following is accurate regarding the use of corticosteroids for immune hemolytic anemia? Select all that apply.
They decrease the macrophages ability to clear the antibody-coated RBCs. If the hemoglobin returns to normal, the corticosteroid dose can be lowered. Explanation: The treatment consists of high doses of corticosteroids until hemolysis decreases. Corticosteroids decrease the macrophage's ability to clear the antibody-coated RBCs. If the hemoglobin level returns to normal, usually after several weeks, the corticosteroid dose can be lowered or, in some cases tapered and discontinued.
A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment?
For cancer of the bladder Explanation: Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
It lowers serum and uric acid levels. Explanation: Adequate hydration, diuresis, alkalinization of the acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity.
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?
Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?
Shorten the period of neutropenia Explanation: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.
Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)? You Selected: Syndrome of inappropriate antidiuretic hormone release (SIADH)
SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding. Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?
Provide time for the patient to discuss her concerns. Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery (Chart 15-4). The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.
Carcinogens are factors related to the formation of various malignancies. Which of the listed factors has the greatest impact on the development of all cancers?
Chemical agents Explanation: Chemical agents in the environment are believed to account for 75% of all cancers. Environmental factors include prolonged exposures to sunlight, radiation, and pollutants. Although such factors have been linked to cancer, they are not considered its leading cause. Viruses and bacteria are implicated in many cancers. However, they do not have the greatest impact on the development of all cancers. It is known that genes play a major role in cancer prevention or development. Defective genes are responsible for diverse cancers. However, they do not have the greatest impact on the development of all cancers.
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?
Dilute the liquid preparation with another liquid such as juice and drink with a straw. Explanation: Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.
A nurse practitioner suspects that a patient may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis?
Laboratory values consistent with a diagnosis of aplastic anemia would be a hemoglobin less than 9 g/dL, significant neutropenia and thrombocytopenia, and a reduced erythrocyte count.
Parents arrive to the clinic with their 5-year-old child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?
"The child must inherit two defective genes, one from each parent." Explanation: Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.
Which type of surgery is utilized in an attempt to relieve complications of cancer?
You Selected: Palliative Explanation: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing non-vital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?
You Selected: Adjuvant therapy is likely. T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?
Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below:
Explanation: The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls below 10,000/?l. Although platelet counts of 20,000/?l and 75,000/?l are below normal and increase the client's risk for bleeding, they don't increase the risk as much as a platelet count below 10,000/?l. A platelet count of 135,000/?l is normal and wouldn't occur in a client with ITP.
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:
A-positive blood to an A-negative client. Explanation: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.
A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client? You Selected: Wear personal protective equipment when handling blood, body fluids, and feces.
Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?
Correct response: Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? You Selected: "I'll play card games with my friends."
During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?
Explain to the patient that she will continue to emit radiation while the implant is in place. Explanation: When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean? You Selected: Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Explanation: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.
Chemotherapeutic agents have which effect associated with the renal system?
Increased uric acid excretion Explanation: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. There is increased urinary excretion of uric acid from chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
An 82-year-old client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?
Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease. Therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage.
Which of the following is considered an antidote to heparin?
Protamine sulphate Explanation: Protamine sulphate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin).
