MCA II Exam 3 - Hematologic Disorders, HIV, Cancer Questions

The nurse who is about to give a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which of the following items is important to check regarding the age of blood cells before the transfusion is begun? A. Expiration date B. Presence of clots C. Blood group and type D. Blood identification number

expiration date (Clue: "age of blood")

The client with O+ blood is in need of an emergency transfusion but the lab does not have any O+ blood available. Which potential unit of blood could be given to the client? 1. 0- unit 2. A+ unit 3. B+ unit 4. Any Rh+ unit

"Correct answer: Answer 1. 1. O- negative blood is considered the universal donor because it does not contain the antigens A, B, or Rh. (AB+ is considered the universal recipient because a person with this blood type has all the anti-gens on the blood). 2.A+ blood contains the antigen A that the client will react to, causing the development of antibodies. The unit being Rh+ is compatible with the client. 3.B+ blood contains the antigen B that the client will react to, causing the development of anti-bodies. The unit being Rh+ is compatible with the client. 4.This client does not have antigens A or B on the blood. Administration of these types would cause an antigen/antibody reaction within the client's body, resulting in a massive hemolysis of the client's blood and death.

"The client is admitted to the ED after a MVA. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? 1.) Type and crossmatch for RBCs immediately (STAT). 2.) Initiate an IV with an 18-gauge needle and hang normal saline. 3.) Have the client sign a consent for an exploratory laparotomy. 4.) Notify the significant other of the client's admission.

*2.) The first action in a situation in which the nurse suspects the client has a fluid volume loss is to replace the volume as quickly as possible (CORRECT). 1.) This should be done, but the client requires the IV fluids first because they are at risk for shock (omit #1). 3.)The client will probably need to have surgery to correct the source of the bleeding, but stabilizing the client with fluid resuscitation is first priority (omit #3). 4.) This is the last thing on this list in order of priority (omit #4).

A patient with lung cancer is receiving morphine for severe pain. During a follow-up visit, the nurse finds that the patient has developed resistance to opioids and persistent pain. Which adjuvant medication would be beneficial to prescribe? 1 Antiseizure drug 2 Corticosteroid drug 3 Bisphosphonate drug 4 Nonsteroidal antiinflammatory drug

1 A patient who is no longer responding to opioids such as morphine has developed resistance. If the patient still experiences pain, this pain will be neuropathic. Thus, adjuvant medications such as antiseizure drugs will help the patient. Corticosteroid and bisphosphonate drugs will not treat neuropathic pain. Nonsteroidal antiinflammatory drugs are used as adjunct for pain relief along with opioids; these drugs will not treat neuropathic pain. Text Reference - p. 279

The patient has a rupture of the carotid artery. Which cancer does the nurse suspect? 1 Head 2 Kidneys 3 Pancreas 4 Spinal column

1 A patient with a tumor in the head or neck is at risk of a carotid artery rupture due to the close proximity of tumor to the carotid arteries. The kidneys, pancreas and spinal column are not close to the carotid artery. Text Reference - p. 278

While caring for a patient with cancer, the primary health care provider instructs the nurse to monitor albumin and prealbumin levels frequently. Which condition would the nurse suspect that the patient has? 1 Malnutrition 2 Cardiac tamponade 3 Tumor lysis syndrome 4 Third space syndrome

1 Altered albumin and prealbumin levels are indicators of malnutrition. Cardiac tamponade, tumor lysis syndrome, and third space syndrome are not associated with altered albumin and prealbumin levels. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 276

A nurse is collecting health history information from a patient who states, "I had cancer in the cartilage of my leg." The nurse recalls that this type of malignancy found in connective tissue is known as: 1 Sarcoma 2 Osteoma 3 Adenoma 4 Myeloma

1 Cancer of the connective tissue is known as a sarcoma. Osteoma refers to cancer originating in bone. Adenoma refers to cancer originating in glandular tissue. Myeloma refers to cancer originating in blood-forming tissues such as bone marrow. Text Reference - p. 254

What should the experienced registered nurse tell the novice nurse is the reason behind the detection of elevated serum alpha-fetoprotein level in a cancer patient? 1 "The protein may be newly formed due to altered expression of protooncogenes." 2 "This protein may normally get elevated and should not be associated with cancer." 3 "The protein may be newly formed due to altered expression of a tumor-inducing gene." 4 "The protein may be newly formed due to altered expression of a tumor-inhibiting gene."

1 Carcinogens may induce the unlocking of protooncogenes and cause genetic alterations and mutations. The new proteins, such as alpha-fetoprotein, can be produced by the cancerous cells, and can be detected in human blood. Therefore, this elevated level may be associated with an altered expression of protooncogenes, because they are associated with cancer and their elevated level should not be considered normal. The alteration of tumor-inducing genes and tumor-inhibiting genes may not be associated with high levels of alpha-fetoprotein. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 250

Which condition is associated with grade IV histologic classification of tumors? 1 Anaplasia 2 Mild dysplasia 3 Severe dysplasia 4 Moderate dysplasia

1 Grade IV of histologic classification of tumors is associated with anaplasia. The grade I histologic classification is associated mild dysplasia. The grade III histologic classification of tumors indicates severe dysplasia. The grade II histologic classification of tumors is associated with moderate dysplasia. Text Reference - p. 254

A nurse is caring for an older adult patient with multiple myeloma. This patient has developed hypercalcemia. The primary health care provider advises hydration therapy for the patient and also prescribes diuretics. What is the reason for prescribing diuretics to the patient? 1 To prevent heart failure or edema 2 To inhibit the action of osteoclasts 3 To reduce serum calcium levels 4 To prevent bone complications

1 Hypercalcemia, or high calcium levels, is a metabolic emergency in patients with advanced cancers. Hydration therapy is the choice of treatment to prevent irreversible kidney failure. However, elderly patients may develop heart failure or edema if infused with 3 L of fluids per day. Therefore, diuretics may need to be added with hydration therapy to prevent heart failure or edema as a result of fluid overload. Bisphosphonates are used to inhibit the action of osteoclasts, reduce serum calcium levels, and prevent bone complications. Text Reference - p. 278

The registered nurse is reviewing the histology report of a patient and finds that the patient has grade IV tumors. Which characteristic feature of tumors would be applicable to this patient with grade IV tumors? 1 Undifferentiated 2 Well differentiated 3 Poorly differentiated 4 Moderately differentiated

1 In histologic grading of tumors, both the appearance of cells and the degree of differentiation are evaluated pathologically. The cells in grade IV tumors are immature, primitive, and undifferentiated and the cell of origin is difficult to determine (high grade). The cells in grade I tumors differ slightly from normal cells and are well differentiated. Cells in grade III tumors are very abnormal and are poorly differentiated. Grade II tumor cells are more abnormal and are moderately differentiated. Text Reference - p. 254

Which type of oncofetal antigen is found in ovarian cancer? 1 CA-125 2 CA-15-3 3 CA-19-9 4 CA-27-29

1 Oncofetal antigens are a type of tumor antigens. They are found on both the surfaces and the inside of cancer cells and fetal cells. These antigens are an expression of the shift of cancerous cells to a more immature pathway, which is associated with fetal periods of life. CA-125 is the oncofetal antigen found in ovarian carcinoma. CA-15-3 is the oncofetal antigen found in breast cancer. CA-19-9 is the oncofetal antigen found in pancreatic and gall bladder cancers. CA-27-29 is found in breast cancer. Text Reference - p. 253

After reviewing the prescription order of a patient, the nurse tells the patient, "You will need to increase your intake of fiber and fluids because you are at a risk for constipation. " Which medication does the nurse find in the patient's prescription? 1 Fentanyl 2 Vincristine 3 Furosemide 4 Demeclocycline

1 Opioid analgesics such as fentanyl can cause constipation as a side effect. If a patient is prescribed fentanyl, the nurse should advise the patient to eat a high-fiber diet to reduce the risk of constipation. Vincristine is used to treat cancer; it increases antidiuretic hormone production. Furosemide is a diuretic that treats the syndrome of inappropriate antidiuretic hormone. Demeclocycline is a tetracycline drug that treats the syndrome of inappropriate antidiuretic hormone. These drugs do not cause constipation. Text Reference - p. 279

The nurse is interacting with the caregivers of different patients who are diagnosed with cancer. Which patient does the nurse expect to take less time to cope with cancer? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

1 Patient A's statement about losing a job a few months ago but still trying to strive hard at the next job indicates that he or she has a positive attitude and may take less time to cope with the situation. Patient B had a negative experience with cancer; this patient may take a lot of time to cope with cancer. Patient C is worried about the disruption of body image with treatment; he or she may take excessive time to cope with the condition. Patient D is disturbed due to continuous nausea and diarrhea; he or she may take a lot of time to cope with cancer. Text Reference - p. 279

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? 1 A bland, low-fiber diet 2 A high-protein, high-calorie diet 3 A diet high in fresh fruits and vegetables 4 A diet emphasizing whole and organic foods

1 Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea. Text Reference - p. 266

Which treatment strategy is most effective for treating bone pain? 1 Samarium-153 2 Antiseizure drugs 3 Acetaminophen 4 Antidepressant drugs

1 Samarium-153 is a radiopharmaceutical that diffuses bone pain effectively. Antiseizure medications are used to treat neuropathic pain. Acetaminophen is a nonsteroidal antiinflammatory drug that reduces visceral pain. Antidepressant drugs are used in adjuvant therapy and are effective for neuropathic pain. Text Reference - p. 279

The registered nurse is explaining to a student nurse about the risk of different types of cancer associated with the alteration of specific tumor suppressor genes. Which statement made by the student nurse needs correction? 1 APC tumor suppressor gene alteration increases the risk for lung cancer." 2 p53 tumor suppressor gene alteration increases the risk for liver cancer ." 3 BRCA1 tumor suppressor gene alteration increases the risk for breast cancer." 4 BRCA2 tumor suppressor gene alteration increases the risk for ovarian cancer."

1 The alterations in the APC gene may increase the risk of familial adenomatous polyposis, not lung cancer. The p53 tumor suppressor gene alteration increases the risk of liver cancer. The BRCA1 tumor suppressor gene alteration is associated with an increased risk of breast cancer. The BRCA2 tumor suppressor gene alteration is associated with an increased risk of ovarian cancer. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 250

A patient who is undergoing a course of outpatient chemotherapy reports feeling lonely and isolated and expresses the desire to resume normal activities, such as socialization with friends. Which precaution should the nurse recommend when allowing the patient to resume these activities? 1 Avoiding crowds 2 Drinking only bottled water 3 Refraining from eating outside the home 4 Using the bathroom at home, not in public places

1 The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions. Text Reference - p. 266

The nurse is caring for a cancer patient and finds that the patient has tumor lysis syndrome. Which other condition should the nurse check for? 1 Renal failure 2 Cardiac arrest 3 Venous thrombosis 4 Rheumatoid arthritis

1 Tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly due to chemotherapy. This cellular destruction is characterized by a rapid development of hyperuricemia and hyperphosphatemia, and can lead to acute renal failure. Cardiac arrest and rheumatoid arthritis are not common complications with tumor lysis syndrome. Venous thrombosis would occur with a patient who has a tumor in the superior vena cava. Text Reference - p. 278

Which responses are shown by cytotoxic T cells? Select all that apply. 1 Killing tumor cells 2 Resisting tumor growth 3 Producing specific antibodies 4 Getting stimulated by γ-interferon and IL-2 5 Directly lysing tumor cells without prior sensitization

1, 2 Cytotoxic T cells play an important role in resisting tumor growth and are capable of killing tumor cells. Production of specific antibodies is the response of B cells. Natural killer cells are stimulated by the γ-interferon and IL-2, resulting in increased cytotoxic activity. Natural killer cells directly lyse tumor cells without any prior sensitization, because these cells show innate immunity. Text Reference - p. 252

A cancer patient is undergoing excisional biopsy. Which components may be examined in the patient? Select all that apply. 1 Nodule 2 Lymph node 3 Entire lesion 4 Core of tissue 5 Cells from mass

1, 2, 3 Excisional biopsy involves the surgical removal of nodule, lymph node, or the entire lesion. Large-core biopsy uses the core of the tissue to diagnose cancer. Fine needle aspiration aspirates cells from the mass for cytologic examination. Text Reference - p. 256

A patient recently has been diagnosed with early stages of cervical cancer. On which of these interventions is most appropriate for the nurse to focus at this time? Select all that apply. 1 Maintain the patient's hope. 2 Listen actively to the patient's fears and concerns. 3 Assist the patient in maintaining usual lifestyle patterns. 4 Discuss replacement child care for the patient's children. 5 Explain in detail the aspects of the upcoming radiation therapy.

1, 2, 3 Provide essential information (not extreme details) regarding cancer and cancer care that is accurate and establishes realistic expectations about what the patient will experience. Maintaining hope is the key to effective cancer care. Hope varies, depending on the patient's status: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, hope to achieve meaningful goals, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care. It is also important to assist the patient in maintaining usual lifestyle patterns as much as possible. Discussing replacement child care is not appropriate at this time. Text Reference - p. 279

The laboratory reports of a patient with stomach cancer indicate that the patient has excess production of ectopic hormones from the tumor. Which would be the most prevalent complications in the patient? Select all that apply. 1 Septic shock 2 Hypercalcemia 3 Tumor lysis syndrome 4 Third space syndrome 5 Superior vena cava syndrome 6 Disseminated intravascular coagulation

1, 2, 3, 6 A tumor may produce and release ectopic hormones resulting in metabolic disturbances, including septic shock, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation. Third space syndrome and superior vena cava syndrome are obstructive emergencies caused by the blockage of an organ or blood vessel. Text Reference - p. 277

A patient with breast cancer experiences a 3-kilogram weight loss over the course of a week. The nurse is evaluating the patient after teaching necessary interventions to reduce the risk of malnutrition. Which statement made by the patient indicates effective learning? Select all that apply. 1 "I can use packages of instant breakfast." 2 "I can add cheese to sandwiches or snacks." 3 "I can take low-calorie foods throughout the day." 4 "I can supplement puddings and cereals with Ensure." 5 "I can use raw milk when preparing milkshakes and sauces."

1, 2, 4 A cancer patient who has lost 3 kilograms in a week is at a high risk of malnutrition. Instant breakfast packages can be sprinkled over puddings and sausages because they contain protein. Cheese contains protein and calories, which are essential for a patient suffering from weight loss. Ensure is a commercial nutritional supplement that provides adequate protein and fat for the patient. Low-calorie foods can further cause weight loss in the patient. Raw milk may contain bacteria, which would place the patient at a high risk of infection. Text Reference - p. 276

A patient with lung cancer has been treated with an anticancer drug that has a high propensity to cause myelosuppression. What nursing interventions would be helpful to this patient? Select all that apply. 1 Monitoring the red blood cell (RBC) count 2 Monitoring the platelet count 3 Monitoring the basophil count 4 Monitoring the neutrophil count 5 Monitoring the eosinophil count

1, 2, 4 Monitoring the RBC count helps the nurse to detect the severity of anemia and assess the need for administering RBC growth factors or an RBC transfusion. Monitoring the platelet count helps to detect the risk of bleeding in the patient and the need for using platelet growth factors or a platelet transfusion. Monitoring the neutrophil count helps to detect the risk of infection and the need for using white blood cell (WBC) growth factors and measures to prevent infection. Eosinophil and basophil counts should be assessed only in patients who have an allergic predisposition or if the drug is known to produce allergic reactions. Text Reference - p. 265

A patient with cancer develops sudden onset of chest heaviness, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds. The nurse expects that the immediate treatment plan for this patient will include what interventions? Select all that apply. 1 Administration of oxygen therapy 2 Administration of IV hydration 3 Administration of vasodilators 4 Placement of a pericardial catheter 5 Surgical establishment of a pericardial window

1, 2, 4, 5 Sudden onset of heaviness in the chest, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds are suggestive of cardiac tamponade. The nurse manages this patient by administering oxygen to promote tissue oxygenation. A pericardial catheter or surgical establishment of a pericardial window is necessary to relieve pressure from the heart. The patient should be given IV hydration for maintaining fluid balance. The patient should be administered vasopressor therapy, not vasodilators, to avoid a fall in blood pressure. Text Reference - p. 278

A patient is diagnosed with constriction of the pericardium by a tumor. Which treatment plan would be beneficial to the patient? Select all that apply. 1 Oxygen therapy 2 Vasopressor therapy 3 Corticosteroid therapy 4 Decompressive laminectomy 5 Indwelling pericardial catheter

1, 2, 5 A patient with a constriction of the pericardium by a tumor will have cardiac tamponade, which is characterized by shortness of breath, tachycardia, excess perspiration, and reduced consciousness. Oxygen therapy is used to improve oxygenation. Vasopressor therapy is used to improve cardiac output. Indwelling pericardial catheters can reduce constriction and pain caused by the tumor. Corticosteroid therapy and decompressive laminectomy will help to reduce spinal cord compression caused by a tumor but not by cardiac tamponade. Text Reference - p. 278

The registered nurse is explaining about cancer cell biology to a student nurse. Which statement should be included while teaching? Select all that apply. 1 "The cell growth occurs one on top of the other." 2 "The cell proliferation is indiscriminate and continuous." 3 "The cell proliferation is equivalent to cell degeneration." 4 "The cell proliferation is activated only when the cell degenerates." 5 "The cell proliferation rate is normal with different response to intracellular signals that maintain equilibrium."

1, 2, 5 Cancer cells lose the contact inhibition mechanism and cross cell boundaries, allowing these cells to potentially grow on top of one another. The cell proliferation in cancer is indiscriminate and occurs as a continuous process. The cells proliferate at a normal rate, but the response to intracellular signals that maintains dynamic equilibrium is different. A normal cell is characterized by the maintenance of dynamic equilibrium. It is maintained by the equivalency of cell proliferation to cell degeneration. The normal cells proliferate after the cell degenerates. Text Reference - p. 249

A nurse is caring for a patient experiencing severe side effects of chemotherapy. On examination, the nurse notices stomatitis. Which interventions should the nurse perform to relieve stomatitis? Select all that apply. 1 Apply topical anesthetics. 2 Give diuretics and laxatives regularly. 3 Encourage nutritional supplements. 4 Encourage oral application of alcohol. 5 Discourage the use of oral irritants like tobacco

1, 3, 5 Stomatitis is an inflammation of the mouth. It occurs when the epithelial cells get damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements helps to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged, because they can worsen stomatitis and increase discomfort. Text Reference - p. 266

A nurse is caring for a patient undergoing brachytherapy for prostate cancer. Which are appropriate nursing interventions to protect oneself from radiation hazards? Select all that apply. 1 Limit close proximity to the patient to only those care tasks that must be performed near the source. 2 Share the film badge with a colleague who forgot his or her own badge. 3 Organize care to limit the time spent in direct contact with the patient. 4 Wear the film badge at all places of work to indicate your nature of work. 5 Use shielding when providing any care to the patient.

1, 3, 5 When working with patients receiving radiation therapy, the nurse should exercise all precaution to prevent radiation hazards. The precautions include using as low of a dose as possible, limiting the time and distance with and around patient, and shielding oneself. The nurse should organize care to limit the time spent in direct contact with the patient. The nurse should use shielding whenever possible. A film badge indicates cumulative radiation exposure, and all the health professionals in the radiation therapy unit should wear it. The badge should not be shared and should be worn only when working in the radiation therapy unit. STUDY TIP: Try to decrease your workload and maximize your time by handling items only once. Most of us spend a lot of time picking up things we put down rather than putting them away when we have them in hand. Going straight to the closet with your coat when you come in instead of throwing it on a chair saves you the time of hanging it up later. Discarding junk mail immediately and filing the rest of your bills and mail as they come in rather than creating an ever-growing stack saves time when you need to find something quickly. Filing all items requiring further attention in some fashion helps you remember to take care of things on time rather than being so engrossed in your schoolwork that you forget about them. Many nursing students have had their power or telephone service cut off because the bill simply was forgotten or buried in a pile of old mail. Text Reference - p. 264

While assessing a patient with lung cancer, the nurse finds that the patient has severe water retention, nonexisting edema, and weight gain. Which treatment strategy would be most effective for the patient? Select all that apply. 1 Administering furosemide 2 Administering pamidronate 3 Administering oxygen therapy 4 Administering demeclocycline 5 Administering 0.9% saline solution

1, 4, 5 Weight gain without edema and severe water retention in a patient with lung cancer indicates that the patient has the syndrome of inappropriate antidiuretic hormone (SIADH). Furosemide is a loop diuretic, which helps to balance electrolytes, reduce water retention, and treat SIADH. Demeclocycline is a xanthine inhibitor, which helps to treat SIADH effectively, because it maintains sodium-water balance. A 0.9% saline solution will increase the sodium concentration, which helps to reduce water retention and combat SIADH. Pamidronate is a bisphosphonate that helps to reduce hypercalcemia by inhibiting osteoclasts; this medication is not effective in reducing water retention. Oxygen therapy will help a patient with shortness of breath; however, the patient with SIADH may or may not have shortness of breath. Test-Taking Tip: Cancer patients will have complication due to impaired metabolism, which results in impairment in functioning of hormones. Identify which hormone imbalance may results in water retention; this will help you to determine the treatment. Text Reference - p. 278

The oncology nurse finds that a person is using a sunscreen lotion with sun protection factor (SPF) 10. What is the accurate response of the nurse in this situation? 1 "You should use a sunscreen of SPF 5." 2 "You should use a sunscreen of SPF 15." 3 "You should apply this sunscreen only to your face." 4 "You should apply it at least 30 minutes before going out in the day time."

2 A sunscreen lotion of SPF 15 can help protect the skin against harmful ultraviolet radiations, which cause cancer. A sunscreen of SPF 5 may not protect the skin against harmful ultraviolet radiations. Using a sunscreen of SPF 10 only on the face does not prevent exposure of the body to ultraviolet radiations. Applying the sunscreen 30 minutes before going out does not effectively act against ultraviolet radiations, which cause cancer. Text Reference - p. 255

Which criterion of pain is of primary concern while using adjuvant therapy to reduce cancer pain? 1 Cause 2 Nature 3 Intensity 4 Location

2 Adjuvant therapy is used to reduce neuropathic pain; thus, the nature of the pain is the primary concern. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 279

A patient is about to receive an infusion of α-interferon. The nurse will premedicate the patient with which of these drugs to prevent fever and shivering during this infusion? 1 Aspirin 2 Acetaminophen 3 Morphine sulfate 4 Ondansetron

2 Common side effects of interferons include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, and nausea. Acetaminophen administered every four hours, as prescribed, often reduces the severity of the flu-like syndrome. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms. In addition, large amounts of fluids help decrease the symptoms. Aspirin would not be appropriate because of its platelet aggregation-inhibiting effect. Morphine is an opioid analgesic. Ondasetron is for prevention and treatment of nausea. Text Reference - p. 259

The nurse is explaining the stages of cancer development to a support group of cancer survivor families. Which of these is a characteristic of the promotion stage in the development of cancer? 1 Mutation of the cell's genetic structure. 2 A period of latency before clinical detection of cancer. 3 An irreversible steady growth facilitated by carcinogens. 4 Proliferation of cancer cells in spite of host control mechanism

2 During the promotion stage, a period of time known as the latent period, ranging from 1 to 40 years elapses between the initial genetic alteration and the actual clinical evidence of cancer. During the promotion stage, development of cancer is characterized by the reversible proliferation of the altered cells. The initiation stage of cancer development is characterized by mutation of the cell's genetic structure. Proliferation of cancer cells occurs during the third stage of cancer development, known as the progression stage. Text Reference - p. 251

A patient is suspected of having stage II lung cancer. Which procedure would be performed on this patient? 1 Incisional biopsy 2 Excisional biopsy 3 Large-core biopsy 4 Fine-needle aspiration

2 Excisional biopsy is a process that involves the surgical removal of an entire lesion. Incisional biopsy is performed when excisional biopsy is not feasible; it involves partial excision of a lesion. In large-core biopsy, an actual piece of tissue is obtained with cutting needles. This procedure helps to preserve the histologic architecture of the tissue specimen. In fine-needle aspiration, cells from the lesion are aspirated through a small needle gauge for cytologic examination. Text Reference - p. 256

A patient has a brain tumor. Which biopsy is used as a surgical procedure to diagnose and remove the tumor? 1 Incisional biopsy 2 Excisional biopsy 3 Endoscopic biopsy 4 Percutaneous biopsy

2 Excisional biopsy is a surgical procedure that involves the removal of the entire lesion, lymph node, nodule, or mass. This biopsy, unlike others, involves the removal of a piece of the tumor for pathologic analysis. Incisional biopsy is partial excision of the tumor, which can be performed through a scalpel or dermal punch. It is performed only if an excisional biopsy is not possible. Endoscopic biopsy is performed to remove a sample of tissue for pathologic analysis from the lungs or other intraluminal lesions (esophageal, colon, and bladder). Percutaneous biopsy is commonly performed for tissues that can be safely reached through the skin. Text Reference - p. 256

A patient needs surgical removal of the lymph node. Which intervention would be performed on this patient? 1 Incisional biopsy 2 Excisional biopsy 3 Large-core biopsy 4 Fine needle aspiration

2 Excisional biopsy is performed for complete removal of a lesion, lymph node, nodule, or, mass. Incisional biopsy is a partial excision. Large-core biopsy is performed to remove actual pieces of tissue, so they can be investigated. Fine needle aspiration is performed to aspirate cells from the mass for cytologic examination. Text Reference - p. 256

A patient with a large tumor in the chest is undergoing aggressive chemotherapy and is at risk of renal failure. The primary health care provider has prescribed allopurinol for the patient. Which change would the nurse expect in the patient after treatment? 1 Increase in urine output 2 Decrease in uric acid levels 3 Increase in serum sodium levels 4 Decrease in serum calcium levels

2 If a cancer patient is undergoing aggressive chemotherapy and is at risk of renal failure, he or she may have tumor lysis syndrome, which manifests as an increase in uric acid levels. Allopurinol is a xanthine oxide inhibitor that can reduce uric acid levels. Hydration therapy would increase a patient's urine output. Bisphosphonates are used to decrease serum calcium levels. Furosemide reduces syndrome of inappropriate antidiuretic hormone (SIADH) by increasing sodium levels. Text Reference - p. 278

The nurse is administering a vesicant chemotherapy agent to a patient who has colon cancer. During rounds, the nurse notes that the intravenous site is reddened and swollen, and the patient complains that it is painful. What is the first action the nurse will take? 1 Slow the infusion rate. 2 Turn off the infusion. 3 Check the patient's vital signs. 4 Notify the primary health care provider.

2 It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. Immediately turn off the infusion and follow protocols for drug-specific extravasation procedures to minimize further tissue damage. It is not appropriate to slow the infusion rate. The health care provider should be notified, and vital signs checked, but they are not the first action that should be taken. Text Reference - p. 259

Which tumor suppressor gene mutation can lead to increased risk for liver cancer? 1 APC gene 2 p53 gene 3 BRCA1 and BRCA2 4 Carcinoembryonic antigen (CEA)

2 Mutations in the p53 tumor suppressor genes increase a person's risk for liver cancer. Mutations in the APC gene can result in an increased risk for familial adenomatous polyposis, which is a precursor for colorectal cancer. Mutations in BRCA1 and BRCA2 can increase the risk for breast cancer. Carcinoembryonic antigens (CEA) are the oncofetal antigens present on the surface and inside the cancer cells. Elevated levels of CEA are found in nonmalignant conditions. Text Reference - p. 250

The nurse is reviewing the laboratory reports of a patient with cancer and anticipates that the patient is at an increased risk for infection. Which finding supports this conclusion? 1 Anemia 2 Neutropenia 3 Hyperkalemia 4 Hyponatremia

2 Neutropenia, or a decreased white blood cell count, indicates that the patient at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has infection. Hyperkalemia and hyponatremia also do not indicate infection. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 277

The nurse providing care for a patient with suspected cancer recalls that the only diagnostic procedure that is definitive for a diagnosis of cancer is: 1 MRI 2 Biopsy 3 CT scan 4 Tumor marker

2 Only a biopsy is a definitive means of diagnosing cancer, because it actually identifies the pathologic cells. Many tests, such as MRI, CT scan, and tumor markers, are indicative of cancer, but they do not confirm the presence of cancer cells like an examination of a specimen obtained by biopsy does. Text Reference - p. 256

Which term is used when cancer cells produce more than two cells at the time of mitosis? 1 Doubling time 2 Pyramid effect 3 Generation time 4 Contact inhibition

2 Proliferation of cancer cells is indiscriminate and continuous. Sometimes, they produce more than two cells at the time of mitosis which means, there is a continuous growth of the tumor mass. This is termed the pyramid effect. Doubling time is the time required for the tumor mass to double its size. The time from when the cell enters the cell cycle till when the cell divides into two identical cells is called the generation time. Contact inhibition is the mechanism that controls proliferation in the normal cells. Text Reference - p. 249

A patient on chemotherapy for eight weeks started at a weight of 130 lb. The patient now weighs 125 lb and complains that he or she cannot taste food anymore. Which nursing interventions would be a priority? 1 Advise the patient to try foods that are fatty, fried, or high in calories. 2 Suggest that the patient try foods with various spices and seasonings that are not spicy. 3 Advise the patient to drink a nutritional supplement beverage at least five times a day. 4 Confer with the primary health care provider about the need for parenteral or enteral feedings.

2 Tell the patient to experiment with spices and other seasoning agents in an attempt to mask the taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and ham may enhance the taste of vegetables. It is not recommended for a patient to eat foods high in fat and fried. It is not necessary for the patient to drink nutritional supplements five times daily. The patient does not need parenteral or enteral feedings at this point. Text Reference - p. 277

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? 1 Teach the patient to exercise daily 2 Teach the patient promoting factors to avoid 3 Tell the patient to have the cancer surgically removed now 4 Teach the patient which vitamins will improve the immune system

2 The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role. Text Reference - p. 251

The laboratory reports of a patient who is undergoing aggressive chemotherapy for cancer show increased DNA and RNA components in the blood. What does the nurse interpret from this finding? 1 The patient has cardiac tamponade. 2 The patient has tumor lysis syndrome. 3 The patient has carotid artery rupture. 4 The patient has superior vena cava syndrome.

2 Tumor lysis syndrome is caused by the destruction of cells due to chemotherapy. As cells are destroyed, DNA, RNA, and intracellular components are released into the bloodstream. Cardiac tamponade is a complication associated with an increase of fluid in the pericardial space. Carotid artery rupture is an infiltrative emergency, which results in the blowout of blood from the ruptured artery. Superior vena cava syndrome involves an obstruction of the superior vena cava due to thrombosis. Text Reference - p. 278

A patient who has undergone a modified radical mastectomy sees the surgical site for the first time. The patient appears shocked and exclaims, "I look horrible! Will it ever look better?" Which response by the nurse is most appropriate? 1 "Would you like to meet another patient who's had a mastectomy?" 2 "You're shocked by the change in your appearance from the surgery?" 3 "After it heals and you're dressed, you won't even know you've had surgery." 4 "Don't worry. You know that the tumor is gone, and the area will heal very soon."

2 When a patient appears shocked by her appearance after a mastectomy, the nurse should help her express her feelings and offer supportive care. Reflecting the patient's statement will allow her to expand and discuss her feelings. "After it heals" and "Don't worry" diminish the patient's distress regarding having undergone a modified radical mastectomy. "Would you like me to?" is an appropriate statement but does not allow the patient to verbalize her fears and concerns. Text Reference - p. 280

When administering IV chemotherapy, for which acute toxicity symptoms should the nurse be observant? Select all that apply. 1 Alopecia 2 Extravasation 3 Flare reaction 4 Cardiac dysrhythmias 5 Bone marrow suppression

2, 3, 4 The nurse should be observant for symptoms like extravasation, flare reaction, and cardiac dysrhythmias, which may indicate acute toxicities of chemotherapy. Acute toxicity occurs during and immediately after drug administration. Other symptoms may include anaphylactic and hypersensitivity reactions, and anticipatory nausea and vomiting. Alopecia and bone marrow suppression are delayed toxicities and include delayed nausea and vomiting, mucositis, skin rashes, and altered bowel function. Text Reference - p. 262

A patient is treated with radiation therapy for lung cancer. The nurse finds that the patient has dry desquamation of the skin due to the radiation therapy. How should the nurse prevent infection and facilitate healing of the skin? Select all that apply. 1 Apply ice packs. 2 Avoid the use of heating pads. 3 Avoid constricting garments. 4 Suggest the use of deodorants. 5 Avoid rubbing the affected area.

2, 3, 5 Radiation therapy may cause skin changes due to desquamation, and the skin is prone to infection. The nurse should avoid extreme temperatures on the affected area. Heating pads may cause burns and should be avoided. Constricting garments may traumatize the skin and should be avoided. Rubbing the affected area may also traumatize the skin and should be avoided. Ice packs may cause damage to the affected skin. Deodorants are chemicals and may irritate and traumatize the affected area, and should be avoided. Text Reference - p. 269

A patient with lung cancer presents with intense, localized, and persistent back pain. The patient also has motor and sensory disturbances. What nursing interventions would be helpful to this patient? Select all that apply. 1 Withhold narcotics. 2 Administer corticosteroids. 3 Encourage a graded increase in patient activity. 4 Prepare the patient for a laminectomy. 5 Prepare the patient for radiation therapy

2, 4, 5 A lung cancer patient with symptoms of intense, persistent, and localized back pain associated with motor and sensory disturbances is suggestive of spinal cord compression. Therefore, this patient would require administration of corticosteroids, radiation therapy, and surgical decompression (laminectomy). Corticosteroids help to prevent inflammation related to the spinal cord compression. Radiation therapy helps to control metastasis. Surgical decompression helps to relieve the pressure from the nerves and provide relief from symptoms. To provide symptomatic relief, the patient needs to be immobilized and administered pain killers. Text Reference - p. 277

A nurse is teaching a group of patients who are at high risk of developing cancer due to family history. Which agents should the nurse discuss as being known to be cancer-promoting, not cancer-initiating? Select all that apply. 1 Radiation 2 Dietary fats 3 Chemical agents 4 Cigarette smoking 5 Alcohol consumption

2, 4, 5 Dietary fats, cigarette smoking, and alcohol consumption are cancer-promoting agents and need to be excluded from the patient's lifestyle. Promotion is the second stage of cancer development in which the altered cells undergo reversible proliferation. This proliferation is promoted by promoting agents, such as single alteration of the genetic structure of the dietary fat, obesity, cigarette smoking, and alcohol consumption. Changing a person's lifestyle to modify these risk factors can reduce the chance of cancer development. Radiation and chemical agents are cancer-initiating agents rather than promoting agents. Text Reference - p. 251

A patient with a renal tumor has spinal cord compression. Which symptom does the nurse associate with the patient's condition? 1 Nocturia 2 Periorbital edema 3 Sensory paresthesia 4 Jugular vein distension

3 A patient with a spinal cord compression will have intense back pain and sensory paresthesia. A patient who has hypercalcemia associated with multiple myeloma will have nocturia. Periorbital edema and jugular vein distension are complications associated with superior vena cava syndrome. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 277

While assessing a patient with breast cancer, the nurse finds that the patient has tender vertebrae and intense back pain, which gets worse when the Valsalva maneuver is applied. Which complication does the nurse expect in the patient? 1 Third space syndrome 2 Tumor lysis syndrome 3 Spinal cord compression 4 Superior vena cava syndrome

3 A patient with breast cancer who has tender vertebrae and intense back pain that gets worse when the Valsalva maneuver is applied probably has spinal cord compression. Third space syndrome is an obstructive emergency that manifests as low central venous pressure, hypovolemia and tachycardia. Tumor lysis syndrome is a metabolic complication associated with cell destruction after chemotherapy, resulting in hyperuricemia. Superior vena cava syndrome is an obstructive complication associated with thrombosis that manifests with facial and periorbital edema. Text Reference - p. 277

A patient with cancer has third spacing and is on plasma protein replacement therapy. During the treatment, the nurse observes increased central venous pressure and shortness of breath. Which intervention would provide effective treatment? 1 Administering corticosteroids 2 Administering cyclophosphamide 3 Reducing rate of fluid administration 4 Administering potassium sparing diuretic

3 Although plasma protein replacement therapy will help to treat third spacing effectively, the patient may have hypervolemia, which leads to an increase in central venous pressure and shortness of breath. An effective treatment is to reduce fluid administration. Corticosteroids will help to reduce surgical spinal compression. Cyclophosphamide is an alkylating agent that increases antidiuretic hormone levels; the patient will have complications if this drug is administered. Potassium-sparing diuretics do not reduce the side effects of plasma protein replacement. Text Reference - p. 277

A nurse is learning about the different types of cancers. Which cancer has the highest incidence among men? 1 Lung cancer 2 Colon cancer 3 Prostate cancer 4 Thyroid cancer

3 Among all the cancers in men, prostate cancer has the highest incidence (29%). Lung cancer has the highest death rate among men (29%). The incidence of colon cancer in males is 9%. Thyroid cancer is more common in women than men. Text Reference - p. 248

The patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about the care of the skin? 1 Use Dial soap to feel clean and fresh 2 Scented lotion can be used on the area 3 Avoid heat and cold to the treatment area 4 Wear the new bra to comfort and support the area

3 Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing, such as a bra, over the treatment field and will want to expose the area to air as often as possible. Text Reference - p. 269

The patient is told that the adenoma tumor is not encapsulated, but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? 1 It will recur. 2 It has metastasized. 3 It is probably benign. 4 It is probably malignant.

3 Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do. Surgery is necessary because the tumor may become malignant and has the potential to cause health complications over time. Text Reference - p. 258

The patient was told that he or she would have intraperitoneal chemotherapy. The patient asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? 1 It is delivered via an Ommaya reservoir and extension catheter. 2 It is instilled in the bladder via a urinary catheter and retained for one to three hours. 3 A Silastic catheter will be placed percutaneously into the peritoneal cavity for chemotherapy administration. 4 The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

3 Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter, and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump. Text Reference - p. 261

The nurse is performing an assessment on a patient who has been receiving chemotherapy and radiation for breast cancer. The patient's most recent complete blood count (CBC) results are shown in the chart. Considering the patient's CBC results, which of these additional assessment findings is of most concern? Refer to the chart. 1 Nausea 2 Fatigue 3 Temperature of 101.8° F 4 Skin redness at site of radiation

3 Neutropenia is most common in patients receiving chemotherapy and can place them at serious risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly, because fever in the setting of neutropenia is a medical emergency. Nausea, fatigue, and skin redness at the site of radiation are expected effects of chemotherapy and radiation therapy. Text Reference - p. 33

A 33-year-old patient recently has been diagnosed with stage II cervical cancer. The nurse should understand what about the patient's cancer? 1 It is in situ 2 It has metastasized 3 It has spread locally 4 It has spread extensively

3 Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ. Stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread and stage IV denotes metastasis. Text Reference - p. 254

A nurse is caring for a patient with metastatic breast cancer. The nurse finds that the patient has developed facial and periorbital edema, and has distention of veins of the face, neck, and chest. What condition do these findings indicate to the nurse? 1 Spinal cord compression 2 Third space syndrome 3 Superior vena cava syndrome 4 Tumor lysis syndrome

3 Superior vena cava syndrome (SVCS) is an obstructive emergency. There can be many causes, including lung cancer, metastatic breast cancer, and non-Hodgkin's lymphoma. In these instances, SVCS results due to the obstruction of the superior vena cava by a tumor or thrombosis. Spinal cord compression is also an obstructive emergency caused by a malignant tumor in the epidural space of the spinal cord. It can be caused by breast, lung, prostate, GI, and renal tumors and melanomas. Third space syndrome is an obstructive emergency caused by the shifting of fluid from the vascular space to the interstitial space. It may occur due to extensive surgical procedures, biologic therapy, or septic shock. Tumor lysis syndrome is a metabolic emergency caused by rapid release of intracellular components in response to chemotherapy. Text Reference - p. 277

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says there is still pain in the leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? 1 "Where is the pain?" 2 "Is the pain getting worse?" 3 "What does the pain feel like?" 4 "Do you use medications to relieve the pain?"

3 The UAP told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale also should be assessed. Text Reference - p. 279

The oncologist has told the patient that he or she has a benign tumor in the liver. The patient asks the nurse, "What is the main difference between benign and malignant tumors?" Which answer by the nurse is correct? 1 "Malignant tumors usually are encapsulated." 2 "Malignant tumors have a rare recurrence rate." 3 "Benign tumors do not invade and spread to other organs." 4 "Malignant tumors require less nutrients for their cells than benign tumors."

3 The ability of malignant tumor cells to invade and metastasize is the major difference between benign and malignant neoplasms. Benign tumors usually are encapsulated; metastasis is absent, and recurrence is rare. Malignant tumors rarely are encapsulated, are capable of metastasis, and are capable of recurring. Text Reference - p. 253

The nurse is discussing the effects of chemotherapy with a patient who has a new diagnosis of cancer. Which statement by the patient reflects an adequate understanding of the teaching? 1 "I will need to use effective birth control methods for the rest of my life." 2 "My doctor will stop the chemotherapy if nausea and vomiting occur during treatment." 3 "I will join a support group after my therapy is finished to help me get back on my feet." 4 "I probably won't be able to do anything I used to do anymore now that I have cancer."

3 The impact of a cancer diagnosis can affect many aspects of a patient's life, with cancer survivors commonly reporting financial, vocational, marital, and emotional concerns even long after treatment is over. These psychosocial effects can play a profound role in a patient's life after cancer, with issues related to living in uncertainty being encountered frequently. Participation in appropriate supportive care and community resources would benefit the patient in recovery or ongoing care. It will not be necessary for the patient to use birth control for the rest of the patient's life; nausea and vomiting are expected effects of chemotherapy and treatment will continue unless the vomiting becomes severe. Text Reference - p. 61

The registered nurse is teaching a student nurse about cancer cell proliferation. Which statement given by the student nurse indicates a need for further teaching? 1 "The cancer cells respond differently to the intracellular signals." 2 "The rate of proliferation of cancer cells is the same as normal cells." 3 "The rate of proliferation of cancer cells is more rapid than normal cells." 4 "There is an indiscriminate and continuous proliferation of cancer cells.

3 The rate of proliferation of cancer cells is not as rapid as that of normal cells. Cancer cells respond differently to the intracellular signals that regulate the state of equilibrium in the body. The rate of proliferation of cancer cells is the same as that of normal cells in the tissue from which they originate. The only difference between the normal cells and cancer cells is the indiscriminate and continuous proliferation of cancer cells, unlike the normal body cells. Text Reference - p. 249

What is the most common cause of superior vena cava syndrome? 1 Ovary cancer 2 Renal cancer 3 Breast cancer 4 Gastrointestinal cancer

3 The superior vena cava is close to the breast and chest cavity. Thus, superior vena cava syndrome is most common in patients with breast cancer Text Reference - p. 277

The nurse is reviewing the laboratory test results for a 67-year-old patient with cancer and diabetes mellitus. The total serum protein level is 6.4 mg/dL. The nurse interprets this finding as: 1 The total protein level is normal; however, the patient would benefit from albumin infusion 2 The protein level is reduced, which is consistent with malnutrition 3 The protein level is normal, and therefore the patient does not have malnutrition 4 The protein level is increased, which is a common finding in patients with cancer

3 Total serum protein level should be between 6.0 and 8.0 g/dL. A protein level of 6.4 is normal. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 266

A patient with breast cancer who recently had extensive surgical procedures develops hypotension, tachycardia, and decreased urinary output. Which nursing actions would be useful for management of this patient? Select all that apply. 1 Administer fibrinolytic agents. 2 Discourage fluid intake. 3 Replace fluids and electrolytes. 4 Administer plasma protein replacement. 5 Prepare the patient for radiation therapy.

3, 4 Extensive surgical procedures in a cancer patient can lead to third space syndrome which involves a shift of fluid from the vascular space to the interstitial space. Its management involves replacement of plasma proteins and fluid and electrolytes. The use of fibrinolytic agents further aggravates the patient's condition. Fluid intake should be encouraged, not discouraged. Use of radiation therapy does not prevent the shifting of fluids. Text Reference - p. 277

A nurse is caring for a patient with breast cancer who is receiving chemotherapy. The patient has developed alopecia as a result of chemotherapy and is noticeably upset about what happened. Which nursing actions are appropriate for this patient? Select all that apply. 1 Instruct the patient to use shampoo every day. 2 Instruct the patient to brush and comb hair frequently. 3 Suggest the patient use scarves and wigs. 4 Suggest the patient cut long hair before therapy. 5 Instruct the patient to avoid the use of hair dryers.

3, 4, 5 Alopecia refers to loss of hair from the head or the body and is a common side effect of cancer treatment. The patient can use scarves and wigs to improve body image. Long hair should be cut before therapy, because it needs more care and is more prone to fall out. Hair dryers should be avoided, because their use can worsen alopecia. Shampoos are chemicals that may harm the hair and should not be used daily. Brushing and combing should be done carefully and infrequently, because excessive brushing and combing can worsen alopecia. Text Reference - p. 266

Arrange the process of immunologic escape chronologically. 1. Suppressor T cells induction 2. Suppression of immune response 3. Suppression of T cell stimulating factors 4. Cancer cells escapes through immunologic surveillance 5. Blocking antibodies that binds tumor associated antigens 6. Immune system becomes tolerant to some tumor antigens

3, 5, 1, 2, 4, 6 The initial step of immunologic escape is suppressing the T cell stimulating factors to react with the cancer cells. The weak surface antigens allow cancer cells to escape through immunologic surveillance. The immune system becomes tolerant to some tumor antigens and this results in suppression of the immune response by the cancer cells. Then, the induction of suppressor T cells occurs. Finally, the antibodies that bind with tumor-associated antigens are blocked. This prevents their recognition by T cells. Text Reference - p. 253

What is the site and tumor type of rhabdomyoma? 1 Cartilage, malignant 2 Meninges, malignant 3 Fibrous tissue, benign 4 Striated muscle, benign

4 A benign tumor in the striated muscle is called a rhabdomyoma. A malignant tumor in the cartilage is called a chondrosarcoma. A malignant tumor present in the meninges is called a meningeal sarcoma. A benign tumor in the fibrous tissue is called a fibroma. Text Reference - p. 254

While providing care for a patient with head cancer, the nurse applies pressure to his or her neck with a finger. Which complication in the patient is responsible for this nursing intervention? 1 Carotid tamponade 2 Third space syndrome 3 Tumor lysis syndrome 4 Carotid artery rupture

4 A carotid artery rupture is an infiltrative emergency commonly seen in a patient with head or neck cancer. Because this ruptured artery results in a blowout, the nurse should apply firm pressure to the carotid artery to reduce the blood flow. Cardiac tamponade is a complication associated with accumulation of fluid in the pericardial space. Third space syndrome and tumor lysis syndrome are obstructive and metabolic complications that are not associated with blowout from the artery. Text Reference - p. 278

A patient with cancer has dysgeusia and tells the student nurse, "I don't want to eat. Everything tastes bitter." Which advice given by the student nurse indicates the need for further teaching? 1 "You should add onions to the vegetables." 2 "You should use mint juice while cooking fish." 3 "You should use lemon juice marinade to the meat." 4 "You should increase spices and seasoning in your food."

4 A patient with cancer may develop dysgeusia because cancer cells release substances that make the taste buds bitter. Using different spices and seasoning agents will help to enhance the taste. However, increasing spices and seasoning will not reduce dysgeusia and in fact may further increase gastric irritation in the patient. Onions help to enhance the taste of vegetables so the patient will have reduced bitterness. Mint and lemon juice helps to enhance the taste of meat and fish so the patient will have reduced dysgeusia. Text Reference - p. 277

The nurse is reviewing the laboratory reports of a patient diagnosed with cancer and finds that the patient has neutropenia. On examination, the nurse finds that the patient has a body temperature of 100.4° F (38° C). What is the priority nursing intervention in this situation? 1 Administering parenteral fluids 2 Administering aspirin to the patient 3 Administering pamidronate to the patient 4 Notifying the primary health care provider

4 A patient with cancer who has neutropenia (low white blood cell count) is vulnerable to infection. A body temperature of 100.4° F (38° C) indicates hyperthermia. The nurse should immediately notify the primary health care provider in this situation. Hydration therapy with parenteral fluids will treat hypocalcaemia, which is a complication of cancer and may cause nephrocalcinosis. Aspirin can reduce hyperthermia; however, it is not preferable for a patient with a low white blood cell count. Pamidronate is a bisphosphonate that inhibits serum calcium levels and help to treat hypercalcemia effectively. Test-Taking Tip: Neutropenia is low count of white blood cell; you need to what type complications are associated with low WBC. Text Reference - p. 277

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? 1 Firm-bristle toothbrush 2 Hydrogen peroxide rinse 3 Alcohol-based mouthwash 4 1 tsp salt in 1 L water mouth rinse

4 A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, a side effect of chemotherapy. A soft-bristle toothbrush should be used. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue. Text Reference - p. 268

Which technique does the surgeon use to improve tissue localization during biopsy? 1 Craniotomy 2 Thoracotomy 3 Sigmoidoscopy 4 Computed tomography

4 Computed tomography is a diagnostic procedure that can be performed in combination with biopsy to improve tissue localization; this technique helps to visualize the tumor. Craniotomy and thoracotomy are surgical procedures that are performed when the tumor is not easily accessible. Sigmoidoscopy is an endoscopic examination, which is useful to diagnose cancer, but it does not help in tumor localization. Text Reference - p. 256

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? 1 "It is probably nothing." 2 "Let's discuss that later." 3 "Everyone feels that way." 4 "Let's talk about your concerns.

4 During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience. Text Reference - p. 255

A patient with bronchial cancer is undergoing chemotherapy with cisplatin. After assessing the patient on a follow up visit, the primary health care provider prescribes furosemide. What electrolyte imbalance should the nurse observe in the laboratory reports of the patient? 1 Hyperkalemia 2 Hyperuricemia 3 Hypercalcemia 4 Hypotonic hyponatremia

4 Furosemide is a diuretic used to treat hypotonic hyponatremia, an electrolyte imbalance associated with syndrome of inappropriate antidiuretic hormone (SIADH). Hyperkalemia and hyperuricemia are complications associated with tumor lysis syndrome. Hypercalcemia is associated with hyperparathyroidism and would be treated with bisphosphonate instead of furosemide. Test-Taking Tip: The patient develops complications with chemotherapy and is on furosemideor diuretic therapy. Correlate these findings and recall which metabolic complication is present in the patient. Text Reference - p. 278

When caring for the patient with cancer, the nurse understands that which of the following is the response of the immune system to antigens of the malignant cells? 1 Metastasis 2 Tumor angiogenesis 3 Immunologic escape 4 Immunologic surveillance

4 Immunologic surveillance is the process in which lymphocytes check cell surface antigens, and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance, which allows the cancer cells to reproduce. Text Reference - p. 252

The medical records of a patient indicate stage IV malignant cancer. What would be the anatomic extent of the disease? 1 Cancer is in situ 2 Tumor growth is localized 3 Spread of cancer cells is limited 4 Cells have undergone metastasis

4 In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 254

The surgeon uses laparotomy while collecting a tissue sample for cytologic examination. What could be the reason behind this intervention? 1 The lesion is large. 2 The lesion is superficial. 3 The lesion is not localized. 4 The lesion is not easily accessible.

4 Laparotomy involves making a large incision in the abdominal wall, which helps provide accessibility to the inner tissues of the abdomen when the lesion is not easily reached. A large lesion is easily accessible, so laparotomy is not required. A superficial lesion is easily accessible so the patent will not require laparotomy. Computed tomography and magnetic resonance imaging help improve tissue localization. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 256

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? 1 Acute pain 2 Hypothermia 3 Powerlessness 4 Risk for infection

4 Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain also are possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount. Text Reference - p. 265

Which diagnostic test is a cytologic examination that helps to detect cancer? 1 Guaiac test 2 Sigmoidoscopy 3 Mammography 4 Papanicolaou (Pap) test

4 Papanicolaou (Pap) test is a cytologic examination that helps to detect cervical cancer. Guaiac test and sigmoidoscopy are endoscopic examinations that help detect cancer. Mammography is a radiologic examination used to detect cancer. Text Reference - p. 256

A patient is scheduled for pelvic radiation therapy. The patient asks why the instructions state to go for radiation therapy with a full bladder. What explanation should the nurse give? 1 A full bladder indicates adequate fluid intake. 2 A full bladder improves effectiveness of the treatment. 3 A full bladder prevents harmful effects of radiation therapy on the bladder. 4 A full bladder moves the bowels out of the treatment field.

4 Radiation therapy may compromise the gastrointestinal function, leading to diarrhea. The small bowel is highly sensitive to radiation therapy and may not tolerate significant doses. A full bladder helps to move the bowels out of the treatment field and minimizes the radiation effects on it. An adequate urine output indicates an adequate fluid intake. A full bladder does not improve the effectiveness of the therapy, and does not prevent harmful effects of radiation therapy on the bladder. Text Reference - p. 268

Which item would be most beneficial when providing oral care to a patient with cancer who is at risk for oral-tissue injury? 1 Hydrogen peroxide rinses 2 Use of oral swabs only 3 Alcohol-based mouthwash 4 Soft-bristled toothbrush

4 Soft-bristled toothbrushes will prevent further irritation to oral tissue that is fragile. Alcohol-based mouthwash and hydrogen peroxide may further damage fragile oral tissue. Oral swabs may be used; however, these are not as effective in cleaning the oral cavity and teeth and reducing bacteria accumulation in the mouth. Text Reference - p. 268

The registered nurse is teaching a student nurse about differences in cancer development due to gender. Which statement by the student nurse indicates the need for further teaching? 1 "Men are at a higher risk for lung cancer than women." 2 "Men are more likely to develop liver cancer than women." 3 "Esophageal cancer is more prevalent in men than in women." 4 "Women have a greater incidence of head and neck cancer than men."

4 The incidence of head and neck cancers is higher in men than in women. Men are more prone to develop liver cancer than women. Esophageal cancer incidence is more prevalent in men than in women. Women are less likely to get lung cancer than men. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 248

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? 1 Increase intake of liquids at mealtime to stimulate the appetite. 2 Serve three large meals per day plus snacks between each meal. 3 Avoid the use of liquid protein supplements to encourage eating at mealtime. 4 Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

4 The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are tolerated best. Supplements can be helpful. Text Reference - p. 276

The experienced registered nurse is teaching a new nurse about the rate of cell proliferation in the body tissues. Which statement made by the new nurse indicates a need for further teaching? 1 The rate of cell proliferation is slow in cartilage. 2 The rate of cell proliferation is rapid in hair follicles. 3 The rate of cell proliferation is rapid in bone marrow. 4 The rate of cell proliferation is slow in epithelial lining of the gastrointestinal tract.

4 The rate of cell proliferation from the time of cell birth to the time of cell death occurs at different rates within the various tissues of the body. The rate of cell proliferation is rapid in the epithelial lining of the gastrointestinal tract. Similarly, the rate of proliferation is rapid in hair follicles and bone marrow. Either the cell proliferation rate is slow or completely absent in the cartilage. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 249

What is the immediate event that occurs after the adherence of tumor cells to the vessel walls in the pathogenesis of cancer metastasis? 1 Invasion 2 Metastasis 3 Angiogenesis 4 Extravasation

4 To produce metastases, tumor cells must detach from the primary tumor and enter the circulation. They survive in the circulation, adhere to the capillary basement membrane, and gain entrance into the organ parenchyma. The cells respond to the growth factors and start proliferating which results in angiogenesis. The tumor cells finally evade host defenses. The immediate event after the adherence of tumor cells to the vessel wall would be extravasation from the host cell, which finally leads to metastasis. Invasion of the host cells occurs after angiogenesis. Metastasis would be the final stage of pathogenesis. Text Reference - p. 252

A nurse is caring for a patient with breast cancer. The primary health care provider has prescribed trastuzumab for the patient. How does this drug control cell growth in breast cancer? 1 The drug prevents the mechanisms and pathways necessary for vascularization of tumors. 2 The drug prevents blood vessel growth by binding with vascular endothelial growth factor. 3 The drug inhibits BCR-ABL tyrosine kinase that suppresses proliferation of cancer cells and promotes apoptosis. 4 The drug inhibits the abnormal growth of cells by targeting the human epidermal growth factor receptor2 (HER-2) protein.

4 Trastuzumab (Herceptin) targets the human epidermal growth factor receptor 2 (HER-2). HER-2 is overexpressed in certain cells, especially in breast cancer cells. Trastuzumab acts by binding to HER-2 receptors and inhibits the growth of cells. Angiogenesis inhibitors prevent the mechanisms and pathways necessary for vascularization of tumors. Bevacizumab prevents blood vessel growth by binding with vascular endothelial growth factor. Imatinib inhibits BCR-ABL tyrosine kinase that suppresses proliferation of cancer cells and promotes apoptosis. Text Reference - p. 273

A patient with cancer is receiving massive doses of chemotherapeutic agents. The nurse reviews the patient's laboratory results to assess for which findings that suggest the development of tumor lysis syndrome (TLS)? Select all that apply. 1 Hypokalemia 2 Hyponatremia 3 Hypercalcemia 4 Hyperuricemia 5 Hyperphosphatemia

4, 5 Tumor lysis syndrome is a metabolic change that occurs whenever a tumor sensitive to chemotherapy is subjected to chemotherapeutic agents. It is characterized by hyperuricemia and hyperphosphatemia. Hyperkalemia is associated with tumor lysis syndrome, but not hypokalemia. Tumor lysis syndrome is not associated with hyponatremia. In tumor lysis syndrome there is hypocalcemia, but not hypercalcemia. Text Reference - p. 278

A client receiving a transfusion of packed red blood cells begins to vomit. The client's blood pressure is 90/50 from a baseline of 125/78. Temp is 100.8 from baseline 99.2 orally. The nurse determines patient is experiencing which complication with blood transfusion? a. septicemia B. hyperkalemia. c. circulatory overload. D. Delayed tranfusion reaction.

A, septicemia occurs with transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and development of shock. Hyerkalemia causes weakness, paresthesia, abdominal cramps, diarrhea, and dysrythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. Delayed transfusion reaction can occer days or weeks after transfuison. Signs include fever, mild jaundice, and a decrease hematocrit level.

In discharging the client diagnosed with AIDS, which statement by the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors? A. "Have you had sex with men or women or both?" B. "I hope you use condoms to protect your partners." C. "You must tell me all your partners' names, so I can let them know about possibly having AIDS." D. "You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."

A. "Have you had sex with men or women or both?" • Correct: A straightforward approach is nonjudgmental. • (B) "I hope you use" is a judgmental statement. • (C) Naming partners is voluntary. Also, assuming that more than one partner exists is judgmental. • (D) Asking for information in the name of the public health department is not straightforward, and the tone of this statement is judgmental.

The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention (CDC) regarding HIV testing? Select all that apply. A. "I am 78 years old, and I was treated and cured of syphilis many years ago." B. "In 1986, I received a transfusion of platelets." C. "Seven years ago, I was released from a penitentiary." D. "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." E. "At 68, I am going to get married for the fourth time."

A. "I am 78 years old, and I was treated and cured of syphilis many years ago." C. "Seven years ago, I was released from a penitentiary." E. "At 68, I am going to get married for the fourth time." • Correct Feedback: A. People with a sexually transmitted disease should be tested. C. People who are in or have been in correctional institutions such as jails or prisons should be HIV tested. E. People who are planning to get married should be HIV tested. • Incorrect Feedback: B. HIV testing is recommended for clients who received a blood transfusion between 1978 and 1985. D. People who have used injection drugs should be tested.

The client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates the need for further teaching by the nurse? A. "With this treatment, I probably cannot spread this virus to others." B. "This treatment does not kill the virus." C. "This medication prevents the virus from replicating in my body." D. "Research has shown the effectiveness of this therapy if I do not forget to take any doses."

A. "With this treatment, I probably cannot spread this virus to others." • Correct: HAART reduces viral load and improves CD4+ T-cell counts, but the client must still protect others from contact with his or her body fluids; this statement indicates the need for further teaching. • (B) This is true. The medication inhibits viral replication. • (C) This is true. The medication inhibits viral replication. • (D) This is true. Remembering to take all doses of HAART is very important for preventing drug resistance.

The nurse is aware that which factors are possible transmission routes for HIV? Select all that apply. A. Breast-feeding B. Anal intercourse C. Mosquito bites D. Toileting facilities E. Oral sex

A. Breast-feeding - Correct B. Anal intercourse - Correct E. Oral sex - Correct • Correct Feedback: A. HIV can be transmitted from breast milk from an infected mother to child. B. Anal intercourse not only allows seminal fluid to make contact with the mucous membranes of the rectum, but it also tears the mucous membranes, making infection more likely E. Oral sexual contact exposes the mucous membranes to infected semen or vaginal secretions. • Incorrect Feedback: C. Incorrect: HIV is not spread by mosquito bites or by other insects. D. Incorrect: HIV is not transmitted by casual contact, and sharing toilet facilities does not allow transmission of HIV.

Which interventions will the home health nurse teach to family members to reduce confusion in the client diagnosed with AIDS dementia? Select all that apply. A. Change the decorations in the home according to the season. B. Put the bed close to the window. C. Write out detailed instructions, and have the client read them over before performing a task. D. Ask the client what time he or she prefers to shower or bathe. E. Mark off the days of the calendar, leaving open the current date.

A. Change the decorations in the home according to the season. B. Put the bed close to the window. D. Ask the client what time he or she prefers to shower or bathe. E. Mark off the days of the calendar, leaving open the current date. • Correct Feedback: A. Changing decorations according to the season will help to keep the client oriented. B. Keeping the bed close to the window may help keep the client oriented. D. The client should be included in planning the daily schedule. E. Using a calendar and marking off the days helps to keep the client oriented. • Incorrect Feedback: C. INCORRECT: Directions should be short and simple and uncomplicated.

1. Which member of the health care team demonstrates reducing the risk for infection for the client with acquired immune deficiency syndrome (AIDS)? A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. B. The social worker encourages the client to verbalize about stressors at home. C. Housekeeping thoroughly cleans and disinfects the hallways near the client's room. D. The health care provider orders vital signs including temperature every 8 hours.

A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. • Correct: This limits the number of health care personnel entering the room. • (B) Verbalizing stressors does not reduce the risk for infection. • (C) Cleaning of bathrooms, not hallways, at least once daily by housekeeping reduces infection. • (D) Vital signs, including temperature, should be taken every 4 hours to detect potential infection but does not reduce the risk for infection.

The nurse is obtaining the health history of a client who has iron deficiency anemia. Which factor in this client's history does the nurse correlate with this diagnosis? a. Eating a meat-free diet b. Family history of sickle cell disease c. History of leukemia d. History of bleeding ulcer

ANS: A A diet high in protein and iron helps keep the client's levels of iron within normal limits. Meat is a good source of protein and iron. A bleeding ulcer could cause anemia but would not cause iron deficiency. Sickle cell disease causes sickle cell anemia. Leukemia causes a decrease in white blood cells.

The nurse is administering a prescribed fibrinolytic to a client who is having a myocardial infarction (MI). Which adverse effect does the nurse monitor for? a. Bleeding b. Orthostatic hypotension c. Deep vein thrombosis d. Nausea and vomiting

ANS: A A fibrinolytic lyses any clots in the body, thus causing an increased risk for bleeding. Fibrinolytic therapy does not place the client at risk for hypotension, thrombosis, or nausea and vomiting. pg 861

The nurse is caring for a client who has a decreased serum iron level. Which intervention does the nurse prioritize for this client? a. Dietary consult b. Family assessment c. Cardiac assessment d. Administration of vitamin K

ANS: A Diets can alter cell quality and affect blood clotting. Diets low in iron can cause anemia and decrease the function of all red blood cells. The question does not say that the hemoglobin is low enough to affect the cardiac function. Family assessment may be important in finding out any genetic or family lifestyle causes of the low serum iron level. However, the first intervention that the nurse can provide is to have the client's dietary habits evaluated and changed so that iron levels can increase. Vitamin K is involved with clotting, not with iron stores.

The nurse is assessing a 75-year-old male client. Which blood value indicates that the client is experiencing normal changes associated with aging? a. Hemoglobin, 13.0 g/dL b. Platelet count, 100,000/mm3 c. Prothrombin time (PT), 14 seconds d. White blood cell (WBC) count, 5000/mm3

ANS: A Hemoglobin levels in men and women fall after middle age. Therefore, this client's hemoglobin value would be considered part of the aging process. Platelet counts and blood-clotting times are not age related; the client's platelet count and PT are elevated for some other reason. The WBC count shown is normal. pg 860

The nurse is assessing a client with numerous areas of bruising. Which question does the nurse ask to determine the cause of this finding? a. "Do you take aspirin?" b. "How often do you exercise?" c. "Are you a vegetarian?" d. "How often do you take Tylenol?"

ANS: A Platelet aggregation is essential for blood clotting. An inability to clot blood when an injury occurs can result in bleeding, which would cause bruising. Aspirin is a drug that interferes with platelet aggregation and has the ability to "plug" an extrinsic event, such as trauma. Vitamin K found in green vegetables enhances clotting factors, which would improve the ability to stop bleeding associated with an extrinsic event. Acetaminophen (Tylenol) and exercise do not inhibit clotting factors.

The nurse is planning discharge teaching for a client who has a splenectomy. Which statement does the nurse include in this client's teaching plan? a. "Avoid crowds and people who are sick." b. "Do not eat raw fruits or vegetables." c. "Avoid environmental allergens." d. "Do not play contact sports."

ANS: A The spleen is the major site of B-lymphocyte maturation and antibody production. Those who undergo splenectomies for any reason have a decreased antibody-mediated immune response and are particularly susceptible to viral infections. Eating raw fruits and vegetables places the client at risk for bacterial infections. The body responds to environmental allergens with an unspecific inflammatory process. The client is not at risk for bleeding or injury due to contact sports.

The nurse is assessing a client whose warfarin (Coumadin) therapy was discontinued 3 weeks ago. Which laboratory test result indicates that the client's warfarin therapy is no longer therapeutic? a. International normalized ratio (INR), 0.9 b. Reticulocyte count, 1% c. Serum ferritin level, 350 ng/mL d. Total white blood cell (WBC) count, 9000/mm3

ANS: A Warfarin therapy increases the INR. Normal INR ranges between 0.7 and 1.8. Therapeutic warfarin levels, depending on the indication of the disorder, should maintain the INR between 1.5 and 3.0. When the effects of warfarin are no longer present, the INR returns to normal levels. Warfarin therapy does not affect white blood cell count, serum ferritin level, or reticulocyte count. pg 866

The nurse is teaching a client who is receiving sodium warfarin (Coumadin). Which topics does the nurse include in the teaching plan? (Select all that apply.) a. Foods high in vitamin K b. Using acetaminophen (Tylenol) for minor pain c. Daily exercise and weight management d. Use of a safety razor and soft toothbrush e. Blood testing regimen

ANS: A, B, D, E The client on warfarin will need to know which foods are high in vitamin K because vitamin K intake must be consistent to avoid interfering with the anticoagulant properties of warfarin. Clients should not take aspirin or NSAIDs for minor pain owing to their anticoagulant properties. Clients must use safety razors and soft toothbrushes to avoid bleeding episodes. The client on warfarin needs regular blood tests for prothrombin time (PT) and international normalized ratio (INR). Daily exercise and weight management are not specifically important to this client.

The nurse is monitoring a client with liver failure. Which assessments does the nurse perform when monitoring for bleeding in this client? (Select all that apply.) a. Gums b. Lung sounds c. Urine d. Stool e. Hair

ANS: A, C, D The liver is the site for production of clotting factors. Without these factors, the client is at risk for bleeding. Common areas of bleeding include the gums and mucous membranes, bladder, and gastrointestinal tract. Lung sounds and hair are part of the assessment but are not essential in the presence of liver failure and hematologic abnormalities.

The nurse is completing the preoperative checklist on a client. The client states, "I take an aspirin every day for my heart." How does the nurse respond? a. "I will call your doctor and request a prescription for pain medication." b. "I need to call the surgeon and reschedule your surgery." c. "I'll give you the prescribed Tylenol to minimize any headache before surgery." d. "I need to administer vitamin K to prevent bleeding during the procedure."

ANS: B Aspirin and other salicylates interfere with platelet aggregation—the first step in the blood-clotting cascade—and decrease the ability of the blood to form a platelet plug. These effects last for longer than 1 week after just one dose of aspirin. The client may need to have the surgery rescheduled. Vitamin K, prescribed pain medication, and Tylenol cannot reduce the anticlotting effects of aspirin.

The nurse is caring for a client who is receiving heparin therapy. How does the nurse evaluate the therapeutic effect of the therapy? a. Evaluate platelets. b. Monitor the partial thromboplastin time (PTT). c. Assess bleeding time. d. Monitor fibrin degradation products.

ANS: B The PTT assesses the intrinsic clotting cascade. Heparin therapy is monitored by the PTT. Platelets are monitored by the platelet count laboratory value, bleeding time evaluates vascular and platelet activity during hemostasis, and fibrin degradation products help assess for fibrinolysis.

The nurse is teaching a client who has undergone a bone marrow biopsy. Which instruction does the nurse give the client? a. "Wear protective gear when playing contact sports." b. "Monitor the biopsy site for bruising." c. "Remain in bed for at least 12 hours." d. "Use a heating pad for pain at the biopsy site."

ANS: B The most important instruction is to have the client monitor the area for external or internal bleeding. Activities such as contact sports should be avoided, and an ice pack can be used to limit bruising.

The nurse is planning care for a client who has a platelet count of 30,000/mm3. Which intervention does the nurse include in this client's plan of care? a. Oxygen by nasal cannula b. Bleeding Precautions c. Isolation Precautions d. Vital signs every 4 hours

ANS: B The normal platelet count ranges between 150,000 and 400,000/mm3. This client is at extreme risk for bleeding. Although it is necessary to notify the provider, the nurse would first protect the client by instituting Bleeding Precautions. The other interventions are not related to the low platelet count.

The nurse helps to ambulate a client who has anemia. Which clinical manifestation indicates that the client is not tolerating the activity? a. Blood pressure of 120/90 mm Hg b. Heart rate of 110 beats/min c. Pulse oximetry reading of 95% d. Respiratory rate of 20 breaths/min

ANS: B The red blood cells contain thousands of hemoglobin molecules. The most important feature of hemoglobin is its ability to combine loosely with oxygen. A low hemoglobin level can cause decreased oxygenation to the tissues, thus causing a compensatory increase in heart rate. The other options are close to normal range and are not indicative of not tolerating this activity.

The nurse is preparing a client for a bone biopsy and aspiration. The client asks, "Will this be painful?" How does the nurse respond? a. "The procedure is always done under general anesthesia." b. "The biopsy lasts for only 2 minutes." c. "There is a chance that you may have pain." d. "You can relieve pain with guided imagery."

ANS: C Clients may have pain during this procedure. The type and amount of anesthesia or sedation depend on the physician's preference, the client's preference, and previous experience with bone marrow aspiration. The procedure takes from 5 to 15 minutes. Guided imagery can relieve pain but works well only with some clients.

The nurse is assessing a client's susceptibility to rejecting a transplanted kidney. Which result does the nurse recognize as increasing the client's chances of rejection? a. Decreased T-lymphocyte helper b. Decreased white blood cell count c. Increased cytotoxic-cytolytic T cell d. Increased neutrophil count

ANS: C Cytotoxic-cytolytic T cells function to attack and destroy non-self-cells, specifically virally infected cells and cells from transplanted grafts and organs. A high level of these cells would increase the chances of rejection. Decreased white blood cells would indicate immune suppression. Neutrophils are increased during an infection. pg 857

A female client is admitted with the medical diagnosis of anemia. The nurse assesses for which potential cause? a. Diet high in meat and fat b. Daily intake of aspirin c. Heavy menses d. Smoking history

ANS: C Iron levels can be low because intake of iron is too low, or because loss of iron through bleeding is excessive. A premenopausal woman may be having unusually heavy menses sufficient to cause excessive loss of blood and iron. Smoking and aspirin do not cause iron deficiency. A diet high in meat provides iron. pg 861

The nurse observes yellow-tinged sclera in a client with dark skin. Based on this assessment finding, what does the nurse do next? a. Assess the client's pulses. b. Examine the soles of the client's feet. c. Inspect the client's hard palate. d. Auscultate the client's lung sounds.

ANS: C Jaundice can best be observed in clients with dark skin by inspecting the oral mucosa, especially the hard palate, for yellow discoloration. Because sclera may have subconjunctival fat deposits that show a yellow hue, and because foot calluses may appear yellow, neither of these areas should be used to assess for jaundice. The client's pulse and lung sounds have no correlation with an assessment of jaundice.

The nurse is caring for a client who is receiving chemotherapy for cancer. Which intervention does the nurse implement for this client? a. Assess the client's fibrinogen level. b. Administer the prescribed iron. c. Maintain strict Standard Precautions. d. Monitor the client's pulse oximetry

ANS: C The client who is receiving chemotherapy drugs that suppress the bone marrow will be at risk for a decreased white blood cell (WBC) count and infection. The nurse will be most therapeutic by adhering to Standard Precautions to prevent infection, such as handwashing. The nurse will not expect the fibrinogen level to be affected by this therapy. Iron is not typically administered with chemotherapy because this is bone marrow suppression, so the administration of epoetin (Epogen) or filgrastim (Neupogen) is most effective. Monitoring the pulse oximetry is part of routine care and probably would not need to be done continuously.

The nurse is caring for four clients with hematologic-type problems. Which client does the nurse prioritize to see first? a. 18-year-old female with decreased protein levels b. 36-year-old male with increased lymphocytes c. 60-year-old female with decreased erythropoietin d. 82-year-old male with an increased thromboxane level

ANS: C The kidney releases more erythropoietin when tissue oxygenation levels are low. This growth factor then stimulates the bone marrow to increase red blood cell (RBC) production, which improves tissue oxygenation and prevents hypoxia. Hypoxia causes the body to increase its respiratory rate to overcome decreased oxygenation of the tissues. All these clients are important, but the woman with decreased erythropoietin takes priority because of her risk for hypoxia.

The nurse is performing an admission assessment on a 46-year-old client, who states, "I have been drinking a 12-pack of beer every day for the past 20 years." Which laboratory abnormality does the nurse correlate with this history? a. Decreased white blood cell (WBC) count b. Decreased bleeding time c. Elevated prothrombin time (PT) d. Elevated red blood cell (RBC) count

ANS: C The liver is the site for production of prothrombin and most of the blood-clotting factors. If the liver is damaged because of chronic alcoholism, it is unable to produce these clotting factors. Therefore, the PT could become elevated, which would reflect deficiency of some clotting factors. The WBC would not be elevated in this situation because no infection is present. Bleeding time would likely increase. The client's RBC count most likely would not be affected unless the client was bleeding, in which case it would decrease.

A client who has a chronic vitamin B12 deficiency is admitted to the hospital. When obtaining the client's health history, which priority question does the nurse ask this client? a. "Are you having any pain?" b. "Are you having blood in your stools?" c. "Do you notice any changes in your memory?" d. "Do you bruise easily?"

ANS: C Vitamin B12 deficiency impairs cerebral, olfactory, spinal cord, and peripheral nerve function. Severe chronic deficiency may cause permanent neurologic degeneration. The other options are not symptoms of vitamin B12 deficiency.

The nurse is assessing the following laboratory results of a client before discharge. Which instruction does the nurse include in this client's discharge teaching plan? Test Result Hemoglobin 15 g/dL Hematocrit 45% White blood cell (WBC) count 2000/mm3 Platelet count 250,000/mm3 a. "Avoid contact sports." b. "Do not take any aspirin." c. "Eat a diet high in iron." d. "Perform good hand hygiene."

ANS: D A normal WBC count is 5000 to 10,000/mm3. A white blood cell count of 2000/mm3 is low and makes this client at risk for infection. Good handwashing technique is the best way to prevent the transmission of infection. The other laboratory results are all within normal limits.

The nurse is assessing a client with liver failure. Which assessment is the highest priority for this client? a. Auscultation for bowel sounds b. Assessing for deep vein thrombosis c. Monitoring of blood pressure hourly d. Assessing for signs of bleeding

ANS: D All these options are important in assessment of the client, but the most important action is assessment for signs of bleeding. The liver is the site of production of prothrombin and most of the blood-clotting factors. Clients with liver failure run a high risk of having problems with bleeding.

The nurse is caring for a client who has an elevated white blood cell count. Which intervention does the nurse implement for this client? a. Administer the prescribed Tylenol. b. Hold the client's prescribed steroids. c. Assess the client's respiratory rate. d. Obtain the client's temperature.

ANS: D White blood cells provide immunity and protect against invasion and infection. An elevated white blood cell count could indicate an infectious process, which could cause an elevation in body temperature. Tylenol would treat a fever but not the elevated white blood cell count. Steroids place the client at higher risk for infection but should not be stopped suddenly. The respiratory rate does not need to be assessed in this client.

A client diagnosed with HIV is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon) and asks the nurse what will happen if the prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is the nurse's best response? A. "This will not make any difference in the viral load." B. "Blood concentrations will be decreased, which will lead to increased viral replication." C. "If only one dose of medication is missed, this will not make a difference." D. "This will cause an increase in opportunistic infections."

B. "Blood concentrations will be decreased, which will lead to increased viral replication." • Correct: When doses are missed, blood concentrations become lower than what is needed for inhibition of viral replication (often called the inhibitory concentration). When this concentration is too low, the organism can replicate and produce new organisms that are resistant to the drugs being used. Therefore it is critical to ensure that HAART drugs are not missed, delayed, or administered in lower-than-prescribed doses in the inpatient setting. Teach clients the importance of taking their drugs exactly as prescribed to maintain the effectiveness of HAART drugs. • (A) The viral load will be affected because blood concentrations will become lower. • (C) This increases the chance of drug resistance. • (D) The chance of drug resistance is increased.

The home health nurse is making an initial home visit to the client currently living with family members after being hospitalized with pneumonia and newly diagnosed with AIDS. Which statement by the nurse best acknowledges the client's fear of discovery by his family? A. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?" B. "Is there somewhere private in the home we can go and talk?" C. "I hope that all of your family members know about your disease and how you need to be protected, because you have been so sick." D. "It is your duty to protect your family members from getting AIDS."

B. "Is there somewhere private in the home we can go and talk?" • Correct: A nonthreatening approach used initially to find out whether the client has informed family members or desires privacy is very important. • (A) The client has a right to privacy and can make the decision whether to post handwashing signs. Caution signs invade the client's right to privacy. • (C) Protection from infection is important, but this approach is not respectful of the client's right to privacy. • (D) This statement by the nurse is rather intimidating. It is the client's right to make the decision whether to inform or not inform family members about his or her illness. However, this "nonaction" could be grounds for a lawsuit if the client were to infect someone inadvertently.

Which statement made to the nurse by a health care worker assigned to care for the client with HIV indicates a breach of confidentiality and requires further education by the nurse? A. "I told family members they need to wash their hands when they enter and leave the room." B. "The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room." C. "Yes, I understand the reasons why I have to wear gloves when I bathe my client." D. "The client's spouse told me she got HIV from a blood transfusion."

B. "The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room." • Correct: Discussing this client's illness outside the client's room is a breach of confidentiality and requires further education by the nurse. • (A) Instruction on handwashing to family members or friends is not a breach of confidentiality. • (C) This recognizes Standard Precautions in direct care and is not a breach of confidentiality. • (D) The health care worker is relaying the conversation to the nurse. This is not a breach of confidentiality.

The nurse is assigned to care for four clients. Which client will the nurse assess first? A. An HIV-positive client with Kaposi's sarcoma who is described increased swelling to the right arm sarcoma lesion B. A client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature C. A client who has been admitted to receive a monthly dose of immune serum globulin to treat Bruton's agammaglobulinemia D. A client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count

B. A client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature • Correct: The temperature elevation indicates that infection may be occurring in this client, who is at risk for overwhelming infection because of cyclosporine-induced immune suppression. Immediate assessment by the nurse is indicated. • (A) Information regarding this client indicates that the physiologic status is relatively stable. • (C) Information regarding this client indicates that the physiologic status is relatively stable. • (D) Information regarding this client indicates that the physiologic status is relatively stable, and it is not unusual for a client who is undergoing radiation to have a decreased total lymphocyte count.

A client diagnosed with HIV is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions will the nurse recommend to the client? A. Clean toothbrush once a week. B. Bathe daily, using an antimicrobial soap. C. Eat salad at least once a day. D. Wash dishes in cool water.

B. Bathe daily, using an antimicrobial soap. • Correct: Bathing daily and using an antimicrobial soap will help decrease the risk for opportunistic infections by reducing the number of bacteria found on the skin. • (A) Toothbrushes should be cleaned daily through the dishwasher or by rinsing in liquid laundry bleach. • (C) Salads and raw fruits and vegetables could be contaminated and should be avoided. • (D) Dishes should be washed in hot, soapy water or in a dishwasher.

The nurse understands that which factor relates most directly to a diagnosis of primary immune deficiency? A. History of viral infection Incorrect B. Full-term infant surfactant deficiency C. Contact with anthrax toxin D. Corticosteroid therapy

B. Full-term infant surfactant deficiency • Correct: Genetic mutation causes surfactant deficiency. This is a primary immune deficiency. • (A) Viral infection can cause a secondary immune deficiency. • (C) Anthrax is an example of a secondary immune deficiency. • (D) Medical therapy is an example of a secondary immune deficiency.

A client who is HIV positive is experiencing anorexia and diarrhea. Which nursing actions will the nurse delegate to a nursing assistant? A. Collaborate with the client to select foods that are high in calories. B. Provide oral care to the client before meals to enhance appetite. C. Assess the perianal skin every 8 hours for signs of skin breakdown. D. Discuss the need to avoid foods that are spicy or irritating.

B. Provide oral care to the client before meals to enhance appetite. • Correct: Providing oral care is within the scope of practice of unlicensed personnel such as nursing assistants. • (A) Diet planning is a higher level action that requires more broad education and scope of practice; this should be done by licensed staff. • (C) Assessment is a higher level action that requires more broad education and scope of practice; this should be done by licensed staff. • (D) Client teaching is a higher level action that requires more broad education and scope of practice; this should be done by licensed staff.

The nurse is providing care to the client with impaired gas exchange related to anemia. Which nursing intervention has the highest priority? A. Administer antibiotics as prescribed. B. Transfuse ordered packed red blood cells. C. Teach pursed-lip breathing. D. Encourage increased fluid intake.

B. Transfuse ordered packed red blood cells. • Correct: Packed red blood cells increase hemoglobin molecules; this increases sites at which oxygen can attach and improves gas exchange. • (A) Antibiotics improve infection, not gas exchange. • (C) Mouth breathing does not improve gas exchange related to anemia. • (D) Fluid intake does not have an effect on improving gas exchange.

The nurse is conducting a health assessment interview with a client who is HIV positive. Which statement by the client will the nurse immediately address? A. "When I injected heroin, I was exposed to HIV." B. "I don't understand how the antiretroviral drugs work." C. "I remember to take my antiretroviral drugs almost every day." D. "My sex drive is weaker than it used to be since I started taking my antiviral medications."

C. "I remember to take my antiretroviral drugs almost every day." • Correct: Because inconsistent use of antiretroviral medications can lead to unsuccessful therapy and the development of drug-resistant HIV strains, it is important that clients take these drugs consistently. The nurse should immediately assess the reasons why the client does not take the medications daily and then should implement a plan to improve adherence. • (A) The nurse should assess whether the client is still injecting drugs and should make certain the client understands the risks for infection with another strain of HIV or other bloodborne pathogens and the risk for spreading HIV, but this does not need to be addressed immediately. • (B) The nurse needs to provide further education about how the medications work, but this does not need to be addressed immediately. • (D) The nurse should provide further education about medications to assess how lack of knowledge or decreased libido influences compliance, but this does not need to be addressed immediately.

The nurse is instructing an unlicensed health care worker on care of the client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions? A. "I need to know my HIV status, so I must get tested before caring for any clients."' B. "Putting on a gown and gloves will cover up the itchy sores on my elbows." C. "Washing my hands and putting on a gown and gloves is what I must do before starting care." D. "I will wash my hands before going into the room, and then will put on gown and gloves only for direct contact with the client's genitals."'

C. "Washing my hands and putting on a gown and gloves is what I must do before starting care." • Correct: Standard Precautions include whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes. • (A) Knowing HIV status is important for preventing transmission of HIV but is not a Standard Precaution. • (B) Health care workers with weeping dermatitis should not provide direct client care regardless of the use of gown and gloves. • (D) Unlicensed health care workers cannot make the determination of what is required for PPE or Standard Precautions.

A client who is HIV positive and has a CD4+ count of 15 has just been admitted with a fever and abdominal pain. Which physician request will the nurse implement first? A. Obtain a 12-lead electrocardiogram (ECG). B. Call for a portable chest x-ray. C. Obtain blood cultures from two sites. D. Give cefazolin (Kefzol) 500 mg IV.

C. Obtain blood cultures from two sites. • Correct: Antibiotics should be given as soon as possible to immune compromised clients, but blood cultures must be obtained first so that culture results will not be affected by the antibiotic. • (A) A 12-lead ECG can be obtained after other priority requests have been carried out. • (B) Calling for a portable chest x-ray can be done after other priority requests are carried out. • (D) Antibiotic therapy should be initiated as rapidly as possible in immune compromised clients but should be given after blood cultures are taken so that laboratory results will not be affected by the antibiotic.

In planning care for the client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority? A. Loss of social contact related to misunderstanding of acquiring secondary immune deficiency transmission and the social stigma B. Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency C. Potential for infection transmission related to recurring opportunistic infections D. High risk for inadequate nutrition less than body requirements related to acquired secondary immune deficiency and Candida albicans

C. Potential for infection transmission related to recurring opportunistic infections • Correct: Protecting the client from further opportunistic infection such as Candida albicans is a priority. • (A) Loss of social contact is not a priority problem with an opportunistic infection. • (B) This would be the secondary concern because Candida albicans causes mouth sores. • (D) Nutrition will be affected because of Candida albicans. However, it is not a priority.

"Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? " 1. The blood will coagulate if left out of the refrigerator for >four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure."

Correct 2 1. Blood will coagulate if left out for an extended period , but blood is stored with a preservative that prevents this and prolongs the life of the blood. 2. (CORRECT). Blood is a medium for bacterial growth, and any bacteria contaminating the unit will begin to grow if left outside of a controlled refrigerated temperature for longer than four (4) hours, placing the client at risk for septicemia. 3. Blood components are stable and do not break down after four (4) hours. 4. These are standard nursing and laboratory procedures to prevent the complication of septicemia."

The nurse is working in a blood bank facility procuring units of blood from donors. Which client would not be a candidate to donate blood? 1.The client who had wisdom teeth removed a week ago.2.The nursing student who received a measles immunization 2 months ago.3. The mother with a six (6)-week-old newborn.4.The client who developed an allergy to aspirin in childhood

Correct 3 1. Oral surgeries are associated with transient bacteremia, and the client cannot donate for 72 hours after an oral surgery. 2.The client cannot donate blood following rubella immunizations for one (1) month. 3. CORRECT The client cannot donate blood for 6 months after a pregnancy because of the nutritional demands on the mother. 4.Recent allergic reactions prevent donation because passive transference of hypersensitivity can occur. This client has an allergy that developed during childhood

"The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should immediately be taken next? 1. remove the intravenous line 2. run a solution of 5% dextrose in water 3.run normal saline at a keep-vein-open rate 4. obtain a culture of the tip of the catheter device removed from the client

Correct 3 If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further physician prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume. The nurse would not remove the IV line because then there would be no IV access route. Obtaining a culture of the tip of the catheter device removed from the client is incorrect. First the catheter should not be removed. Second, cultures are performed when infection, not transfusion reaction, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump.

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

Correct A "The fresh frozen plasma should be administered as rapidly as possible and should be used within 2 hours of thawing. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion."

Following surgery, the client requires a blood transfusion. The main reason the nurse wants to complete the unit transfusion within a four-hour period that blood: A. Hanging for a longer four hours creates an increased risk of sepsis B. May clot in the bag C. May evaporate D. May not clot in the recipient after this time period

Correct A Hanging for a longer four hours creates an increased risk of sepsis, which is why the nurse wants to complete the unit transfusion in less than four hours. The remaining items are not likely to happen.

Halfway through the administration of blood, the female client complains of lumbar pain. After stopping the infusion Nurse Hazel should: a. Increase the flow of normal saline b. Assess the pain further c. Notify the blood bank d. Obtain vital signs.

Correct A The blood must be stopped at once, and then normal saline should be infused to keep the line patent and maintain blood volume.

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before the beginning transfusion, the nurse assessess which of the following items? A. Vital signs B. Skin Color C. Urine ouput D. Latest hematocrit level.

Correct Answer A Change in vital signs during the transfusion from the baseline may indicate that a transfusion reaction is occuring. This is why nurse assesses vital signs before the procedure and again after 15 mintues. The other options do not identify assessment that are required just before beginning a transfusion.

"Before starting a transfusion of packed red blood cells for an anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? A. 5 minutes B. 15 minutes C. 60 minutes D. 30 minutes

Correct B Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing

The nurse is preparing to administer a blood transfusion of PRBCs. The correct solution to use to flush the tubing when administering a blood transfusion is: A. 5% dextrose in water (D5W). B. Lactated Ringer's solution (LR). C. 0.9% NaCl (normal saline) solution D. Plasmalyte-A

Correct C The correct answer is normal saline. Normal saline is the only solution used to flush the tubing during a blood transfusion. The other solutions listed aren't indicated and may hemolyze the RBCs.

A child with beta-thalassemia is receiving long-term blood transfusion therapy for the treatment of this disorder. Chelation therapy is prescribed to prevent organ damage from the presence of too much iron in the body as a result of the transfusions. Which of the following medications would the nurse anticipate to be prescribed in chelation therapy? 1. Meopenem (Merrem) 2. Metoprolol (Toprol-XL) 3. Deferoxamine (Desferal) 4. Dalteparin sodium (Fragmin)

Correct answer: 3. Deferoxamine (Desferal) Rationale: Beta-Thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with Beta-Thalassemia major). The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either deferasirox (Exjade) or deferoxamine (Desferal) may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Dalteparin is an anticoagulant used as prophylaxis for postoperative DVT. Meropenem is an antibiotic. Metoprolol is a Beta-blocker used to treat HTN.

A nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse asks which initial questions? 1. Have you ever had a transfusion before? 2. Why do you think that you need the transfusion? 3. Have you ever gone into shock for any reason in the past? 4. Do you know the complications and risks of a transfusion?

Correct: 1 Asking the client about personal experience with tranfusion therapy provides a good starting point for client teaching about this procedure.

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 mg/dL. The HCP has ordered two (2) units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply 1. Obtain a signed consent. 2.Initiate a 22-gauge IV. 3.Assess the client's lungs. 4.Check for allergies. 5.Hang a keep-open IV of D5W

Correct: 1, 3, 4. Not 2 (gauge needs to be 18, 19), Not 5 (ONLY NS)

"Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? (Med Surg Success)" 1. The blood will coagulate if left out of the refrigerator for longer than four(4)hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure. "

Correct: 2 1.Blood will coagulate if left out for an extended period, but blood is stored with a preservative that prevents this and prolongs the life of the blood. 2.***Blood is a medium for bacterial growth, and any bacteria contaminating the unit will begin to grow if left outside of a con- trolled refrigerated temperature for longer than four (4) hours, placing the client at risk for septicemia.*** 3)Blood components are stable and do not break down at four 4.)These are standard nursing and laboratory procedures to prevent the complication of septicemia."

A 28-year old client with cancer is afraid of experiencing a febrile reaction associated with blood transfusions. He asks the nurse if this will happen to him. The nurse's best response is which of the following? 1) Febrile reactions are caused when antibodies on the surface of blood cells in the transfusion are directed against antigens of the recipient. 2) Febrile reactions can usually be prevented by administering antipyretics and antihistamines before the start of the transfusion. 3) Febrile reactions are rarely immune-mediated reactions and can be a sign of hemolytic transfusion. 4) Febrile reactions primarily occur within 15 minutes after initiation of the transfusion and occur during the blood transfusion.

Correct: 2 The administration of antipyretics and antihistamines before initiation of the transfusion in the frequently transfused client can decrease the incidence of febrile reactions. Febrile reactions are immune-mediated and are caused by antibodies in the recipient that are directed against antigens present on the granulocytes, platelets, and lymphocytes in the transfused component. They are the most common transfusion reaction and may occur with onset, during transfusion, or hours after transfusion is completed.

A 52-year-old woman is admitted with a new diagnosis of gastrointestinal (GI) bleed. The physician has ordered the client to receive 2 units of packed red blood cells (PRBCs) for a hemoglobin (Hgb) of 6.8g/dL. The nurse begins the infusion of the first unit at 100mL/hr. Fifteen minutes after the start of the infusion, the client complains that she is feeling chilled, is short of breath, and is experiencing lumbar pain rated 8 on a 1-10 scale. Which of the following should be the nurse's FIRST action. 1. Obtain vital signs and notify the physician of potential reaction 2. Slow the infusion to 75mL/hr and reassess in 15 minutes 3. Stop the infusion and run normal saline (NS) to keep the vein open (KVO) 4. Administer PRN pain medication as ordered, apply oxygen at 2 L/min, and provide an additional blanket"

Correct: 3 1. ""Obtain vital signs..."" - vital signs should be obtained, and the physician notified after treatment is discontinue. The unit in quesiton should not be restarted, and any other units that were issued should not be implemented. 2. ""Slow the infusion..."" - just slowing the infusion will not resolve the issue of an allergic reaction to the treatment (CORRECT):3. ""Stop the infusion..."" - The symptoms of feeling chilled, being short of breath, and having back pain could indicate an acute hemolytic reaction. This medical emergency requires swift action on the part of the nurse, including immediately discontinuing the infusion, flushing the IV site, and saving the unit of blood in question for testing. 4. ""Administer PRN pain medication..."" - Treating the symptoms of the reaction will not resolve the issue of an allergic reaction to the treatment"

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy? 1) Bacteriemia. 2) Hypovolemia. 3) Fluid overload 4) Transfusion reaction

Correct: 3 With fluid overload, the client has the presence of crackles in addition to dyspnea. An allergic reation, a type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not complication of blood transfusions. With bacteriemia, the client would have fever, a symptom not presented.

"The nurse and unlicensed nursing assistant are caring for clients on an oncology floor. Which nursing task would be delegated to the unlicensed nursing assistant? 1. Assess the urine output on a client who has had a blood transfusion reaction. 2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs. 3. Auscultate the lung sounds of a client prior to a transfusion. 4. Assist a client who received ten (10) units of platelets in brushing teeth.

Correct: 4 1. Unlicensed nursing assistants cannot assess. The nurse cannot delegate assessment. 2. The likelihood of a reaction is the greatest during the first 15 minutes of a transfusion.The nurse should never leave the client until after this time. The nurse should take and assess the vital signs during this time. 3. Auscultation of the lung sounds and administering blood based on this information are the nurse's responsibility. Any action requiring nursing judgment cannot be delegated. 4. The unlicensed nursing assistant can assist a client to brush the teeth. Instructions about using soft-bristle toothbrushes and the need to report to the nurse any pink or bleeding should be given prior to delegating the procedure. (CORRECT) TEST-TAKING HINT: The test taker must be aware of delegation guidelines. The nurse cannot delegate assessment or any intervention requiring nursing judgment. Options "1," "2," and "3" require judgment and cannot be delegated to an unlicensed assistant."

The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first: 1. Discontinue the I.V. catheter if a blood transfusion reaction occurs. 2. Administer the PRBCs through a percutaneously inserted central catheter line with a 20-gauge needle. 3. Flush PRBCs with 5% dextrose and 0.45% normal saline solution. 4. Stay with the client during the first 15 minutes of infusion.

Correct: 4 The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 mL of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution.

"(from nclex reviewers) The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is:" a. 0.9 percent sodium chloride b. 5 percent dextrose in water solution c. Sterile water d. Heparin sodium

Correct: A 0.9 percent sodium chloride is normal saline. This solution has the same osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are hypotonic solutions and can cause red cell lysis. The solution in option 4 may anticoagulate the patient and result in bleeding."

"Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? a. packed red blood cells b. platelets c. plasma d. granulocytes

Correct: A Red blood cells contain antigens and antibodies that must be matched between donor and recipient. The blood products in options 2-4 do not contain red cells. Thus, they require no cross-match.

A nurse check a unit of blood received from the blood bank and notes the presence of gas bubbles in the bag. Which should the nurse implement? A. Return the bag to the blood bank. B. Infuse the blood using the filter tubing. C. Add 10ml of NS to the bag. D. Agitate the bag to mix contents gently.

Correct: A The nurse should return the blood to the blood bank because the gas bubbles in the bag indicate possible contamination. If the nurse were going to administer the blood, the nurse would use filter tubing to trap the particulate matter. Although normal saline can be infused concurrently with the blood, NS or any other substance should never be added to the blood in a blood bag. The blood should not be agitated this can harm the RBCs.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? a. Schilling's test, elevated b. Intrinsic factor, absent. c. Sedimentation rate, 16 mm/hour d. RBCs 5.0 million

Correct: B ANSWER B. The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: a. Nothing related to the blood transfusion b. Graft-versus-host disease (GVHD) c. Myelosuppression d. An allergic response to a recent medication

Correct: B GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD

"Which organ is at greatest risk due to the effects of hemolytic anemia?" A. Heart B. Spleen C. Kidney D. Liver

Correct: C For all causes of hemolysis, a major focus of treatment is to maintain renal function. When RBCs are hemolyzed, the hemoglobin molecule is released and filtered by the kidneys. The accumulation of hemoglobin molecules can obstruct the renal tubules and lead to acute tubular necrosis

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

Correct: D Leukocyte-reduced blood products drastically reduce the risk of blood transfusion-associated viral infections, including CMV.

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which of the following health team members in the nurses' station to assist in checking the unit before administration? A: Unit Secretary B: A Phlebotomist C: A Physician's Assistant D: Another Registered Nurse

Correct: D Before hanging a transfusion, the registered nurse must check the unit with ANOTHER RN or with a licensed practical (vocational) nurse, depending on agency policy. Checking blood products is not in the unit secretary's or phlebotimist's scope of practice. The physician assistant is not another RN or licensed practical nurse.

The client with an acquired immune deficiency is seen in the clinic for re-evaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? A. Therapeutic highly active antiretroviral therapy (HAART) level B. Positive HIV, enzyme-linked immunosorbent assay (ELISA), Western blot C. Positive Papanicolaou (Pap) test D. Improved CD4+ T-cell count and reduced viral load

D. Improved CD4+ T-cell count and reduced viral load • Correct: Improved CD4+ T-cell count and reduced viral load reflect the response to prescribed HAART medication. • (A) This is the recommended medication combination given to clients with HIV to cause an increase in the CD4+ T-cell count. • (B) This test, if positive, indicates that the client is HIV positive (a fact already known for this client) and does not indicate response to prescribed medication. • (C) Pap smears can be precancerous in an HIV-positive client, but the test does not indicate the immune system's response to prescribed medication.

About ten minutes after the nurse begins an infusion of packed RBCs, the patient complains of chills, chest and back pain, and nausea. His face is flushed, and he's anxious. Which is the priority nursing action? 1. Administering antihistamines STAT for an allergic reaction. 2. Notifying the physician of a possible transfusion reaction. 3. Obtaining a urine and serum specimen to send to the lab immediately. 4. Stopping the transfusion and maintaining a patent IV catheter.

The correct answer is 4. This appears to be a transfusion reaction. Stop the transfusion and maintain a patent IV line. The other options may be indicated but aren't the priority in this case.

A unit of packed red blood cells has been prescribed for a client with low hemoglobin and hematocrit levels. The nurse notifies the blood bank of the order, and a blood specimen is drawn from the client for typing and cross-matching. The nurse receives a telephone call from the blood bank and is informed that he unit of blood is ready for administration. Arrange the actions in order of priority that the nurse should take to administer the blood. hang the bag of blood obtain the unit of blood from the bank ensure that an informed consent has been signed verify the physician's order for the blood transfusion insert an 18 or 19-gauge IV catheter into the client ask a licensed nurse to assist in confirming blood compatibility and verifying client identity.

The nurse would first VERIFY the physician's order for the blood transfusion and ensure that the client has been informed about the procedure and has signed an informed CONSENT. Once this has been done, the nurse would ensure that at least an 18- or 19-gauge intravenous needle is INSERTED into the client. Blood has a thicker and stickier consistency than intravenous solutions and using an 18- or 19-gauge catheter ensures that the bore of the catheter is large enough to prevent damage to the blood cells. Next, the blood is OBTAINED from the blood bank, once the nurse is sure that the client has been informed and has an adequate access for administering the blood. Once the blood has been obtained, two registered nurses, or one registered and a licensed practical nurse (depending on agency policy), must together SECOND CHECK the label on the blood product against the client's identification number, blood group, and complete name. This minimizes the risk of error in checking information on the blood bag and thereby minimizes the risk of harm or injury to the client. The nurse should measure VITALS signs and assess lung sounds and then HANG the transfusion. (don't forget, education, stay and assess)

Which is used as a genetic marker for diagnosing cancer? 1 AFP 2 CEA 3 BRCA2 4 CA-125

3 The BRCA2 gene is used as a genetic marker for cancer. AFP, CEA, and CA-125 are tumor markers associated with cancer. Text Reference - p. 256

Packed red blood cells have been prescribed for a client with a low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6 degrees orally. Which of the following is the appropriate nursing action? A) Begin the transfusion as prescribed B) Delay hanging blood and notify the physician C) Administer an antihistamine and begin the transfusion D) Administer two tablets of Tylenol and begin the transfusion"

"Correct Answer B: If the client has a temperature higher than 100 degrees, the unit of blood should not be hung until the physician is notified and has the opportunity to give further prescriptions. The physician will likely prescribe that the blood be administered regardless of the temperature, but the decision is not within the nurses's scope of practice to make. The nurse needs a physician's prescription to administer medications to the client. Options A, C, and D can all be excluded as they indicate beginning the transfusion."

Situation: A client recently diagnosed with HIV is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client? A. Fluconazole (Diflucan) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Rifampin (Rifadin) D. Acyclovir (Zovirax)

A. Fluconazole (Diflucan) • Correct: Fluconazole (Diflucan) is indicated for opportunistic candidiasis infection related to HIV. • (B) Trimethoprim/sulfamethoxazole (Bactrim) is indicated for bacterial infections such as urinary tract infection. • (C) Rifampin (Rifadin) is used for treatment of tuberculosis. • (D) Acyclovir (Zovirax) is an antiviral agent.

The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurse's initial action? A. Slow the transfusion. B. Document the finding as the only action. C. Stop the blood transfusion and turn on the normal saline. D. Assess the client's pupils.

Answer A is correct. The client is exhibiting symptoms of fluid volume excess; slowing the rate is the proper action. The nurse would not stop the infusion of blood, as in answer C, and answers B and D would not help.

The physician orders 2 units of packed RBCs to be administered to the client. At 0600 the night shift nurse initiates the first unit's transfusion before going off shift. At 1000 the day shift nurse notes the IV line has clotted off and the transfusion has not been completed. The nursing assessment revealed the transfusion was only approximately 75% complete. Which of the actions by the nurse is most appropriate? A. Advise the blood bank about the delay for the next unit. B. Restart another peripheral line with 0.9% NS and restart the blood transfusion with the remaining blood unit. C. Discontinue the transfusion. D. Document the amount infused thus far and continue the transfusion."

Answer C Rationale: A unit of blood should be administered within a 4 hour period of time. The nurse should discontinue the transfusion, document the findings and notify the blood bank. The agency policy will need to be followed concerning the documentation process and notification of appropriate personnel. Continuing the transfusion with the "open" unit will expose the client to an increase risk of injury."

"The nurse is preparing to initiate a blood transfusion. The client has a peripheral intravenous infusion in their left arm that the physician has ordered not be slowed or rate reduced. The nurse prepares to start another line in the right arm. The client asks the nurse to use the existing site to avoid the trauma of having another line started. Which of the following statements by the nurse is correct? A. ""That will be fine"" B. "I will need to infuse the blood through a separate IV line." C. "I will let the physician know about your preferences." D. "We will need to assess the line before I can make a determination about your request.""

Answer: B "Rationale: A blood infusion must be administered via a separate IV line. The other responses indicate to the client their request is being considered"

During a blood transfusion a client develops chills and a headache, what is the priority nursing action A) cover the client B) stop the transfusion at once C) notify the physician immediately D) decrease the rate of blood infusion

B) stop the transfusion because chills, headache, and nausea are all signs of transfusion reaction

When preparing the newly diagnosed client with HIV and the significant other for discharge, which explanation by the nurse accurately describes proper condom use? A. "Condoms should be used when lesions are present on the penis." B. "Always position the condom with a space at the tip of an erect penis." C. "Make sure it fits loosely to allow for penile erection." D. "Use adequate lubrication such as petroleum jelly."

B. "Always position the condom with a space at the tip of an erect penis." • Correct: This allows for collection of semen at the tip of the condom. • (A) Condoms must be used at all times with sexual activity, with or without the presence of lesions. • (C) Condoms should be applied on an erect penis and should fit snugly, leaving space without air at the tip. • (D) Lubricants should be water-based only.

"73. A client brought to the emergency department states that he has accidentally been taking two times his prescribed dose of warfarin (Coumadin) for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to do which of the following? 1. Prepare to administer an antidote. 2. Draw a sample for type and crossmatch and transfuse the client. 3. Draw a sample for an activated partial thromboplastin time (aPTT) level. 4. Draw a sample for prothrombin time (PT) and international normalized ratio (INR).

Correct - 4 - no rationale

A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately? a. The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion. b. The new RN starts an intravenous line for the transfusion using a 22-gauge catheter. c. The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. d. The new RN tells the client that the PRBCs may cause a serious transfusion reaction.

Correct: C ANSWER C - Normal saline, an isotonic solution, should be used when priming the IV line to avoid causing hemolysis of RBCs. Ideally, blood products should be infused as soon as possible after they are obtained; however, a 20-minute delay would not be unsafe. Large-gauge IV catheters are preferable for blood administration; if a smaller catheter must be used, normal saline may be used to dilute the RBCs. Although it is appropriate to instruct clients to notify the nurse if symptoms of a transfusion reaction such as shortness of breath or chest pain occur, it will cause unnecessary anxiety to indicate that a serious reaction is likely to occur. Focus: Prioritization

The nurse is caring for a client who had a bone marrow aspiration. The client begins to bleed from the aspiration site. Which action does the nurse perform? a. Apply external pressure to the site. b. Elevate the extremities. c. Cover the site with a dressing. d. Immobilize the leg.

NS: A All these options could be done after a bone marrow aspiration and biopsy. However, the most important action when bleeding occurs is to apply external pressure to the site until hemostasis is ensured. The other measures could then be carried out.