Cellular Regulation

Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood. To allay parental guilt and anxiety, it is important to acknowledge how difficult it is to recognize severe illness on the basis of changes in the child's behavior and ecchymoses that can result when a child bangs into an object, a common occurrence in young children. A bone marrow aspiration or biopsy is required for a definitive diagnosis. ALL in children has a favorable prognosis, depending on several factors, including the child's age at diagnosis, the white blood cell count, and the type of cell involved. Even if the mother missed the fact that her child was so ill, mentioning this may cause more anxiety and guilt and interfere with the development or a nurse-client rapport.

A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). The mother states that changes in her child's behavior and the "black and blue" marks were noticed several days ago. She blames herself for not bringing her child to the clinic sooner. On what information about the pathophysiology of leukemia should the nurse base a response? 1 The diagnosis can be certain only after a blood smear is analyzed. 2 If leukemia is diagnosed, the child's prognosis is probably guarded. 3 Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood. 4 The description of the clinical findings indicates that the child has been ill for longer than a single week.

Teach the client to examine the oral mucosa daily. Encourage the client to use artificial saliva to manage dryness.

A 67-year-old client is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply. Teach the client to speak slowly. Teach the client to enunciate clearly. Encourage the client to drink only thin liquids. Teach the client to examine the oral mucosa daily. Encourage the client to use artificial saliva to manage dryness.

Cerebellum

A client is admitted to the hospital with a suspected brain tumor. Based on the history of loss of equilibrium and coordination, where does the nurse suspect the tumor is located? 1 Cerebellum 2 Parietal lobe 3 Basal ganglia 4 Occipital lobe

"Have you noticed any change in your appetite?" Problems involving the oral cavity often result in nutritional problems and weight loss, requiring the nurse to intervene. The question "Have you noticed any change in your appetite?" will elicit more information. The nurse needs to determine a client's past and current appetite and nutritional status. An inability to sleep usually is not a characteristic symptom of cancer of the oral cavity; it may occur after the diagnosis because of worry or fear. Gum infections usually are not an early problem after diagnosis of oral cancer. Although a dentist may be the first to identify oral cancer, medical treatment is needed.

A client is recently diagnosed with a cancerous lesion of the mouth. Which question should the nurse ask when assessing the client's need for health education in relation to this condition? 1 "Are you having difficulty sleeping?" 2 "Do feel like your gums are inflamed?" 3 "How frequently are you seeing the dentist?" 4 "Have you noticed any change in your appetite?"

Avoid contact sports. Wash hands frequently. Avoid crowded places such as shopping malls. Avoid people who have received live attenuated vaccines.

A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions would the nurse plan to include in the client's discharge teaching plan? Select all that apply. Avoid contact sports. Wash hands frequently. Increase intake of fresh fruits and vegetables. Avoid crowded places such as shopping malls. Treat a sore throat with over-the-counter products. Avoid people who have received live attenuated vaccines.

High uric acid levels

A client with leukemia is receiving busulfan and allopurinol. The nurse would plan to tell the client that the purpose of the allopurinol is to prevent which problem? Nausea Alopecia Vomiting High uric acid levels

Tumor necrosis factor affects the satiety center. Macrophages release tumor necrosis factor (TNF), which crosses the blood-brain barrier and affects the satiety center, causing anorexia. Depression does not occur in all clients with cancer, and when it does, it does not necessarily cause anorexia. Decreased saliva impeding chewing and swallowing is not a commonality associated with all clients with cancer; it may occur in clients who receive treatment to the head and neck. Nutrients not being absorbed through the gastrointestinal mucosa is not a commonality associated with all clients with cancer; it may occur in clients who receive treatment that affects the gastrointestinal tract.

A nurse identifies that clients with cancer often lose weight and may become cachectic. What common response do clients with cancer experience, regardless of the site of the cancer that accounts for this weight loss? 1 Depression precipitates anorexia. 2 Tumor necrosis factor affects the satiety center. 3 Decreased saliva impedes chewing and swallowing. 4 Nutrients are not absorbed through the gastrointestinal mucosa.

1 Pallor 2 Fatigue 4 Multiple bruises Pallor is the result of anemia associated with leukemia. Fatigue is the result of anemia associated with leukemia. Multiple bruises are the result of thrombocytopenia associated with leukemia. Jaundice usually indicates liver damage or excessive hemolysis and is not an early sign of leukemia. Edema is not a manifestation of the disease because the pathophysiology does not involve transport of fluids.

A nurse is caring for a child with newly diagnosed acute lymphoblastic leukemia. What clinical findings does the nurse anticipate when assessing the child? Select all that apply. 1 Pallor 2 Fatigue 3 Jaundice 4 Multiple bruises 5 Generalized edema

Listlessness Bone marrow depression Listlessness in a child with leukemia is caused by anemia; anemia is expected in children with leukemia because of generalized bone marrow depression. Depressed bone marrow production of formed elements of blood is characteristic of nonlymphoid leukemia; it leads to neutropenia and increases susceptibility to infection. Urine output will be within expected limits; there is no kidney involvement at this stage of the disease. There are more, not fewer, stem cells in the peripheral blood and bone marrow; the production of mature blood cells is depressed. The swallowing reflex is not affected.

A nurse is reviewing the health history and laboratory results of a school-aged child admitted to the pediatric unit with acute nonlymphoid leukemia (acute myeloid leukemia). What clinical findings does the nurse expect? Select all that apply. 1 Oliguria 2 Listlessness 3 Few stem cells 4 Difficulty swallowing 5 Bone marrow depression

Bone marrow biopsy

The nurse is caring for a client who the physician suspects could have leukemia. The nurse anticipates that the physician will prescribe which of the following to confirm the diagnosis? Platelet count Bone marrow biopsy White blood cell count Complete blood cell count

Hypernatremia Hypertension Metabolic alkalosis Adrenal adenoma may cause primary hyperaldosteronism, which may result in high aldosterone in the urine, low specific gravity of the urine, and hypokalemia (indicated by a serum potassium level less than 3.5 mEq/L [mmol/L]). Increased aldosterone levels may result in sodium retention, which leads to hypernatremia. Sodium retention increases blood volume, which raises blood pressure and causes hypertension. High aldosterone levels may excrete hydrogen ions leading to metabolic alkalosis. Hypoglycemia is caused by a deficiency of adrenocorticotropic hormone. Hypercalcemia is associated with adrenal insufficiency.

The laboratory reports of a client with adrenal adenoma show high urine aldosterone levels and a low specific gravity of urine. The serum potassium is found to be 2.8 mEq/L (2.8 mmol/L). Which other findings will be present upon assessment? Select all that apply. 1 Hypernatremia 2 Hypertension 3 Hypoglycemia 4 Hypercalcemia 5 Metabolic alkalosis

Periorbital edema Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

The nurse caring for a client with lung cancer assesses for which early sign of vena cava syndrome? Cyanosis Arm edema Periorbital edema Mental status changes Submit

"I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."

The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for further instruction regarding self-care related to the radiation therapy to treat lung cancer? "I need to eat a high-protein diet." "I need to avoid exposure to sunlight." "I need to wash my skin with a mild soap and pat dry." "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."

Increased uric acid level Hyperuricemia is especially common following treatment for leukemias and lymphomas, because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? Anemia Decreased platelets Increased uric acid level Decreased leukocyte count

Oxytocin to promote uterine contractions

The nurse is caring for a client in labor whose medical report states posterior pituitary hormone deficiency. Which medication administration is required for the client considering the medical condition? 1 Oxytocin to promote uterine contractions 2 Prolactin to promote breast milk ejection 3 Luteinizing hormone to promote painless labor 4 Follicle-stimulating hormone to promote estrogen secretion

Place the client on neutropenic precautions.

The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate? Place the client on bleeding precautions. Place the client on neutropenic precautions. Remove the rectal thermometer from the client's room. Instruct the dietary department to eliminate all proteins from the client's diet. Submit

A decline in the amount of circulating androgens

The nurse is caring for a client with prostate cancer who is being treated with a hormone therapy. What would the nurse monitor for in order to evaluate the effect of this treatment? An increase in testosterone levels An increase in prostaglandin levels An increase the amount of circulating androgens A decline in the amount of circulating androgens

Remove the rectal thermometer from the client's room.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse would prepare to implement which action based on this finding? Remove the fresh flowers from the client's room. Remove the rectal thermometer from the client's room. Instruct family members to wear a mask when entering the client's room. Call the dietary department to report that the client will be on a low-bacteria diet.

Calcium level of 15 mg/dL (3.75 mmol/L) Hypercalcemia is a serum calcium level greater than 10.5 mg/dL (2.6 mmol/L). It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the PHCP needs to be notified. Options 2, 3, and 4 indicate normal laboratory values.

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. The nurse would contact the primary health care provider (PHCP) if which finding is noted? Calcium level of 15 mg/dL (3.75 mmol/L) Potassium level of 3.8 mEq/L (3.8 mmol/L) Platelet count of 200,000 mm3 (200 × 109/L) White blood cell (WBC) count of 6000 mm3 (6 × 109/L)

Removing fresh-cut flowers from the client's room Instructing family members on the proper technique for hand washing Instructing family members to wear a mask when entering the client's room

The nurse is reviewing the laboratory test results for a client with leukemia receiving chemotherapy. The nurse notes that the white blood cell and neutrophil counts are extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply. Allowing only fresh fruits in the client's room Removing fresh-cut flowers from the client's room Encouraging the client to eat any types of fresh vegetables Instructing family members on the proper technique for hand washing Instructing family members to wear a mask when entering the client's room

Nagging cough or hoarseness Indigestion or difficulty swallowing Change in bowel or bladder habits

The nurse is teaching a group of adults about the warning signs of cancer. Which signs and symptoms would the nurse mention to the group? Select all that apply. Areas of alopecia Sores that do not heal Nagging cough or hoarseness Indigestion or difficulty swallowing Change in bowel or bladder habits Absence or decreased frequency of menses

"I have to avoid excessive exposure to sunlight." "I am at higher risk for skin cancer because my parent had it."

The nurse is teaching the client about risk factors for skin cancer. Which statements by the client indicate that teaching was successful? Select all that apply. "I have to avoid excessive exposure to sunlight." "My dark skin color predisposes me to skin cancer." "I am at higher risk for skin cancer because my parent had it." "I am at higher risk for skin cancer because I am 20 years old." "I am immune to skin cancer because I work as a pest control exterminator."

Check secretions for frank or occult blood. Encourage fluid intake to avoid constipation. Provide oral sponges or a soft toothbrush for oral care.

Which interventions are the most appropriate for a client who is experiencing thrombocytopenia? Select all that apply. Use a straight-edge razor for shaving. Obtain a rectal temperature every 8 hours. Check secretions for frank or occult blood. Give vitamin K by the intramuscular route. Encourage fluid intake to avoid constipation. Provide oral sponges or a soft toothbrush for oral care.

Stop the infusion. Prepare to apply ice or heat to the site. Notify the primary health care provider (PHCP). Prepare to administer a prescribed antidote into the site.

he nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication to treat breast cancer. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and would take which actions? Select all that apply. Stop the infusion. Prepare to apply ice or heat to the site. Notify the primary health care provider (PHCP). Restart the IV at a distal part of the same vein. Prepare to administer a prescribed antidote into the site. Increase the flow rate of the solution to flush the skin and subcutaneous tissue.

"Flush the toilet at least 3 times after use."

A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client? "Flush the toilet at least 3 times after use." "Increase intake of fruits with a core, such as apples and pears." "Avoid contact with pregnant women, infants, and children for 3 months." "Use disposable eating utensils, plates, and cups for the next 6 months."

Total catecholamines - 640 mmol/24 hr

A client is diagnosed with pheochromocytoma. Which finding in the urinalysis report supports the diagnosis? 1 Sodium - 200 mmol/24 hr 2 Calcium - 5.6 mmol/24 hr 3 Urea nitrogen - 0.5 mmol/24 hr 4 Total catecholamines - 640 mmol/24 hr

"A localized skin reaction usually occurs." Localized skin reactions can occur with radiation. The word "burn" may increase the client's anxiety and should be avoided. Emollients are contraindicated; they may alter the calculated x-ray route and cause injury to healthy tissue. Some skin reactions can be quite severe. The response "They may be misinformed" does not answer the client's concern.

A client who is to receive external radiation for cancer says to the nurse, "My family and friends say that I will get a radiation burn." Which response by the nurse is best? 1 "Daily application of an emollient will prevent the burn." 2 "A localized skin reaction usually occurs." 3 "It will be no worse than a sunburn." 4 "They may be misinformed."

Review side effects of chemotherapy and treatment with the client. Teach the client to pace activities with rest so as to maintain strength. Offer information on available counseling services and support groups. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about hair loss and severe fatigue from the treatment. Which interventions would the nurse plan to implement for this client? Select all that apply. Review side effects of chemotherapy and treatment with the client. Teach the client how to resolve specific concerns of her personal life. Teach the client to pace activities with rest so as to maintain strength. Offer information on available counseling services and support groups. Tell the client about some other clients who have had breast cancer treatment. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

Stomatitis Dysgeusia Xerostomia Stomatitis (inflammation of the mucous lining in the mouth), dysgeusia (distorted sense of taste), and xerostomia (dry mouth) are local effects of external radiation to the head and neck. Options 4 and 6 are systemic effects and would most likely occur if radiation were applied to areas around the bone marrow. Option 1 is unrelated to the client's condition.

A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse would monitor the client for which side and adverse effects of external radiation? Select all that apply. Cystitis Stomatitis Dysgeusia Leukopenia Xerostomia Thrombocytopenia

"You need to consult with the primary health care provider (PHCP) before receiving immunizations."

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication to treat breast cancer. When implementing the plan, the nurse would make which statement to the client? "You can take aspirin as needed for headache." "You can drink beverages containing alcohol in moderate amounts each evening." "You need to consult with the primary health care provider (PHCP) before receiving immunizations." "It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."

Prolonged blood clotting times Asparaginase can cause severe adverse effects; however, they often are different from those of other antineoplastic medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. Signs and symptoms of central nervous system depression ranging from confusion to coma can occur. Nausea and vomiting can be intense and may limit the dose that can be tolerated. In contrast with most antineoplastic medications, asparaginase does not depress the bone marrow, nor does it cause alopecia, oral ulceration, or intestinal ulceration.

The nurse is monitoring a client with acute lymphocytic leukemia for toxic effects of asparaginase. The nurse would notify the primary health care provider if monitoring reveals which finding? Alopecia Oral ulcerations Prolonged blood clotting times Decreased white blood cell count

Lymphadenopathy CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore, the client will have enlarged and swollen lymph nodes. Options 1 and 2 are clinical manifestations of acute leukemias. Option 3 is a clinical manifestation of hairy cell leukemia.

The nurse is monitoring a client with chronic lymphocytic leukemia (CLL). Which sign would the nurse specifically monitor for and report to the primary health care provider? Anemia Bleeding Pancytopenia Lymphadenopathy

Use a vaginal dilator 3 times a week. Radiation causes scarring and fibrosis of the vagina, with a decrease in normal vaginal secretions. The client is instructed to use a vaginal dilator to prevent vaginal narrowing and stenosis. A vaginal discharge often occurs, and the client may need to douche twice daily for as long as the discharge and odor persist. Sexual activity after internal radiation treatment can be resumed in about 3 weeks. Bed rest is not required.

The nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with a radiation (cesium) implant. Which instruction would the nurse plan to provide to the client? Avoid douching for at least 1 year. Use a vaginal dilator 3 times a week. Sexual activity can be resumed in about 2 months. Bed rest is recommended for at least 1 week after discharge.

"I will use a washcloth to wash the affected area."

The nurse is providing instructions to the client who is receiving external radiation therapy to the breast for the treatment of cancer. Which statement, if made by the client, indicates the need for further instruction? "I will dry affected areas with patting motions." "I will wear soft clothing over the affected site." "I will use a washcloth to wash the affected area." "I need to make sure I carry bags of groceries on the unaffected side."

"I can't believe my hair loss is going to be permanent."

The nurse is providing teaching to a client with breast cancer who will undergo chemotherapy for cancer, and alopecia is expected from the chemotherapeutic agent. Which statement made by the client indicates a need for further teaching? "Excessive hair brushing needs to be avoided." "I can't believe my hair loss is going to be permanent." "I guess I'll have to stop using my electric hair dryer and curling rod." "I will have my hair stylist cut my hair short just before I start my treatments."

3Palpating for peripheral edema

The nurse is reviewing laboratory test results for the client with liver cancer and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels? 1 Evaluating for asterixis 2 Inspecting for petechiae 3Palpating for peripheral edema 4 Evaluating for decreased level of consciousness

4"I will limit sun exposure to 1 hour daily."

The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction? 1"I will handle the area gently." 2"I will wear loose-fitting clothing." 3"I will avoid the use of deodorants." 4"I will limit sun exposure to 1 hour daily."