Cellular regulation (general concept) NCLEX questions

Which precaution is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination? A. Take antibiotics exactly as prescribed. B. Perform mouth care three times daily. C. Avoid the use of pepper and raw foods. D. Report any burning on urination immediately.

B. Autocontamination is the overgrowth of the client's own normal flora or the translocation of his or her normal flora from its normal location to a different one. Performing frequent mouth care can reduce the number of normal flora organisms in the mouth and decrease the risk for developing an infection from autocontamination. Taking antibiotics does not prevent autocontamination, nor does reporting symptoms of an infection. Avoiding exposure to environmental organisms does not prevent autocontamination.

The client with prostate cancer asks why he must have surgery instead of radiation, even if it is the least invasive type. What is the nurse's best response? A."It is because your cancer growth is large." B. "Surgery is the most common intervention to cure the disease." C. "Surgery slows the spread of cancer." D. "The surgery is to promote urination."

B. Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound

B. Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.Night sweats is a symptom of the lymphomas.

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

C. A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow. the other options are too complex

With which male client will the nurse conduct prostate screening and education? A. Young adult with a history of urinary tract infections. B. Client who has sustained an injury to the external genitalia. C. Adult who is older than 50 years. D. Sexually active client.

C. A man who is 50 years or older is at higher risk for prostate cancer.

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."

C. Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.

A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrates the client with 1000 mL of IV normal saline B. Initiates the administration of prescribed antibiotics C. Obtains requested cultures D. Places the client on Bleeding Precautions

C. Obtaining cultures to identify the infectious agent correctly is the priority for this client.

A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? A. "Don't worry, most lumps are discovered by women during breast self-examination." B. "Does anyone in your family have breast cancer?" C. "Finding a cancer in the early stages increases the chance for cure." D. "Have you noticed a lump or thickening in your breast?"

C. Providing truthful information addresses the client's concern.

The issue that is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse is the alteration of which factor? A. Comfort because of surgical pain. B. Mobility because of treatment. C. Nutrition because of radiation treatment. D. Sexual function after treatment.

D. : Altered sexual function is one of the biggest concerns of men after cancer treatment.

The nurse is providing discharge instructions to a client being treated for cancer. For which symptoms should the client be instructed to call for help at home? Select all that apply A. Difficulty breathing B. Significant increase in vomiting C. Desire to end life D. improve sense of well-being E. new onset of bleeding

A, B, C, E

The client with benign prostatic hyperplasia (BPH) is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? Select all that apply. A. Avoid drugs used to treat erection problems. B. Be careful when changing positions. C. Keep all appointments for follow-up laboratory testing. D. Hearing tests will need to be conducted periodically. E. Take the medication in the afternoon.

A, B, C: Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension, can cause liver damage, do not affect hearing and should be taken in the evening to decrease the risk of problems related to hypotension.

The nurse is caring for a client who is diagnosed with cancer. Which diagnostic tests may be helpful to assist with treatment options? Select all that apply. A) Tumor markers B) Urinalysis C) Physical assessment D) MRI E) Stool analysis

A, B, D

The nurse instructs a group of community members on the difference between benign and malignant neoplasms. Which participant statements indicate that teaching has been effective? Select all that apply A. benign tumor grow slowly B. malignant tumors are easy to remove C. benign tumors stay in one area D. malignant tumors crowd out surrounding tissue E. malignant tumors can grow back

A, C, E

Combinations of antineoplastic drugs are frequently used for which purpose? (Select all that apply.) A Prevent drug resistance B Lower cost of treatment C Decrease drug tolerance D Provide a synergistic action E Decrease the severity of adverse effects

A, D, E

The nurse has completed a seminar teaching a group in the community about ways to reduce cancer risks. The nurse returns a month later to evaluate the effectiveness of the seminar. Which statements made by members of the group indicate retention and application of the material presented by the nurse to reduce the risk of developing cancer? Select all that apply A. i stated using sunscreen when i work outside B. i began drinking two drinking glasses of red wine a day with dinner C. i have reduced my intake of fiber D. i have increased the amount of fried fish in my diet C. i am trying to quit smoking

A, E

The nurse includes which of the following in teaching regarding the warning signs of cancer? Select all that apply. A. Persistent constipation B. Scab present for 6 months C. Curdlike vaginal discharge D. Axillary swelling E. Headache

A,B,D: Change in bowel habit, A sore that does not heal, A lump or thickening in the breast or elsewhere is a warning signal of cancer.

The nurse is caring for a pt who requires compromised host precautions. Which action is most important for the nurse to take before delivering the pt's breakfast tray? A. Ask pt if she feels like eating at this time B. Remove fresh apple and orange from tray C. Call dietary department and ask for disposable utensils D. Declutter room before assisting pt to to couch to eat

B

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: A. MRI B. Biopsy C. CT scan D. Tumor marker

B

The client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client is maladaptive? A. Avoiding eye contact with staff B. Saying, "I feel like less of a woman" C. Requesting a temporary prosthesis immediately D. Saying, "This is the ugliest scar ever"

A. Avoiding eye contact may be an indication of decreased self-image.

What type of information is most relevant to a 21-year-old patient who will be undergoing surgery and radiotherapy for treatment of cancer of the testis? A. A discussion about deep breathing to prevent pneumonia B. A discussion about sperm banking because of possible sterility C. A referral to the Look Good, Feel Better program because of altered body image D. A referral to the Agency for Healthcare Research and Quality to manage cancer pain

B

During a treatment meeting on an oncology unit, the nurse learns that a client is scheduled for chemotherapy before and after surgery. What are the purposes for this client to receive chemotherapy a these specific times? Select all that apply A. Eradicate all cancer cells B. Shrink the tumor C. Kill remaining cancer cells D. Allow the immune system to kill cancer cells E. improve wound healing

B, C

The nurse is caring for a thin, older adult client who is diagnosed with cancer and is receiving aggressive chemotherapy. the client is experiencing severe side effects from the therapy and has lost 10 pounds in the past week. What should the nurse teach the client to do? Select all that apply A. purchase fast foods and prepared foods B. Eat cold foods rather than hot foods C. Keep a food diary and record intake D. Eat large frequent meals high in calories E. Drink liquid supplement to increase intake of nutrients

B, C, E

The nurse instructs a group of community members about ways to reduce the development of cancer. Which participant statements indicate that teaching has been effective? Select all that apply. A) "I should eat at least two servings of fruits or vegetables each day." B) "Sunscreen should be applied before spending time outdoors." C) "I need to cut down on my smoking." D) "I need to get my home tested for radon." E) "I need to minimize my child's exposure to secondhand smoke.

B, D, E

The nurse is teaching a group of clients about cancers related to tobacco or tobacco smoke. Identify the common cancers related to tobacco use. Select all that apply. A. Cardiac cancer B. Lung cancer C. Cancer of the tongue D. Skin cancer E. Cancer of the larynx

B,C,E: The heart does not contain cells that divide; therefore cardiac cancer is unlikely.

When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply. A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns

B,D,E

The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all the apply. A. Limit sodium intake. B. Avoid beef and processed meats. C. Increase consumption of whole grains. D. Eat "colorful fruits and vegetables," including greens. E. Avoid gas-producing vegetables such as cabbage.

B-D. Eating cruciferous vegetables such as broccoli, cauliflower, brussels sprouts, and cabbage may reduce cancer risk.

The nurse explains to the client that which risk factor most likely contributed to his primary liver carcinoma? A. Infection with hepatitis B virus B. Consuming a diet high in animal fat C. Exposure to radon D. Familial polyposis

A. Hepatitis B and C are risk factors for primary liver cancer. Consuming a diet high in animal fat may predispose to colon or breast cancer. Exposure to radon is a risk factor for lung cancer. Familial polyposis is a risk factor for colorectal cancer.

Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)? A. Recent radical mastectomy client who requires chemotherapy administration B. Modified radical mastectomy client who needs discharge teaching C. Stage III breast cancer client who is requesting information about radiation and chemotherapy D. A client with a Jackson-Pratt drain in place who has just arrived from the postanesthesia care unit (PACU) after a quadrantectomy

D. A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains.

Which of the following items 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? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse

D. A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles 4x/wk C. A history of cardiac disease D. Advancing age

D. Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.

A client had a transurethral resection of the prostate (TURP) yesterday. The staff nurse notes that the hemoglobin is 8.2 g/dL. What is the nurse's best action? A. Notify the charge nurse as soon as possible. B. Irrigate the catheter with 30 mL normal saline. C. Document the assessment in the medical record. D. Prepare for a blood transfusion.

D. Blood transfusions are commonly given after a TURP surgery; a blood transfusion is warranted for a hemoglobin reading of 8.2 g/dL. The nurse is capable of managing this situation with the physician, especially since blood transfusions after a TURP are common. Irrigating the catheter is necessary only if the color of the drainage indicates bleeding or there is a presence of clots. Documentation should be done, but it is not the first priority.

The nurse understands that hormone treatment for prostate cancer works by which action? A. Decreases blood flow to the tumor. B. Destroys the tumor. C. Shrinks the tumor. D. Suppresses growth of the tumor.

D. Hormone therapy, particularly anti-androgen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Anti-androgens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation).

The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."

D. Pain in the back of the legs could indicate prostate cancer in an older man.

The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. A. Brain B. Bone C. Lymph nodes D. Kidneys E. Liver

A, B, C, E

The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.

A,C,D,F: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms, as well as Flowers and plants. Thrombocytopenia cause bleeding, not low neutrophils.The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply. A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A,C,D: Fever is a sign of infection secondary to neutropenia.Pallor is a sign of anemia.

The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammography every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A CT scan will be done every year after I turn 50."

A. A strong family history of breast cancer indicates a risk for breast cancer. Annual screening may be indicated for a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. An annual mammography is performed after age 40 or in younger clients with a strong family history.

The client has undergone transurethral resection of the prostate (TURP). Which intervention will the nurse incorporate in this client's postoperative care? A. Administer antispasmodic medications. B. Encourage the client to urinate around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place the client in a supine position, with his knees flexed.

A. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur after TURP.

A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client? A) Vitamin B6 levels B) Vitamin B12 levels C) Potassium levels D) Iron levels

B

The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression. A. Client with hemoglobin of 7.4 and hematocrit of 21.8 B. Client with diarrhea and potassium level of 2.9 mEq/L C. Client with 250,000 platelets D. Client with 5000 white blood cells/mm3

A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.

When caring for a client with cachexia, the nurse expects to note which symptom? A. Weight loss B. Anemia C. Bleeding tendencies D. Motor deficits

A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.

A client newly diagnosed with acute leukemia asks why he is at such extreme risk for infection when his white blood cell count is so high. What is the nurse's best response? A. "Even though you have many white blood cells, they are too immature to fight infection." B. "For now, your risk is low; however, when the chemotherapy begins, your risk for infection will be high." C. "These white blood cells are cancerous and live longer than normal white blood cells, so they are too old to fight infection." D. "It is not the white blood cells that provide protection; it is the red blood cells, which are very low in your blood right now."

A. For clients who understand that white blood cells are a great protection against infection, being at great risk for infection even when WBC counts are sometimes ten times normal is confusing. These are leukemic cells that overgrow at a very immature level. Therefore even though there can be huge numbers of circulating WBCs, these cells are so immature that they are nonfunctional. In addition, the heavy production of immature leukemic cells prevents normal WBCs, RBCs, and platelets from forming and maturing into functional cells.

A client with anemia is prescribed synthetic erythropoietin. When teaching the client about the therapeutic effect of this treatment, which is appropriate for the nurse to include? A) Increase in platelets B) Increase in red blood cells C) Decrease in white blood cells D) Decrease in lymph fluid

B

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. A client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. A client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. A client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

A. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first.

A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct? a. "The drugs may be given in less toxic doses if two drugs are used." b. "Two agents used together can have synergistic effects." c. "Use of two drugs will increase tumorcidal activity in the G0 phase of the cell." d. "Using two agents will shorten the length of time chemotherapy is needed."

B

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

A. Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements

A. Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.

The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy? a. There will be less nausea and vomiting. b. Increased cancer-cell killing will occur. c. The drugs will prevent metastasis. d. Combination therapy reduces the need for radiation therapy.

B

A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, "I just don't know how this could have happened to me." Which of these responses by the nurse will be most appropriate? A. "Tell me what you mean when you say you don't know how this could have happened to you." B. "Do you have a family history that might make you more likely to develop breast cancer?" C. "Would you like me to help you find more information about how breast cancer develops?" D. "Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it."

A. The client's statement may indicate shock and denial or a request for more information. To provide appropriate care, further assessment is needed about the client's psychosocial status. The first action by the nurse in this situation is to obtain more data by asking open-ended questions.

When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? A. Tobacco use B. Ethnicity C. Gender D. Increased age

A. lthough all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.

Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual (Pap) smears

B. Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. all the other options are secondary levels of prevention.

Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time

B. The focus of palliative surgery is to improve quality of life during the survival time.

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Risk for Injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction

B. The highest priority is safety.

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? A. Vomiting B. Back pain C. Frequent urination D. Cyanosis of the toes

B. Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control.

Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy? A. Assess anxiety level about the surgery. B. Monitor the vital signs after surgery. C. Obtain data about breast cancer risk factors. D. Teach about postoperative routine care.

B. Vital sign assessment is included in nursing assistant education and usually is part of the job description for UAP working in a hospital setting.

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B. When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO.

A client is on chemotherapy and has a platelet count of 25,000. Which intervention is most important to teach this client? a. "Eat a low-bacteria diet." b. "Take your temperature daily." c. "Use a soft-bristled toothbrush."

C

A client is receiving a platelet transfusion. The nurse determines that the client is gaining from this therapy if the client exhibits which of the following? A. Less frequent febrile episodes. B. Increased level of hematocrit. C. Less episodes of bleeding. D. Increased level of hemoglobin

C

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? A "Malignant tumors usually are encapsulated." B "Malignant tumors have a rare recurrence rate." C "Benign tumors do not invade and spread to other organs." D "Malignant tumors require less nutrients for their cells than benign tumors."

C

A preschool-age child is seen in a pediatric oncology clinic. The nurse assigned to care for the client anticipates a diagnosis of cancer. What reactions are considered common for the preschool0age child to experience with illnesses and hospitalization? Select all that apply A. unawareness of the illness and severity B. understanding of what cancer is and how it is treated C. thoughts that they caused their illness and are being punished D. confusion as to why a parent is unable to make the illness go away E. acceptance, especially if able to discuss the disease with child their own age

C, D

The nurse is preparing to perform a health assessment on an adult client who has a family history of cancer. Which questions should the nurse ask the client to assess for the early warning signs of cancer? Select all that apply. A) "Do you have a cough that is associated with seasonal allergies?" B) "Have you noticed a change in your appetite?" C) "Have you noticed any cuts that have not healed?" D) "Have you had any changes in bowel or bladder habits?" E) "Have you experienced any problems swallowing?"

C, D, E

Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day

C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia.

What is important nursing care for pediatric clients with leukemia on chemotherapeutic protocols? A. Preventing physical activity B. Taking vitals every 2 hours C. Having them avoid contact with infected persons D. Reduce unnecessary environmental stimuli

C. Chemotherapy and acute lymphoblastic leukemia (ALL) cause immunosuppression (low white blood cells), thus increasing the risk for infection. Avoiding contact with infected persons is a necessary precaution. The client should maintain physical activity that can be tolerated. Although vital signs must be checked to assess for changes in pulse or blood pressure, unless there is clinical evidence of bleeding, it is not necessary to obtain vital signs every 2 hours. Children need stimulation that is appropriate for their developmental level except when acutely ill.

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)

C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.

Which intervention will be most helpful for the client with mucositis? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Mouth swabs are soft and disposable and therefore clean. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa.

Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back.

C. Radiation therapy that is directed in or around the oral cavity has a variety of actions that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are affected, which changes the composition of the person's saliva and often causes "dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In addition, the radiation damages the integrity of the enamel and also damages some of the living cells in the tooth. All contribute to an increased risk for dental infections and cavities.

The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.

Six weeks after hematopoietic stem cell transplantation for leukemia, the client's white blood cell (WBC) count is 8200/mm3. What is the nurse's best action in view of this laboratory result? A. Notify the health care provider immediately. B. Assess the client for other symptoms of infection. C. Document the laboratory report as the only action. D. Remind the client to avoid crowds and people who are ill.

C. The WBC count is now within the normal range (5000 to 10,000/mm3) and is an indicator of successful engraftment. The client is not at any particular risk for infection at this time, nor is there reason to believe an infection is present. (At any post-transplantation check-up, the client is assessed for infection.)

A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm

C. The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.

A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which of the following? a. Increased hematocrit level b. Increased hemoglobin level c. Decline of elevated temperature to normal d. Decreased oozing of blood from puncture sites and gums

D

A client with acute leukemia develops a low white blood cell count. In addition to the institute of isolation the nurse should: A. Request that food be served with disposable utensils B. Ask the client to wear a mask when visitors are present C. Prep IV with mild soap, water, and alcohol D. Provide foods in seal single serving packages

D

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

D. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat.

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill.

A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion? A. Warning the client about the possibility of fluid overload B. Monitoring the client's response, particularly within the first 10 minutes C. Adjusting the client's transfusion flow rate so that it infuses at a consistent rate during the procedure D. Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion

Transfusion reactions usually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. The risk of fluid overload is unlikely, and this information can be frightening. The donor's, not the recipient's, blood is tested for HIV. The flow rate should be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.

Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? select all that apply. A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing

a,c,d,e: Radiation therapy to any site produces fatigue,may cause clients to report changes in taste. Radiation side effects are site specific; the larynx is in this area, therefore changes in the skin may occur and dysphagia may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair.