Oncology/ Heme
Which client does the nurse determine has the highest risk for developing ovarian cancer?
60-year-old obese woman who has never been pregnant
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?
elevate head of bed 90 degrees
The nurse is conducting a health history for a client at risk for cancer. Which lifestyle factor is considered a risk for colorectal cancer?
high fat, low fiber
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?
"I floss my teeth every morning." --at risk for bleeding <40,000
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?
"I will have to take vitamin B12 shots up to 1 year after surgery."
A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when the client says
"The advance directive allows me to state my healthcare wishes while I'm still able to do so."
A nurse is reviewing the laboratory test results of a 3-year-old child. Which absolute neutrophil count would the nurse identify as indicating neutropenia?
1.0 less than 1.5
The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?
11-13 sec
Which client has the highest risk of ovarian cancer?
45-year-old woman who has never been pregnant
The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?
A 15-year-old adolescent who has heavy menstrual periods
When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?
Acute lymphoblastic leukemia (ALL)
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?
Administer broad-spectrum antibiotics intravenously.
After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?
Administer epinephrine.
A child develops treatment-related thrombocytopenia. When preparing the plan of care for the child, which would the nurse include? Select all that apply.
Applying pressure to a puncture site for a full 5 minutes Limiting the use of adhesive tape on the child's skin Administering medications orally or intravenously
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?
Deferasirox
A nursing instructor is describing childhood hematologic disorders to students. Which would the instructor include as being commonly affected by hematologic disorders? Select all that apply.
Erythrocytes Leukocytes Thrombocytes
After a lobectomy for lung cancer, the nurse instructs the client to perform deep breathing exercises. What is the expected outcome of these exercises?
Expand the alveoli and increase lung surface available for ventilation.
The nurse at the gynecologic clinic is teaching the client about the results of her Papanicolaou test, which demonstrated dysplasia. Which represents the nurse's best intervention?
Explain that the results show cervical changes that require follow up.
The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions are most important? Select all that apply.
Expose the irradiated area to air Administer antiemetics as prescribed Help the child devise "mind games" to play during the procedure
Parents have just been informed that their child has a malignancy. The mother breaks down in tears, while the father appears to be in shock. What is an appropriate nursing diagnosis for this family?
Fear related to diagnosis of cancer
A nurse is preparing a presentation for a parent group on childhood cancers. As part of the presentation, the nurse plans to discuss rhabdomyosarcoma. What are some common sites where rhabdomyosarcoma occurs? Select all that apply.
Head Neck Extremities
stage 1
In general, stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically
A client with a suspected diagnosis of lung cancer has a bronchoscopy with biopsy. What intervention should the nurse perform immediately after the procedure?
Monitor the client for signs of pneumothorax.
The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care?
Monitoring for allergic reactions or anaphylaxis.
When developing the plan of care for a client with aplastic anemia, the nurse should include which goal?
Perform activities of daily living without excessive fatigue or dyspnea.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important?
Placing a "no abdominal palpation" sign above the child's bed
The nurse is planning care for a client with acute myeloid leukemia (AML). What is an appropriate goal for this client?
Prevent hemorrhage -bleeding and infection are major complications and causes of death
The nurse is educating a client about allergy management at home. What information should the nurse include in the teaching? Select all that apply.
Put pull shades on windows. Use steam for heating.
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?
Reed-Sternberg cells
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child?
Risk for imbalanced nutrition, less than body requirements, related to inflammation
A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy?
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
stage 3
Stage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).
The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first?
Stay with the client during the first 15 minutes of infusion.
A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?
Testicular cancer is a highly curable type of cancer.
A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide
The cancer has spread in the brain itself but the chance of complete surgical removal is good.
A client who follows a vegetarian diet was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client needs further nutritional counseling?
The client drinks coffee or tea with meals.
In setting goals for a client with advanced liver cancer who has poor nutrition, which is a desired outcome for the client?
The client will maintain current weight.
The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors?
Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)
A client who is receiving chemotherapy develops stomatitis. What should the nurse instruct the client to do?
Use a soft-bristled toothbrush after each meal.
A nurse is monitoring a client who developed facial edema after receiving a medication by tablet. What should the nurse do next?
assess for SOB
Which mechanism is central to cancers in children?
cellular growth
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority?
emergent transfusion
A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client?
encouraging him to express his feelings nonverbally and in writing
Which lab values should the nurse report to the health care provider (HCP) when the client has anemia?
intrinsic factor, absent
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:
seizures
stage 2
stage II means there is some local spread but the chance for complete surgical removal is good
A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider?
vitamin B12 deficiency
The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?
Not to pick or irritate the nose
A physician performs a bone marrow aspiration from the posterior iliac crest on a client with a platelet count of 80,000 mm3. Which intervention should the nurse perform after the procedure?
Place pressure over the aspiration site for 5-10 minutes.
A client's husband expresses concern that his dying wife keeps saying, "I have to go to the store." Which statement by the nurse will be most effective in assisting the husband to understand the dying process?
"Comments related to going somewhere or leaving on a trip are common in dying clients."
A physician orders gentamicin sulfate, 80 mg I.V. every 8 hours for a client with Pseudomonas aeruginosa. The nurse should infuse this drug over at least:
30 minutes
A nurse applies standard precautions when caring for a client with human immunodeficiency virus (HIV). The nurse takes what action when applying standard precautions?
wearing gloves for providing mouth care
After one week in the hospital for chemotherapy treatment related to lymphocytic leukemia, a client develops abdominal pain, fever, and foul-smelling diarrhea. What priority recommendation does the nurse make to the healthcare provider?
Collect stool sample for Clostridium difficile.
A client with a nagging cough makes an appointment to see the healthcare provider. For what other signs or symptoms will the nurse assess as a priority?
change in voice and unexplained weight loss
A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity?
swimming in rivers or lakes
A nurse is giving preoperative instructions to a client who is scheduled for a breast biopsy. Which medication should the nurse instruct the client to stop 1 week before the procedure?
vitamin E
A medication nurse is preparing to administer 0900 medications to a client with liver cancer. Which consideration is the nurse's highest priority?
metabolism of the medication
A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?
nonmobile mass with irregular edges --breast cancers are fixed, hard, and poorly delinated w irregular edges
A nurse is assessing a woman who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client's health history, the nurse should ask the client which question?
"Have you had nausea or vomiting?"
A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply.
"I can apply an ice pack or a cold compress to the puncture site." "I will not be able to play basketball for the next 2 days." "I will take acetaminophen for pain."
A client has been informed of a diagnosis of cancer. Which client statement should the nurse address first?
"I need to end this before the cancer kills me."
A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement?
"I will need to take an iron supplement even if my laboratory values are normal."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
"I will receive parenteral vitamin B12 therapy for the rest of my life."
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?
"Red meat is a good option; he loves the hamburgers from the drive-thru."
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?
"She has been down, but playing in soccer camp will cheer her up."
The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate?
"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively."
The parents of a child diagnosed with low-grade cerebral astrocytoma ask the nurse about their child's prognosis. Which would be an accurate response?
"The prognosis is favorable with complete surgical resection, with minimal neurologic deficits postoperatively."
A client with a new diagnosis of human immunodeficiency virus (HIV) tells the nurse, "I did not think drinks, dinner, and great sex would lead to a life-threatening disease." Which of the following is a therapeutic response by the nurse?
"This sounds distressing for you. What questions do you have?"
A 1-year-old child is diagnosed with pernicious anemia due to lack of intrinsic factor and is prescribed vitamin B12 injections. After teaching the child's parents about this treatment, the nurse determines that the teaching was successful based on which statement?
"We will give the injection once a month for the rest of our child's life."
A client with lymphoma tells the nurse that a holistic practitioner has offered to treat the client with coffee enemas. How does the nurse respond?
"You should speak with your oncologist about this treatment."
----ONCOLOGY--------
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The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?
Calling the doctor if the child gets a sore throat
After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:
Factor VIII
Which factor places a client at greatest risk for skin cancer?
Fair skin and history of chronic sun exposure
The nurse is educating the parents of a 16-year-old boy who has just been diagnosed with Hodgkin disease. Which discussion is most appropriate at this time?
Describing the two ways of staging the disease.
A hospitalized client with end-stage heart failure does not want to be resuscitated. The health care provider (HCP) has written the do-not-resuscitate (DNR) prescription on the client's record. The client has a cardiac arrest, and the wife tells the nurse she wants the client to be resuscitated and asks the nurse to "do something." What should the nurse do?
Discuss the DNR prescription with the wife.
Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?
Disturbed sensory perception related to enucleation
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?
Ensure neutropenic precautions are in place.
A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?
Handle the child gently when transferring to a stretcher.
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?
Have the parent bring the child to the pediatric oncology clinic as soon as possible.
A client is newly diagnosed with cancer and is beginning a treatment plan. Which action by the nurse will be most effective in helping the client cope?
Identify available resources for the client and family.
During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?
Kaposi's sarcoma
The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?
One pupil appears white.
A client is taking doxorubicin and is distressed about hair loss. What should the nurse do?
Provide resources for a wig selection before hair loss begins.
A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?
Stop the transfusion, infuse normal saline solution, and call the physician.
The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics?
Telling the child exactly what to expect of further treatments.
The nurse is teaching a client about self-breast examination (SBE). Which pattern of palpation would the nurse encourage based on ACS recommendations?
The ACS recommends an up-and-down vertical pattern as the most effective pattern for covering the whole breast
A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs?
The child has redness or swelling at the central venous access site.
A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?
The client entered a clinical trial through the National Cancer Institute.
The health care provider prescribed an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?
They are cell cycle-nonspecific, destroying both resting and dividing cells.
The nurse is assessing a client with chronic hepatitis B who is receiving lamivudine. What information about the client is most important to communicate to the health care provider? You Selected:
a 3-kg weight gain over 2 days
A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice?
acetaminophen PRN
A client has an abnormal result on a Papanicolaou test. The client asks the nurse what dysplasia means. Which definition should the nurse provide?
alteration in the size, shape, and organization of differentiated cells
Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution?
anaphylactic reaction
A terminally ill client's husband tells the nurse, "I wish we had taken that trip to Europe last year. We just kept putting it off, and now I'm furious that we didn't go." The nurse interprets the husband's statement as indicating which stage of adaptation to dying?
anger
While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply.
antihystamine oxygen discontinue transfusion
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?
apply heat to the site of bleeding
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?
assessing LOC
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?
bladder
The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?
brush his or her teeth
The nurse will select which meal as the best choice for a child with iron-deficiency anemia?
cheeseburger, broccoli, and fresh strawberries
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include
chemotherapy exposure and risk factors.
Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor?
christmas factor
A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding?
compression
A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?
disseminated intravascular coagulation
While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. When notifying the health care provider, the nurse would identify the client's skin as having:
ecchymoses.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?
following guidelines for reverse isolation
Which risk factors will the nurse identify when screening infants for iron-deficiency anemia? Select all that apply.
frequent vomiting and regurgitation drinking 48 oz milk in a bottle daily maternal anemia during pregnancy birth prior to 37 weeks' gestation
A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?
graft-versus-host disease
Which factor is most important to assess when determining the impact of the cancer diagnosis and treatment modalities on a long-term survivor's quality of life?
individual values and beliefs
A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?
infection
Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?
inform the physician immediately
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)?
lethargy, bruises, and lymphadenopathy
Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for:
leukemic cells.
After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, the nurse prioritizes which nursing intervention?
monitoring temperature and blood cell count
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?
mucositis
A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the formation events in their proper sequence. What is the proper sequence?
multipotent stem cell myeloid progenitor megakaryocyte/erythroid progenitor megakaryocyte platelets
Which symptom is an early indication that the client's serum potassium level is below normal?
muscle weakness in the legs
87. A client is being treated with internal radium implants. The nurse should assess the client for which adverse effects associated with radiation therapy to the cervix?
nausea and a foul vaginal discharge.
The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of:
neuroblastoma.
A client was diagnosed with AIDS several years ago and now has a CD4 T-lymphocyte count of 110 units/L. Which outcome is appropriate for this client?
no development of opportunistic infections
The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment.
oral steroids and vincristine through an intravenous line high-dose methotrexate and 6-mercaptopurine low doses of 6-mercaptopurine and methotrexate chemotherapy through an intrathecal catheter
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?
painless, enlarged lymph node
A client with pancreatic cancer, who has been bed-bound for 3 weeks, has just returned from having a left subclavian, long-term, tunneled catheter inserted for administration of analgesics. The nurse has not yet received radiographic results for confirmation of placement. The client becomes restless and dyspneic and has chest pain radiating to the middle of the back. Physical assessment reveals tachycardia and absent breath sounds in the left lung. What should the nurse further assess?
pneumothorax
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
practice frequent, gentle oral hygiene
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?
prepare to administer factor replacement medication
The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis?
tachycardia and respiratory distress
A nurse is administering daunorubicin to a patient with lung cancer. Which situation requires immediate intervention?
the I.V. site is red and swollen
On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. What is most important for the nurse to include in discharge teaching?
the need for continued breast self-examination on the right breast
The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response?
the tumor is in the muscle
The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?
uncontrolled bleeding
A client was discharged from the hospital for cancer-related pain. While in the hospital the pain was well controlled on patient-controlled administration (PCA) of IV morphine, and on discharge 2 days ago was taking oral morphine. The client now reports pain as an 8 on a 10-point scale and is asking the nurse about using PCA for the morphine at home. Which explanation is the most likely for the client's reports of inadequate pain control?
undermedicated on the oral opioid.
A client with breast cancer received chemotherapy approximately 10 days ago. The complete blood count today is below. Which teaching is appropriate based on these laboratory results? white blood cells 5000/mm3 neutrophils 75% hemoglobin 13 g/dL, hematocrit 40% platelets 45,000/mm3
use an electric razor to shave
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?
"My finger joints are oddly shaped."
The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?
Antiemetic
A client with suspected cervical cancer had a colposcopy with conization. What information should the nurse give the client about her menstrual periods after this surgery?
Her next two or three periods may be heavier and more prolonged than usual.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?
Ineffective tissue perfusion related to poor platelet formation
A client had a total abdominal hysterectomy and bilateral oophorectomy for ovarian carcinoma yesterday. She received 2 mg of morphine sulfate IV by patient-controlled analgesia (PCA) 10 minutes ago. The nurse was assisting her from the bed to a chair when the client felt dizzy and fell into the chair. What should the nurse do next?
Take the client's blood pressure.
The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?
No routine live vaccines are administered while on chemotherapy.
A middle-aged female with a history of breast-conserving surgery, axillary node dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen. Which action should the nurse suggest?
See the health care provider immediately.
A child diagnosed with a malignancy is receiving long-term corticosteroid therapy as part of the chemotherapy regimen. The nurse would be especially alert for the development of which effect?
cushingoid facies-- develop a typical "moon face," red cheeks, and a stocky build
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
notify a health care provider if the child develops an upper respiratory infection.
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?
protect the abdomen from manipulation
A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding:
removal or covering of flaking paint on the walls of the home.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?
risk for bleeding related to insufficient platelet formation
A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects?
It inhibits deoxyribonucleic acid (DNA) synthesis.
A public health nurse is teaching a class for social workers serving at-risk clients from lower socioeconomic backgrounds about breast cancer prevention. A learner asks what can be done to better help these clients on a daily basis. The nurse advises that the most effective way of helping clients is to do what? Select all that apply.
Provide information on free screening programs. Provide education on breast cancer self exams.
The registered nurse (RN) must assign an unlicensed assistive personnel (UAP) to help care for an oncology client who is on neutropenic precautions. Which factor is most important in making this assignment?
The UAP has had cold symptoms for the last 2 days.
A client had a right pneumonectomy for lung cancer yesterday and now has dyspnea. What position in bed will be best for this client?
HOB elevated
When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which physiologic functions?
bleeding tendencies
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?
platelet count, prothrombin time, and partial thromboplastin time
A 25-year-old client taking hydroxychloroquine for rheumatoid arthritis reports difficulty seeing out of the left eye. What does this finding indicate?
possible retinal degeneration
The nurse interviews a client with systemic lupus erythematosus (SLE) who reports to the emergency department with severe back pain after a minor fall. What aspect of the client's medical history is most relevant to the potential cause of this injury?
prescription for prednisone
To help prevent hip flexion deformities associated with rheumatoid arthritis, the nurse should help the client assume which position in bed several times a day?
prone
A client diagnosed with metastatic cancer is preparing for discharge. The physician orders morphine sulfate controlled-release tablets 100 mg every 12 hours as needed after discharge. What legal rights and responsibilities should the nurse address when teaching the client about morphine sulfate use?
"Federal law prevents refills of this medication. Your physician will give you a new prescription when you need more medicine."
A nurse is preparing to administer a unit of blood to a client with anemia. After removal of the blood from the refrigerator, the transfusion of the blood must be completed within:
4 hours
A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which should be the primary focus of nursing care for this client?
Decrease cardiac demands by promoting rest.
The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. What is the most appropriate goal for this client?
Gradually increase activity tolerance.
A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that the client has warm, flushed, dry skin; a heart rate of 110 beats per minute; and a temperature of 101.8° F (38.8° C). Which is the nurse's next best action?
Notify the healthcare provider.
A client is taking nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain from rheumatoid arthritis. What instruction should the nurse give the client about NSAIDs?
Take the prescribed medication with food and fluids.
A client who is sexually active asks the nurse about using pre-exposure prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300 milligrams tenofovir disoproxil fumarate and 200 milligrams emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with HIV?
anyone who is in an ongoing sexual relationship with an HIV-infected partner
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
extravasation
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife uses which pain relief strategies? Select all that apply.
gives her husband a long-acting or sustained-release oral pain medication regularly around the clock uses an immediate-release medication (oxycodone) for breakthrough pain has her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal uses music for distraction as well as heat or cold in combination with medications
The nurse is teaching a client about risk factors for the development of colon cancer. What risk factor would the nurse include in the discussion?
history of inflammatory bowel disease
After a gastric cancer resection, a client is scheduled to undergo radiation therapy. What is the most important information the nurse should include in the discharge teaching plan?
how to maintain adequate nutrition
A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?
injury related to the decreased platelet count
A client must receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product?
normal saline solution as this is considered an isotonic solution
The nurse is teaching a client about preventing toxic shock syndrome (TSS). Which action is a risk factor for toxic shock syndrome?
only tampons at night
The nurse assesses the mouth and oral cavity of a client with human immunodeficiency virus (HIV) infection because the most common opportunistic infection initially presents with which symptom?
oral candidiasis -
A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for
pathologic bone fractures.
When conducting a focused assessment of the respiratory system, what should the nurse note as an early sign of laryngeal cancer?
persistent mild hoarseness
Which action is most important when the nurse is planning pain management for a client after a lobectomy for lung cancer?
reassessing the client after administering pain medication
After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which activity observed by the nurse indicates the need for additional teaching?
carrying a laundry basket with clinched fingers and fists exp-Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.
The nurse is conducting an initial nursing history of a client who is experiencing pain related to bone cancer. The most important information to gather in this initial assessment is the:
client's self-reporting of the pain experience.
A nurse notes the following laboratory values for a client receiving chemotherapy: white blood cell count 6000/µL, red blood cell count (RBC) 3.7 million cells/cm3, hematocrit 35%, platelet count 80,000 mm3. Which order would the nurse question?
rectal temp every 4 hours
A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom?
respiratory infection
In providing discharge teaching for the client after a modified radical mastectomy, the nurse should instruct the client to avoid:
working in her rose garden
A client receiving 5-fluorouracil is experiencing nausea and vomiting. What is the nurse's best course of action?
Administer ondansetron prior to administering the 5-fluorouracil.
A client with a history of pancreatic cancer is revived following cardiac arrest but is determined to have suffered brain death. The family tells the nurse they want to donate any usable body organs so their loved one can live on in others. Which action by the nurse is appropriate?
Call the local organ procurement representative to meet with them.
The daily white blood cell (WBC) count in a client with aplastic anemia drops overnight from 3,900 to 2,900/µl (3.9 to 2.9 X 109/L). Which is the appropriate nursing intervention?
Call the primary care provider, and request that the client be placed in reverse isolation.
When the client who has had a modified radical mastectomy returns from the operating room to the recovery room, what should the nurse do first?
Ensure that the client's airway is free of obstruction.
A client diagnosed with testicular cancer expresses concerns about fertility. The client and his spouse desire to eventually have a family, and the nurse discusses the option of sperm banking. What should the nurse tell the couple about the best time to donate the sperm?
before treatment is started
A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest?
bran muffin, skim milk, stir-fried broccoli --high fiber, low fat for colon cancer
The client who is receiving chemotherapy is not eating well but otherwise feels healthy. What should the nurse suggest the client eat?
broiled chicken, green beans, and cottage cheese
A nurse is caring for several clients on an oncology unit. Which client should the nurse see first?
client with a white blood cell count of 2000 µL
A client with AIDS develops a fever, severe headache, and stiff neck and begins to vomit. Family members state they have noticed that the client does not seem to be as alert and oriented as before. What is the nurse's priority intervention?
protecting the client's airway exp- Cryptococcus neoformans is a common opportunistic infection among clients with AIDS, and it causes neurologic disease. It is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures. The priority intervention is to make sure the client's airway is protected prior to any other interventions.
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/µl. What term should the nurse use to describe this low platelet count?
thrombocytopenia
A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client receives busulfan until their white blood cell (WBC) count falls to between 10,000/mm3 and 25,000/mm3. Then the drug is stopped. When should treatment resume?
when the WBC count rises to 50,000/mm3
The nurse is assessing a client who is suspected of being in the early symptomatic stages of human immunodeficiency virus (HIV) infection. Which indication of infection should the nurse detect during this stage?
whitish yellow patches in the mouth
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
"I'm worried I'll expose my family members to radiation."
A client receiving a blood transfusion begins to have chills and headache within the first 15 minutes of the transfusion. What should the nurse do first?
discontinue the transfusion
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
inspecting the skin for petechiae once every shift
The nurse understands that the client who is undergoing induction therapy for leukemia needs additional instruction when the client makes which statement?
"I cannot wait to get home to my cat!"
