Oncology Practice Questions
What are the priority care issues during chemotherapy? Select all that apply. A. Resources available for the nurse B. Handling the chemotherapy drugs C. Managing the client's complications D. Protecting the client from side effects E. Treatment areas in which to serve clients
C, D Managing the client's complications and protecting the client from side effects are the high-priority care issues to be considered during chemotherapy. Handling resources available for the nurse, the chemotherapy drugs, and the treatment areas in which to serve clients can be managed by effective planning of the healthcare team.
A client with newly diagnosed multiple myeloma asks, "How long do you think I have to live?" What is the most appropriate response by the nurse? A. "Let me ask your primary healthcare provider for you." B. "I can understand why you are worried." C. "Tell me about your concerns as of the moment." D. "It depends on whether the tumor has spread."
C The response, "Tell me about your concerns as of the moment," encourages the client to review facts and provides an opportunity to talk about feelings. While clients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. Their anxiety may arise from myths and misconceptions about cancer. Correcting those misconceptions can help to minimize their anxiety. Avoid communication patterns that may hinder exploration of feelings and meaning, such as providing false reassurances, redirecting the discussion, generalizing, and using overly technical language as a means of distancing yourself from the client. These self-protective strategies deny clients the opportunity to share the meaning of their experience. In addition, they can jeopardize your ability to build a trusting relationship with your clients. The response, "Let me ask your primary healthcare provider for you," suggests the nurse does not want to discuss the subject; it abdicates the nurse's responsibility to explore the issue with the client. Although it is an empathic answer, the response, "I can understand why you are worried," does not encourage the client to explore feelings; it may increase anxiety. Although the statement, "It depends on whether the tumor has spread," is true, the response does not encourage the client to examine feelings.
The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. A. Monitor for signs of alopecia. B. Encourage an increase in fluids. C. Wash hands before entering the client's room. D. Advise use of a soft toothbrush for oral hygiene. E. Report an elevation in temperature immediately. F. Encourage the client to eat raw, fresh fruits and vegetables.
C, D, E It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.
The nurse is teaching a post-radiation therapy client regarding proper skin care to the radiation treatment area. Which statement made by the client indicates the nurse needs to follow up? A. "I will avoid wearing tight-fitting clothing." B. "I will avoid using adhesive bandages." C. "I will avoid exposing the area to cold temperatures." D. "I will avoid rinsing the area with the saline solution."
D A client who underwent radiation therapy should rinse the radiation treatment area with saline solution to prevent infection. Therefore the nurse should follow up to correct the misconception of not using saline. Tight-fitting clothing such as brassieres and belts should be avoided in the area of the treatment field. The use of adhesive bandages should be avoided and should not be used unless permitted by the radiation therapist. The radiation treatment area should not be exposed to cold temperatures.
A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy? A. Platelets B. Hemoglobin level C. Red blood cell count D. White blood cell count
D Antineoplastic drugs depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (RBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of packed red blood cells.
A client is diagnosed with multiple myeloma. What does the nurse expect the plan of care to include? A. Radiotherapy on an outpatient basis B. Human leukocyte interferon therapy C. Surgery to remove the invasive lesions D. Chemotherapy employing a combination of drugs
D Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic drugs affect rapidly dividing cells at different stages of cell division. Although radiotherapy on an outpatient basis may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach. Although human leukocyte interferon therapy may be done, it is not the primary treatment. Multiple myeloma is a diffuse disorder of the bone, and no single lesion can be removed.
When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so sick to my stomach. The medication is useless." What is the best response by the nurse that uses the technique of paraphrasing? A. "You get sick to your stomach." B. "Tell me more about how you feel." C. "I'll get a prescription for an antiemetic." D. "You don't think the medication is helping you."
D Rewording of the client's statement is paraphrasing that promotes further verbalization. The response "You get sick to your stomach" is not paraphrasing; this repeats the client's exact words. The response "Tell me more about how you feel" is clarifying, a therapeutic technique; it is not paraphrasing. The response "I'll get a prescription for an antiemetic" is not an interviewing technique; it does not address the theme in the client's statement, and it cuts off communication.
A client with the diagnosis of breast cancer is scheduled to receive radiation therapy to the affected area. The nurse teaches the client about how to care for the area that will be irradiated. Which client statement indicates the nurse needs to follow up? A. "I will leave the skin markings intact." B. "I will protect the skin from sources of heat." C. "I will wear soft clothing over the upper body." D. "I will use an oatmeal-based lotion after each treatment."
D While undergoing radiation therapy, lotions, powders, and ointments should not be applied to the area. The skin markings should not be removed, because they form the parameters for the delivery of radiation. To protect the irradiated skin, sunlight and heat should be avoided. Nonirritating clothing should be worn over the area to prevent trauma to the delicate irradiated skin.
A client with multiple myeloma asks how the disease and therapy progresses. What would be appropriate to include in the client's teaching? A. Blood transfusions may be necessary. B. Frequent urinary tract infections may result. C. Intravenous (IV) fluid therapy may be administered in the home. D. The disease is exacerbated by exposure to ultraviolet rays.
A Blood products (packed red blood cells [RBCs] or platelets) are administered when warranted. Renal insufficiency, not infections, may occur because of chronic hypercalcemia, proteinemia, and hyperuricemia. Fluid replacement should be provided in carefully supervised clinical settings, because if dehydration occurs it may result in renal shutdown. Ultraviolet rays are not related to exacerbations.
An adolescent with acute lymphocytic leukemia (ALL) completes parenteral chemotherapy, and the healthcare provider prescribes mercaptopurine. The nurse teaches the adolescent about this medication. What statement indicates that the adolescent has understood the information? A. "This will help prevent a relapse." B. "I guess I'll need an intravenous line for this drug." C. "I guess this drug is a substitute for brain radiation." D. "This will stop the cancer from spreading to my stomach."
A Mercaptopurine is given as maintenance therapy to prevent relapses. Mercaptopurine is an oral medication. Oral chemotherapy is an adjunct to other therapies in childhood leukemia, not an alternative for other therapies. The prime site of metastasis of ALL is the central nervous system.
A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do considering the side effects of radiation? A. Observe the feces for the presence of blood. B. Monitor the blood pressure for hypertension. C. Administer enemas to remove sloughing tissue. D. Provide a high-bulk diet to prevent constipation.
A Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.
A nurse obtains a health history from the parents of a toddler who is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What problems does the nurse expect the parents to report? Select all that apply. A. Loss of appetite B. Sores in the mouth C. Paleness of the skin D. Inability to fall asleep E. Purplish spots on the skin
A, C, E Anorexia, a presenting symptom of ALL, may be the result of enlarged lymph nodes, areas of inflammation in the intestinal tract, and catabolism. Pallor is another presenting sign of ALL; the number of red blood cells (RBCs) is decreased (anemia) because of bone marrow depression. Decreased platelet production results in bleeding tendencies; petechiae often are a presenting sign of ALL. Sores in the mouth are not a presenting sign of ALL but often result from chemotherapy. Because of bone marrow depression there is a reduced number of RBCs and therefore less oxygen being carried to body cells. The child will be lethargic and sleep excessively.
The registered nurse observes the student nurse caring for the skin of the client who recently underwent radiation therapy. Which actions made by the student nurse should the nurse correct? Select all that apply. A. Using a washcloth for cleaning the radiated site B. Rinsing soap thoroughly from the skin of the client C. Drying the irradiated area with rubbing motions D. Wearing loose clothing over the skin at the radiation site E. Removing the ink marks that identify the location of the focused beam of radiation
A, C, E The nurse should use a hand rather than a washcloth when cleansing the radiated site. This is to provide gentle care to the site. The irradiated area should be dried using patting motions rather than rubbing motions. The ink marks present on the site exactly identify where the location of beam radiation is to be focused. The nurse should take care not to remove these. The skin of the client should be thoroughly rinsed using a mild soap as prescribed by the radiation oncology department. The client's clothing should be loose over the radiation site.
A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which types of care will now be removed from the treatment plan? Select all that apply. A. Chemotherapy B. Repositioning C. Regular oral care D. Blood transfusion E. Radiation therapy
A, D, E Palliative care is a combination of care provided when cure is not possible for a chronic disease. It may include symptom management and comfort measures. Chemotherapy, radiation therapy, and blood transfusions are a part of palliative care meant to alleviate symptoms and promote well-being. These therapies may not be required in a client who is about to die and is receiving end-of-life care. End-of-life care comprises measures to make the client as comfortable as possible. It may include measures such as regular oral care and repositioning.
After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, what advice should the nurse share about alopecia characteristics? A. Usually rare B. Not permanent C. Frequently prolonged D. Sometimes preventable
B Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the drugs are being received; once the drugs are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.
A client with Hodgkin disease is started on chemotherapy. The nurse teaches the client to notify the healthcare provider to seek treatment for which adverse response to chemotherapy? A. Hair loss B. Sores in the mouth C. Moderate diarrhea after treatment D. Nausea for 6 hours after treatment
B Stomatitis is a common response to chemotherapy and should be brought to the healthcare provider's attention because a swish-and-swallow anesthetic solution can be prescribed to make the client more comfortable. Hair loss is also anticipated with some chemotherapeutic drugs; the effects are temporary and reversible. Moderate diarrhea is expected and is not a cause for concern unless dehydration results. Nausea is expected but should be reported if it lasts more than 24 hours.
A client has a tentative diagnosis of Hodgkin disease. How does the nurse expect the diagnosis to be confirmed? A. Bone scan B. Lymph node biopsy C. Computed tomography (CT) scan D. Radioactive iodine ( 131I) uptake study
B The diagnosis depends on the identification of characteristic histologic features of an excised lymph node. A bone scan is a diagnostic device to assess bony metastasis of cancers. CT scans identify the extent of the disease in the abdominal and thoracic cavities. A radioactive iodine ( 131I) uptake study is not indicated for Hodgkin disease; it is used for radiotherapy or diagnosis of thyroid diseases.
A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? A. Steroid hormones have a depressant effect on the spleen and bone marrow. B. Lymph node activity is depressed by radiation therapy used before chemotherapy. C. Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. D. Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.
C Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.
A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? A. Platelets B. Hematocrit C. Red blood cells (RBCs) D. White blood cells (WBCs)
D Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.
A client with Hodgkin disease enters a remission period and remains symptom free for 6 months before a relapse occurs. The client is diagnosed at stage IV. What therapy option does the nurse expect to be implemented? A. Radiation therapy B. Combination chemotherapy C. Radiation with chemotherapy E. Surgical removal of the affected nodes
B A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols generally are used. Radiation, alone or in combination with chemotherapy, is used in stages IA, IB, IIA, IIB, and IIIA. Radiation with chemotherapy is recommended for use in stage IIIA. Surgical removal of the affected nodes is not a therapy for Hodgkin disease at any stage. The nodes may be removed for biopsy or irradiated as part of therapy.
Which group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? A. Children B. Older adults C. Young adults D. Middle-aged persons
B The incidence increases with age; the disease is more common in men and older adults. Younger individuals have a lower incidence of non-Hodgkin lymphomas.
What is the nurse primarily attempting to prevent when caring for a client in the initial stages of chronic lymphocytic leukemia (CLL)? A. Injury B. Fatigue C. Infection D. Cachexia
C Although lymphocytosis is always present, defects in humoral and cellular immunity increase the risk for infection. Injury becomes an issue later in the disease when thrombocytopenia may develop. Fatigue becomes an issue later in the disease when anemia may develop. Although excessive weight loss is a concern, it does not pose the same threat as infection for clients with CLL
A client receiving chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy should the nurse consider when formulating a response? A. Liver B. Blood C. Bone marrow D. Lymph nodes
C Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.
A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply. A. Nausea B. Melena C. Purpura D. Diarrhea E. Hematuria
B, C, E Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Nausea and vomiting are not related to thrombocytopenia; they occur because of the effect of chemotherapy on the rapidly dividing cells of the mucous membranes of the gastrointestinal system. Diarrhea may be a side effect of chemotherapy, but it is not a thrombocytopenic side effect.
A client is receiving combination chemotherapy for treatment of metastatic carcinoma. For which systemic side effect should the nurse monitor the client? A. Ascites B. Nystagmus C. Leukopenia D. Polycythemia
C Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.
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. A. Pallor B. Fatigue C. Jaundice D. Multiple bruises E. Generalized edema
A, B, D Sorry I forgot to copy the Rationale :/
A young adult male client is undergoing tests to confirm the diagnosis of Hodgkin lymphoma. The wife states, "Don't you think it is unlikely for someone like my husband to have cancer?" The nurse's response is based on what information about Hodgkin lymphoma? A. More likely to affect women than men B. Diagnosed during adolescence and young adulthood C. Primarily a disease of older rather than younger adults D. Common among populations of Asian heritage
B Hodgkin lymphoma occurs most often between the ages of 15 and 35 years and above 55 years of age. Hodgkin lymphoma is twice as prevalent in men as in women. The incidence of Hodgkin lymphoma is not limited to people in older age groups. The prevalence of Hodgkin lymphoma is increased in teenagers and young adults (15 to 30 years of age). No mention of a cultural prevalence related to the development of Hodgkin lymphoma.
A client with a history of chronic myelogenous leukemia and splenomegaly is admitted to the hospital. What should the nurse expect to identify when completing the admission assessment? A. Increased urinary output B. Tender mass in the left upper abdomen C. Elevated erythrocytes, platelets, and granulocytes D. Polydipsia, increased appetite, and urinary frequency
B Splenomegaly usually accompanies chronic myelogenous leukemia; the spleen usually is gross, palpable, and tender and necessitates removal. The spleen is located high in the abdomen on the left side and usually is not palpable unless it is enlarged. The urinary output is not affected with these conditions. With leukemia and splenomegaly there is increased destruction of blood cells; the erythrocyte count will be low. Polydipsia, increased appetite, and urinary frequency are not associated with leukemia or splenomegaly, but rather diabetes.
Which diagnostic test is performed under general anesthesia to detect non-Hodgkin lymphoma and requires the client to sign an informed consent form? A. A thoracentesis B. A bronchoscopy C. A mediastinoscopy D. Computed tomography (CT)
C A mediastinoscopy is a surgical procedure that requires the client to sign an informed consent form. This procedure is performed under general anesthesia and is used to detect non-Hodgkin lymphoma. A thoracentesis is a diagnostic procedure used to obtain a specimen of pleural fluid for diagnosis, to remove pleural fluid, or to instill medication. A bronchoscopy is used to diagnose a condition, to biopsy, to collect a specimen, or to suction mucous plugs, and remove foreign objects. Computed tomography (CT) is performed to diagnose lesions difficult to assess via conventional X-ray studies.
Parents are considering a bone marrow transplant for their child who has recurrent leukemia. The parents ask the nurse for clarification about the procedure. What is the best response by the nurse? A. "Bone marrow transplantation is rarely performed in children these days." B. "The hematopoietic stem cells are surgically implanted in the bone marrow." C. "Your child's immune system must be destroyed before the transplantation can take place." D. "It is a simple procedure with little preparation needed, and the stem cells are infused as in a blood transfusion."
C An intensive preparatory regimen is needed to destroy the child's immune system. The procedure is performed in children for recurrent malignancies. Once the process is started, no rescue therapy except for the transplant is provided. The child's bone marrow must be clear of all cells before transfusion of the stem cells is performed.
A nurse is performing an assessment on a client with probable acute lymphocytic leukemia (ALL). Which clinical manifestation will the nurse expect to be present? A. Alopecia B. Insomnia C. Ecchymosis D. Hypertension
C Bleeding tendencies occur because of bone marrow suppression and rapidly proliferating leukocytes. Alopecia is associated with chemotherapy; there is no change in hair with leukemia. The client more likely will be sleeping excessively. Hypertension is not a clinical manifestation of leukemia.
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. A. Fever B. Diarrhea C. Headache D. Hematuria E. Ecchymosis
C, D, E Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes headache (bleeding into brain tissue), hematuria (bleeding within the renal system) and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy, but are not findings specifically attributed to thrombocytopenia.
A nurse teaches about osteochondroma. Which information should the nurse include in the teaching session? A. It is a common malignant tumor. B. It occurs most often in the age group of 10 to 25. C. It has a high rate of local occurrence after surgery. D. It frequently arises in cancellous ends of arm and leg bones.
B tumor. Osteoclastoma has a high rate of local occurrence after surgery and chemotherapy. Osteoclastoma frequently arises in cancellous ends of arm and leg bones; osteocondroma occurs in the metaphyseal portion of long bones.
A client who has bone pain of insidious onset is suspected of having multiple myeloma. The nurse expects which diagnostic finding specific for multiple myeloma? A. Occult blood in the stool B. Low serum calcium levels C. Bence Jones protein in the urine D. Positive bacterial culture of sputum
C Bence Jones protein (globulin) results from tumor cell metabolites. It is present in clients with multiple myeloma. Occult blood in the stool is not specific for the diagnosis of multiple myeloma; it is a late complication of multiple myeloma related to coagulation defects. Hypercalcemia, not hypocalcemia, occurs with multiple myeloma because of bone erosion. Multiple myeloma is not caused by a bacterial infection.
An adolescent with leukemia is to be given a chemotherapeutic agent that is known to cause nausea and vomiting. When is the best time for the nurse to administer the prescribed antiemetic? A. Before each dose of chemotherapy B. As nausea occurs C. 1 hour before meals D. Just before each meal is eaten
A The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.
Which statements are true regarding chondrosarcoma? Select all that apply. A. Chondrosarcoma can arise from benign bone tumors. B. Chondrosarcoma develops in the medullary cavity of long bones. C. Chondrosarcoma is mostly treated by radiation and chemotherapy. D. Chondrosarcoma occurs mostly in young males between ages 10 and 25 years. E. Chondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones.
A, E Chondrosarcoma is a malignant type of bone tumor that can arise from benign bone tumors. Chrondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones. Ewing's sarcoma develops in the medullary cavity of long bones. Chondrosarcoma is mostly treated by wide surgical resection. Chondrosarcoma occurs mostly in older adults between ages 50 and 70 years.
What is the most definitive test to confirm a diagnosis of multiple myeloma? A. Bone marrow biopsy B. Serum test for hypercalcemia C. Urine test for Bence Jones protein D. X-ray films of the ribs, spine, and skull
A A definite confirmation of multiple myeloma can be made only through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction. Although calcium is lost from bone tissue and hypercalcemia results, this is not a confirmation of the disease. Although Bence Jones protein is found in the urine, it does not confirm the disease. X-ray films will show the characteristic "punched-out" areas caused by the increased number of plasma cells, which contributes to the making of the diagnosis. The definitive diagnosis is made on biopsy.
A client with multiple myeloma who is receiving chemotherapy has a temperature of 102.2° F (39° C). The temperature was 99.2° F (37.3° C) when it was taken 6 hours ago. What is a priority nursing intervention in this case? A. Assess the amount and color of urine; obtain a specimen for a urinalysis. B. Administer the prescribed antipyretic and notify the primary health care provider. C. Note the consistency of respiratory secretions and obtain a specimen for culture. D. Obtain the respirations, pulse, and blood pressure; recheck the temperature in 1 hour.
B Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.
A client receiving chemotherapy takes a steroid daily. The client has a white blood cell count of 3,600/mm 3 and a red blood cell count of 4.5 million/mm 3. What is the priority instruction that the nurse should teach the client? A. Omit the daily dose of prednisone. B. Avoid large crowds and persons with infections. C. Shave with an electric shaver rather than a safety razor. D. Increase the intake of high-protein foods and red meats.
B Moderate leukopenia increases the risk of infection; the client should be taught protective measures. Leukopenia is a side effect of cyclophosphamide, not prednisone. The platelet count has not been provided, so bleeding precautions are not indicated. Increasing the intake of high-protein foods and red meat are measures to correct anemia; protection from infection takes priority.
A primary healthcare provider recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. What should the nurse suggest they discuss? A. Causes of cancer and details about the treatment B. Chemotherapy and the possibility of an amputation C. The amputation and information about chemotherapy D. Treatment choices and that it is too soon for a final decision
C Honesty is essential in helping the adolescent accept the loss of the leg; only a brief discussion of chemotherapy is needed, because otherwise the adolescent may be overwhelmed. A theoretical discussion and detailed information will not be heard or understood during a crisis situation. The amputation is necessary; lying avoids the issue and may destroy the adolescent's trust in parents and staff.
A client who underwent chemotherapy has leukopenia. Which instruction from the nurse will be beneficial for the client? A. "You should avoid exposure to the sun." B. "You should eat high-fiber foods and increase fluid intake." C. "You should avoid large crowds and people with infections." D. "You should consume iron supplements and erythropoietin."
C Low levels of white blood cells are called leukopenia. A leukopenic client should avoid large crowds and people with infection as the client may contract infection due to compromised immunity. The suggestion of avoiding exposure to the sun would be beneficial for a client with chemotherapy-induced skin changes. The suggestion of eating high-fiber foods and increasing fluid intake would be beneficial for a client with constipation after chemotherapy. Consuming iron supplements and erythropoietin would be required for a client who developed anemia after chemotherapy.
