Sem 3 - Unit 2 - Cellular Regulation - NCO

A laboratory report shows that a client tested positive for human epidermal growth factor (HER), and a medical report reveals the presence of advanced breast cancer. Which medication would be used to treat this condition? 1 Erlotinib 2 Lapatinib 3 Rituximab 4 Tositumomab

2 Lapatinib HER-2 is overexpressed in clients with advanced breast cancer. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Rituximab and tositumomab are administered to treat non-Hodgkin's lymphoma.

A client with metastatic breast cancer is started on a multiple drug regimen that includes docetaxel. The nurse assesses the client for which nontherapeutic effects of docetaxel? Select all that apply. 1 Alopecia 2 Constipation 3 Febrile neutropenia 4 Increased blood pressure 5 Hypersensitivity reaction

1 Alopecia 3 Febrile neutropenia 5 Hypersensitivity reaction Alopecia is a nontherapeutic response to docetaxel. Docetaxel affects interphase and mitosis of the cell cycle. Febrile neutropenia is a common nontherapeutic effect. Clients should concurrently receive a growth factor support agent such as pegfilgrastim when given a regimen of docetaxel. Hypersensitivity reactions (e.g., flushing, rash, local eruption) are common nontherapeutic reactions, particularly within the first few minutes of the infusion. Minor reactions do not require discontinuation of the therapy. Nausea, vomiting, and diarrhea, not constipation, are nontherapeutic effects of docetaxel. Hypotension, not hypertension, is a nontherapeutic effect of docetaxel.

A client who is suspected of having leukemia has a bone marrow aspiration. What should the nurse do Immediately after the procedure? 1 Apply brief pressure to the site. 2 Have the client lie on the affected side. 3 Swab the site with an antiseptic solution. 4 Monitor vital signs every hour for 4 hours

1 Apply brief pressure to the site. Brief pressure is generally enough to prevent bleeding at the aspiration site. Complications are rare; no special positions are required. The site is cleaned before aspiration. Frequent monitoring is unnecessary.

A nurse is obtaining a health history from the parents of a toddler who has recently been diagnosed with acute lymphocytic leukemia. Which early physiologic changes does the nurse expect the parents to report? Select all that apply. 1 Pale skin 2 Loss of hair 3 Eating less food 4 Sores in the mouth 5 Purplish spots on the skin

1 Pale skin 3 Eating less food 5 Purplish spots on the skin Pallor is a presenting sign of leukemia and reflects anemia because of decreased erythrocytes. Lack of appetite (anorexia) resulting in the consumption of less food is a presenting symptom of leukemia; it may be the result of enlarged lymph nodes and areas of inflammation in the intestinal tract. Decreased platelet production with petechiae and bleeding is a presenting sign of leukemia. Alopecia results from chemotherapy, not the leukemia. Sores in the mouth are not a presenting sign but often result from chemotherapy.`

A client who is to undergo a mastectomy for breast cancer tells the nurse that she is worried about what she will look like after the surgery. What is the most appropriate initial response by the nurse? 1"I understand that you'd be concerned." 2 "Try not to think about the surgery now." 3 "Everyone having this surgery feels the same way." 4 "Perhaps you should discuss this with your husband."

1"I understand that you'd be concerned." Women facing breast surgery often have feelings relating to their sexuality and change in body image; the nurse plays a vital role in helping the client verbalize feelings, and this response keeps channels of communication open. The client's concerns are real, and a statement such as "Try not to think about the surgery now" will only block further communication. The response "Everyone having this surgery feels the same way" does not focus on the importance of the client as an individual; each person feels differently. The response "Perhaps you should discuss this with your husband" can be interpreted as the nurse's reluctance to listen; the client may not be able to talk with the husband about this.

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. 1 Nausea 2 Melena 3 Purpura 4 Diarrhea 5 Hematuria

2 Melena 3 Purpura 5 Hematuria 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.

The parents of a school-aged child with leukemia ask the nurse why irradiation of the spine and skull is necessary. What is the most accurate response by the nurse? 1 "Radiation retards the growth of cells in the bone marrow of the cranium." 2 "This therapy decreases cerebral edema and prevents increased intracranial pressure." 3 "Leukemic cells may invade the nervous system, but the usual drugs are ineffective in the brain." 4 "Neoplastic drug therapy without radiation is effective in most cases, but this is a precautionary treatment."

3 "Leukemic cells may invade the nervous system, but the usual drugs are ineffective in the brain." The protective blood-brain barrier initially screens leukemic cells from the central nervous system. However, in advanced stages leukemic infiltration occurs. Chemotherapeutic agents, also screened out by the blood-brain barrier, are ineffective. Radiation destroys, not just retards, malignant cells. Radiation does not decrease cerebral edema. Irradiation of the cranium is needed because chemotherapy does not pass the blood-brain barrier.

A client responds well after extensive pulmonary surgery for lung cancer and is discharged. A week after discharge the home care nurse observes the client's downcast eyes and lack of interest in the environment. The client's family states that this behavior started a few days after discharge. How should the nurse interpret these findings? 1 Unusual, indicating mental illness 2 Normal, and no follow-up is required 3 Expected, but needs to be addressed 4 Serious, needing immediate acute care

3 Expected, but needs to be addressed Depression is an expected part of grieving that requires supportive care. Although depression is a normal response, intervention is necessary because it cannot be assumed that the depression will be of short duration. Depression is an expected response to the diagnosis of cancer; it does not indicate mental illness. Unless the client is suicidal, immediate acute care is not indicated.

On admission, the laboratory results of a client with leukemia indicate elevated blood urea nitrogen (BUN) and uric acid levels. What would the nurse determine that these laboratory results may be related to? 1 Lymphadenopathy 2 Thrombocytopenia 3 Hypermetabolic status 4 Hepatic encephalopathy

3 Hypermetabolic status The hypermetabolic state associated with leukemia causes more urea and uric acid (end products of metabolism) to be produced and to accumulate in the blood. Enlarged lymph nodes will not increase blood urea and uric acid. Thrombocytopenia causes a decrease in platelets, which causes bleeding. Hepatic encephalopathy is associated with liver disease, not leukemia. `

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? 1 "I will leave the skin markings intact." 2 "I will protect the skin from sources of heat." 3 "I will wear soft clothing over the upper body." 4 "I will use an oatmeal-based lotion after each treatment.

4 "I will use an oatmeal-based lotion after each treatment. 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 oat-cell lung cancer is scheduled for a mediastinoscopy and biopsy. What should the nurse include in the client's education? 1 Chest tubes will be in place after the procedure. 2 The procedure will visualize the mainstem bronchus. 3 Some pleural fluid will be removed during the procedure. 4 The procedure is an endoscopic examination of lymph nodes.

4 The procedure is an endoscopic examination of lymph nodes. A mediastinoscopy is an endoscopic examination of mediastinal lymph nodes through a small suprasternal incision; this generally is done to diagnose mediastinal involvement of pulmonary malignancy or other conditions. Chest tubes are not required unless the lungs are accidentally punctured. A bronchoscopy permits visualization of the mainstem bronchus. Fluid is removed from the pleural space during a thoracentesis.

A 9-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). What early signs and symptoms of leukemia does the nurse expect to identify? Select all that apply. 1 Flushing 2 Anorexia 3 Limb pain 4 Splenomegaly 5 Mouth lesions

2 Anorexia 3 Limb pain 4 Splenomegaly Hypermetabolism associated with the leukemic process results in loss of appetite. Bone marrow dysfunction and invasion of the periosteum result in bone pain. Infiltration, enlargement, and fibrosis of the spleen occur early in the disease process as the excess white blood cells are trapped. Flushing is not expected. Bone marrow dysfunction results in anemia, and pallor accompanies the decreased erythrocyte count. Mouth lesions (stomatitis) occur later during the disease process or as a result of chemotherapy.

The nurse is providing postoperative care to a client with lung cancer who had a partial pneumonectomy. When inspecting the client's dressing, the nurse notes puffiness of the tissue around the surgical site. When the nurse palpates the site, the tissue feels spongy, and crackles can be felt. How does the nurse describe this assessment finding? 1 Stridor 2 Crepitus 3 Pitting edema 4 Chest distention

2 Crepitus There is air in the tissues, and palpation results in a crackling sound referred to as crepitus. Stridor is a harsh, high-pitched sound usually produced on inspiration because of airway obstruction. Pitting edema is excessive accumulation of fluid in tissue spaces. The size of the chest is determined by the bony structure; a barrel chest with an increase in the anteroposterior (AP) diameter is associated with chronic obstructive pulmonary disease (COPD), not cancer of the lung.

A nurse is performing an assessment on a fifth-grader who has been admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What early clinical findings does the nurse expect to identify? 1 Nosebleeds and papilledema 2 Fatigue and ecchymotic areas 3 Abdominal pain and reddened complexion 4 Enlargement of the axillary and groin lymph nodes

2 Fatigue and ecchymotic areas Fatigue and ecchymoses are early clinical findings to ALL. They are caused by decreased white blood cell, red blood cell (RBC), and platelet production that results when the bone marrow is crowded with abnormal lymph cells. Although epistaxis does occur, papilledema is not a common presenting sign because the blood-brain barrier is an initial deterrent. Pain is not an early symptom of ALL. The skin will be pale, not reddened, because of a decreased RBC count. Enlargement of lymph nodes in the axillae and groin is a sign of lymphoma or a late, not early, sign of leukemia.

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

2 Listlessness 5 Bone marrow depression Listlessness in a child with leukemia is caused by anemia; anemia is expected in children with leukemia because of generalized bone marrow depression. Depressed bone marrow production of formed elements of blood is characteristic of nonlymphoid leukemia; it leads to neutropenia and increases susceptibility to infection. Urine output will be within expected limits; there is no kidney involvement at this stage of the disease. There are more, not fewer, stem cells in the peripheral blood and bone marrow; the production of mature blood cells is depressed. The swallowing reflex is not affected.

A nurse is caring for a school-aged child with acute lymphoid leukemia. While examining the child's laboratory results, the nurse notes that the child is neutropenic. What does the nurse recognize as the cause of the neutropenia? 1 Internal bleeding 2 Overwhelming infection 3 Increased immature cell growth 4 Decreased intake of iron-rich nutrients

3 Increased immature cell growth Extensive growth of lymphoblasts suppresses the usual growth of red cells, white cells, and platelets. Internal bleeding does not cause neutropenia. Infection is a result, not the cause, of leukopenia. An iron-intake deficit will not result in neutropenia.

A client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana will help. What is the nurse's best response? 1 "Smoking marijuana is not legal in any state." 2 "Marijuana is effective for nausea and vomiting if it is injected." 3 "Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting." 4 "Tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people."`

4 "Tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people." Tetrahydrocannabinol, an ingredient in marijuana, acts as an antiemetic in some persons and can be absorbed through the gastrointestinal tract or inhaled. The statement "Smoking marijuana is not legal in any state" does not answer the client's question and is inaccurate. Marijuana is not injected. Tetrahydrocannabinol, an ingredient in marijuana, is an effective antiemetic for some clients.

A client with a tentative diagnosis of lung cancer is scheduled for a mediastinoscopy with biopsy. Which is a priority nursing action? 1 Tell the client that chest tubes will be present after the procedure. 2 Explain that the procedure will allow visualization of lungs and chest cavity. 3 Inform the client that some pleural fluid will be removed during this procedure. 4 Advise the client to avoid eating or drinking anything for several hours before the test.``

4 Advise the client to avoid eating or drinking anything for several hours before the test. To prevent aspiration during the procedure, clients are required to be nothing by mouth before the procedure. Chest tubes are not required unless the lungs are punctured accidentally. A mediastinoscopy permits visualization of the anterior mediastinum or hilum extrapleurally; bronchoscopy permits visualization of the larynx, trachea, and bronchi. Fluid is removed from the pleural space during a thoracentesis.

The parents of a child who is undergoing chemotherapy for acute lymphocytic leukemia (ALL) ask the nurse about the prognosis of children with this diagnosis. What does the nurse respond is the expected outcome for children with this type of leukemia? 1 Guarded, but the therapy keeps them pain-free 2 Limited to a few months in most of the children affected 3 Positive, with probable cure in 95% of the children affected 4 Extended to at least 5 years in more than 75% of the children treated

4 Extended to at least 5 years in more than 75% of the children treated Five-year disease-free survival rates for children with ALL are currently 75% to 85%. The long-term prognosis of a 95% cure rate is too favorable, although this is the percentage of children who achieve the first remission. The other projected prognoses (guarded, limited to a few months) are too pessimistic.

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? 1 Platelets 2 Hematocrit 3 Red blood cells (RBCs) 4 White blood cells (WBCs)

4 White blood cells (WBCs) 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.