Test 3 PrepU

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response? "Benign tumors invade surrounding tissue." "Benign tumors grow very rapidly." "Benign tumors can spread from one place to another." "Benign tumors don't usually cause death."

"Benign tumors don't usually cause death." Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.

A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? "I'll bowl with my team after discharge." "I'll play card games with my friends." "I'll eat lunch in a restaurant every day." "I'll take a long trip to visit my aunt."

"I'll play card games with my friends." During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Side effects are rare with therapy." "The goal of therapy is palliation." "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy."

"Intrathecal chemotherapy is used primarily as preventive therapy." Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It is a hyperimmune response to something in the environment that is usually harmless." "It means you are very sensitive to something inside of yourself." "It is a harmless reaction to something in the environment." "It is a muted response to something in the environment."

"It is a hyperimmune response to something in the environment that is usually harmless." An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse? "If you don't take your medication, you will become very ill." "As long as you are not having symptoms, you can take a medication vacation." "Be sure to let the physician know after you stop your medications." "It is important that you continue to take your medication to avoid an acute exacerbation."

"It is important that you continue to take your medication to avoid an acute exacerbation." Even with remission, most people must continue taking prescribed medications to avoid another acute exacerbation. The client should be encouraged to maintain the therapeutic regimen in order to avoid an exacerbation and prolong the period of remission as long as possible. If the client is considering the discontinuation of the medication, he should notify the physician prior. The nurse is not at liberty to allow the client to discontinue medication use. Informing the client he will become ill if he discontinues the medication does not inform them of the rationale.

The nurse is obtaining an assessment and health history from the parents of a 6-month-old infant with an elevated temperature. Which statement by the parents alerts the nurse to a possible immunodeficiency disorder? "This is the third infection with a high fever the baby has had in the past month." "My husband's family has a history of hemophilia; could this be the problem?" "I had a good prenatal care and vaginal birth, although they had to use forceps." "I usually feed the baby a bottle every 4 to 6 hours during the day."

"This is the third infection with a high fever the baby has had in the past month." Infants with X-linked agammaglobulinemia usually become symptomatic after the natural loss of maternally transmitted immunoglobulins, which occurs at about 5 to 6 months of age. Symptoms of recurrent pyogenic infections usually occur by that time.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is "You will be unable to have children." "You will experience menopause now." "You will continue having your menses every month." "You will need to practice birth control measures."

"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? Too many erythrocytes A decrease in granulocytes A general reduction in neutrophils and basophils A general reduction in all white blood cells

A general reduction in all white blood cells Leukopenia is a general reduction in all WBCs. Leukopenia does not have anything to do with erythrocytes.

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? An aberrant psychologic reaction to the chemotherapy. A normal reaction to the diagnosis of cancer. A side effect of the neoplastic drugs. A psychiatric diagnosis everyone has at one time or another.

A normal reaction to the diagnosis of cancer. Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy life-style. They also may express anger related to the diagnosis and their inability to be in control. While depression is a psychiatric diagnosis not everyone has the diagnosis sometime in their life; depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? candidiasis cytomegalovirus (CMV) distal sensory polyneuropathy (DSP) AIDS dementia complex (ADC)

AIDS dementia complex (ADC) ADC, a neurologic condition, causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

A client is given a dose of ketorolac, a nonsteroidal anti-inflammatory drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client's eyes, lips, and face begin to swell, and the nurse hears stridor. What priority measure should the nurse prepare to do? Administer epinephrine. Intubate the client. Assess the client's vital signs. Perform an electrocardiogram (ECG).

Administer epinephrine. Anaphylaxis is a rapid and profound type I hypersensitivity response. A massive release of histamine causes vasodilation; increased capillary permeability; angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs); hypotension; and bronchoconstriction. A nurse must administer 0.2 mg of epinephrine subcutaneously to a client experiencing a severe allergic reaction. It is outside of the nurse's practice to intubate a client. Performing an ECG and assessing the vital signs delays the treatment of the client and can have negative outcomes.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? Anticipatory grieving Chronic low self-esteem Disturbed body image Impaired swallowing

Anticipatory grieving Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Monitor temperature at least once per shift. Eliminate direct contact with others who are infectious. Apply prolonged pressure to needle sites or other sources of external bleeding. Implement neutropenic precautions.

Apply prolonged pressure to needle sites or other sources of external bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Eat warm or hot foods. Eat wholesome meals. Avoid intake of fluids. Avoid spicy and fatty foods.

Avoid spicy and fatty foods. The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? Family history Drug history Allergy history Blood studies

Blood studies Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? Bone marrow transplantation Antibiotics Radiation therapy Removal of the thymus gland

Bone marrow transplantation Treatment options for SCID include stem cell and bone marrow transplantation.

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. Severe thrombocytopenia Gradual muscle paralysis Debilitating fatigue Bone pain in the back of the ribs

Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; patients may report that they have less pain on awakening but the pain intensity increases during the day.

A B-cell deficiency, such as CVID, is a disorder characterized by the following. Choose all that apply. Disease onset occurs most often in the second decade of life. There is a disappearance of germinal centers from lymphatic tissue. There is complete lack of antibody production. There is an excess of plasma cells. It is associated with the most common immunodeficiency seen in childhood.

There is a disappearance of germinal centers from lymphatic tissue. There is complete lack of antibody production. Disease onset occurs most often in the second decade of life. Two types of inherited B-cell deficiencies exist. The first results from lack of differentiation of B-cell precursors into mature B cells. As a result, plasma cells are absent, and the germinal centers from all lymphatic tissues disappear, leading to a complete absence of antibody production against invading bacteria, viruses, and other pathogens. Although it usually presents within the first two decades of life, most clients are diagnosed as adults, because CVID often goes unrecognized. CVID is the most common primary immunodeficiency seen in adults, not childhood.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Tumor pressure against normal tissues Random, rapid growth of the tumor Cells colonizing to distant body parts Emission of abnormal proteins

Tumor pressure against normal tissues Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? Throw I.V. tubing in the trash after the infusion is stopped. Disconnect I.V. tubing with gloved hands. Break needles after the infusion is discontinued. Wear disposable gloves and protective clothing.

Wear disposable gloves and protective clothing. A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? Western blot assay OraSure test p24 antigen capture assay Nucleic acid sequence-based amplification

Western blot assay A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. The OraSure test uses saliva to perform an EIA test. The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load and evaluate response to treatment. However, the reverse transcriptase-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based tests have replaced the p24 antigen test. The RT-PCR tests may be used to confirm a positive EIA result.

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: polymerase chain reaction test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis. p24 antigen test for confirmation of diagnosis. Western blot test for confirmation of diagnosis.

Western blot test for confirmation of diagnosis. The enzyme-linked immunosorbent assay (ELISA) test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to detect compromised ventilation. anticipate the need for airway management. reduce deficits in the blood oxygen concentration. increase lung expansion.

increase lung expansion. For a client with Hodgkin disease who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse keeps the neck in the midline and places the client in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for increased lung expansion improve air exchange. The nurse administers oxygen, per the physician's orders, to reduce deficits in the blood oxygen concentration. The nurse assesses the client's respiratory status during each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.

Chap 34: A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: hypoxemia. pathologic bone fractures. chronic liver failure. acute heart failure.

pathologic bone fractures. Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

A pediatric client is recovering from an anaphylactic reaction to an allergen. In the first assessment, the client presents with a periorbital accumulation of blood, a common occurrence in children. What type of allergic reaction presents "allergic shiners"? type IV type III type II type I

type I Less severe localized hypersensitivity type I responses can include dark areas under the eyes, referred to as "allergic shiners," which are due to accumulation of blood around the orbit of the eye.

A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client? Nausea and vomiting are only a factor for the first 24 hours after treatment. Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Clinical trials are opening up new cancer treatments all the time. Most clients believe the discomfort is well worth the cure for cancer.

Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: Chronic diarrhea. Nausea and vomiting. Anorexia. Oral candida.

Chronic diarrhea. Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Acute lymphocytic leukemia Chronic myelogenous leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia

Chronic lymphocytic leukemia Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.

The drug interleukin-2 is an example of which type of biologic response modifier? Monoclonal antibodies Cytokine Antimetabolites Retinoids

Cytokine Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.

While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to Administer a neutralizing solution. Discontinue the intravenous medication. Aspirate as much of the fluid as possible. Apply a warm compress.

Discontinue the intravenous medication. If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply. Warn client to avoid extremes in temperatures Warn client to avoid abrupt position change Encourage ambulation Encourage range of motion exercises Encourage hydration

Encourage ambulation Encourage hydration Muscle cramping can be alleviated or reduced by encouraging hydration and ambulation. Warning the client to avoid abrupt position change best supports the client with postural hypotension. Parathesias (tingling) can best be mediated with range of motion exercises. Clients experiencing hypoesthesia should be warned to avoid extremes in temperatures.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Encourage fluid intake to dilute the urine. Take measures to acidify the urine and prevent uric acid crystallization.

Encourage fluid intake to dilute the urine. The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

Which blood test confirms the presence of antibodies to HIV? p24 antigen Erythrocyte sedimentation rate (ESR) Reverse transcriptase Enzyme-linked immunoabsorbent assay (ELISA)

Enzyme-linked immunoabsorbent assay (ELISA) ELISA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA.

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? Thrombosis Flare Erythema Extravasation

Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? Graft-versus-host disease Acute respiratory distress syndrome Remission Bone marrow depression

Graft-versus-host disease Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.

A client with AIDS is brought to the clinic by their family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? HIV encephalopathy Candidiasis Distal sensory polyneuropathy (DSP) Cytomegalovirus (CMV)

HIV encephalopathy HIV encephalopathy, also called AIDS dementia complex or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? Lifestyle assessments, such as exercise routines Health history, such as bleeding, fatigue, or fainting Age and gender Menstrual history

Health history, such as bleeding, fatigue, or fainting When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.

Which of the following indicates that a client with HIV has developed AIDS? Weight loss of 10 lb over 3 months Pain on standing and walking Herpes simplex ulcer persisting for 2 months Severe fatigue at night

Herpes simplex ulcer persisting for 2 months A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. Hyperuricemia Hyperkalemia Hyperphosphatemia Hypercalcemia

Hyperuricemia Hyperkalemia Hyperphosphatemia When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? It functions against disseminated disease. It causes a systemic reaction. It attacks cancer cells during their vulnerable phase. It targets normal body cells as well as cancer cells.

It targets normal body cells as well as cancer cells. Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.

The nurse teaches the client that reducing the viral load will have what effect? Shorter survival Longer immunity Shorter time to AIDS diagnosis Longer survival

Longer survival The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Maintain nutrition. Place the client in reverse isolation. Administer pain medication. Address issues of negative body image.

Maintain nutrition. Maintaining nutrition is the most important goal after induction therapy because the client experiences severe diarrhea and can easily become nutritionally deficient and develop fluid and electrolyte imbalance. The client is most likely not in pain at this point, and this is an intervention, not a goal.

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is Malnutrition Neutropenia Chronic diarrhea Hypocalcemia

Malnutrition The most prevalent cause of immunodeficiency worldwide is severe malnutrition.

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? Monitor the client's toilet patterns. Monitor the client's physical condition. Monitor the client closely to prevent infection. Monitor the client's heart rate.

Monitor the client closely to prevent infection. Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? Leukemia Hemolytic anemia Multiple myeloma Polycythemia vera

Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

What assessment findingbest indicates that the client has recovered from induction therapy? Absence of bone pain No evidence of edema Vital signs within normal ranges Neutrophil and platelet counts within normal limits

Neutrophil and platelet counts within normal limits Recovery from induction therapy is indicated when the neutrophil and platelet counts have returned to normal and any infection has resolved. Stable vital signs, lack of edema, and absence of pain are not indicative of recovery from induction therapy.

The nurse's base knowledge of primary immunodeficiencies includes which of the following statements? Primary immunodeficiencies occur most commonly in the aged population. Primary immunodeficiencies develop early in life after protection from maternal antibodies decreases. Primary immunodeficiencies develop as a result of treatment with antineoplastic agents. Primary immunodeficiencies disappear with age.

Primary immunodeficiencies develop early in life after protection from maternal antibodies decreases. These disorders may involve one or more components of the immune system. Primary immunodeficiencies are seen primarily in infants and young children. Primary immunodeficiencies are rare disorders with genetic origins. Without treatment, infants and children with these disorders seldom survive to adulthood.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Promotion Progression Prolongation Initiation

Progression Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? Checking regularly for signs and symptoms of stomatitis Monitoring the client's platelet and leukocyte counts Providing a solution of viscous lidocaine for use as a mouth rinse Recommending that the client discontinue chemotherapy

Providing a solution of viscous lidocaine for use as a mouth rinse To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

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, which nursing diagnosis takes priority? Imbalanced nutrition: Less than body requirements Anxiety Risk for injury Risk for infection

Risk for infection Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Jaundice skin and sclera Pale skin and mucous membranes Bronze skin tone Ruddy complexion

Ruddy complexion Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.

You are caring for a client who has a diagnosis of HIV. Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? The action of each antiretroviral drug Side effects of drug therapy What vaccinations to have The use of condoms

Side effects of drug therapy Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? Neutropenia Stomatitis Nadir Extravasation

Stomatitis The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? Stool specimen for ova and parasites Blood specimen for electrolyte studies Sputum specimen for acid fast bacillus Urine specimen for culture and sensitivity

Stool specimen for ova and parasites A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? Breast and testicular self-exams Pool and water safety Sun safety and use of sunscreen Hand washing and infection prevention

Sun safety and use of sunscreen Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.

client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care? Aerosolized pentamidine TMP-SMZ Clindamycin Azithromycin

TMP-SMZ TMP-SMZ is the treatment of choice for pneumocystis pneumonia. Alternative regimens may include dapsone and TMP, primaquine plus clindamycin, or atovaquaone suspension. Aerosolized pentamidine is not used because of its limited efficacy and more frequent cases of relapse. Azithromycin or clarithromycin are the preferred prophylactic agents for Mycobacterium avium complex.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? The client with enlarged lymph nodes in the neck. The client with a painful sore throat. The client with painful lymph nodes under the arm. The client with painful lymph nodes in the groin.

The client with enlarged lymph nodes in the neck. Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "It doesn't matter if you take this drug with or without food." "When you take this drug, eat a high-fat meal immediately afterwards." "You should take the drug with an antacid."

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat." Didanosine should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

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." "I'll wash my skin with mild soap and water only." "I'll wear protective clothing when outside." "I'll not use my heating pad during my treatment."

"I'm worried I'll expose my family members to radiation." The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.

A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? Administer fluids 100 mL/hour IV. Encourage the client to drink more fluids. Assess liver function tests. Assess blood urea nitrogen and creatinine.

Assess blood urea nitrogen and creatinine. Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urean nitrogen and creatinine for clients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the client's problem, which should be assessed before intervention are administered.

A client presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention? Encourage ambulation. Assess for signs of injury. Elevate the client's legs. Keep the feet cool.

Assess for signs of injury. A client with hypothesia of the feet will have decreased sensation and numbness. The nurse should assess for signs of injury. If the client is injured, he or she will not be able to feel it; this could lead to the development of infection. Ambulation will not help the client, and elevating the legs may make the problem worse, as blood flow to the feet would be decreased. Keeping the feet cold will also decrease blood flow.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's pulse and blood pressure. Assess the client's skin. Check the client's history. Assess the client's hemoglobin and platelets.

Assess the client's hemoglobin and platelets. Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? Proton therapy Teletherapy External Brachytherapy

Brachytherapy In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.

Which occurs when fluid accumulates in the pericardial space and compresses the heart? SIADH Cardiac tamponade DIC Superior vena cava syndrome (SVCS)

Cardiac tamponade If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

A client with paroxysmal hemoglobinuria, a deficiency of complement proteins, reports headache and weakness of the right arm and leg. Based on these symptoms, for which health complication should the nurse assess? Edema in subcutaneous tissues of the extremities Rheumatoid arthritis Cerebral venous thrombosis Bacterial meningitis

Cerebral venous thrombosis Paroxysmal nocturnal hemoglobinuria is an acquired clonal stem cell disorder resulting from a somatic mutation in hematopoietic stem cells. Clinical manifestations may be indolent or life threatening. The disorder is characterized by hemoglobinuria that increases during sleep, as well as intravascular hemolysis, cytopenia, infections, bone marrow hyperplasia, and a high incidence of life-threatening venous thrombosis, which occurs most commonly in the abdominal and cerebral veins.

During assessment of a patient with Kaposi's sarcoma, the nurse knows to look for the initial sign of: Lymphedema of the lower extremities. Deep purple cutaneous lesions. Venous stasis and phlebitis formation. Joint pain severe enough to cause immobility.

Deep purple cutaneous lesions. Localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of patients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

The nurse assesses that extravasation of a chemotherapy agent has occurred. What should the initial action of the nurse be? Discontinue the infusion. Inject an antidote, if required. Place ice over the site of infiltration. Apply a warm compress to the area.

Discontinue the infusion. If extravasation is suspected, the medication administration is stopped immediately, and depending on the drug, the nurse may attempt to aspirate any remaining drug from the extravasation site. The other actions listed may be appropriate to perform, but should occur after discontinuing the infusion.

Chap 15: 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? Thrombosis Flare Erythema Extravasation

Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Administering aspirin if the temperature exceeds 102° F (38.8° C) Inspecting the skin for petechiae once every shift Placing the client in strict isolation Providing for frequent rest periods

Inspecting the skin for petechiae once every shift Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

Which term refers to a form of white blood cell involved in immune response? Thrombocyte Granulocyte Lymphocyte Spherocyte

Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

According to the tumor-node-metastasis (TNM) classification system, T0 means there is Distant metastasis No evidence of primary tumor No regional lymph node metastasis No distant metastasis

No evidence of primary tumor T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.

A majority of clients with CVID develop which type of anemia? Sickle cell Hemolytic Macrocytic Pernicious

Pernicious A majority of clients with CVID develop pernicious anemia (occurs when your body can't absorb enough vitamin B-12 to function properly). They majority do not develop the other types of anemia listed.

Which nursing intervention is most appropriate for a client with multiple myeloma? Restricting fluid intake Monitoring respiratory status Balancing rest and activity Preventing bone injury

Preventing bone injury When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake.

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor? Radiation can result in myelosuppression. Fighting off infection is an exhausting venture. The cancer is spreading. The cancer cells are dying in large numbers.

Radiation can result in myelosuppression. Fatigue results from anemia associated with myelosuppression and decreased RBC production. The spreading of cancer can cause many symptoms dependent on location and type of cancer but not a significant factor to support fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support presence of infection in this client.

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately Places the client on oxygen by nasal cannula Stops the chemotherapeutic infusion Gives prednisolone IV Administers diphenhydramine

Stops the chemotherapeutic infusion The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The second and third drugs increase the effectiveness of the first drug. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. The three drugs can be given at lower doses.

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? Thymus Adrenal Thyroid Pituitary

Thymus T-cell deficiency occurs when the thymus gland fails to develop normally during embryogenesis.

A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy? Stomatitis Angiogenesis Fatigue To prevent metastasis

To prevent metastasis Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission? Breast milk Semen Blood Urine

Urine HIV is transmitted in body fluids that contain free virions and infected CD4+ T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. Urine is not a body fluid responsible for HIV transmission.

Telangiectasia is the term that refers to Difficulty swallowing Vascular lesions caused by dilated blood vessels Inability to understand the spoken word Uncoordinated muscle movement

Vascular lesions caused by dilated blood vessels Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia-telangiectasia is an autosomal-recessive disorder affecting both T-cell and B-cell immunity. Receptive aphasia is an inability to understand the spoken word. Dysphagia refers to difficulty swallowing.

The majority of patient with primary immunodeficiency are in which age group? 51 to 60 20 to 40 Younger than 20 41 to 50

Younger than 20 About 80% of the patients with primary immunodeficiency are younger than age 20 years.

A decrease in circulating white blood cells is leukopenia. neutropenia. granulocytopenia. thrombocytopenia.

leukopenia A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.

Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women? lung and colon colon and skin skin and brain lung and skin

lung and colon Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.