Davis questions on Leukemia, Skin and Lung Cancer

The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? A. A left shift in the white blood cell (WBC) count differential B. A large number of WBCs that decreases after the administration of antibiotics C. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level D. Red blood cells (RBCs) that are larger than normal

A A left shift indicates immature white blood cells are being produced and released into the circulating blood volume. This should be investigated for the malignant process of leukemia.

The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? A. Fever and infections B. Nausea and vomiting C. Excessive energy and high platelet counts D. Cervical lymph node enlargement and positive acid-fast bacillus

A Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection

The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? A. The lesion is asymmetrical and has irregular borders B. The lesion has a waxy appearance with pearl like borders C. The lesion has a thickened and scaly appearance D. The lesion appeared as a thickened area after an injury

A Malignant melanomas are the most deadly of the skin cancers. Asymmetry, irregular borders. variegated color, and rapid growth are characteristic of them.

the client diagnosed with lung cancer is being discharged. Which statement made by the client indicates more teaching is required? A. "It doesn't matter if I smoke now. I already have cancer." B. "I should see the oncologist at my scheduled appointment." C. "If I begin to run a fever, I should notify the HCP." D. "I should plan for periods of rest throughout the day."

A Research indicates smoking will still interfere with the client's response to treatment, so more teaching is needed.

The client has had a squamous cell carcinoma removed from the lip. Which discharge instructions should the nurse provide? A. Notify the HCP if a non-healing lesion develops around the mouth B. Squamous cell carcinoma tumors do not metastasize C. Limit foods to liquid or soft consistency for one month D. Apply heat to the area for 20 minutes every 4 hours

A The client should be aware of symptoms that indicate development of another skin cancer. Squamous cell carcinoma can develop in areas of the skin and mucous membranes.

The nurse and the licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? A. The client newly diagnosed with chronic lymphocytic leukemia B. The client who is four (4) hours post-procedure bone marrow biopsy C. The client who received two (2) units of PRBCs) on the previous shift D. The client who is receiving multiple intravenous piggyback medications

A The newly diagnosed client will need to be taught about the disease and about treatment options. The registered nurse cannot delegate teaching to an LPN.

The spouse of a client dying from lung cancer states, "I don't understand this death rattle. She has not had anything to drink in days. Where is the fluid coming from?" Which is the hospice care nurse's best response? A. "The body produces about 2 teaspoons of fluid every minute on its own." B. "Are you sure someone is not putting ice chips in her mouth?" C. "There is no reason for this, but it does happen from time to time." D. "I can administer a patch to her skin to dry up the secretions if you wish."

A The respiratory tract cells produce liquid as a defense mechanism against bacteria and other invaders. About 9 mL a minute are produced. The "death rattle" can be disturbing to family members, and the nurse should intervene but not with suctioning, which will increase secretions and the need to suction more.

The nurse is caring for clients in an outpatient surgery clinic. Which client should be assessed first? A. The client scheduled for a skin biopsy who is crying B. The client who had surgery three hours ago and is sleeping C. The client who needs to void prior to discharge D. The client who has received discharge instructions and is ready to go home

A This client has an unexpected situation occurring and should be assessed before any stable client.

The client diagnosed with lung cancer has been told the cancer has metastasized to the brain. Which intervention should the nurse implement? A. Discuss implementing an advance directive B. Explain the use of chemotherapy for brain involvement C. Teach the client to discontinue driving D. Have the significant other make decisions for the client

A This situation indicates a terminal process, and the client should make decisions for the end of life.

Which client physiological outcome (goal) is appropriate for a client diagnosed with skin cancer who has had surgery to remove the lesion? A. The client will express feelings of fear B. The client will ask questions about the diagnosis C. The client will state a diminished level of pain D. the client will demonstrate care of the operative site

C Pain is a physiological problem; this is an appropriate physiological goal.

The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? (Select all that apply) A. Apply O2 via nasal cannula B. Have the dietitian plan for six (6) small meals per day C. Place the client in respiratory isolation D. Assess vital signs for fever E. Listen to lung sounds every shift

A,B,D,E Respiratory distress is a common finding in clients diagnosed with lung cancer. As the tumor grows and takes up more space or blocks air movement, the client may need to be taught positioning for lung expansion. The administration of oxygen will help the client to use the lung capacity that is available to get oxygen to the tissues. Clients with lung cancer frequently become fatigues trying to eat. Providing six small meals spaces the amount of food the client eats throughout the day. Clients with cancer of the lung are at risk for developing an infection from lowered resistance as a result of treatments or from the tumor blocking secretions in the lung. Therefore, monitoring for the presence of fever, a possible indication of infection, is important. Assessment of the lungs should be completed on a routine and prn basis.

The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? (Select all that apply) A. Administer high-dose chemotherapy B. Teach the client about autologous transfusions C. Have the family members' HLA typed D. Monitor the complete blood cell count daily E. Provide central line care per protocol

A,C,D,E All of the bone marrow cells must be destroyed prior to "implanting" the healthy bone marrow. High-dose chemotherapy and full-body irradiation therapy are used to accomplish this. The best bone marrow donor comes from an identical twin; next best comes from a sibling who matches The most complications occur from a matched unrelated donor (MUD). The client's body recognizes the marrow as foreign and tries to reject it, resulting in graft-versus-host disease (GVHD).The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. Clients will have at least one multiple-line central venous access. These clients are seriously ill and require multiple transfusions and antibiotics.

The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented? A. Hold all venipuncture sites for at least five (5) minutes B. Limit fresh fruits and flowers C. Place all clients in reverse isolation D. Have the clients use a soft-bristle toothbrush

B Fresh fruits and flowers may carry bacteria or insects on the skin of the fruit or dirt on the flowers and leaves, so they are restricted around clients with low white blood cell counts

The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regarding investigational regimens should the nurse teach? A. Investigational regimens provide a better change of survival for the client B. Investigational treatments have not been proven to be helpful to clients C. Clients will be pain to participate in an investigational program D. Only clients who are dying qualify for investigational treatments

B Investigational treatments are just that - treatments being investigated to determine if they are effective in the care of clients diagnosed with cancer. There is no guarantee the treatments will help the client.

The nurse is discussing cancer statistics with a group from the community. Which information about death rates from lung cancer is accurate? A. Long cancer has a low mortality rate because of new treatment options B. Lung cancer is the number-one cause of cancer deaths in both men and women C. Long cancer deaths are not significant in relation to other cancers D. Lung cancer deaths have continued to increase in the male population

B Lung cancers are responsible for almost twice as many deaths among males as any other cancer and more deaths than breast cancer in females.

The nurse writes a nursing problem of "altered nutrition" for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? A. Administer an antidiarrheal medication prior to meals B. Monitor the client's serum albumin levels C. Assess for signs and symptoms of infection D. Provide skin care to irradiated areas

B Serum albumin is a measure of the protein content in the blood that is derived from the foods eaten; albumin monitors nutritional status.

The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 X 10(6)/mm3, WBC count 150 X 10(3)/mm3, platelets 22 X 10(3)/mm(3), K+ 3.8, and Na+ 139. Based on these results, which intervention should the nurse teach the client? A. Encourage the client to eat foods high in iron B. Instruct the client to use an electric razor when shaving C. Discuss the importance of limiting sodium in the diet D. Instruct the family to limit visits to once a week

B The platelet count is 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and holding all venipuncture sites for a minimum of five (5) minutes.

The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse? A. The client has an intake of 1500 mL IV and an output of 1000mL B. The client has 450 mL of bright-red drainage in the chest tube C. The client is complaining of pain at a "10" on a 1-to-10 pain scale D. The client has absent lung sounds on the side of the surgery

B This is about a pint of blood loss and could indicate the client is hemorrhaging.

The female client admitted for an unrelated diagnosis asks the nurse to check her back because "it itches all the time in that one spot." When the nurse assesses the client's back, the nurse notes an irregular-shaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? A. Notify the HCP to check the lesion on rounds B. Measure the lesion and note the color C. Apply lotion to the lesion D. Instruct the client to make sure the HCP checks the lesion

B This is part of assessing the lesion and should be completed. The ABCDs of skin cancer detection include the following: 1) Asymmetry - is the lesion balanced on both sides with an even surface? 2) Borders - are the borders rounded and smooth or notched and indistinct? 3) Color - is the color a uniform light brown or is it variegated and darker or reddish purple? 4) Diameter - A diameter exceeding 4 to 6 mm is considered suspicious.

The male client diagnosed with acquired immunodeficiency syndrome (AIDS) states that he has developed a purple-brown spot on his calf. Which action should the nurse do first? A. Refer the client to an HCP for a biopsy of the area B. Assess the lesion for size, color, and symmetry C. Discuss end-of-life decisions with the client D. Report the sexually transmitted illness to the health department

B This is the first step in deciding how to help the client. The nurse should assess the lesion to determine if it could be a Kaposi's sarcoma tumor or a healing contusion.

The nurse is caring for a client diagnosed with squamous cell skin cancer and writes a psychosocial problem of "fear." Which nursing interventions should be included in the plan of care? A. Explain to the client that the fears are unfounded B. Encourage the client to verbalize the feeling of being afraid C. Have the HCP discuss the client's fear with the client D. Instruct the client regarding all planned procedures

B This is the most commonly written therapeutic communication goal. This addresses the client's concerns.

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse? A. The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup B. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table C. The client receiving Procrit, a biologic response modifier, has a T 99.2, P 68, R 24, and BP of 198/102 D. The client receiving prednisone, a steroid, is complaining of an upset stomach after eating breakfast

C Biologic response modifiers stimulate the bone marrow and can increase the client's blood pressure to dangerous levels. his BP is high and warrants immediate attention.

Which medication is contraindicated for a client diagnosed with leukemia? A. Bactrim, a sulfa antibiotic B. Morphine, a narcotic analgesic C. Epogen, a biologic response modifier D. Gleevec, a genetic blocking agent

C Epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. The bone marrow is the area of malignancy in leukemia. Stimulating the cone marrow would be generally ineffective potential to stimulate malignant growth.

The client diagnosed with leukemia has central nervous system involvement. Which instruction should the nurse teach? A. Sleep with the HOB elevated to prevent increased intracranial pressure B. Take an analgesic medication for pain only when the pain becomes severe C. Explain radiation therapy to the head may result in permanent hair loss D. Discuss end-of-life decisions prior to cognitive deterioration

C Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. Radiation therapy has longer lasting side effects than chemotherapy. If the radiation therapy destroys the hair follicles, the hair will not grow back

The nursing staff on an oncology unit is interviewing applicants for the unit manager position. Which type of organizational structure does this represent? A. Centralized decision making B. Decentralized decision making C. Shared governance D. Pyramid with filtered-down decisions

C Shared governance is a system where the staff is empowered to make decisions such as scheduling and hiring of certain staff. Staff members are encouraged to participate in developing policies and procedures to reach set goals.

The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included in the teaching? A. Wear a sunscreen with a protection factor of 10 or less when in the sun B. Try to stay out of the sun between 0300 and 0500 daily C. Perform a thorough skin check monthly D. Remember caps and long sleeves do not help prevent skin cancer

C The American Cancer Society recommends a monthly skin check using mirrors to identify any suspicious skin lesion for early detection.

The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach? A. The test will confirm the results of the MRI B. The client can eat and drink immediately after the test C. The HCP can do a biopsy of the tumor through the scope D. There is no discomfort associated with this procedure

C The HCP can take biopsies and perform a washing of the lung tissue for pathological diagnosis during the procedure.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a dermatology clinic. Which task should not be delegated to the UAP? A. Stock the rooms with the equipment needed B. Weigh the clients and position the clients for the examination C. Discuss problems the client has experienced since the previous visit D. Take the biopsy specimens to the laboratory

C This is part of assessing the client and cannot be delegated.

Which client is at the greatest risk for the development of skin cancer? A. The African American male who lives in the northeast B. The elderly Hispanic female who moved from Mexico as a child C. The client who has a family history of basal cell carcinoma D. The client with fair complexion who cannot get a tan

D Clients with very little melanin in the skin (fair-skinned) have an increased risk as a result of the UV damage to the underlying membranes. Damage to the underlying membranes never completely reverses itself; a lifetime of damage causes changes at the cellular level that can result in the development of cancer.

The clinic nurse in interviewing clients. Which information provided by a client warrants further investigation? A. The client uses Vicks VapoRub every night before bed B. The client has had an appendectomy C. The client takes a multiple vitamin pill every day D. The client has been coughing up blood in the mornings

D Coughing up blood is not normal and is cause for investigation. It could indicate lung cancer.

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? A. Infection B. Anemia C. Nutrition D. Grieving

D Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration.

The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? A. CLL is not serious, and clients die from other causes first B. There are no symptoms with this form of leukemia C. This is a childhood illness and is self-limiting D. In early stages of CLL, the client may be asymptomatic

D In this form of leukemia, the cells seem to escape apoptosis (programmed cell death), which results in many thousands of mature cells clogging the body. Because the cells are mature, the client may be asymptomatic in the early stages.

The middle-aged client has had two lesions diagnosed as basal cell carcinoma removed. Which discharge instruction should the nurse include? A. Teach the client that there is no more risk for cancer B. Refer the client to a prosthesis specialist for prosthesis C. Instruct the client how to apply sunscreen to the area D. Demonstrate care of the surgical site

D On discharge, all clients should receive instructions in the care of surgical incisions.

The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate interventions? A. T 99, P 102, R 22, and BP 132/68 B. Hyperplasia of the gums C. Weakness and fatigue D. Pain in the left upper quadrant

D Pain is expected, but it is a priority, and pain control measures should be implemented.

The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? A. The client worked with asbestos for a short time many years ago B. The client has no family history for this type of lung cancer C. The client has numerous tattoos covering both upper and lower arms D. The client has smoked two (2) packs of cigarettes a day for 20 years

D Smoking is the number-one risk factor for developing cancer of the lung. More than 85% of lung cancers are attributable to inhalation of chemicals. There are more than 400 chemicals in each puff of cigarette smoke, 17 of which are known to cause cancer.

The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? A. Sunscreen is only needed during the hottest hours of the day B. Toddles should not have sunscreen applied to their skin C. Sunscreen does not help prevent skin cancer D. The higher the number of the sunscreen, the more it blocks UV rays

D Sunscreen products range in numerical value from 4 to 50; the higher the number of the sunscreen, the greater the UV protection.

The client diagnoses with oat cell carcinoma of the lung tells the nurse, "I am so tired of all this. I might as well just end it all." Which statement should be the nurse's first response? A. Say, "This must be hard for you. Would you like to talk?" B. Tell the HCP of the client's statement C. Refer the client to a social worker or spiritual advisor D. Find out if the client has a plan to carry out suicide

D The priority action anytime a client makes a statement regarding taking his or her own life is to determine if the client has thought it through enough to have a plan. A plan indicates an emergency situation.