Final Exam Semester 2 Oncology/Autoimmune

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? 1. Assess level of consciousness 2. Assess temperature 3. Assess bowel sounds 4. Assess skin turgor

1 A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.

A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? 1. One entire lung 2. A lobe of the lung 3. A small, localized area near the surface of the lung. 4. A segment of the lung, including a bronchiole and its alveoli.

3 A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy.

Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? 1. Faster growing cells are less susceptible to chemotherapy. 2. Non-dividing cells are more susceptible to chemotherapy 3. Faster growing cells are more susceptible to chemotherapy 4. Slower growing cells are more susceptible to chemotherapy.

3 The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy non-dividing cells as they begin active cell division.

When a client has a lobectomy, what fills the space where the lobe was? 1. The space stays empty. 2. The surgeon fills the space with gel 3. The lung space fills up with serous fluid 4. The remaining lobe or lobes overexpand to fill the space.

4 **NO CHEST TUBES USED IN LOBECTOMY BECAUSE WANT TO FILL SPACE The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. The space can't remain "empty" because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. The surgeon doesn't use a gel to fill the space. Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift.

The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery? 1. Sanguineous drainage in the Jackson-Pratt drain 2. Pain at the incisional site 3. Complaints of decreased sensation near the operative site 4. Arm edema on the operative side

4 Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. The other options are expected occurrences.

One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is: 1. Underlying liver disease 2. Brain metastasis 3 Intravenous heparin therapy 4. Sepsis

4 Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinical DIC; however, sepsis is the most common cause.

Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? 1. Cervical dysplasia 2. A dermoid cyst 3. Endometrial polyps 4. Ovarian cancer

4 Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.

A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is most likely responsible for her symptoms? 1. Hiatal hernia 2. Stomatitis 3. Radiation enteritis 4. Esophagitis

4 Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall.

Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? 1. Dizziness 2. Generalized weakness 3. Hypotension 4. Recurrent pleural effusion

4 Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren't typically considered warning signals, but may occur in advanced stages of cancer.

Jenny, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately? A Vision changes B Hearing loss C Headache D Anorexia

A The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn't associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don't warrant a change in therapy.

A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: A hair loss. B stomatitis. C fatigue. D vomiting

C Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)? A White, cottage cheese-like patches on the tongue B Yellow tooth discoloration C Red, open sores on the oral mucosa D Rust-colored sputum

C The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.