Oncology & Anemia Questions
A complication of the hyperviscosity of polycythemia is
thrombosis
The nursing management of a patient in sickle cell crisis includes (select all that apply)
-monitoring CBC. -optimal pain management and O2 therapy. -blood transfusions if required and iron chelation. -rest as needed and deep vein thrombosis prophylaxis.
The nurse is reviewing a HCP's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply.
-restrict fluid intake -give meperidine, 25 mg intravenously, every 4 hours for pain
the community health nurse is instructing a group of young female clients bout breast self-examination. The nurse should instruct the clients to perform the examination at which time?
1 week after menstruation begins
A nurse is caring for a client who is receiving warfarin for anticoagulation therapy. Which of the following laboratory test results indicates to the nurse that the client needs an increase in the dosage?
INR 1.1
The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents?
admin iron through a straw
Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia?
red blood cells that are microcytic and hypochromic
A nurse is completing an integumentary assessmentof a client who has anemia. Which of the following findings should the nurse expect?
spoon shaped nails
The recommended treatment for an initial VTE in an otherwise healthy person with no significant co-morbidities would include
subcutaneous low-molecular-weight heparin as an outpatient
A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that his aneurism has ruptured?
sudden, severe low back pain and bruising along his flank
The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child?
swimming
Multiple drugs are often used in combinations to treat leukemia and lymphoma because
the drugs work by different mechanisms to maximize killing of malignant cells.
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP?
vomiting
The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply.
-Facial edema in the morning -Serum calcium level of 12 mg/dL -Numbness and tingling of the lower extremities
A nurse is monitoring a client who began receiving a unitof packed RBCs 10 min ago. Which of the following findings should the nurse identify as an indication of a febrile transfusion reaction? (Select all that apply.)
-Heart rate change from 88/min pretransfusion to 120/min -Client appears flushed
When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply.
-Keeping pregnant women out of the client's room -Placing the client in a private room with a private bath -Wearing a lead shield when providing direct client care
Which are clinical findings in a person with an acute lower extremity VTE (select all that apply)?
-Mild to moderate calf pain and tenderness -Unilateral edema and induration of the thigh
A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following laboratory values indicates the client's clotting factors are depleted? (Select all that apply.)
-Platelets 100,000/mm3 -Fibrinogen levels 57 mg/dL
A nurse is planning care for a client who has Hgb 7.5 g/dL and Hct 21.5%. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)
-Provide assistance with ambulation. -Monitor oxygen saturation. -Obtain stool specimen for occult blood. -Schedule daily rest periods.
A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply
-Radiation -Chemotherapy -Serum sodium level determination -Medication that is antagonistic to antidiuretic hormone
Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply.
-Reduce exposure to environmental organisms. -Use strict aseptic technique for all procedures. -Ensure that anyone entering the child's room wears a mask.
Which clinical manifestations are seen in patients with either Buerger's disease or Raynaud's phenomenon (select all that apply)?
-Sensitivity to cold temperature -Gangrenous ulcers on fingertips -Color changes of fingers and toes
A nurse is caring for a client who is receiving a blood transfusion. Which of the following actions should the nurse expect if an allergic transfusion reaction is suspected? (Select all that apply.)
-Stop the transfusion -Maintain an IV infusion with 0.9% sodium chloride. -Administer diphenhydramine.
Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply)
-administering analgesics as necessary -instructing on need to lie still with a sterile pressure dressing intact -monitoring vital signs and assessing the site for excess drainage or bleeding
Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2° F and severe neutropenia include (select all that apply)
-administering the prescribed antibiotic STAT. -drawing peripheral and central line blood cultures. -ongoing monitoring of the patient's vital signs for septic shock. -taking a full set of vital signs and notifying the physician immediately.
A nurse is teaching a client who has a new Rx for clopidogrel. Which of the following instructions should the nurse inlcude
-avoid grapefruit -monitor for black, tarry stools
The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply.
-easy bruising occurs -gum bleeding occurs - it is a hereditary bleeding disorder -treatment and care are similar to that for hemophilia -the disorder causes platelets to adhere to damaged endothelium
Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply)
-instructions for high-iron diet -monitoring stools for occult blood
A key aspect of teaching for the patient on anticoagulant therapy includes which instructions?
Monitor for and report any signs of bleeding
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?
Periorbital edema
In a severely anemic patient, the nurse would expect to find
dyspnea tachycardia
While assessing the lymph nodes, the nurse should
lightly palpate superficial lymph nodes with the pads of the fingers
When reviewing laboratory results of an older patient with an infection, the nurse would expect to find
minimal leukocytosis
The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that
non-Hodgkin's lymphoma can manifest in multiple organs.
A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to
notify the HCP of the change in peripheral perfusion
A nurse is performing a physical assessment of a client who has chronic peripheral arterial disease (PAD). Which of the following is an expected finding?
pallor on elevation of the client's limbs and rubor when his limbs are dependent
The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child?
partial thromboplastin time
A nurse is providing teaching for a client who is scheduled for a bone marrow biopsy of the iliac crest. Which of the following statements made by the client indicates an understanding of the teaching?
"I will need to stay in bed for about an hour after the test."
As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement?
"I'm going to take aspirin for my headache as soon as I get home."
A nurse is caring for a client who has a deep-vein thrombosis (DVT) and has been taking unfractionated heparin for 1 week. Two days ago, the provider also prescribed warfarin (Coumadin). The client questions the nurse about receiving both heparin and warfarin at the same time. Which of the following is an appropriate response by the nurse?
"It takes three or four days before the effects of warfarin are achieved and the heparin can be discontinued."
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother?
"The flowers from your garden are beautiful, but should not be placed in the child's room at this time."
A nurse is providing preoperative teaching for a client who requests autologous donation in preparation for a scheduled orthopedic surgical procedure. Which of the following statements should the nurse include in the teaching?
"You can donate blood each week if your hemoglobin is stable."
A nurse is providing discharge teaching to a client who had a gastrectomy for stomach cancer. Which of the following information should the nurse include in the teaching? (Select all that apply.)
-"You will need a monthly injection of vitamin B12 for the rest of your life." -"Using the nasal spray form of vitamin B12 on a daily basis can be an option."
The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. The nurse understands that which assessment findings are specifically characteristic of this disease? Select all that apply.
-Abdominal pain -Painless, firm, and movable adenopathy in the cervical area
What are the priority nursing interventions after and abdominal aortic aneurysm repair?
Administration of IV fluids and monitoring of kidney function
A nurse is preparing to administer packed RBCs to a client who has a Hgb of 8 g/dL. Which of the following actions should the nurse plan to take during the first 15 min of the transfusion?
Assess for an acute hemolytic reaction.
You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5x10^3/uL, Hgb 13.4 g/dL, Hct 40%, platelets 50x10^3/uL. What are you MOST concerned about?
At risk for bleeding
The nurse is caring for a client who is postoperative following a pelvic exenteration and the health care provider changes the client's diet from NPO (nothing by mouth) status to clear liquids. The nurse should check which priority item before administering the diet?
Bowel sounds
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which more appropriate action?
Continue to monitor the drainage
The first priority of inter professional care of a patient with a suspected acute aortic dissection is to
Control BP
A nurse is caring for a client who has idiopathic thrombocytopenic purpura (ITP). The nurse should notify the provider and report possible small‐vessel clotting when which of the following is assessed?
Cyanotic nail beds
When teaching a client who has a new Dx of severe PAD. Which instructions should the nurse include
place both legs in dependent position while sleeping
A child with beta-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed?
Deferoxamine
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign of this oncological emergency?
Electrocardiographic changes
If a lymph node is palpated, what is a normal finding?
Firm, mobile nodes
A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following information should the nurse include in the teaching?
Foods high in vitamin C will promote absorption.
A nurse is caring for a client who has DIC. Which of the following medications should the nurse anticipate administering?
Heparin
A nurse is teaching a newly licensed nurse about heparin‐induced thrombocytopenia. Which ofthe following risk factors forthis disorder should the nurse include in the teaching?
Heparin therapy for deep‐vein thrombosis
A nurse in a clinic is caring for a client who has suspected anemia. Which of the following laboratory test results should the nurse expect?
Hgb 10 g/dL
Significant information obtained from the patient's health history that relates to the hematologic system includes
Jaundice
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action?
Notify the health care provider (HCP).
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately?
Notify the health care provider (HCP).
A nurse preceptor is observing a newly licensed nurse on the unit who is preparing to administer a blood transfusion to an older adult client. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure?
Obtains vital signs every 15 min throughout the procedure.
he mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment?
Palpating the abdomen for a mass
While giving care to a client with an internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action?
Pick up the implant with long-handled forceps and place it in a lead container.
DIC is a disorder in which
a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.
A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral after disease (PAD)) that must be modified are
Tobacco use and high BP
The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy?
Teach the client and family about the need for hand hygiene.
A nurse in a clinic receives aphone call from a client seeking information about a new prescription for erythropoietin. Which of the following information should the nurse review with the client?
The client should have his hemoglobin checked twice a week.
A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition?
The development of a vesicovaginal fistula
An anticoagulant such as warfarin (Coumadin) that interferes with prothrombin production will alter the clotting mechanism during
activation of thrombin
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease?
The presence of Reed-Sternberg cells in the lymph nodes
The patient at highest risk for venous thromboembolism (VTE) is
a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe
The nursing student is presenting a clinical conference and discusses the cause of beta-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these?
a child of mediterranean descent
A nurse is caring for a client who has chronic venous insufficiency. The provider prescribed thigh-high compression stockings. The nurse should instruct the client to...
apply the stockings in the morning upon awakening and before getting out of bed
In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is
applying graduated compression stockings
The nurse is instructing a client to perform a testicular self-examination (TSE). The nurse should provide the client with which information about the procedure?
best time to examine is after the shower
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis?
bone marrow biopsy showing blast cells
The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is appropriate?
change the dressing as Rx
The most common type of leukemia in older adults is
chronic lymphocytic leukemia.
When caring for a patient with thrombocytopenia, the nurse instructs the patient to
dab nose instead of blowing it
Rest pain is a manifestation of PAD that occurs due to a chronic
decrease in arterial blood flow to the nerves of the feet
Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing
decreased phagocytosis of bacteria
Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect to find include a(n)
deficiency of all cellular blood components.
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about
dietary intake of iron
A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client?
enlarged lymph nodes
A nurse is assessing a client and suspects the client is experiencing DIC. Which of the following physical findings should the nurse anticipate?
epistaxis
The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and
factor VIII
The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction?
fluid overload
An individual who lives at a high altitude may normally have an increased Hgb and RBC count because
hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis
When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find
increased platelet count
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care?
initiate bleeding precautions
A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription?
intravenous infusion of factor VIII
