Oncology pharmacology and general

The nurse is reviewing the laboratory results of a client with bladder cancer and bone metastasis and notes that the calcium level is 15 mg/dL. The nurse should take which appropriate action?

2

A client with cancer is receiving daunorubicin intravenously. The nurse assigned to assist in caring for the client monitors for which commonly expected side effect?

4

A client diagnosed with testicular cancer is prescribed cisplatin. The nurse should monitor for which toxic effect of this medication?

2

The nurse is assisting in providing a session to community members about the risks associated with laryngeal cancer. A client indicates an understanding of the risks by listing which factors? Select all that apply.

2 3 4 5 6

The nurse is assisting in caring for a client with a diagnosis of bladder cancer who recently received chemotherapy. The nurse receives a telephone call from the laboratory who reports that the client's platelet count is 20,000 mm3. Based on this laboratory value, the nurse revises the plan of care and suggests including which interventions? Select all that apply.

2 5

A cervical radiation implant is placed in the client for treatment of cervical cancer. Which intervention would the nurse most likely expect to note in the primary health care provider's prescriptions?

4

The nurse is collecting data from a client suspected of having ovarian cancer. Which question should the nurse ask the client to elicit information specifically related to this disorder?

4

The nurse has reinforced discharge instructions regarding home care to a client following a prostatectomy for cancer of the prostate. He is being discharged with an indwelling urinary catheter. Which statement by the client indicates a need for further teaching?

2

The nurse is developing a teaching plan for a client following a radical mastectomy and includes measures that will assist in preventing lymphedema of the affected arm. The nurse should include which interventions when reviewing instructions with the client to prevent this complication? Select all that apply.

1 3 4

A client with benign prostatic hyperplasia is being administered finasteride. Which information should be included in the plan of care?

1

The nurse reviews the care plan of a client with cancer undergoing chemotherapy. The nurse notes that the client has a concern about her appearance as a result of alopecia. The nurse plans to tell the client which information about hair loss and regrowth to assist the client in coping with this possible change?

2

A client who has just been told by the primary health care provider that she has breast cancer responds by stating, "Oh, no, this has to be a big mistake." The nurse interprets the client's initial response as which type of reaction?

3

Anastrozole is prescribed for a postmenopausal client with breast cancer. The nurse assists in developing a plan of care for the client and suggests monitoring the client closely for which adverse effect of this medication?

3

A client with endometrial cancer is receiving doxorubicin, an antineoplastic agent. The nurse should specifically collect data about which criteria? Select all that apply.

1 5

The nurse is caring for a client dying of cancer. During care, the client states, "If I can just live long enough to attend my daughter's graduation, I'll be ready to die." Which phase of coping is this client experiencing?

bargaining Denial, bargaining, anger, depression, and acceptance are recognized stages that a person experiences when facing a life-threatening illness. The client's statement is indicative of bargaining. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn. Anger may also be a first response to upsetting news, and the predominant theme is "Why me?" or the blaming of others.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value should the nurse note as a result of the massive cell destruction that occurred from the chemotherapy?

increased uric acid level Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill, releasing uric acid into the blood. Although anemia, decreased platelets, and decreased leukocytes also may be noted, an increased uric acid level is related specifically to cell destruction. Massive cell destruction may result in high levels of potassium, not hypokalemia.

A client with cancer has undergone a total abdominal hysterectomy and has an indwelling Foley catheter in place. The nurse should expect to note which types of urinary drainage immediately following this surgery? Select all that apply.

1 4

The nurse is caring for a client with cancer receiving chemotherapy who has developed stomatitis. The nurse plans to give mouth care by using oral care agents and devices that meet which additional criterion?

3

A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which late symptom of this disease?

2`

A client diagnosed with acute lymphocytic leukemia has been prescribed asparaginase. Which finding represents possible medication toxicity?

3

A client is receiving radiation therapy to the brain because of a diagnosis of a brain tumor. Which sign/symptom of the client is noted to be a positive outcome of the radiation therapy?

3

The nurse determines that a client with which history is most at risk for endometrial cancer?

3

The client with non-Hodgkin's lymphoma is receiving daunorubicin. Which sign/symptom should indicate to the nurse that the client is experiencing a toxic effect related to the medication?

crackles Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects.

Megestrol acetate, an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history?

thrombophlebitis Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. Gout, asthma, and myocardial infarction are not contraindications for this medication.

The nurse is caring for a child who is receiving chemotherapy for treatment of leukemia and prepares to address which expected needs of this client? Select all that apply.

1 2 4

The nurse is teaching a local women's church group about the risks of cervical cancer. The nurse determines that there is a need for further teaching if a group member states that which is a risk factor?

4

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that which is the primary action of this medication?

compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen reduces DNA synthesis and estrogen response.

A client is receiving chemotherapy that carries a risk of phototoxicity as an adverse effect. Which finding indicates that the client experienced this side effect?

2

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?

2

A client with advanced ovarian cancer is being treated with paclitaxel. The nurse monitors the client closely for which side effect of the medication?

2

Letrozole is prescribed for a postmenopausal client with advanced breast cancer. Which side effect of this medication should the nurse reinforce in the instructions to the client?

2

The nurse is reinforcing instructions to a group of high school males in a health class about how to perform a testicular self-examination (TSE). The nurse should make which statement?

3

The nurse is reviewing the health record of a client with laryngeal cancer. The nurse should expect to note which most common risk factor for this type of cancer documented in the record?

3

Exemestane 25 mg orally daily is prescribed for a client with advanced breast cancer. When reinforcing instructions to the client about the medication, which time does the nurse tell the client to take the medication?

1

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter, especially meats. The nurse should instruct the client to eat which foods instead of meat? Select all that apply.

1 2

The nurse is caring for a client who will have insertion of an internal cervical radiation implant. Which interventions should the nurse review with the client to prepare her for this procedure? Select all that apply.

1 2 3

Which information should the nurse provide to the client who will be receiving chemotherapy with doxorubicin? Select all that apply.

1 3 4 5 6

A client with ovarian cancer is scheduled to receive chemotherapy with cisplatin. The nurse assisting in caring for the client reviews the plan of care, expecting to note which interventions? Select all that apply.

2 5

The nurse is assisting in planning care for a client with Hodgkin's disease who is neutropenic as a result of radiation and chemotherapy. Which actions should be included in the client's plan of care? Select all that apply.

3 4 5

The nurse is reinforcing instructions to a group of adults about the seven warning signs of cancer. The nurse determines that a member of the group needs further teaching if the member states which sign/symptom is a warning sign?

4

The nurse is reviewing the record of a client admitted to the hospital for treatment of bladder cancer. Which risk factor related to this type of cancer should the nurse likely note in the client's record?

4

The nurse is reinforcing instructions to a group of female clients about breast self-examination (BSE). When should the nurse instruct the pre-menopausal client to perform this examination?

one week after menstruation begins The BSE should be performed monthly about 7 days after the menstrual period begins. It is not recommended to perform the examination weekly; at the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

The nurse should monitor for which laboratory result as indicating an adverse reaction in the client who is receiving chemotherapy?

2

The nurse working in an obstetrical-gynecological primary health care provider's office is instructing a small group of premenopausal female clients about breast self-examination (BSE). Which instruction should the nurse reinforce as the first step to begin the BSE?

2

A client with breast cancer is being treated with cyclophosphamide. The nurse plans care, knowing that this medication fits which classification?

4

A client with carcinoma of the breast is admitted to the hospital for treatment with intravenous vincristine. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. After offering an open-ended question in reply, the client expresses how she feels. The nurse then gives the client information. The nurse makes which appropriate response to the client?

4

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse assists in planning care, knowing that which is the primary action of this medication?

4

The nurse is caring for a client with metastatic lung cancer. The client was medicated 2 hours ago and now reports a new and sudden sharp pain in the back. The nurse appropriately interprets this finding as possibly spinal cord compression. Which should the nurse do next?

4

The nurse is assisting with caring for a client with cancer who is receiving cisplatin. Which adverse effects are associated with this medication? Select all that apply.

tinnitus ototoxicity nephrotoxicity hypomagnesemia Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase nonspecific and affect the synthesis of DNA by causing its cross-linking to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine may be administered before cisplatin to reduce the potential for renal toxicity.

The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast?

under the left shoulder The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the left breast is to be examined, the pillow would be placed under the left shoulder. Options 2 and 4 are incorrect.

A client with lung cancer receiving chemotherapy tells the nurse that the food on the meal tray tastes "funny." Which is the appropriate nursing intervention?

2

The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which nursing intervention should be included to prevent renal failure for this client? Select all that apply.

Encourage fluids monitor serum calcium and uric acid levels In order to prevent renal failure in the client with multiple myeloma, the nurse should encourage fluids and monitor serum calcium and uric acid levels. Hypercalcemia secondary to bone destruction is a priority concern in the client with multiple myeloma. The nurse should encourage fluids in adequate amounts to maintain an output of 1.5 L to 2 L a day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium and uric acid, but also to prevent protein from precipitating in the renal tubules. Oral care, encouraging coughing and deep breathing, and monitoring the red blood cell count are important for clients with cancer, but these interventions are not specific to prevention of renal failure.

The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide. Which instruction should the nurse provide to the client?

Increase fluid intake to 2000 to 3000 mL daily. Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client should not be told to increase potassium intake. The client should not be instructed to alter sodium intake.

The client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value should the nurse specifically monitor during treatment with this medication?

Uric acid level Busulfan can cause an increase in the uric acid level because of massive cell death of malignant cells. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Clotting time, potassium, and glucose blood levels are not specifically related to this medication.

When reinforcing teaching about signs and symptoms of ovarian cancer with a community group of women, the nurse emphasizes which sign/symptom as being a typical manifestation of the disease recognized by persons diagnosed with the condition?

abdominal distention or fullness Ovarian cancer is the leading cause of death from gynecological cancers and occurs in women older than 50 years. The most common sign and symptom of ovarian cancer is abdominal distention or fullness. Less common are vague symptoms of urinary frequency and urgency, and GI symptoms such as a change in bowel habits. Pelvic cramping, sharp abdominal pain, or postmenopausal vaginal bleeding are not the most typical signs and symptoms.

The client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which adverse effect is specific to this medication?

extremity numbness Vincristine is a vinca alkaloid antineoplastic (miotic inhibitor) medication that has an adverse effect, specifically peripheral neuropathy. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation, rather than diarrhea, is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching? Select all that apply.

i will limit sun exposure to 1 hour daily i will apply moisturizer with a cotton tipped applicator for itching The client needs to be instructed to avoid exposure to the sun because of the risk of burns, resulting in altered tissue integrity. No lotions, ointments, or medications should be applied to the skin unless prescribed by the radiologist.

A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?

monitor the client for bleeding Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Monitoring the temperature relates to infection, particularly if leukopenia is present. The options indicating to ambulate the client and monitor for pathological fractures are also important to the plan of care but are not directly related to thrombocytopenia.

The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle? Select all that apply.

pregnant women are not allowed into the clients room wear a lead apron while delivering bedside care to the client A client receiving treatment for cancer with internal radioactive implant is emitting radioactive beams and others in the environment must take precautions to avoid injury. Pregnant persons are not allowed in the room. Nurses delivering bedside care must wear a lead apron which will stop the radioactive beams. The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room. Children less than 16 years old and pregnant women are not allowed in the client's room. These guidelines protect individuals from radiation exposure.

The nurse is assisting with creating a plan of care for a client with pancytopenia as a result of chemotherapy. The nurse should suggest including which in the plan of care? Select all that apply.

restricting fresh fruits and vegetables in the diet applying a face mask to the client if outside the room A client who is experiencing pancytopenia (decrease in all blood cells types: red, white, and platelets) is at high risk for infection because of significantly low immunity. The client should not eat fresh fruits and vegetables because they are at a potential for ingesting bacteria. All foods should be cooked thoroughly. The client should wear a mask when outside of the room to avoid potential infection spread from persons in the hallways. Not all visitors are restricted, but the client is protected from people with known infections. Fluids should be encouraged because dehydration increases the risk for infection. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infection.

The nurse is obtaining data from a client admitted with a diagnosis of bladder cancer. Which question should the nurse ask the client to determine if the client experienced the most common symptom associated with this type of cancer?

1

The nurse is assisting in developing a postoperative plan of care for a client following a right mastectomy. Which interventions will be included in the plan of care? Select all that apply.

1 2 3 5 6

A client with cancer is receiving cisplatin. Which findings indicate that the client is experiencing an adverse effect of the medication? Select all that apply.

1 4

Capecitabine is prescribed for a client with metastatic breast cancer. The nurse reinforces information to the client about the medication including what frequent side effect?

2

The nurse is reviewing the laboratory results of a client receiving chemotherapy for cancer. The nurse reports which abnormal result to the primary health care provider?

2

Cyclophosphamide is prescribed for a client with a diagnosis of breast cancer. The nurse has reinforced instructions to the client regarding the medication to prevent hemorrhagic cystitis. Which statement by the client indicates an understanding of this chemotherapeutic regimen?

3

Docetaxel is prescribed for a client with metastatic breast cancer. In addition, dexamethasone is prescribed to be administered before initiation of the docetaxel. What is the rationale for the addition of dexamethasone to the treatment plan that the nurse should explain to the client?

3

The nurse is assisting in caring for a client receiving chemotherapy. On review of the morning laboratory results, the nurse notes that the white blood cell count is extremely low, and the client is immediately placed on neutropenic precautions. The client's breakfast tray arrives, and the nurse inspects the meal and prepares to bring the tray into the client's room. Which action should the nurse take before bringing the meal to the client?

3

The nurse is assisting in caring for a client with an inoperable lung tumor and helps develop a plan of care by addressing complications related to the disorder. The nurse includes monitoring for the early signs of vena cava syndrome in the plan. Which early sign of this oncological emergency should the nurse include monitoring for in the plan of care?

3

A nursing student is assisting in caring for a client with a lung tumor; the client will be having a pneumonectomy. The nursing instructor reviews the postoperative plan of care developed by the student and suggests deleting which item from the plan?

4

The nurse is preparing a client for an intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. The nurse provides instructions to the client regarding the procedure. Which client statement indicates an understanding of this procedure?

4

The nurse is reinforcing information regarding chemotherapy with a client who has been diagnosed with cancer. The nurse tells the client that which is an advantage of continuous intravenous (IV) chemotherapy?

4

The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? Select all that apply.

CXR pulmonary function studies Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. During pulmonary fibrosis, the lung tissue becomes very scarred and hard. Pulmonary fibrosis is not reversible and the client is continuously short of breath. Pulmonary function studies and chest x-ray, along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and adventitious sounds, which could indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Cardiac studies such as an echocardiogram and electrocardiogram, and a cervical radiograph are unrelated to the specific use of this medication.

A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?

malignant proliferation of plasma cells and tumors within the bone Multiple myeloma is a neoplastic condition that is characterized by the abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Altered red blood cell production and altered production of lymph nodes are not characteristics of multiple myeloma. Exacerbation in the number of leukocytes describes the leukemic process.

The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines that further teaching is needed if a community member states that which is a sign/symptom of testicular cancer? Select all that apply.

alopecia elevation of PSA levels Alopecia is not a sign/symptom of testicular cancer. However, it may occur as a result of radiation or chemotherapy. Elevated PSA levels are associated with prostate cancer. Testicular swelling without pain and a feeling of heaviness in the scrotum occur with testicular cancer as a result of the tumor growing. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

The nurse is assisting in the care of a client diagnosed with multiple myeloma who has been prescribed an intravenous solution of 0.9% normal saline at 125 mL per hour. Which finding would indicate a positive response to this treatment?

1

The nurse is assisting in preparing a teaching plan of care for a client being discharged from the hospital following surgery for testicular cancer. Which instruction should the nurse suggest to include in the plan?

3

The nurse is caring for a client who has undergone pelvic exenteration. In addressing psychosocial issues related to the surgery, which statement by the nurse should be therapeutic?

3

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action? Select all that apply.

apply pressure on the radiated area to prevent bleeding avoid standing within six feet of the persons under the age of 18 The client should avoid pressure on the radiated area and wear loose-fitting clothing to prevent a disruption in the skin integrity. A client receiving external radiation is not radioactive and does not need to avoid other persons, including young people. A diet high in protein assists in the healing process. Avoiding sunlight and washing the skin with gentle soap and patting dry will assist with preventing skin disruption.

The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication that may become a chronic problem related to the surgery?

arm edema on the operative side Clients who undergo mastectomy for breast cancer, especially those with axillary node resection, may develop chronic lymphedema or excessive swelling in the arm and hand. Lymphedema is a complication that may develop immediately after mastectomy, months, or even years after surgery. Slight edema may occur in the immediate postoperative period, but should decrease especially if the client rests with the arm supported on a pillow. Women should avoid injury to the arm on the affected side and not allow venipunctures or blood pressures to be taken in that arm. Pain and numbness near the incision and drainage from the surgical site are expected occurrences after mastectomy and are not indicative of a complication.

The nurse is collecting data from a client with a history of bladder cancer. Which signs/symptoms should the nurse expect the client to report? Select all that apply.

dysuria hematuria urgency frequency The most common sign of bladder cancer is painless, intermittent hematuria. Other signs and symptoms include bladder irritability; infection, with dysuria, frequency, and urgency; and decreased stream of urine. Headache is not associated with bladder cancer and dull ache in the flank area is associated with renal cancer.

A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is therapeutic?

1

A client with bladder cancer is receiving cisplatin and vincristine. The nurse plans care, knowing that which is the purpose of administering both of these medications?

4

A client with cancer develops white, dough-like patches on the mucous membranes of the oral cavity. Which action should the nurse take when noting this?

4

A client is diagnosed as having a bowel tumor, and several diagnostic tests are prescribed. The nurse reinforces instructions to the client and includes information that which test will confirm the diagnosis of malignancy?

1

A client with lung cancer is receiving a high dose of methotrexate. Leucovorin is also prescribed. The nurse who is assisting in planning care for the client understands that administering the leucovorin with methotrexate is for which purpose?

1

A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs additional study if the student states that which is an associated characteristic?

1

The nurse is caring for a client in the oncology unit who has developed stomatitis during chemotherapy. The nurse should plan which measure to treat this complication?

1

The nurse is preparing a client with a bowel tumor for surgery. The primary health care provider has informed the client that the surgery is palliative in the treatment of the tumor. Which rationale is the reason to perform this type of surgery?

1

A client is scheduled to receive chemotherapy with a group of medications, one of which is asparaginase. The nurse anticipates that this medication should be removed from the regimen after noting which findings in the client's medical record? Select all that apply.

1 5

A client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client makes which statements? Select all that apply.

1 5

A client with which type of cancer is at greatest risk for experiencing the complication vena cava syndrome?

2

The nurse is helping prepare instructions for a client who has developed stomatitis following the administration of a course of antineoplastic medications. Which instructions should the nurse suggest to include in the plan of care? Select all that apply.

2 3 5

A client with cancer has received a course of chemotherapy with fluorouracil. The nurse should plan to reinforce which instructions?

3

The nurse admitting a client to the hospital is reviewing the client's history and medications taken at home. Which condition in the client's history is being treated with tamoxifen citrate?

3

The nurse caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer is reinforcing discharge instructions to the client. Which statement by the client indicates the need for further teaching regarding care of the stoma?

3

The nurse discusses the risk factors associated with gastric cancer as part of a health promotion program. The nurse determines that there is a need for further teaching if a member attending the program states that which factor is a risk?

3

The nurse is caring for a client receiving chemotherapy and determines that the client has developed myelosuppression. Which laboratory value would support the client's diagnosis of myelosuppression?

3

A client undergoing chemotherapy with intravenous vincristine sulfate has been given information about the treatment. The nurse determines that the client has adequate understanding if the client identifies which sign or symptom as a potential adverse/side effect of the medication?

4

The nurse is orienting a new nurse to the care of a client who has an internal radiation implant. Which statement by the new nurse demonstrates the need for further teaching?

4

The nurse is reinforcing instructions to the client on how to maintain optimal skin integrity during external radiation therapy. The nurse determines that there is a need for further teaching if the client states plans to do which action?

4

The nurse tells a client with leukemia that allopurinol has been added to the medication list. The client is currently receiving busulfan. When the client asks the purpose of the new medication, the nurse responds that allopurinol is intended to prevent which complication?

4

A client has just been told by the primary health care provider about her diagnosis of breast cancer. The client responds, "Oh no, does this mean I'm going to die?" The nurse interprets which response as the client's initial reaction?

1

The nurse is providing care for a client with a diagnosis of germ cell cancer of the testes who has been prescribed ifosfamide. The nurse anticipates that the client will also be prescribed which additional antineoplastic medication?

1

The nurse reviews the care plan of a client with cancer and notes that the client has a problem with adequate food intake related to side effects of therapy. In order to enhance appetite and nutrition, the nurse should offer which advice to the client?

1

When inspecting the stoma of a client following an ureterostomy 6 hours ago, the nurse notes that the stoma appears pale in color. Which interpretation does the nurse make based on this finding?

1

A client with carcinoma is admitted to the hospital for a chemotherapy treatment with intravenous bleomycin sulfate. The plan of care mentions observing for interstitial pneumonitis as the priority of care. Which finding most closely correlates to symptoms of interstitial pneumonitis and requires reporting?

2

The nurse is collecting data from a client who is admitted to the hospital for diagnostic studies to rule out the presence of Hodgkin's disease. Which question should the nurse ask the client to elicit information specifically related to this disease?

4

The nurse is monitoring a client on chemotherapy for signs and symptoms related to tumor lysis syndrome. The nurse understands that which is an early sign of this oncological emergency?

4

The nurse is reinforcing instructions to a client scheduled for conization in 1 week for the treatment of microinvasive cervical cancer. The procedure has been explained by the primary health care provider, and the nurse is reviewing the complications associated with the procedure. The nurse determines that the client needs further teaching if the client states that which is a complication of this procedure?

4

The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?

calcium levels Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain. Tamoxifen does not increase glucose or potassium levels, or increase the prothrombin time.

The nurse is reviewing the medical history of a client admitted to the hospital with a diagnosis of colorectal cancer. The nurse understands that which information documented in the medical history are risk factors of this type of cancer? Select all that apply.

1 3 4 5

The nurse is caring for a client with a diagnosis of metastatic breast carcinoma. Tamoxifen citrate 10 mg orally twice daily is prescribed for the client, and the nurse is reinforcing instructions to the client regarding the medication. Which statement by the client would indicate an understanding of the medication?

4

The nurse is reinforcing client education regarding symptoms of testicular cancer. The nurse encourages the client to report which symptoms as being associated with testicular cancer? Select all that apply.

4 5

The nurse is caring for a client after a mastectomy. Which nursing interventions should assist with preventing lymphedema of the affected arm? Select all that apply.

elevating the affected arm on a pillow above the heart level avoid taking blood pressure measurements on the affected arm Lymphedema is a potential complication of mastectomy, especially if the surgery included axillary node resection. After mastectomy, the primary health care provider's prescriptions regarding positioning are followed. No compression of the arm, as with a blood pressure measurement, should ever be done in the arm. The arm on the surgical side is usually elevated above the level of the heart, and simple arm exercises should be encouraged. No blood pressure readings, injections, IV line insertions, or blood draws should be performed on the affected arm. Cool compresses are not a recommended measure to prevent lymphedema from occurring.

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which signs and symptoms of the client are associated with Hodgkin's disease? Select all that apply.

fatigue weakness night sweats enlarged lymph nodes Hodgkin's disease (lymphoma) is a chronic, progressive neoplastic disorder of the lymphoid tissue that is characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Other signs and symptoms include fatigue, weakness, weight loss, and night sweats. Weight gain and joint pain are not associated with Hodgkin's disease.

The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis?

increased calcium level Findings that are indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia as a result of the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased white blood cell count may or may not be present, but this is not specifically related to multiple myeloma.

The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for further teaching if a member of the community group makes which statement regarding this type of cancer?

it most often occurs in women The incidence of bladder cancer is greater among men than among women, and it affects the white population twice as often as the black population. Age over 40, environmental exposure to certain chemicals, and cigarettes especially are associated with the incidence of bladder cancer.

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action?

pick up the implant with long handled forceps and place into a lead container A lead container and long-handled forceps should be kept in the client's room at all times during internal radiation therapy. Lead is an element that has a high density and high atomic number and is used to shield persons from radiation. If dislodged, the implant must be handled carefully to limit radiation exposure to the client and all persons in the environment. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it into the lead container. The radiation safety officer of the institution should be notified. Although the PHCP needs to be notified, this is not the immediate action. The nurse cannot reinsert the implant. A radioactive implant is specifically placed inside the client to kill the cancer while limiting damage to adjacent tissues and organs. Touching the implant with gloves and flushing this down the toilet exposes the nurse and the environment to unsafe levels of radiation.

The licensed practical nurse (LPN) is assisting the registered nurse (RN) to create a teaching plan for the client receiving an antineoplastic medication. The LPN expects which information to be included? Select all that apply.

rinse the mouth after meals and use a soft toothbrush maintain oral hygiene and inspect mouth for sores daily consult with HCP before receiving immunizations Clients with cancer treated with antineoplastic medications must be aware of how to care for themselves and it is important that client teaching is included in the care plan. Because antineoplastic medications affect the bone marrow, clients are often anemic, have lower immunity, and may be at risk for bleeding. Oral hygiene is important and clients should inspect their mouths daily, rinse after meals, and use a soft toothbrush. The client should check with the PHCP before receiving any immunizations. The client should notify the PHCP for a low grade temperature such as 99.5° F (39.7° C) and a sore throat. These are often associated with low white blood cell counts.

The nurse is reinforcing instructions to a client on performing a testicular self-examination (TSE). Which instructions should the nurse provide to the client? Select all that apply.

the best time for the exam is after a shower set up a schedule for performing TSE on the same day each month The TSE is recommended after a warm bath or shower when the scrotal skin is relaxed. The client should set up a schedule of performing TSE the same day each month in order not to forget. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps. The TSE should be performed monthly.

The client with small cell lung cancer is being treated with etoposide and the nurse is assisting with caring for the client during administration. The client gets up to use the bathroom and is dizzy and very weak. The nurse understands these symptoms are likely as a result of which side/adverse effect that is specifically associated with this medication?

orthostatic hypotension A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

The nurse reinforces the teaching plan for a client with a family history of breast cancer. Which teaching point should be included?

2

A client with acute nonlymphocytic anemia receives treatment with cytarabine. The nurse reinforces medication instructions to the client and tells the client that it is important to report which adverse effect to the primary health care provider?

4

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which is documented in the client's history?

pancreatitis Asparaginase is a antineoplastic enzyme that is contraindicated if hypersensitivity exists in the case of pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between the administration of doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The medication may be used for clients with a history of diabetes mellitus, myocardial infarction, or chronic obstructive pulmonary disease.

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a suprapubic prostatectomy. The nurse should reinforce which discharge instruction? Select all that apply.

take the prescribed stool softener every day avoid lifting objects heaver than 20# for 6 weeks A suprapubic approach involves a lower abdominal incision to remove the prostate to treat prostate cancer. The nurse will reinforce instructions about the incision activity, medications, and when to contact the urologist. The client should take the prescribed stool softener because constipation will lead to straining and cause pain and tension on the surgical site. The client should avoid lifting more than 20 pounds for 6 weeks to avoid tension on the surgical site. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A daily fluid intake of 2 L to 2.5 L per day (unless contraindicated) should be maintained to limit clot formation and prevent infection. The incision is not on the scrotum but in the lower abdominal area. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery and do not need to be reported.

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric (NG) tube. Which action should the nurse take?

monitor the drainage Following gastrectomy, drainage from the NG tube is normally bloody for 24 hours postoperatively, changing to brown-tinged and then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. There is no need to notify the PHCP at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, an NG tube should not be irrigated.

The nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling. The nurse should take which appropriate action?

notify the RN immediately When antineoplastic medications are administered via IV, great care must be taken to prevent extravasation, the condition in which the medication escapes into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site. If extravasation occurs, the RN needs to be notified at once and the infusion will be stopped. The nurse will contact the PHCP. Depending on the specific medication, actions are taken to counteract the negative effects. The medication may be aspirated out, ice or warmth applied, and the area infiltrated with a neutralizing agent specific to the medication.

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which are side/adverse effects of the external radiation? Select all that apply.

sore throat red and dry skin all over neck External radiation is used to treat cancer in a specific area by emission of ionizing radiation beams that destroy cancer cells and have minimal damage to the surrounding normal cells. The client receiving external radiation experiences both general side/adverse effects such as fatigue, nausea, anorexia and localized side/adverse effects in the specific area receiving radiation. A client who is receiving radiation to the larynx is most likely to experience a sore throat and dry, reddened skin in the throat area. Diarrhea or constipation occur with radiation to the gastrointestinal (GI) tract. Dyspnea may occur with lung involvement.

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy?

increased uric acid level Hyperuricemia, elevated levels of uric acid, is especially common after treatment for leukemias and lymphomas, because the therapy results in massive cell destruction and the release of uric acid. Anemia (low red blood cell count), low platelet levels, and low white blood cell counts are associated with the bone marrow abnormalities that are a part of the leukemias and lymphoma disease process.

The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. Besides treatment of the lung cancer, the nurse anticipates that which interventions may be prescribed to treat the SIADH? Select all that apply.

institute safety measures monitor sodium blood levels gather neuro status data administer antagonistic to ADH Syndrome of inappropriate ADH (SIADH) is a condition in which excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is a potential complication associated with cancer, especially small cell lung cancer. SIADH is managed by treating the condition and its cause. The SIADH induces low sodium blood levels and results in altered neurological states, including confusion and unresponsiveness. Treatment of SIADH includes fluid restriction, increased sodium intake, and a medication with a mechanism of action that is antagonistic to ADH, such as demeclocycline. Sodium blood levels and neurological status are monitored closely and safety interventions must be instituted. The client should not be treated with an increase in fluid intake or a decrease in the sodium intake.

The nurse is reviewing the record of a client with a diagnosis of cervical cancer. Which should the nurse expect to note in the client's record related to a risk factor associated with this type of cancer?

4

The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which risk factors associated with cancer? Select all that apply.

low fat high fiber diet maintain normal weight A healthy life style is one way to lower the risk of cancer. This includes maintaining a normal weight and following a low-fat, high-fiber diet. Viruses may be one of multiple agents that act to initiate carcinogenesis and that have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. High-fiber diets may reduce the risk of colon cancer. A diet that is high in fat and obesity may increase the risk of the development of certain cancers.

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 mm3 (10 × 109/L). On the basis of this laboratory value, the nurse should perform which interventions? Select all that apply.

monitor stools for occult blood instruct the client not to bend over at the waist or lift instruct the client to blow nose very gently without blocking either nostril Platelets or thrombocytes are necessary for a client to clot. A high risk of hemorrhage exists when the platelet count drops below 20,000 mm3 (20 × 109/L). Fatal central nervous system hemorrhage or massive GI hemorrhage can occur when the platelet count is less than 10,000 mm3 (10 × 109/L). The client may be treated with medications or platelet or blood transfusions to improve the platelet count. The nurse should monitor the client's stools for blood, both obvious and occult. The client should be very gentle if blowing the nose and not cause any pressure to build up in the head. The client also needs to avoid starting bleeding from epistaxis (nosebleed). The client should not bend over at the waist because this action would increase the pressure within the head and increase the risk for an intracerebral bleed. Clients with decreased immunity, which is not stated in the question, should avoid ill persons. The client should not floss the teeth and only use a soft toothbrush to avoid bleeding in the mouth.