Oncology PRACTICE Q
Answer D. Anemia. Anemia is the most common hematologic condition affecting elderly patients; with each successive decade of life, the incidence of anemia increases. Anemia frequently results from iron deficiency (in the case of blood loss) or from a nutritional deficiency, particularly folate or vitamin B12 deficiency or protein--calorie malnutrition; it may also result from inflammation or chronic disease.
The nurse recognizes this as the most common hematologic condition associated with aging. A. Thrombocytopenia B. Leukopenia C. Agranulocytosis D.Anemia
Answer A, C, D. The head of the bed should be maintained no higher than 15 degrees. Elevation of the head, sitting or standing up, puts the patient at risk for perforation of the uterus and bladder as a result of forward movement of the implant.
A nurse is caring for a patient receiving brachytherapy for cervical cancer. Which of the following statements regarding the nursing care of this patient is true? Select all that apply. A. The patient must be maintained on bed rest. B. The head of the bed must be elevated more than 30 degrees to decrease the risk of aspiration. C. Pain management is a priority. D. The patient will have an indwelling urinary catheter.
Answer C. The formula for determining the absolute neutrophil count (ANC) is the white blood cell (WBC) count multiplied by the sum of the %neutrophil count (segs) and %bands. An ANC <500 is severe neutropenia and is associated with high risk for infection.
A patient presents to her primary care provider with a complaint of a "cold that just won't go away." She has a CBC drawn, revealing the following: WBC 4.5: segs 5, bands 0, lymphs 45, eosinophils 5, basophils 5, monocytes 5, blasts 35. What is the patient's absolute neutrophil count? A. 500 B. 250 C. 225 D. 2,250
Answer C. Notify the health care provider. Platelet counts ≤10,000/mm³ are associated with serious episodes of spontaneous bleeding, including intracranial hemorrhage; thus complaints of headaches or change in the level of consciousness necessitate immediate notification of the health care provider.
A nurse is caring for a patient who is 73 years old with a platelet count of 5,000/mm3 resulting from myelodysplastic syndrome. At 10 PM, the patient complains of a headache. What should be the nurse's immediate action to take? A. Administer aspirin per p.r.n. order. B. Administer acetaminophen per p.r.n. order. C. Notify the health care provider. D. Administer a nonpharmacologic intervention, such as a cool compress.
Answer D. Tumor lysis syndrome includes hyperuricemia (>6 mg/dL in women, >7 mg/dL in men), hyperkalemia (>5 mEq/L), hyperphosphatemia (>4.5 mg/dL), and elevated creatinine (>1.2 mg/dL).D is the only lab that includes the abnormalities above.
A nurse is caring for a patient with newly diagnosed leukemia who is receiving chemotherapy for the first time. Twenty-four hours after the first dose of chemotherapy, the patient experiences decreased urine output, an abnormal heart rate, and lethargy. Which of the following laboratory results would help support the nurse's suspicion for tumor lysis syndrome? A. Serum calcium 13.0 mg/dL, potassium 3.5 mEq/L, magnesium 2.0 mg/dL B. Potassium 2.0 mEq/L, phosphorous 3.0 mg/dL, calcium 6.0 mg/dL C. Uric acid 4.0 mg/dL, creatinine 3.0 D. Uric acid 10.0 mg/dL, potassium 5.5 mEq/L, phosphorous 5.0 mg/dL
Answer D. Primary prevention includes interventions that decrease the risk of developing certain types of cancer. Secondary prevention includes methods for early detection such as screening. Answer D is the only intervention listed aimed at modifying risk.
A nurse is creating a public health intervention that targets teenagers at risk for skin cancer secondary to sun and tanning bed exposure. Which of the following is an example of primary prevention? A. Establishing a van that travels to high schools to perform skin assessments B. Establishing a clinic based in the school nurse's office that performs screening examinations for skin cancer C. Developing an educational intervention to teach skin self-assessment D. Developing a television commercial, to be aired on the music television network, educating teens on the risks of sun exposure
Answer C. DIC is marked by fibrinogen and platelet consumption (evidenced by a decreased fibrinogen and a decreased platelet count) and a prolonged PTT.
A patient is being treated for sepsis. On the second day of receiving care, the patient experiences epistaxis and persistent bleeding from a venipuncture site. The nurse suspects DIC. Which laboratory result supports the nurse's suspicion? A. Increased fibrinogen, decreased PTT, decreased platelets B. Decreased fibrinogen, increased PTT, increased platelets C. Decreased fibrinogen, increased PTT, decreased platelets D. Increased fibrinogen, increased PTT, increased platelets
Answer B. Open-ended, therapeutic questions are the best way to elicit from the caregiver what he or she feels about the dying process; and they are a good way to lead into teaching the caregiver about what happens with appetite and thirst in the dying patient. The nurse may follow the caregiver's answer to the question "Tell me why you feel that way?" with the following education: "It must be difficult to see your loved one not want to eat or drink. But studies have shown that, as people draw near death, adding artificial nutrition and hydration does not improve anything. Actually, there are beneficial effects to letting your loved one decide how much she will eat and drink; among other things, these include decreasing the size of her belly and discomfort that may come from a lot of fluid in her stomach and decreasing the amount of fluids in her lungs. Let's think about ways you can care and demonstrate love besides offering food and drink."
A patient is nearing death from metastatic cancer and is receiving hospice care in the home. The home care nurse visits. The patient's family caregiver states that the patient has not eaten well for the last several days and rarely wishes to drink, only sucking on ice now and then. The caregiver thinks that it is cruel to let the dying patient starve to death, or die from dehydration. What would the nurse's best response be? A. "I think it is cruel, too. If this were my mother, I would not let her die like that." B. "Tell me why you feel that way?" C. "It's okay, because this may hasten death and relieve suffering." D. "This is what happens when people die."
Answer A, B, C. Patients experiencing mucositis should avoid any products containing alcohol, as alcohol is drying to the oral mucosa and may impair healing.
A patient is receiving external beam radiation therapy for head and neck cancer. The patient reports moderate pain to the tongue and buccal mucosa that is interfering with his ability to eat, sleep, and speak. Which of the following interventions would you recommended for this patient? Select all that apply. A. Take pain medication 30 minutes before meals. B. Avoid acidic, spicy, and sharp foods such as chips. C. Keep dentures out when not eating to promote healing. D. Rinse the oral mucosa regularly with an alcohol-based solution.
Answer B. Apply pressure to the nares and position the patient in a high Fowler's position, leaning slightly forward. Sitting upright decreases the risk of aspiration of blood and pressure is applied for a minimum of 5 minutes. Ice may also be applied to the nares. The patient's mouth should be open so that blood can drain rather than be swallowed, which may cause vomiting.
A patient with thrombocytopenia due to chemotherapy develops a nose bleed (epistaxis). What is the nurse's expected response? A. Apply ice to the anterior surface of the nose and place the patient in a supine position B. Apply pressure to the nares and position the patient in a high Fowler position, leaning slightly forward C. Squeeze the nares together firmly and position the patient in prone position with mouth open D. Ask the patient to blow the nose vigorously as the nurse applies firm pressure to the nares
Answer C. Neutropenic fever is an oncologic emergency. Neutropenic patients who have a fever must notify their health care provider immediately and anticipate going to the provider office or the emergency room for evaluation. If the patient cannot reach their health care provider by phone, the patient should go to the nearest hospital.
In assessing the neutropenic patient's understanding of discharge education, which patient statement indicates that the nurse needs to provide further education? A. "I should stay away from crowds and people who are sick." B. "I should wash my hands carefully after using the bathroom and before eating meals." C. "If I have a fever or chills, I should take acetaminophen immediately and recheck my temperature an hour later." D. "My WBC count should recover about 14 days after my treatment is completed."
Answer B. During the initial treatment of acute leukemia, the ANC often drops below 100/mm3, placing the patient at very high risk for infection. Empiric antibiotics are used to preemptively treat infection when the patient has a fever of 100.4°F or greater.
The nurse is caring for a patient diagnosed with ALL who is receiving initial treatment. The patient has been complaining of a dry cough. The patient also has diminished breath sounds upon auscultation. What should the nurse monitor as priority with regard to potential complications in this patient? A. Hemoglobin B. Absolute neutrophil count (ANC) C. Hematocrit D. Urine
Answer B. Fatigue related to decreased cellular oxygenation. A low red blood cell (RBC) count decreases oxygen availability to the tissues, and fatigue, shortness of breath, and weakness may be noted.
What is the priority nursing diagnosis for a client experiencing anemia? A. Risk for injury related to poor blood clotting B. Fatigue related to decreased cellular oxygenation C. Risk of infection related to decreased leukocytes D. Imbalanced nutrition; less than body requirements related to anorexia
