Saunders NCLEX-RN Ch 52: Hematological and Oncological Disorders

A client with carcinoma of the lung develops SIADH as a complication of cancer. The nurse anticipates that the HCP will request which prescriptions? SATA 1) Radiation 2) Chemotherapy 3) Increased fluid intake 4) Decreased oral sodium intake 5) Serum sodium level determination 6) Medication that is antagonistic to antidiuretic hormone

1, 2, 5, 6. CA is a common cause of SIADH, in which excess amts of water are absorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia, and some degree of fluid retention. Syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are closely monitored bc hypernatremia can develop suddenly dt treatment. The immediate institution of appropriate CA therapy, usually radiation or chemo, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

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? SATA 1) Facial edema in the morning 2) Serum Ca level of 12mg/dL 3) Weight loss of 20# in 1 mo 4) Serum sodium level of 136mg/dL 5) Serum K level of 3.4mg/dL 6) Numbness and tingling of the lower extremities.

1, 2, 6. Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, SVC syndrome, tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of SVC syndrome. Serum Ca levels of 12mg/dL indicate hypercalcemia. Numbness and tingling could indicate spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. Sodium level of 136mg/dL is a normal level.

The nurse is caring for a client who is postoperative following a pelvic exenteration and the HCP changes the clients diet from NPO to clear liquids. The nurse should check which priority item before administering the diet? 1) Bowel sounds 2) Ability to ambulate 3) Incision appearance 4) Urine specific gravity

1. Client is NPO until peristalsis returns, usually in 4-6 days. When signs of bowel fx return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. Most important is to assess bowel sounds before feeding. Options 2, 3, 4 unrelated to the data in the question.

The home health care nurse is caring for a client with cancer who is c/o acute pain. The most appropriate determination of the clients pain should include which assessment? 1) The clients pain rating 2) Nonverbal cues from the client 3) The nurses impression of the clients pain 4) Pain relief after appropriate nursing intervention

1. Clients self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurses impression is not appropriate in determining pain. Assessing pain relief is an important measure, but this option is not r/t the subject of the question.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary r/t colorectal cancer if the client identifies which item as an associated risk factor? 1) Age younger than 50 2) History of colorectal polyps 3) Family history of colorectal cancer 4) Chronic inflammatory bowel disease

1. Colorectal cancer risk factors include age over 50, family history, colorectal polyps, chronic inflammatory bowel disease.

The nurse is reviewing the lab results of a client dx with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1) Incr Ca levels 2) Incr WBC 3) Decr BUN 4) Decr number of plasma cells in the bone marrow

1. Findings indicative of multiple myeloma are increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by release of Ca from deteriorating bone tissue, and elevated BUN. Incr WBC count may or may not be present, and is not r/t multiple myeloma.

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment findings indicate that the colostomy is beginning to function? 1) The passage of flatus 2) Absent bowel sounds 3) The clients ability to tolerate foods 4) Bloody drainage from the colostomy

1. Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72hrs after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. Client remains NPO until bowel sounds return and the colostomy is fx. Bloody drainage is not expected from a colostomy.

The nurse is developing a POC for the client with multiple myeloma and includes which priority intervention? 1) Encourage fluids 2) Providing frequent oral care 3) Coughing and deep breathing 4) Monitoring RBC count

1. Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. Nurse should administer fluids in adequate amounts to maintain a urine output of 1.5-2L/day. This requires about 3L/day. The fluid is needed to dilute the Ca overload, prevent protein from precipitating in the renal tubules. Others may be components of the POC but are not priority.

When caring for a client with an internal radiation implant, the nurse should observe which principles? SATA 1) Limiting time with client to 1 hr per shift 2) Keep pregnant women out of client's room 3) Place client in private room with private bath 4) Wearing a lead shield when providing direct client care 5) Removing the dosimeter film badge when entering the client's room 6) Allowing individuals younger than 16yo in the room as long as they are 6ft away from client.

2, 3, 4 The time the nurse spends is 30m per 8 hr shift. The client must be in a private room with a private bath. The nurse should wear a lead shield to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client's room. Children younger than 16 and pregnant women are not allowed in the client's room.

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply. 1) Flatulence 2) Peritonitis 3) Hemorrhage 4) Fistula formation 5) Bowel perforation 6) Lactose intolerance

2, 3, 4, 5. Complications of bowel tumors include bowel perf, which can result in hemorrhage and peritonitis. Other complications include bowel obstruction, and fistula formation. Flatulence can occur but is not a complication; lactose intolerance also is not a complication of intestinal tumor.

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it fells as if she is voiding through the vagina. The nurse interprets that the client may 1) Rupture of the bladder 2) Development of a vesicovaginal fistula 3) Extreme stress caused by the dx of CA 4) Altered perineal sensation as a s/e of radiation therapy

2. A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening bt these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. Clients complaint is not associated with options 1, 3, 4.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1) Placing cool compresses on the affected arm 2) Elevating the affected arm on a pillow above heart level 3) Avoiding arm exercises in the immediate post-op period 4)Maintaining an IV site below the antecubital area on the affected side

2. Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No BP readings, injections, IV lines or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occuring.

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 most appropriate? 1) Clamp the penrose drain 2) Change the dressing as prescribed 3) Notify HCP 4) Remove and replace the perineal packing

2. Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. Therefore the nurse should change the dressing as prescribed. A penrose drain should not be clamped because the action will cause the accumulation of drainage within the tissue. The nurse does not need to notify the HCP at this time. Penrose drains and packing are removed gradually over a period of 5-7d as prescribed. The nurse should not remove the perineal packing.

The nurse is reviewing the hx of a client with bladder CA. The nurse expects to note documentation of which most common symptoms of this type of cancer? 1) dysuria 2) hematuria 3) urgency on urination 4) frequency of urination

2. The most common symptom in clients with bladder CA is hematuria. The client also may experience irritative voiding symptoms s/a frequency, urgency and dysuria, and these symptoms are often associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also signs of a bladder infection.

The nurse is instructing a client to perform a testicular self-exam. The nurse should provide the client with which information about the procedure? 1) to examine the testicles while laying down 2) That the best time for examination is after a shower 3) To gently feel the testicle with one finger to feel for a growth. 4) That testicular self-exam should be done at least every 6 mo.

2. The testicular self-exam is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. Client should stand to examine, using both hands with fingers under the scrotum and thumbs on top. The client should gently roll the testicles, feeling for any lumps.

As part of chemo 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? 1) "I should avoid blowing my nose" 2) "I may need a platelet transfusion if my platelet count is too low" 3) "Im going to take aspirin for my headache as soon as I get home" 4) "I will count the number of pads and tampons I use when menstruating"

3. During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000. The correct option describes an incorrect statement by the client. Aspirin and NSAIDs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2 and 4 are correct statements by the client to prevent and monitor bleeding.

A gastrectomy is performed on a client with gastric cancer. In the immediate post-op period, the nurse notices bloody drainage from the NG tube. The nurse should take which priority action? 1) measure abdominal girth 2) irrigate the NG tube 3) Continue to monitor the drainage 4) Notify the HCP

3. Following the gastrectomy, drainage from the NG tube is normally bloody for 24hrs post-op, changes to brown tinged, and is then yellow or clear. Because bloody drainage is expected in the immediate post-op period, the nurse should continue to monitor the drainage. No need to notify HCP at this time. Measurement of abdominal girth is used to detect development of distention. Following gastrectomy, a NG tube should not be irrigated unless there are specific HCP prescriptions to do so.

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1) Restrict all visitors 2) Restrict fluid intake 3) Teach the client and family about the need for hand hygeine 4) Insert an indwelling urinary catheter to prevent skin breakdown.

3. Meticulous hand hygeine education is implemented for the client, family, visitors and staff in neutropenic clients. Not all visitors are restricted, but client is protected from persons with known infections. Fluids should be encouraged. Invasive measures s/a urinary catheters should be avoided to prevent infections.

The nurse is monitoring a client for s/s r/t SVC syndrome. What is an early sign of this oncological emergency? 1) Cyanosis 2) Arm edema 3) Periorbital edema 4) Mental status change

3. SVC syndrome occurs when the SVC is compressed or obstructed by tumor growth. Early s/s generally occur in the morning and include edema of the face and eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worses, the client experiences edema of the hands and arms. Cyanosis and mental status change are late signs.

The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1) "I change my pouch every week" 2) "I change the appliance in the morning" 3) "I empty the urinary collection bag when it is two-thirds full" 4) "When I'm in the shower I direct the flow of water away from my stoma"

3. The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? 1) Diarrhea 2) Hypermenorrhea 3) Abnormal bleeding 4) Abdominal distention

4. CM's include abd distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor, and effects or urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

A client is admitted to the hospital with a suspected diagnosis of Hodgkins disease. Which assessment finding would the nurse expect to note specifically in the client? 1) Fatigue 2) Weakness 3) Weight gain 4) Enlarged lymph nodes

4. Hodgkins disease is a chronic progressive neoplastic disorder of lymphoid tissue c/b painless enlargement of lymph nodes with progression to extralymphatic sites, s/a spleen and liver. Weight loss is more likely to be noted. Fatigue and weakness may occur but are not significantly r/t the disease.

The nurse manager is teaching the nursing staff about s/s r/t hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign of the oncological emergency? 1) headache 2) dysphagia 3) constipation 4) ECG changes

4. Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. ECG changes include shortened ST segment and a wide T wave.

When 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? 1) call the HCP 2) Reinsert the implant into the vagina 3) Pick up the implant with gloved hands and flush it down the toilet 4) Pick up the implant with long-handled forceps and place it in a lead container.

4. If a radiation implant dislodges, the nurse would first encourage the client to lie still until the source has been placed in a safe closed container. The nurse would use a long-handled forceps to place the source in the lead container that should be in the client's room. The nurse should then call the radiation oncologist, document the event and actions taken. Out of scope of practice to reinsert.

A client is diagnosed with multiple myeloma and the client asks the nurse about the dx. The nurse bases the response on which description of this disorder? 1) Altered RBC production 2) Altered production of lymph nodes 3) Malignant exacerbation in the number of leukocytes 4) Malignant proliferation of plasma cells within the bone

4. Multiple Myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3 describes the leukemic process.

The community health nurse is instructing a group of female clients about breast self-examination. The nurse should instruct the clients to perform the examination at which time? 1) At the onset of menstruation 2) Every month during ovulation 3) Weekly at the same time of day 4) 1 week after menstruation begins

4. The breast self-exam should be performed monthly, 7 days after the onset of the menstrual period. Performing the exam weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.