Pediatric cancer "Correct Answer: A

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to While all of the nursing diagnoses listed here are important, dehydration and fluid and
the nurse, ""I don't understand how this could happen to us. We have been so careful to electrolyte loss secondary to vomiting is the priority for this client."
make sure our child is healthy."" Which response by the nurse is most appropriate?
"A. ""This must be a difficult time for you and your family. Would you like to talk about how "A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000.
you are feeling?"" When planning this child's care, which risk should the nurse consider most significant?
B. ""Why do you say that? Do you think that you could have prevented this?"" "A. Hemorrage
C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" B. Anemia
D. ""Many children are diagnosed with cancer. It is not always life-threatening.""" C. Infection
"Correct Answer: A D. Pain"
Parents of children diagnosed with cancer require major emotional support, and should be "Correct answer: A Hemorrhage
allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is The lab values presented all are normal except for the platelet count. Decreases in platelet
telling the parents that there are many other children with cancer." counts place the child at greatest risk for hemorrhage."
"Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is
"A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which important for the nurse to do which of the following before administering chemotherapy?
of the following would be the best intervention to include in the child's plan of care? "1. Measure abdominal girth
"a. Administer tube feedings. 2. Claculate BMI
b. Offer small, frequent meals. 3. Ask the client about his/her height and weight
c. Offer fluids only between meals. 4. Weigh and measure the client on the day of medication administration"
d. Allow the child to choose what to eat for meals." "Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is
"Correct answer: D usually based on the total Body surface area(BSA) which requires accurate height and
While all options can be done to encourage nutrition, allowing the preschooler choices weight before each med administration.
meets two issues: nutrition and developmental tasks." Simply asking the client about height/weight may lead to inaccuracies in determining BSA.
Calculating BMI and measuring abdominal girth does not provide the data needed."
A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . "Which diagnostic test should be performed annually after age 50 to screen for colon
Which diagnostic test results confirm the diagnosis of Hodgkin's disease? cancer?
1 . Elevated vanillylmandelic acid urinary level. "a. Abdominal computed tomography (CT)
2. The presence of blast cells in the bone marrow b. Abdominal X-ray
3. The presence of Epsetin-Barr virus in the blood. c. Colonoscopy
4. The presence of Reed-Sternberg cells in the lymph nodes d. Fecal occult blood test"
Correct Answer 4 . Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of Answer d: Surface blood vessels of polyps and cancers are fragile and often bleed with the
gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The passage of stools, so a fecal occult blood test and CT scan can help establish tumor size and
presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is metastasis. A colonoscopy can help to locate a tumor as well as polyps, but is only
associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the recommended every 10 years.
urine may be found in children with neroblastoma. "David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings
best indicates that the child is free from pain?
"Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and "a. Decreased appetite
experiencing nausea and vomiting? b. Increased heart rate
"A. Fluid and Electrolyte Imbalance c. Decreased urine output
B. Alterations in Nutrition d. Increased interest in play"
C. Alterations in Skin Integrity "Correct: D
D. Body Image Disturbances" Answer D. One of the most valuable clues to pain is a behavior change: A child who's pain-
free likes to play. A child in pain is less likely to consume food or fluids. An increased heart c. Nausea and vomiting
rate may indicate increased pain; decreased urine output may signify dehydration." d. An abdominal mass"
A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The "CORRECT: D
nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes
intervention would the nurse document in her plan of care. " accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although
"1. Monitor closely for signs of infection. microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor.
2. Temp every four hours. Nausea and vomiting are rare in children with Wilms' tumor."
3. Isolation precautions The mother of a 5-year-old child asks the nurse questions regarding the importance of
4. Use a small toothbrush for mouth care" vigilant use of sunscreen. Which information is most important for the nurse to convey to
4. **Correct... Rationale: Leukemia is a malignant increase in the number of leukocytes, the mother?
usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from "a.) Appropriate use of sunscreen decreases the risk of skin cancer.
decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet b.) Repeated exposure to the sun causes premature aging of the skin.
production. If the platelet count is les than 20,000 than bleeding precautions need to be c.) A child's skin is delicate, and burns easily.
taken. d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other
"The parent of a child undergoing chemotherapy asks forms of cancer."
the nurse why the child must wear a mask in public places. Which of the "Correct: A.
following responses by the nurse would be most appropriate? While all of the answer choices are correct, recommending the use of sunscreen to
"A) ""Chemotherapy causes dry mouth, and the mask will help contain moisture."" decrease the incidence of skin cancer (a) is the best response."
B) ""Chemotherapy decreases immune system function, increasing the risk of acquiring an "A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic
infection."" leukemia. Which of the following signs and symptoms require the most immediate nursing
C) ""Chemotherapy makes the oral mucous membranes deteriorate and makes them intervention?
susceptible to infection."" (Choices were deleted)
D) ""Chemotherapy kills cancer cells, and your child might spread those cells to others.""" Correct: 2. Fever and petechiae associated with acute lymphocytic leukemia indicate a
"Correct: B suppression of normal white blood cells and thrombocytes by the bone marrow and put the
Chemotherapeutic agents decrease the immunity of client at risk for other infections and bleeding. The nurse should initiate infection control
the child. Proper use of the mask will decrease the chance of acquiring and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia
an infection. Cancer is not spread; a mask cannot contain moisture; and due to red blood cell suppression. Although the client should be told about the need for
unsightly mouth sores are not a medical reason to wear a mask." rest and meal planning, such teaching is not the priority intervention. Swollen glands and
A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point lethargy may be uncomfortable but they do not require immediate intervention. An
should the nurse emphasize to the parents? enlarged liver and spleen do require safety precautions that prevent injury to the abdomen;
"1. Do not put pressure on the abdomen. however, these precautions are not the priority.
2. Frequent visits from friends and family will improve morale. A child with leukemia is being discharged after beginning chemotherapy. Which of the
3. Appropriate protective equipment should be worn for contact sports. following instructions will the nurse include when teaching the parents of this child?
4. Encourage the child to remain active." "A. provide a diet low in protein and high in carboydrates
Correct answer: 1. Do not put pressure on the abdomen. Palpation of Wilms' tumor can B. avoid fresh vegetables that are not cooked or peeled
cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be C. notify the doctor if the child's temp exceeds 101 degrees F
exposed to more infections, and activity and sports are discouraged because of the risk of D. increase the use of humidifiers throughout the house"
rupture of the encapsulated tumor. Answer B - fresh vegetables harbor microorganisms, which can cause infections in immune-
"A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to compromised children, fruit or vegetables should be either peeled or cooked. The physician
detect: should be notified of a temp above 100 degrees F. A diet low in protein is not indicated.
"a. Gross hematuria Humidifiers harbor fungi in the water containers.
b. Dysuria
"The pediatric nurse understands that the most common cancer found in children is: "Correct: B.
"1. Non-hodgkin's lymphoma a-— poses little or no threat
2. Acute lymphocytic leukemia B(CORRECT:)- protects patient from exogenous bacteria,
3. Chronic lymphocytic leukemia risk for developing infection from others due to depressed WBC count,
4. Ewing's sarcoma" alters ability to fight infection
"Correct: 2. c-— should be placed in a room alone
1. No - this is not a common cancer in children d-ensure that patient is provided with
2. YES! this is the most common form of cancer found in children is acute lymphocytic opportunities to express feelings about illness"
leukemia. "The postoperative care of a preschool child who has had a brain tumor removed should
3. No - this is not a common cancer in children include which of the following?
4. No - this is not a common cancer in children" "a. colorless drainage is to be expected
"When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most b. analgesics are contraindicated because of altered consciousness
important to avoid which of the following? c. positioning is on the operative side in the Trendelenberg position
"A. Measuring the child's chest circumference d. carefully monitor fluids due to cerebral edema"
B. Palpating the child's abdomen "D CORRECT: Because of cerebral edema and the danger of increased intracranial pressure
C. Placing the child in an upright position postoperatively, fluids are carefully monitored.
D. Measuring the child's occipitofrontal circumference" A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This
"Answer: B. The abdomen of the child with Wilm's tumor should not be palpated because of needs to be reported as soon as possible.
the danger of disseminating tumor cells. Children with Wilm's tumor should always be B. Analgesics can be used for postoperative pain.
handled gently and carefully. C. Child should not be positioned in Trendelenburg position postoperatively."
A child with lymphoma is receiving extensive radiotherapy. Which of the following is the
Other answers. The child's head and chest measuring will not affect Wilm's tumor. most common side effect of this treatment?
Repositioning a child in the upright position may cause more pain to the child, but priority "A. Malaise
this is not worse than disseminating tumor cells." B. Seizures
A nurse is teaching a client about the risk factors associated with colorectal cancer. The C. Neuropathy
nurse determines that further teaching related to the colo-rectal cancer is necessary if the D. Lymphadenopathy"
client identifies which of the following as an associated risk factor? "Answer A is Correct
"1. Age younger than 50 years Malaise is the most common side effect of radiotherapy. For children, the fatigue may be
2. History of coloractal polyps especially distressing because it means they cannot keep up with their peers."
3. Family history of colorectal cancer A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During
4. Chronic inflammatory bowel disease" the course of the nursing assessment, which findings would be expected? Select all that
"Correct: 1. apply.
Colorectal cancer risk factors include age older than 50 years, a family history of the disease, "a) fever.
colorectal polyps, and chronic inflammatory bowel disease." b) painless cervical nodes.
What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia? c) painful cervical nodes.
"(A) to a private room so she will not infect other patients and health care workers d) poor appetite.
(B) to a private room so she will not be infected by other patients and e) complaints of night sweats"
health care workers "Answers: b and d (complaints of night sweats, painless cervical nodes.)
(C) to a semiprivate room so she will have stimulation during her hospitalization Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are
(D to a semiprivate room so she will have the opportunity to express her feelings about her characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of
illness infection."
"
"A nurse is performing an assessment on a 10-year old child suspected having Hodgkin's the mother is:
disease. The nurse understands that which of the following assessment findings is "1. There is no need to be concerned.
characteristic of this disease? 2. Bring the child into the clinic for a vaccine.
"a) fever and malaise 3. Keep the child out of school for 2 week period.
b) anorexia and weight loss 4. Monitor the child for an elevated temperature, and call the clinic if this happens."
c) painful, enlarged inguinal lymph nodes "Correct anwser: 2.
d) painless, firm, and movable adenopathy in the cervical area" Rationale: immunocompromised children are unable to fight varicella adequately.
"D. painless, firm, and movable adenopathy in the cervical area Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed
- Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, to someone with varicella, the child should receive varicella zoster immune globulin within
and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the
also is noted. Although fever, malaise, anorexia, and weight loss are associated with chances of developing the disease."
Hodgkin's disease, these manifestations are seen in many disorders." The nurse is completing a care plan for a client diagnosed with leukemia. Which
"The nurse is admitting a patient who is jaundiced due to pancreatic cancer. The nurse independent problem should be addressed?
should give the highest priority to which of the following needs? "1.Infection.
"1. Nutrition 2.Anemia.
2. Self-image 3.Nutrition.
3. Skin integrity 4.Grieving."
4. Urinary elimination" "Correct: 4.
"Correct: 1. Grieving is an independent problem, and the nurse can assess and treat this problem with
1. profound weight loss and anorexia occur with pancreatic cancer. Correct. or without collaboration."
2. jaundiced patients are concerned about how they look, but physiological needs take A client is admitted to the hospital for a colon resection and in preparation for surgery the
priority physician orders neomycin. The nurse understands the main reason why this antibiotic is
3. jaundice causes dry skin and pruritis, scratching can lead to skin breakdown especially useful before colon surgery is because it:
4. urine is dark due to obstructive process, kidney function is not affected" "A. Will not affect the kidneys
"The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse B. Acts systemically without delay
specialist that the child's abdomen seems to be swollen. During further assessment of the C.Has limited absorption from the GI tract.
subjective data, the mother tells the nurse that the child has been eating well and that the D.Is effective against many different organisms "
activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's "ANSWER:C
tumor, would avoid which of the following during the physical assessment? Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the
"1. Palpating the abdomen for a mass. intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be
2. Assessing the urine for hematuria reduced."
3. Monitoring the temperature for presence of fever "A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included
4. Monitoring the blood pressure for presence of hypertension" in the regimen. The main reason for administering allopurinol as part of the client's
"Answer: 1 chemotherapy regimen is to:
Rationale: Wilm's tumor is the most common intra-abdominal and kidney tumor of "a. Prevent metabolic breakdown of xanthine to uric acid
childhood. If Wilm's tumor is suspected, the tumor mass should not be palpated by the b. Prevent uric acid from precipitating in the ureters
nurse. Excessive manipulation can cause the seeding of the tumor and spread of cancerous c. Enhance the production of uric acid to ensure adequate excretion of urine
cells. Fever, hematuria, and hypertension are all clinical manifestations of Wilm's tumor." d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"
"A 9-year old child with leukemia is in remission and has returned to school. The school "CORRECT: Answer A. The massive cell destruction resulting from chemotherapy
nurse calls the mother of the child and tells the mother that a classmate has just been may place the client at risk for developing renal calculi; adding
diagnosed with chickenpox. The mother immediately calls the clinic nurse because the allopurinol decreases this risk by preventing the breakdown of xanthine
leukemic child has never had chickenpox. The appropriate response by the clinic nurse to
to uric acid. Allopurinol doesn't act in the manner described in the "ANSWER: B
other options." The client must be ready to accept changes in body image and function; this acceptance will
"After teaching the parents of a child newly diagnosed with leukemia facilitate mastery of the techniques of colosotomy care and optimal use of community
about the disease, which of the following descriptions given by the resources."
mother best indicates that she understands the nature of leukemia?" "Nursing considerations related to the administration of chemotherapeutic drugs include
"A) ""The disease is an infection resulting in increased white blood cell production."" which of the following?
B) ""The disease is a type of cancer characterized by an increase in immature white blood "a) Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.
cells."" b) Infiltration will not occur unless superficial veins are used for the intravenous infusion.
C) ""The disease is an inflammation associated with enlargement of the lymph nodes."" c) Many chemotherapeutic agents are vesicants that can cause severe cellular damage if
D) ""The disease is an allergic disorder involving increased circulating antibodies in the drug infiltrates.
blood.""" d) Good hand washing is essential when handling chemotherapeutic drugs, but gloves are
"CORRECT: B. Leukemia is a neoplastic, or cancerous, disorder of blood-forming not necessary."
tissues that is characterized by a proliferation of immature white blood "CORRECT c. Chemotherapeutic agents can be extremely damaging to cells. Nurses
cells." experienced with the administration of vesicant drugs should be responsible for giving
"A 10 year old child with hemophilia A has slipped on the ice and bumped his knee. The these drugs and be prepared to treat extravasations if necessary.
nurse should prepare to administer an: a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.
"A. injection of factor X b. Infiltration and extravasations are always a risk, especially with peripheral veins.
B. intravenous infusion of iron d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be
C. intravenous infusion of factor VIII thoroughly washed afterward."
D. intramuscular injection of iron using the Z track method" A nurse is discussing childhood cancer with the parents of a child in an oncology unit. Which
"CORRECT: C statement by the nurse would be the most accurate?
Hemophila refers to a group of bleeding disorders resulting from a deficiency of specific "A. ""The most common site for children's cancer is the bone marrow.""
coagulation proteins. the primary meds used are to replace missing clotting factor. Factor B. ""All childhood cancers have a high mortality rate.""
VIII will be prescribed intravenously to replace the missing clotting factor and minimize the C. ""Children with leukemia have a higher survival rate if they are older than 11 when
bleeding," diagnosed.""
When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse D. ""The prognosis for children with cancer isn't affected by treatment strategies."""
expects to see which of the following? "Correct: A.
"a. A reduced white blood cell count Childhood cancers occur most commonly in rapidly growing tissue, especially in the bone
b. A decreased platelet count marrow. Mortality depends on the time of diagnosis, the type of cancer, and the age at
c. Shallow respirations which the child was diagnosed. Children who are diagnosed between the ages of 2 and 9
d. Tachypnea" consistently demonstrate a better prognosis. Treatment strategies are tailored to produce
Answer D. The body compensates for metabolic acidosis via the respiratory system, which the most favarable prognosis. (NCLEX-RN Questions & Answers, made Incredibly Easy)"
tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid What assessment finding would the nurse expect to find specifically for a client admitted
respirations, altered white blood cell or platelet counts are not specific signs of metabolic with Hodgkin's disease?
imbalance. "1. Fatigue
The nurse understands a primary step toward achievement of a long range goal associated 2. weakness.
with the rehabilitation of a client with a new colostomy is: 3. Weight gain
"A. Mastery of techniques of colostomy care 4. Enlarged lymph nodes."
B. Readiness to accept an altered body function Correct: 4. Enlarged lymph nodes with progression to extralymphatic sites. This is a
C. Awareness of available community resources characteristic specifically to lymphoma, where as fatigue and weakness can occur with
D.Knowledge of the neccessary dietary modifications. other diseases. Weight loss is more likely than weight gain.
"What is a characteristic manifestation of Hodgkin's Disease? "A. Allow the child to practice injections on a favorite doll.
"1.) petechiae B. Explain the procedure in simple terms.
2.) erythematous rash C. Allow a family member to explain the procedure to the child.
3.) enlarged lymph nodes D. Allow the child to watch an educational video."
4.) pallor" "Answer: B
Correct: #3 "Knowledge of the usual pattern of spread of this lymphoma, with its orderly Preschoolers have the cognitive ability to understand simple terms.
progression through lymph node groups and its typical forms of extranodal involvement, Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might
facilitates timely diagnosis, staging, and treatment planning". perceive the doll is experiencing pain."
"A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is Which condition assessed by the nurse would be an early warning sign of childhood cancer?
essential to: 1. difficulty swallowing \
"A. Request a low-salt diet 2. nagging cough or hoarseness
B. Restrict fluids 3. slight changes in bowel and bladder function
C. Educate the family regarding renal transplants 4. swelling, lumps, masses on body
D. Prevent urinary tract infections" "Correct: 4.
Answer D is correct. Because the child has only one remaining kidney, it is important to Swelling or lumps or masses anywhere on the body are early warning signs whereas
prevent urinary tract infections. Answers A, B, and C are not necessary, so they are difficulty swallowing or cough or hoarseness are signs of cancer in adults. there may be a
incorrect. marked sign in changes to bowel or bladder function, not a slight change"
"The goals of cancer treatment are based on the principle that A patient who has been told by the health care provider that the cells in a bowel tumor are
"a. surgery is the single most effective treatment for cancer. poorly differentiated asks the nurse what is meant by "poorly differentiated." Which
b. initial treatment is always directed toward cure of the cancer. response should the nurse make? "a. ""The cells in your tumor do not look very different
c. a combination of treatment modalities is effective for controlling many cancers. from normal bowel cells.""
d. although cancer cure is rare, quality of life can be increased with treatment modalities. " b. ""The tumor cells have DNA that is different from your normal bowel cells.""
"Correct answer: C c. ""Your tumor cells look more like immature fetal cells than normal bowel cells.""
Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the d. ""The cells in your tumor have mutated from the normal bowel cells."""
goal, treatment is offered that is expected to have the greatest chance of disease "Correct Answer: C
eradication. Curative cancer therapy depends on the particular cancer being treated and Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and
may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or less like the normal cells of the organ or tissue. The DNA in cancer cells is always different
without periods of adjunctive systemic therapy (i.e., chemotherapy)." from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are
"After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic mutations form the normal cells of the tissue."
leukemia, the laboratory test indicates that the client is neutropenic. The nurse should A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC)
perform which of the following? count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing
"a. Advise the client to rest and avoid exertion diagnosis, and measures are being taken to reduce the child's exposure to infection. the
b. Prevent client exposure to infections nurse determines that the plan has been successful when which outcome has been met?
c. Monitor the blood pressure frequently "1. child's WBC count goes up.
d. Observe for increased bruising" 2. child's WBC count goes down.
"Correct Answer: B. Prevent client exposure to infections 3. child's temperature remains within normal range.
Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are 4. parents demonstrate good hand washing technique."
responsible for the body's defense against infection. Rest and avoid exertion would be CORRECT is #3 - RATIONALE: in leukemia, the WBCs that are present are immature and
related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and incapable of fighting infection. increases or decreases in the number of WBCs can be
observing for bruising would be related to platelets and sign and symptoms of bleeding." related to the disease process and treatment, and not related to infection. the only value
A preschool-aged child is to undergo several painful procedures. Which of the following that indicates the child is infection-free is the temperature. the use of proper handwashing
techniques is most-appropriate for the nurse to use in preparing the child? technique is a measure or intervention used to meet a goal. but is not a goal itself.
STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client related to infection from the depressed number of effective leukocytes, and fatigue from
who is immunosuppressed from leukemia. recall that temperature and WBC counts are the anemia.
frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so The other options are not signs of bone marrow involvement."
choose the option related to temperature. A diagnostic workup is being performed on a 1-year-old child with suspected
A pediatric nurse specialist provides a teaching session to the nursing staff regarding neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that
osteogenic sarcoma. Which statement by a member of the nursing staff indicates a need for which of the following findings is most specifically related to this type of tumor?
clarification of the information presented? "1. Elevated vanillylmandelic acid (VMA) urinary levels
"1.) ""The femur is the most common site of this sarcoma."" 2. Presence of blast cells in the bone marrow
2.) ""The child does not experience pain at the primary tumor site."" 3. Projectile vomiting, usually in the morning
3.) ""Limping, if a weight-bearing limb is affected, is a clinical manifestation."" 4. Postive Babinski's sign"
4.) ""The symptoms of the disease in the early stage are almost always attributed to normal ANSWER: 1 Rationale: Neuroblastoma is a solid tumor found only in children. It arises from
growing pains.""" neural crest cells that develop into the sympathetic nervous system and the adrenal
"2.) ""The child does not experience pain at the primary tumor site."" (CORRECT ANSWER-- medulla. Typically, the tumor compresses adjacent normal tissue and organs.
Need for further clarification). Osteogenic sarcoma is the most common bone cancer in Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will
children. Cancer usually is found in the metaphysis of long bones, especially in the lower indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in
extremities, with most tumors occurring in the femur (omit #1). Osteogenic sarcoma is leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's
manifested clinically by progressive, insidious, and intermittent pain at the tumor site sign are clinical manifestations of a brain tumor.
(correct answer: #2). By the time these children receive medical attention, they may be in "The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about
considerable pain from the tumor. All options: 1, 3, 4 are accurate regarding osteogenic her prognosis. Which is the nurse's best response?
sarcoma. "1. Survival for Hodgkin's disease is relatively good with standard therapy.
" 2. Survival depends on becoming involved in an investigational therapy program.
"A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the 3. Survival is poor, with more than 50% of clients dying within six (6) months.
following statements most accurately describes this stage? 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year."
"A) The tumor is less than 3 cm. in size and requires no chemotherapy. "1. Up to 90% of clients respond well to
B) The tumor did not extend beyond the kidney and was completely resected. standard treatment with chemotherapy
C) The tumor extended beyond the kidney but was completely resected. and radiation therapy, and those who
D) The tumor has spread into the abdominal cavity and cannot be resected." relapse usually respond to a change of
"1. Answer: C chemotherapy medications. Survival
depends on the individual client and
The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited the stage of disease at diagnosis (correct).
to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is 2. Investigational therapy regimens would
completely resected; stage III, residual nonhematogenous tumor is confined to the not be recommended for clients initially
abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the diagnosed with Hodgkin's disease because
abdomen; and stage V, bilateral renal involvement is present at diagnosis." of the expected prognosis with standard
"The most common signs and symptoms of leukemia related to bone marrow involvement therapy
are which of the following? 3. Clients usually achieve a significantlylonger survival rate than six (6) months.Many clients
"a. Petechiae, fever, fatigue survive to develop long-termsecondary complications.
b. Headache, papilledema, irritability 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin'sdisease
c. Muscle wasting, weight loss, fatigue has occurred."
d. Decreased intracranial pressure, psychosis, confusion" An adolescent with a history of surgical repair for undescended testes comes to the clinic
"Correct answer: A for a sport physical. Anticipatory guidance for the parents and adolescent would focus on
Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever which of the following as most important?
"a) the adolescent sterility
b) the adolescent future plans
c) technique for monthly testicular self-examinations
d) need for a lot of psychosocial support"
"Answer C Because the incidence of testicular cancer is increased in adulthood among
children who have undescended testes. It is extremely important to teach the adolescent
how to perform the testicular self-examination
mon
 Bone marrow c. "Does anyone in your family bleed a lot?"
A client is scheduled for a bone marrow aspiration. What is the priority nursing action d. "Tell me what you eat in a day."
before this procedure is performed? c. does anyone in your family bleed a lot

a. Hold the client's hand and ask about concerns. To determine if hematologic risks exist while obtaining a health history from a client, the
b. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine). nurse asks if anyone in the client's family bleeds a lot. An accurate family history is
c. Review the client's platelet (thrombocyte) count. important because many disorders that affect blood and blood clotting are inherited.
d. Verify that the client has given informed consent. Genetics cannot be changed.
d. verify that the client has given informed consent Work habits can be a risk, such as working near radiation, but these are behaviors that can
be changed. Diet can affect risk, but it is a health behavior that can be changed.
The priority nursing action before a scheduled bone marrow aspiration is done is for the Excessive bleeding or bruising is a symptom, not a risk.
nurse to verify that the client has been given informed consent. A signed permit must be on The nurse is teaching a client about what to expect during a bone marrow biopsy. Which
the client's chart. statement by the nurse accurately describes the procedure?
Cleaning the biopsy site is done before the procedure, but this is not done until consent is
verified. Cleaning the site will be done just before the procedure is performed. Holding the a. "You will be alone because the procedure is sterile; we cannot allow additional people to
client's hand and offering verbal support may be done during the procedure, but the contaminate the area."
procedure cannot be completed until the consent is signed. Reviewing the client's platelet b. "You will be sedated during the procedure, so you will not be aware of anything."
count is not imperative. c. "You may experience a crunching sound or a scraping sensation as the needle punctures
The nurse is assessing an adult client's endurance in performing activities of daily living your bone."
(ADLs). What question would the nurse ask the client? d. "The doctor will place a small needle in your back and will withdraw some fluid."
c. you may experience a crunching sound or a scaling sensation as the needle punctures
a. "Can you prepare your own meals every day?" your bone
b. "What medications do you take daily, weekly, and monthly?"
c. "How is your energy level compared with last year?" When describing a bone marrow biopsy procedure to a client, it is accurate to describe a
d. "Has your weight changed by 5 pounds (2.3 kg) or more this year?" crunching sound or scraping sensation when the needle punctures the bone. Proper
c. how is your energy level compared with last year expectations minimize the client's fear during the procedure.
A very large-bore needle is used for a bone marrow biopsy, not a small needle, and the
The question the nurse needs to ask the client about endurance in performing ADLs is "How puncture is made in the hip or in the sternum, not the back. A local anesthetic agent is
is your energy level compared with last year"? Asking the client how his or her energy level injected into the skin around the site. The client may also receive a mild tranquilizer or a
compares with last year is an activity exercise question that correctly assesses endurance rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. The
compared with self-assessment in the past. It is most likely to provide data about the nurse, or sometimes a family member, is available to the client for support during a bone
client's ability and endurance for ADLs. marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present
The client may never have been able to prepare his or her own meals, and the ability to without contamination at the site.
prepare meals does not really address endurance. The question about weight change A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the
addresses nutrition and metabolic needs, rather than ADL performance. The question about nurse's best response?
how often the client takes medication addresses nutrition and metabolic needs and focuses
on health maintenance through the use of drugs, not on the client's ability to perform ADLs. a. "How many hours are you sleeping at night?"
The nurse is assessing a client for hematologic risks. Which health history question would b. "Your cells are delivering less oxygen than you need."
the nurse ask to determine if the risk cannot be reduced or eliminated? c. "You are not getting enough iron."
d. "When you are sick you need to rest more."
a. "Where do you work?" b. your cells are delivering less oxygen than you need
b. "Do you seem to have excessive bleeding or bruising?"
The nurse's best response to the client complaining about feeling tired all the time is "Your
cells are delivering less oxygen than you need." The single most common symptom of a. "Your platelets finish the clotting process."
anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to b. "The clotting process begins with your platelets."
meet normal oxygen needs. c. "Blood clotting is prevented by your platelets."
While it may be true that the client isn't getting enough iron, it does not relate to the d. "Platelets will make your blood clot."
client's fatigue. The statement about the client needing rest because of being sick is simply b. the clotting process begins with your platelets
not true. Although assessment of sleep and rest is good, it does not address the cause
related to the diagnosis. The nurse's best response to why platelets are important is that, "The clotting process
A client with anemia asks the nurse, "Do most people have the same number of red blood begins with your platelets." Platelets begin the blood clotting process by forming platelet
cells?" Which is the nurse's best response to the client? plugs, but these platelet plugs are not clots and cannot provide complete hemostasis.
Platelets do not clot blood but are a part of the clotting process or cascade of coagulation.
a. "You have fewer red blood cells because you have anemia." Platelets do not prevent the blood from clotting. Rather they function to help blood form
b. "No, they don't." clots. Platelets do not finish the clotting process, they begin it.
c. "The number varies with gender, age, and general health." A newly admitted client has an elevated reticulocyte count. Which condition does the nurse
d. "Yes, they do." suspect in this client?
c. the number varies with gender, age, and general health
a. Leukemia
The nurse's best response to the client with anemia about most people having the same b. Hemolytic anemia
number of blood cells is, "The number varies with gender, age, and general health." This c. Infectious process
statement is the most educational and reasonable response to the client's question. d. Aplastic anemia
Responding "yes, they do." and "no, they don't." are not educational statements. Although b. hemolytic anemia
telling the client that people do not have the same number of RBCs is true, it is not
informative, and there is a better answer. While it may be true that the client has fewer red The nurse suspects that the client has hemolytic anemia. An elevated reticulocyte count in
blood cells because of anemia, it does not answer the client's general question. an anemic client indicates that the bone marrow is responding appropriately to a decrease
The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more
decreased laboratory value would be of greatest concern to the nurse because it is not age- immature RBCs are in circulation.
related? A low white blood cell count is expected in clients with leukemia. Aplastic anemia is
associated with a low reticulocyte count. A high white blood cell count is expected in clients
a. Platelet (thrombocyte) count with infection.
b. Red blood cell (RBC) count A client on anticoagulant therapy is being discharged. Which statement by the client
c. White blood cell (WBC) response indicates an understanding of the anticoagulants drug action?
d. Hemoglobin level
a. platelet (thrombocyte) count a. "It should prevent my blood from clotting."
b. "It is used to dissolve blood clots."
The decreased laboratory value of the greatest concern to the nurse is the 76-year-old c. "It will thin my blood."
client's platelet count. Platelet counts do not generally change with age. d. "It might cause me to get injured more often."
Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a a. it should prevent my blood from clotting
role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower
in older adults. The WBC count does not rise as high in response to infection in older adults The statement that shows the client understands anticoagulant drug action is, "it will
as it does in younger people. prevent my blood from clotting." Anticoagulants work by interfering with one or more steps
A client with a low platelet count asks the nurse, "Why are platelets important?" Which involved in the blood clotting cascade. Thus, these agents prevent new clots from forming
statement is the nurse's best response? and limit or prevent extension of formed clots.
Anticoagulants do not cause any change in the thickness or viscosity of the blood. The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration.
Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more The nurse provides which discharge instructions to the client?
injuries but may cause more bleeding and bruising when the client is injured.
The nurse is caring for a group of hospitalized clients. Which client is at highest risk for a. "Place an ice pack over the site to reduce the bruising."
infection and sepsis? b. "Avoid contact sports or activity that may traumatize the site for 24 hours."
c. "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."
a. A client with cirrhosis of the liver d. "Inspect the site for bleeding every 4 to 6 hours."
b. A client with recently diagnosed sickle cell anemia a. place an ice pack over the site to reduce bruising
c. A client with hemolytic anemia
d. A client who had an emergency splenectomy Discharge instructions after a bone marrow include placing an ice pack over the site to
d. a client who had an emergency splenectomy reduce bruising. Ice to the site will help limit bruising and tissue damage during the first 24
hours after the procedure.
The client who is at the highest risk for infection and sepsis is the client who had an The client must carefully monitor the site every 2 hours for the first 24 hours after the
emergency splenectomy. Removal of the spleen causes reduced immune function. Without procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days.
a spleen, the client is less able to remove disease-causing organisms and is at increased risk A mild analgesic is appropriate, but it needs to be aspirin-free. Acetaminophen (Tylenol)
for infection. would be a good choice.
A low red blood cell count with hemolytic anemia can contribute to a client's risk for Which client does the medical unit charge nurse assign to a licensed practical nurse
infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver (LPN)/licensed vocational nurse (LVN)?
plays a role in blood coagulation, so this client is more at risk for coagulation problems than
for infection. Sickle cell anemia causes pain and discomfort because of the changed cell a. A client scheduled for a bone marrow biopsy with conscious sedation
morphology, so acute pain, especially at joints, is the greatest threat to this client. b. A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C)
The nurse is assessing the nutritional status of a client with anemia. How does the nurse c. A client with chronic microcytic anemia associated with alcohol use
obtain information about the client's diet? d. A client with atrial fibrillation and an international normalized ratio of 6.6
c. a client with chronic microcytic anemia associated with alcohol use
a. who prepares the client's meals and plans an interview with him or her
b. Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) The medical unit charge nurse assigns the LPN/LVN a client with chronic microcytic anemia
c. Uses a prepared list and finds out the client's food preferences related to alcohol use. Chronic microcytic anemia is not considered life-threatening and is
d. Has the client write down everything he or she has eaten for the past week within the skill level of an LPN/LVN.
d. has the client write down everything he or she has eaten for the past week The client with a bone marrow biopsy with conscious sedation, a history of splenectomy
and a temperature, and atrial fibrillation require more complex assessment or nursing care
The best way for the nurse to assess an anemic client's diet is to have the client write down and would be assigned to RN staff members.
everything he/she has eaten in the last week. Having the client provide a list of items eaten Which task does the nurse delegate to unlicensed assistive personnel (UAP)?
in the past week is the most accurate way to find out what the client likes and dislikes, as
well as what the client has been eating. It will provide information about "junk" food intake, a. Perform a capillary fragility test to check vascular hemostatic function on a client with
as well as protein, vitamin, and mineral intake. liver failure
Determining food preferences from a prepared list provides information about what the b. Refer a client with a daily alcohol consumption of 12 beers for counseling
client enjoys eating, not necessarily what the client has been eating. For instance, the client c. Report any bleeding noted when catheter care is given to a client with a history of
may like steak but may be unable to afford it. Rating scales are good for subjective data hemophilia
collection about some conditions such as pain, but the subjectivity of a response such as d. Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary
this does not provide the nurse with specific data needed to assess a diet. Interviewing the embolism
food preparer is time-consuming and poses several problems, such as whether a number of c. report any bleeding noted when catheter care is given to a client with a history of
people are preparing meals, or if the client goes "out" for meals. hemophilia
 count of 150,000/mm3 (150 × 109/L) in the 49-year-old is normal. The INR of 3.0 in the 44-
The task the nurse delegates to the UAP is to report any bleeding when catheter care is year-old indicates a therapeutic warfarin level.
given to a client with a history of hemophilia. Reporting findings during routine care is Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting
expected and required of unlicensed staff members. with the care of a female client with anemia?
Referring a client for alcohol counseling, drawing a partial thromboplastin time, and
performing a capillary fragility test are more complex and would be done by licensed a. Count the respiratory rate before and after ambulating 20 feet (6 m)
nursing staff. b. Check for sternal tenderness while applying fingertip pressure
The nurse is starting the shift by making rounds. Which client would the nurse assess first? c. Ask about the amount of blood loss with each menstrual period
d. Monitor the oral mucosa for pallor, bleeding, or ulceration
a. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary a. count the respiratory rate before and after ambulating 20 feet
embolism
b. A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on Counting the respiratory rate before and after ambulation is within the scope of practice for
my arm" a UAP. The UAP will report this information to the RN.
c. A 42-year-old with a diagnosis of anemia who reports shortness of breath when Monitoring oral mucosa requires skilled assessment techniques and knowledge of normal
ambulating down the hallway parameters, asking the client about the amount of blood loss with each menstrual period,
d. A 52-year-old who just had a bone marrow aspiration and is requesting pain medication and checking for sternal tenderness would be done by the RN.
a. a 50 year old who has a nosebleed and is receiving heparin to treat a pulmonary A client has a bone marrow biopsy performed. What is the priority postprocedure nursing
embolism action?

After rounds, the nurse would first assess the 59-year-old client who has a nosebleed and is a. Inspect the site for ecchymosis
getting heparin to treat a pulmonary embolism. The client with the nosebleed may be b. Send the biopsy specimens to the laboratory
experiencing the bleeding as a result of excessive anticoagulation and must be assessed first c. Apply pressure to the biopsy site
for the severity of the situation. d. Teach the client to avoid vigorous activity
The client waiting for pain medication would be next on the nurse's "to do" list. Making c. apply pressure to biopsy site
clients wait for pain medication is not desirable, but in this scenario, the client who is
bleeding is the higher priority. The client who had a Rumpel-Leede test and the client with The priority postprocedure action after a bone marrow biopsy would be to stop bleeding by
anemia are more stable and can be assessed later. The Rumpel-Leede test is a tourniquet applying pressure to the site.
test used to determine the presence of vitamin C deficiency or thrombocytopenia. Inspecting for ecchymosis, sending specimens to the laboratory and teaching the client
After reviewing the laboratory test results, the nurse calls the primary care provider about about activity levels will be done after hemostasis has been achieved.
which client?

a. A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8%

b. A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L)
c. A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR)
of 3.0
d. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L)
d. a 46 yr old with a fever and a WBC count of 1500/mm3

The nurse calls the PCP about a 46-year-old client with a fever and a WBC of 1500/mm3 (1.5
× 109/L). This client is neutropenic and is at risk for sepsis unless interventions such as
medications to improve the WBC level and antibiotics are prescribed.
An elevated reticulocyte count in the 52-year-old is expected after hemorrhage. A platelet
 Hematopoietic A ~ To assess pallor in dark-skinned people, assess the conjunctiva of the eye or the mucous
A nursing student wants to know why clients with COPD tend to be polycythemic. What membranes. Looking at the roof of the mouth can reveal jaundice. Opening the hand widely
response by the nurse instructor is best? is not related to pallor, nor is palpating for mild swelling.
a. It is due to side effects of medications for bronchodilation. What is the normal lab value for Hemoglobin (Hgb)?
b. It is from overactive bone marrow in response to chronic disease. Men = 13.5 - 17.5 g/dL
c. It combats the anemia caused by an increased metabolic rate. Women 12.0 - 15.5 g/dL
d. It compensates for tissue hypoxia caused by lung disease. A hospitalized client has a platelet count of 58,000/mm3. What action by the nurse is best?
D ~ In response to hypoxia, more red blood cells are made so more oxygen can be carried a. Encourage high-protein foods.
and delivered to tissues. This is a physiologic process in response to the disease; it is not a b. Institute neutropenic precautions.
medication side effect, the result of overactive bone marrow, or a response to anemia. c. Limit visitors to healthy adults.
What is the normal lab value for Platelet Count? d. Place the client on safety precautions.
A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. D ~ With a platelet count between 40,000 and 80,000/mm3, clients are at risk of prolonged
Having more than 450,000 platelets is a condition called thrombocytosis; having less than bleeding even after minor trauma. The nurse should place the client on safety precautions.
150,000 is known as thrombocytopenia. High-protein foods, while healthy, are not the priority. Neutropenic precautions are not
A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What needed as the client's white blood cell count is not low. Limiting visitors would also be more
response by the nurse is best? likely related to a low white blood cell count.
a. It inhibits thrombin. What is the normal lab value for Hematocrit (Hct)?
b. It inhibits fibrinogen. Men = 38.8% - 50%
c. It thins your blood. Women = 34.9% - 44.5%
d. It works against vitamin K. A client is having a bone marrow biopsy today. What action by the nurse takes priority?
A ~ Rivaroxaban is a direct thrombin inhibitor. It does not work on fibrinogen or vitamin K. It a. Administer pain medication first.
is not a blood thinner, although many clients call anticoagulants by this name. b. Ensure valid consent is on the chart.
What is the normal lab value for Red Blood Cells (RBC)? c. Have the client shower in the morning.
Men = 4.7 to 6.1 million cells per microliter (mcL). Women = 4.2 to 5.4 million mcL. d. Premedicate the client with sedatives.
Children is 4.0 to 5.5 million mcL. B ~ A bone marrow biopsy is an invasive procedure that requires informed consent. Pain
The health care provider tells the nurse that a client is to be started on a platelet inhibitor. medication and sedation are important components of care for this client but do not take
About what drug does the nurse plan to teach the client? priority. The client may or may not need or be able to shower.
a. Clopidogrel (Plavix) What is the normal lab value for Reticulocyte Count?
b. Enoxaparin (Lovenox) 0.5-1.5%
c. Reteplase (Retavase) A nurse is caring for four clients. After reviewing today's laboratory results, which client
d. Warfarin (Coumadin) should the nurse see first?
A ~ Clopidogrel is a platelet inhibitor. Enoxaparin is an indirect thrombin inhibitor. a. Client with an international normalized ratio of 2.8
Reteplase is a fibrinolytic agent. Warfarin is a vitamin K antagonist. b. Client with a platelet count of 128,000/mm3
What is the normal lab value for White Blood Cells (WBC)? c. Client with a prothrombin time (PT) of 28 seconds
4,000 - 11,000 per microliter of blood d. Client with a red blood cell count of 5.1 million/L
A nurse is assessing a dark-skinned client for pallor. What action is best? C ~ A normal PT is 11 to 12.5 seconds. This client is at high risk of bleeding. The other values
a. Assess the conjunctiva of the eye. are within normal limits.
b. Have the client open the hand widely. What is the normal lab value for International Normalized Ratio (INR)?
c. Look at the roof of the client's mouth. 1.1 or less
d. Palpate for areas of mild swelling. A client is having a bone marrow biopsy and is extremely anxious. What action by the nurse
is best?
a. Assess client fears & coping mechanism
b. Reassure the client this is a common test. d. Metformin (Glucophage)
c. Sedate the client prior to the procedure. e. Nitrofurantoin (Macrobid)
d. Tell the client he or she will be asleep. B, C, E ~ Amphotericin B, ibuprofen, and nitrofurantoin all can disrupt the hematologic
A ~ Assessing the client's specific fears and coping mechanisms helps guide the nurse in (immune) system. Acetaminophen & metformin do not.
providing holistic care that best meets the client's needs. Reassurance will be helpful but is A nurse works in a gerontology clinic. What age-related changes cause the nurse to alter
not the best option. Sedation is usually used. The client may or may not be totally asleep standard assessment techniques from those used for younger adults? (SATA)
during the procedure. a. Dentition deteriorates with more cavities.
A client is having a radioisotopic imaging scan. What action by the nurse is most important? b. Nail beds may be thickened or discolored.
a. Assess the client for shellfish allergies. c. Progressive loss of hair occurs with age.
b. Place the client on radiation precautions. d. Sclerae begin to turn yellow or pale.
c. Sedate the client before the scan. e. Skin becomes dry as the client ages.
d. Teach the client about the procedure. B, C, E ~ Common findings in older adults include thickened or discolored nail beds, dry skin,
D ~ The nurse should ensure that teaching is done and the client understands the and thinning hair. The nurse adapts to these changes by altering assessment techniques.
procedure. Contrast dye is not used, so shellfish/iodine allergies are not related. The client Having more dental caries and changes in the sclerae are not normal age-related changes.
will not be radioactive and does not need radiation precautions. Sedation is not used in this In evaluating a young woman, the following laboratory result the nurse recognizes as
procedure. abnormal is
A student nurse learns that the spleen has several functions. What functions do they a. hemoglobin 13 g/dl.
include? (SATA) b. platelet count 20,000/mm3.
a. Breaks down hemoglobin c. red blood cell count 5 million/mm3.
b. Destroys old or defective red blood cells (RBCs) d. white blood cell count 6000/mm3.
c. Forms vitamin K for clotting B ~ A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of
d. Stores extra iron in ferritin blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less
e. Stores platelets not circulating than 150,000 is known as thrombocytopenia.
A, B, E ~ Functions of the spleen include breaking down hemoglobin released from RBCs, The nurse should anticipate an elevated hemoglobin level in a
destroying old or defective RBCs, and storing the platelets that are not in circulation. a. 40-year-old woman with congestive heart failure.
Forming vitamin K for clotting and storing extra iron in ferritin are functions of the liver. b. client who lives in Colorado.
An older client asks the nurse why people my age have weaker immune systems than c. client with iron deficiency anemia.
younger people. What responses by the nurse are best? (SATA) d. dehydrated elderly client being given IV fluids.
a. Bone marrow produces fewer blood cells. B ~ Hemoglobin levels are frequently elevated in people who live in high altitudes (above
b. You may have decreased levels of circulating platelets. 10,000 feet). The other three clients would not show an elevated hemoglobin level.
c. You have lower levels of plasma proteins in the blood. A client has a hematocrit (Hct) of 30%. The nurse interprets this to mean
d. Lymphocytes become more reactive to antigens. a. 30% of the blood will be plasma and plasma products.
e. Spleen function declines after age 60. b. bleeding disorders are possible.
A, C ~ The aging adult has bone marrow that produces fewer cells and decreased blood c. the blood is viscous and concentrated.
volume with fewer plasma proteins. Platelet numbers remain unchanged, lymphocytes d. the individual has fewer red blood cells than normal.
become less reactive, and spleen function stays the same. B ~ Hematocrit measures the percent volume of red cells in whole blood. The normal value
A nursing student learns that many drugs can impair the immune system. Which drugs does in adult women is 37% to 45%.
this include? (SATA) A nurse is explaining the purpose of a bone marrow biopsy (BMB) to a client. The
a. Acetaminophen (Tylenol) information the nurse provides is that a bone marrow biopsy is done to evaluate
b. Amphotericin B (Fungizone) a. blood dyscrasias such as aplastic anemia or leukemia.
c. Ibuprofen (Motrin) b. hemoglobin and hematocrit production.
c. specific parts of the white cell differentiation. b. high white blood cell count.
d. total numbers and types of different lymphocytes. c. low platelet count.
A ~ Several blood dyscrasias can be identified through a BMB, including aplastic anemia, d. shortened bleeding times.
leukemia, pernicious anemia, and thrombocytopenia. The biopsy reveals the number, size, A ~ Anemia may also occur following partial or total gastrectomy or removal of the terminal
and shape of the RBCs, WBCs, and platelet precursors. portion of the ileum because of the consequent reduction in absorption of vitamin B12.
The nurse notes that a client has a higher than normal reticulocyte count. This would Several employees report allergic manifestations. The occupational health nurse would
indicate focus an investigation on the workplaces
a. bone marrow depression. a. food service vendor.
b. dehydration. b. heating and cooling systems.
c. increased erythrocyte production. c. lighting.
d. polycythemia vera. d. water supply.
C ~ An increase in the reticulocyte count indicates an increase in erythrocyte production, B ~ Exposure to allergens at work may trigger reactions. Ask about the heating and cooling
probably because of excessive RBC destruction (hemolytic anemia) or loss (hemorrhage). systems if airborne allergens are suspected.
The laboratory test result that would be most helpful to the nurse in the assessment of a The nurse reads that an assigned client has an immunodeficiency. The nurse reads further
client with a bleeding disorder is in the medical record, anticipating that the client also most likely has a history of
a. differential count. a. conjunctivitis.
b. hematocrit. b. severe headaches.
c. platelet count. c. skin eruptions.
d. RBC count. d. unexplained weight loss.
C ~ Platelets have a key role in blood clotting. An abnormal platelet count would indicate D ~ Clients with immunodeficiencies have a history of recurrent infections, especially of
bleeding problems originating from a platelet disorder. mucous membranes (e.g., oral cavity, anorectal area, genitourinary [GU] tract, respiratory
A client has severe anemia and is being treated with transfusion therapy. The nurse should tract); poor wound healing; diarrhea; and manifestations of systemic activation of the
be alert for a complication of transfusion, such as immune response.
a. flank pain. The nurse is monitoring the laboratory test results for a client receiving anticoagulation
b. hearing loss. therapy. The nurse is aware that the International Normalized Ratio (INR) for most clinical
c. liver damage. conditions requiring anticoagulation is
d. sore throat. a. less than 1.
A ~ Reactions to blood products include fever, chills, back or flank pain, shock, wheezing, b. 1 to 2.
headache, vomiting, or urticaria (hives). c. 2 to 3.5.
The manifestation the nurse would question the client about that is characteristically d. 3 to 5.5.
associated with anemia is C ~ For most clinical conditions that necessitate anticoagulation, the recommended INR is 2
a. fatigue. to 3.5.
b. pruritus. The nurse discovers a client is taking the herb St. John's Wort. The nurse cautions that this
c. rash. herb reduces the effectiveness of
d. ruddy skin color. a. lanoxin.
A ~ Fatigue is one of the most common manifestations of anemia. Other frequent b. prednisone.
complaints include paleness, weakness, bleeding disorders with petechiae, epistaxis & c. theophylline.
bleeding gums or recurrent infections & fever. A rash or pruritus could indicate an allergic d. warfarin.
manifestation. D ~ The anticoagulation properties of warfarin are diminished if taken in conjunction with St.
The nurse assesses the client who underwent partial removal of the stomach a year ago for John's Wort.
the manifestations of A client presents to the ambulatory care center seeking treatment for allergies. When
a. anemia. questioning the client, the nurse would inquire about (SATA)
a. a history of desensitization shots and their effectiveness. b. How often do you exercise?
b. presence of fatigue, headaches, or weakness. c. Are you a vegetarian?
c. previous anaphylactic reactions to food. d. How often do you take Tylenol?
d. seasonal variation in manifestations. A ~ Platelet aggregation is essential for blood clotting. An inability to clot blood when an
e. triggers known to cause manifestations. injury occurs can result in bleeding, which would cause bruising. Aspirin is a drug that
A, C, D, E ~ All four options are related to allergies. The client with allergies would most interferes with platelet aggregation and has the ability to plug an extrinsic event, such as
likely complain of rhinitis, sinusitis, urticaria & pruritus. Not fatigue, headache or weakness. trauma. Vitamin K found in green vegetables enhances clotting factors, which would
The nurse helps to ambulate a client who has anemia. Which clinical manifestation improve the ability to stop bleeding associated with an extrinsic event. Acetaminophen
indicates that the client is not tolerating the activity? (Tylenol) and exercise do not inhibit clotting factors.
a. Blood pressure of 120/90 mm Hg A client who has a chronic vitamin B12 deficiency is admitted to the hospital. When
b. Heart rate of 110 beats/min obtaining the client's health history, which priority question does the nurse ask this client?
c. Pulse oximetry reading of 95% a. Are you having any pain?
d. Respiratory rate of 20 breaths/min b. Are you having blood in your stools?
B ~ The red blood cells contain thousands of hemoglobin molecules. The most important c. Do you notice any changes in your memory?
feature of hemoglobin is its ability to combine loosely with oxygen. A low hemoglobin level d. Do you bruise easily?
can cause decreased oxygenation to the tissues, thus causing a compensatory increase in C ~ Vitamin B12 deficiency impairs cerebral, olfactory, spinal cord, and peripheral nerve
heart rate. The other options are close to normal range and are not indicative of not function. Severe chronic deficiency may cause permanent neurologic degeneration. The
tolerating this activity. other options are not symptoms of vitamin B12deficiency.
The nurse is assessing a client with liver failure. Which assessment is the highest priority for The nurse is planning discharge teaching for a client who has a splenectomy. Which
this client? statement does the nurse include in this client's teaching plan?
a. Auscultation for bowel sounds a. Avoid crowds and people who are sick.
b. Assessing for deep vein thrombosis b. Do not eat raw fruits or vegetables.
c. Monitoring of blood pressure hourly c. Avoid environmental allergens.
d. Assessing for signs of bleeding d. Do not play contact sports.
D ~ All these options are important in assessment of the client, but the most important A ~ The spleen is the major site of B-lymphocyte maturation and antibody production.
action is assessment for signs of bleeding. The liver is the site of production of prothrombin Those who undergo splenectomies for any reason have a decreased antibody-mediated
and most of the blood-clotting factors. Clients with liver failure run a high risk of having immune response and are particularly susceptible to viral infections. Eating raw fruits and
problems with bleeding. vegetables places the client at risk for bacterial infections. The body responds to
The nurse observes yellow-tinged sclera in a client with dark skin. Based on this assessment environmental allergens with an unspecific inflammatory process. The client is not at risk
finding, what does the nurse do next? for bleeding or injury due to contact sports.
a. Assess the client's pulses. The nurse is teaching a client who has undergone a bone marrow biopsy. Which instruction
b. Examine the soles of the client's feet. does the nurse give the client?
c. Inspect the client's hard palate. a. Wear protective gear when playing contact sports.
d. Auscultate the client's lung sounds. b. Monitor the biopsy site for bruising.
C ~ Jaundice can best be observed in clients with dark skin by inspecting the oral mucosa, c. Remain in bed for at least 12 hours.
especially the hard palate, for yellow discoloration. Because sclera may have d. Use a heating pad for pain at the biopsy site.
subconjunctival fat deposits that show a yellow hue, and because foot calluses may appear B ~ The most important instruction is to have the client monitor the area for external or
yellow, neither of these areas should be used to assess for jaundice. The client's pulse and internal bleeding. Activities such as contact sports should be avoided, and an ice pack can
lung sounds have no correlation with an assessment of jaundice. be used to limit bruising.
The nurse is assessing a client with numerous areas of bruising. Which question does the The nurse is assessing a 75-year-old male client. Which blood value indicates that the client
nurse ask to determine the cause of this finding? is experiencing normal changes associated with aging?
a. Do you take aspirin? a. Hemoglobin, 13.0 g/dL
b. Platelet count, 100,000/mm3 a. Administer the prescribed Tylenol.
c. Prothrombin time (PT), 14 seconds b. Hold the client's prescribed steroids.
d. White blood cell (WBC) count, 5000/mm3 c. Assess the client's respiratory rate.
A ~ Hemoglobin levels in men and women fall after middle age. Therefore, this client's d. Obtain the client's temperature.
hemoglobin value would be considered part of the aging process. Platelet counts and D ~ White blood cells provide immunity and protect against invasion and infection. An
blood-clotting times are not age related; the client's platelet count and PT are elevated for elevated white blood cell count could indicate an infectious process, which could cause an
some other reason. The WBC count shown is normal. elevation in body temperature. Tylenol would treat a fever but not the elevated white
The nurse is planning care for a client who has a platelet count of 30,000/mm3. Which blood cell count. Steroids place the client at higher risk for infection but should not be
intervention does the nurse include in this clients plan of care? stopped suddenly. The respiratory rate does not need to be assessed in this client.
a. Oxygen by nasal cannula A female client is admitted with the medical diagnosis of anemia. The nurse assesses for
b. Bleeding Precautions which potential cause?
c. Isolation Precautions a. Diet high in meat and fat
d. Vital signs every 4 hours b. Daily intake of aspirin
B ~ The normal platelet count ranges between 150,000 and 400,000/mm3. This client is at c. Heavy menses
extreme risk for bleeding. Although it is necessary to notify the provider, the nurse would d. Smoking history
first protect the client by instituting Bleeding Precautions. The other interventions are not C ~ Iron levels can be low because intake of iron is too low, or because loss of iron through
related to the low platelet count. bleeding is excessive. A premenopausal woman may be having unusually heavy menses
The nurse is obtaining the health history of a client who has iron deficiency anemia. Which sufficient to cause excessive loss of blood and iron. Smoking and aspirin do not cause iron
factor in this client's history does the nurse correlate with this diagnosis? deficiency. A diet high in meat provides iron.
a. Eating a meat-free diet The nurse is assessing a client's susceptibility to rejecting a transplanted kidney. Which
b. Family history of sickle cell disease result does the nurse recognize as increasing the client's chances of rejection?
c. History of leukemia a. Decreased T-lymphocyte helper
d. History of bleeding ulcer b. Decreased white blood cell count
A ~ A diet high in protein and iron helps keep the client's levels of iron within normal limits. c. Increased cytotoxic-cytolytic T cell
Meat is a good source of protein and iron. A bleeding ulcer could cause anemia but would d. Increased neutrophil count
not cause iron deficiency. Sickle cell disease causes sickle cell anemia. Leukemia causes a C ~ Cytotoxic-cytolytic T cells function to attack and destroy nonself-cells, specifically virally
decrease in white blood cells. infected cells and cells from transplanted grafts and organs. A high level of these cells
The nurse is caring for a client who has a decreased serum iron level. Which intervention would increase the chances of rejection. Decreased white blood cells would indicate
does the nurse prioritize for this client? immune suppression. Neutrophils are increased during an infection.
a. Dietary consult The nurse is caring for a client who is receiving chemotherapy for cancer. Which
b. Family assessment intervention does the nurse implement for this client?
c. Cardiac assessment a. Assess the client's fibrinogen level.
d. Administration of vitamin K b. Administer the prescribed iron.
A ~ Diets can alter cell quality and affect blood clotting. Diets low in iron can cause anemia c. Maintain strict Standard Precautions.
and decrease the function of all red blood cells. The question does not say that the d. Monitor the client's pulse oximetry.
hemoglobin is low enough to affect the cardiac function. Family assessment may be C ~ The client who is receiving chemotherapy drugs that suppress the bone marrow will be
important in finding out any genetic or family lifestyle causes of the low serum iron level. at risk for a decreased white blood cell (WBC) count and infection. The nurse will be most
However, the first intervention that the nurse can provide is to have the client's dietary therapeutic by adhering to Standard Precautions to prevent infection, such as handwashing.
habits evaluated and changed so that iron levels can increase. Vitamin K is involved with The nurse will not expect the fibrinogen level to be affected by this therapy. Iron is not
clotting, not with iron stores. typically administered with chemotherapy because this is bone marrow suppression, so the
The nurse is caring for a client who has an elevated white blood cell count. Which administration of epoetin (Epogen) or filgrastim (Neupogen) is most effective. Monitoring
intervention does the nurse implement for this client?
the pulse oximetry is part of routine care and probably would not need to be done c. Assess bleeding time.
continuously. d. Monitor fibrin degradation products.
The nurse is performing an admission assessment on a 46-year-old client, who states, I have B ~ The PTT assesses the intrinsic clotting cascade. Heparin therapy is monitored by the PTT.
been drinking a 12-pack of beer every day for the past 20 years. Which laboratory Platelets are monitored by the platelet count laboratory value, bleeding time evaluates
abnormality does the nurse correlate with this history? vascular and platelet activity during hemostasis, and fibrin degradation products help assess
a. Decreased white blood cell (WBC) count for fibrinolysis.
b. Decreased bleeding time The nurse is administering a prescribed fibrinolytic to a client who is having a myocardial
c. Elevated prothrombin time (PT) infarction (MI). Which adverse effect does the nurse monitor for?
d. Elevated red blood cell (RBC) count a. Bleeding
C ~ The liver is the site for production of prothrombin and most of the blood-clotting factors. b. Orthostatic hypotension
If the liver is damaged because of chronic alcoholism, it is unable to produce these clotting c. Deep vein thrombosis
factors. Therefore, the PT could become elevated, which would reflect deficiency of some d. Nausea and vomiting
clotting factors. The WBC would not be elevated in this situation because no infection is A ~ A fibrinolytic lyses any clots in the body, thus causing an increased risk for bleeding.
present. Bleeding time would likely increase. The client's RBC count most likely would not Fibrinolytic therapy does not place the client at risk for hypotension, thrombosis, or nausea
be affected unless the client was bleeding, in which case it would decrease. and vomiting.
The nurse is assessing a client whose warfarin (Coumadin) therapy was discontinued 3 The nurse is caring for a client who had a bone marrow aspiration. The client begins to
weeks ago. Which laboratory test result indicates that the clients warfarin therapy is no bleed from the aspiration site. Which action does the nurse perform?
longer therapeutic? a. Apply external pressure to the site.
a. International normalized ratio (INR), 0.9 b. Elevate the extremities.
b. Reticulocyte count, 1% c. Cover the site with a dressing.
c. Serum ferritin level, 350 ng/mL d. Immobilize the leg.
d. Total white blood cell (WBC) count, 9000/mm3 A ~ All these options could be done after a bone marrow aspiration and biopsy. However,
A ~ Warfarin therapy increases the INR. Normal INR ranges between 0.7 and 1.8. the most important action when bleeding occurs is to apply external pressure to the site
Therapeutic warfarin levels, depending on the indication of the disorder, should maintain until hemostasis is ensured. The other measures could then be carried out.
the INR between 1.5 and 3.0. When the effects of warfarin are no longer present, the INR The nurse is preparing a client for a bone biopsy and aspiration. The client asks, "Will this be
returns to normal levels. Warfarin therapy does not affect white blood cell count, serum painful?" How does the nurse respond?
ferritin level, or reticulocyte count. a. The procedure is always done under general anesthesia.
The nurse is completing the preoperative checklist on a client. The client states, "I take an b. The biopsy lasts for only 2 minutes.
aspirin every day for my heart." How does the nurse respond? c. There is a chance that you may have pain.
a. I will call your doctor and request a prescription for pain medication. d. You can relieve pain with guided imagery.
b. I need to call the surgeon and reschedule your surgery. C ~ Clients may have pain during this procedure. The type and amount of anesthesia or
c. I'll give you the prescribed Tylenol to minimize any headache before surgery. sedation depend on the physicians preference, the client's preference, and previous
d. I need to administer vitamin K to prevent bleeding during the procedure. experience with bone marrow aspiration. The procedure takes from 5 to 15 minutes.
B ~ Aspirin and other salicylates interfere with platelet aggregationthe first step in the Guided imagery can relieve pain but works well only with some clients.
blood-clotting cascade & decrease the ability of the blood to form a platelet plug. These The nurse is caring for four clients with hematologic-type problems. Which client does the
effects last for longer than 1 week after just one dose of aspirin. The client may need to nurse prioritize to see first?
have the surgery rescheduled. Vitamin K, prescribed pain medication, and Tylenol cannot a. 18-year-old female with decreased protein levels
reduce the anticlotting effects of aspirin. b. 36-year-old male with increased lymphocytes
The nurse is caring for a client who is receiving heparin therapy. How does the nurse c. 60-year-old female with decreased erythropoietin
evaluate the therapeutic effect of the therapy? d. 82-year-old male with an increased thromboxane level
a. Evaluate platelets. C ~ The kidney releases more erythropoietin when tissue oxygenation levels are low. This
b. Monitor the partial thromboplastin time (PTT). growth factor then stimulates the bone marrow to increase red blood cell (RBC) production,
which improves tissue oxygenation and prevents hypoxia. Hypoxia causes the body to avoid bleeding episodes. The client on warfarin needs regular blood tests for prothrombin
increase its respiratory rate to overcome decreased oxygenation of the tissues. All these time (PT) and international normalized ratio (INR). Daily exercise and weight management
clients are important, but the woman with decreased erythropoietin takes priority because are not specifically important to this client.
of her risk for hypoxia.
The nurse is assessing the following laboratory results of a client before discharge. Which
instruction does the nurse include in this clients discharge teaching plan?
Hemoglobin 15 g/dL
Hematocrit 45%
WBC count 2000/mm3
Platelet count 250,000/mm3

a. Avoid contact sports.

b. Do not take any aspirin.
c. Eat a diet high in iron.
d. Perform good hand hygiene.
D ~ A normal WBC count is 5000 to 10,000/mm3. A white blood cell count of 2000/mm3 is
low and makes this client at risk for infection. Good handwashing technique is the best way
to prevent the transmission of infection. The other laboratory results are all within normal
limits.
The nurse is monitoring a client with liver failure. Which assessments does the nurse
perform when monitoring for bleeding in this client? (SATA)
a. Gums
b. Lung sounds
c. Urine
d. Stool
e. Hair
A, C, D ~ The liver is the site for production of clotting factors. Without these factors, the
client is at risk for bleeding. Common areas of bleeding include the gums and mucous
membranes, bladder, and gastrointestinal tract. Lung sounds and hair are part of the
assessment but are not essential in the presence of liver failure and hematologic
abnormalities.
The nurse is teaching a client who is receiving sodium warfarin (Coumadin). Which topics
does the nurse include in the teaching plan? (SATA)
a. Foods high in vitamin K
b. Using acetaminophen (Tylenol) for minor pain
c. Daily exercise and weight management
d. Use of a safety razor and soft toothbrush
e. Blood testing regimen
A, B, D, E ~ The client on warfarin will need to know which foods are high in vitamin K
because vitamin K intake must be consistent to avoid interfering with the anticoagulant
properties of warfarin. Clients should not take aspirin or NSAIDs for minor pain owing to
their anticoagulant properties. Clients must use safety razors and soft toothbrushes to
 Leukemia (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects,
"The client diagnosed with leukemia has central nervous system involvement. frequently assess for signs of bleeding, bruising, hemorrhage. "
Whichinstructions should the nurse teach? "When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to:
"1.Sleep with the head of the bed elevated to prevent increased intracranial pressure. "a.Discourage the use of stool softeners
2.Take an analgesic medication for pain only when the pain becomes severe. b.Assess temperature readings every six hours
3.Explain that radiation therapy to the head may result in permanent hair loss. c.Avoid invasive procedures
4.Discuss end-of-life decisions prior to cognitive deterioration" d.Encourage the use of a hard, brittle toothbrush
"Correct: 3
1.Sleeping with the head of the bed elevatedmight relieve some intracranial pressure, but it "
will not prevent intracranial pressure from occurring.2.Analgesic medications for clients "Answer: C
with cancer are given on a scheduled basis with a fast-acting analgesic administered PRN for Rationale:
break-through pain.3.Radiation therapy to the head and scalp area is the treatment of
choice for central nervous system involvement of any cancer. If the radiation therapy Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to
destroys the hair follicle, the hair will not grow back.4.Cognitive deterioration does not hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of
usually occur" hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should
The nurse analyzes the laboratory values of a child with leukemia who is receiving be avoided. Temperature is not the most important vital to track in this patient"
chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry "Which statement is correct about the rate of cell growth in relation to chemotherapy?
result, which intervention will the nurse document in the plan of care? "1. Faster growing cells are less susceptible to chemotherapy.
1 Mointor closely for signs of infection 2. Mointor the temperature every 4hours 3. Initate 2. Nondividing cells are more susceptible to chemotherapy.
prptective isolation precautions 4. Use soft small toothbrush for mouth care 3. Faster growing cells are more susceptible to chemotherapy.
Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than 4. Slower growing cells are more susceptible to chemotherapy."
20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or "Answer 3
hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy.
"A client with acute leukemia is admitted to the oncology unit. Which Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles
of the following would be most important for the nurse to inquire? of chemotherapy are used to destroy nondividing cells as the begin active cell division."
"a. ""Have you noticed a change in sleeping habits recently?"" "The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment
b. ""Have you had a respiratory infection in the last 6 months?"" data warrant immediate intervention?
c. ""Have you lost weight recently?"" 1.T 99, P 102, R 22, and BP 132/68.
d. ""Have you noticed changes in your alertness?""" 2.Hyperplasia of the gums.
Answer B is correct. The client with leukemia is at risk for infection and has often had 3.Weakness and fatigue.
recurrent respiratory infections during the previous 6 months. Insomnolence, weight loss, 4.Pain in the left upper quadrant."
and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections "Correct: 4
are the primary clinical manifestations; therefore, answers A, C, and D are incorrect. 1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni-
"What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia? toring at intervals, but they do not indicate animmediate need.
"A. potential for injury 2.Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency.
B. self-care deficit 3.Weakness and fatigue are symptoms of thedisease and are expected.
C. potential for self harm 4.Pain is expected, but it is a priority, andpain control measures should be imple-mented."
D. alteration in comfort" "Which medication is contraindicated for a client diagnosed with leukemia?
"Answer: A potential for injury 1. Bactrim, a sulfa antibiotic
Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave 2. Morphine, a narcotic analgesic
with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures 3. Epogen, a biologic response modifier
4. Gleevec, a genetic blocking agent"
"Correct: C and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar)
to the foods that a patient will eat.
1. Because of the ineffective or nonexistent WBCs characteristic of leukemia, the body
cannot fight infections, and antibiotics are given to treat infections. Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading
2. Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the drug of to eating fewer calories.
choice for most clients with cancer. Eating three large meals isn't possible for a patient on chemotherapy due to the decreased
3. Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs. taste sensation.
The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow Liquid protein supplements should when needed but they lead to less eating during
would be generally ineffective for the desired results and would have the potential to mealtimes due to feeling of satiation."
stimulate malignant growth. A client has developed oral mucositis as a result of radiation to the head and neck. The
4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the nurse shouls teach the client to incorporate which of the following measures in his or her
BCR-ABL protein, preventing the cells from growing and dividing." daily home care routine?
"A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related a) oral hygiene should be performed in the morning and evening
to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, b) high-protein foods, such as peanut butter, should be incorporated in the diet
most appropriately would offer which of the following during this episode of nausea? c) a glass of wine per day will not pose any further harm to the oral cavity
"1. Cool, clear liquids d) a combination of a weak saline and water solution should be used to rinse the mouth
2. Low protein foods before and after each meal"
3. Low-calorie foods "2) D
4. The child's favorite food" Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs
"Correct: 1. in clients receiving radiation to the head and neck. Measures need to be taken to soothe
With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child the mucosa as well as provide effective cleansing of the oral cavity. A combination of a
is nauseated so he doesn't associate if with being sick. Support nutrition with oral weak saline and water solution is an effective cleansing agent."
supplements and foods high in proteins and calories" "The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone
Which of the following laboratory values could indicate that a child has leukemia? marrow transplantation unit. Which nursing task should the nurse delegate?
"1. WBCs 32,000/mm3 "A. Take the hourly vital signs on a client receiving blood transfusions.
2. Platelets 300,000/mm3 B. Monitor the infusion of antineoplastic medications.
3. Hemoglobin 15g/dL C. Transcribe the HCP's orders onto the Medication Administration Record.
4. Blood pH of 7.35" D. Determine the client's reponse to the therapy."
"Correct: 1. "Correct: A.
1. YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high Explanation:
WBC count is diagnostic and is usually confirmed by a blood smear. A. After the first 15 minutes during which the client tolerates the blood transfusion, it is
2-4. None of these indicate leukemia," appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which parameters for the vital signs. Any vital sign outside the normal parameters must have an
of the following strategies would be most appropriate for the nurse to use to increase the intervention by the nurse.
patient's nutritional intake? B. Antineoplastic medication infusions must be monitored by a chemotherapy-certified,
"A. Increase intake of liquids at mealtime to stimulate the appetite. competent nurse.
B. Serve three large meals per day plus snacks between each meal. C. This is the responsibility of the word secretary or the nurse, not the unlicensed personnel.
C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. This represents the evaluation portion of the nursing process and cannot be delegated."
D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods." "The most common signs and symptoms of leukemia related to bone marrow involvement
"Correct Answer: D are which of the following?
"A. Petechiae, fever, fatigue
The nurse can increase the nutritional density of foods by adding items high in protein B. Headache, papilledema, irritability
C. Muscle wasting, weight loss, fatigue 3) Normal WBC count at diagnosis
D. Decreased intracranial pressure, psychosis, confusion" 4) Disease presents between age 2 and 10"
"Answer A is Correct. 1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer
Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever to diagnosis not prognosis.
related to infection from the depressed number of effective leukocytes, and fatigue from "The nurse writes a nursing problem of "altered nutrition" for a client diagnosed
the anemia." withleukemia who has received a treatment regimen of chemotherapy and radiation.
"A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for Which nursing intervention should be implemented?
treatment of hemolytic anemia. Which of the following measures, if incorporated into the "1. Administer an antidiarrheal medication prior to meals
nursing care plan, would best address the patient's needs? 2. Monitor the client's serum albumin levels
"1. Encourage activities with other patients in the day room. 3. Assess for signs and symptoms of infection
2. Isolate him from visitors and patients to avoid infection. 4. Provide skin care to irradiated areas"
3. Provide a diet high in Vitamin C "Answer: 2
4. Provide a quiet environment to promote adequate rest." 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal
"Correct: D. medication
1. does not meet need for rest 2. Serum albumin is a measure of the protein content in the blood that is derived form food
2. no info given about WBC or reverse isolation, on reverse isolation if neutrophil count is eaten; albumin monitors nutritional status
less than 500/mm3 3. Assessment of the nutritional status is indicated for this problem, not assessment of the
3. needed for wound healing and resistance to infection, not best choice s/sx of infections.
4. primary problem activity intolerance due to fatigue. Correct" 4. This addresses an altered skin integrity problem"
"A client diagnosed with leukemia is being admitted for an induction course of "The mother of a 5-year-old child asks the nurse questions regarding the importance of
chemotherapy. Which laboratory values indicate a diagnosis of leukemia? vigilant use of sunscreen. Which information is most important for the nurse to convey to
1. A left shift in the white blood cell count differential. the mother?
2. A large number of WBCs that decrease after the administration of antibiotics. "A. Appropriate use of sunscreen decreases the risk of skin cancer.
3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. B. Repeated exposure to the sun causes premature aging of the skin.
4. Red blood cells that are larger than normal." C. A child's skin is delicate, and burns easily.
"Correct answer is 1. D. In addition to causing skin cancer, repeated sun exposure predisposes the child to other
1. A left shift indicates immature white blood cells are being produced and released into the forms of cancer."
circulating blood volume. This should be investigated for the malignant process of "Correct: A.
leukemia." Appropriate use of sunscreen decreases the risk of skin cancer.
A pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia While all of the answer choices are correct, recommending the use of sunscreen to
with a class of nursing students. Which statement made by a nursing student indicates a decrease the incidence of skin cancer is the best response.
lack of understanding of the pathophysiology of this disease? " Nursing Process: Implementation
1. Normal bone marrow is replaced by blast cells Category of Client Need: Health Promotion and Maintenance
2. Red blood cell production is affected Cognitive Level: Application"
3. the platelet count is decreased A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is
4. the presence of a reed-sternberg cell is found on biopsy" bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted.
4. Reed-sternberg Cell is found in Hodgkins Diagnostic studies are being performed on the child because acute lymphocytic leukemia is
Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? suspected. Which diagnostic study would confirm this diagnosis
" "1. Platelet count
1) Presence of a mediastinal mass 2. LUmbar puncture
2) Late CNS leukemia 3. bone marrow biopsy
4. wbc count"
"Correct: 3. increased metabolism, weight loss may occur.
3 leukemia is a malignant increase in the number of leukocytes, usually at an immature Strategy: It is important to read every word in the question. Do not speed-read."
stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow "After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic
obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for leukemia, the laboratory test indicates that the client is neutropenic. The nurse should
blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or perform which of the following?"
low in leukemia an altered platelet count occurs as a result of the disease but also may "A. advise the client to rest and avoid exertion
occur as a result of chemotherapy and does not confirm the diagnosis" B. prevent client exposure ot infections
"Nursing considerations related to the administration of chemotherapeutic drugs include C. monitor the blood pressure frequently
which of the following? "A. Anaphylaxis cannot occur, since the drugs are considered toxic D. observe for increased bruising"
to normal cells. "Answer: B
B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. Rationale: Neutropenia is a decreased number of
C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if neutrophil cells in the blood which are responsible for the body's
drug infiltrates. defense against infection. Rest and avoid exertion would be related to
D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are erythrocytes and oxygen carrying properties. Monitoring the blood
not necessary." pressure, and observing for bruising would be related to platelets and
"Correct: C 3. Chemotherapeutic agents can be extremely damaging to cells. Nurses sign and symptoms of bleeding.
experienced with the administration of vesicant drugs should be Objective: Describe the major types of leukemia and the most common treatment
responsible for giving these drugs and be prepared to treat modalities and nursing interventions."
extravasations if necessary. "The mother of a child diagnosed with a potentially life-threatening form of cancer says to
1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. the nurse, ""I don't understand how this could happen to us. We have been so careful to
2. Infiltration and extravasations are always a risk, especially with peripheral veins. make sure our child is healthy."" Which response by the nurse is most appropriate?
4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be "A. Why do you say that? Do you think that you could have prevented this?""
thoroughly washed afterward. B. ""This must be a difficult time for you and your family. Would you like to talk about how
you are feeling?""
Level of cognitive ability: Analysis C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault.""
Area of client needs: Physiologic Integrity/Pharmacologic and Parenteral Therapy D.""Many children are diagnosed with cancer. It is not always life-threatening."""
Integrated process: Teaching/Learning; Nursing Process: Implementation" "Answer B
"After a client with a potential diagnosis of leukemia is admitted to the Parents of children diagnosed with cancer require major emotional support, and should be
hospital, the nurse should assess for which of the following? (Select allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is
all that apply.)" " telling the parents that there are many other children with cancer."
A. Reports of fatigue and weakness The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment
B. An elevation in the leukocytes data support this diagnosis?
especially neutrophils "1.) Fever and infections.
C. Signs of bruising easily 2.) Nausea and vomiting.
D. Recent weight gain" 3.) Excessive energy and high platelet counts.
"Correct: A, C 4.) Cervical lymph node enlargement and positive acid-fast bacillus."
ANSWER: Reports of fatigue and weakness Signs of bruising easily "Correct: 1.
Rationale: General manifestations of leukemia 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone
result from anemia, infection, and bleeding. The client would complain marrow is unable to produce WBCs of the number and maturity needed to fight infection
of fatigue and weakness and show signs of bruising. Leukemic cells (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but
replace normal hematopoietic elements preventing the formation of mature not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have
leukocytes. Neutrophil count would be decreased. Because of an low platelet counts. The platelet count is low as a result of the inability of the bone marrow
to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated A
with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit Rationale: Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of
#4)." the risk of bacteria being present. The patient should ambulate in the room rather than the
"A bone marrow transplant is being considered hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap
for treatment of a patient with acute leukemia that has not responded to chemotherapy. In can dry the skin and increase infection risk, showering every other day is acceptable.
discussing the treatment with the patient, the nurse explains that Careful cleaning after having a bowel movement will help to prevent perineal skin
"a. hospitalization will be required for several weeks after the hematopoietic stem cell breakdown and infection.
transplant (HSCT). Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic
b. the transplant of the donated cells is painful because of the nerves in the tissue lining the indicates a need for the nurse to intervene?
bone. a. The NA assists the patient to use dental floss after eating.
c. donor bone marrow cells are transplanted immediately after an infusion of b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water.
chemotherapy. c. The NA adds baking soda to the patient's saline oral rinses.
d. the transplant procedure takes place in a sterile operating room to minimize the risk for d. The NA puts fluoride toothpaste on the patient's toothbrush.
infection." A
"Correct Answer: A Rationale: Use of dental floss is avoided in patients with pancytopenia because of the risk
for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after patient.
HSCT while waiting for the transplanted marrow to start producing cells. The transplanted Which information noted by the nurse reviewing the laboratory results of a patient who is
cells are infused through an IV line, so the transplant is not painful, nor is an operating receiving chemotherapy is most important to report to the health care provider?
room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to a. Hemoglobin of 10 g/L
the transplanted cells by the chemotherapy drug." b. WBC count of 1700/µl
After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year- c. Platelets of 65,000/µl
old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse d. Serum creatinine level of 1.2 mg/dl
to repeat the information. Based on this assessment, which nursing diagnosis is most likely B
for the patient? Rationale: Neutropenia places the patient at risk for severe infection and is an indication
a. Acute confusion related to infiltration of leukemia cells into the central nervous system that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth
b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate
c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis any immediate life-threatening adverse effects of the chemotherapy.
d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain
C the patient's self-esteem, the nurse plans to
Rationale: The patient who has a new cancer diagnosis is likely to have high anxiety, which a. suggest that the patient limit social contacts until regrowth of the hair occurs.
may impact learning and require that the nurse repeat and reinforce information. The b. encourage the patient to purchase a wig or hat and wear it once hair loss begins.
patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely c. have the patient wash the hair gently with a mild shampoo to minimize hair loss.
cause of the confusion. The patient asks for the information to be repeated, indicating that d. inform the patient that hair loss will not be permanent and that the hair will grow back.
lack of interest in learning and denial are not etiologic factors. B
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Rationale: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves,
Which observation by the RN caring for the patient indicates that the nurse should take or hats. Limiting social contacts is not appropriate at a time when the patient is likely to
action? need a good social support system. The damage occurs at the hair follicle and will occur
a. The patient's visitors bring in some fresh peaches from home. regardless of gentle washing or use of a mild shampoo. The information that the hair will
b. The patient ambulates several times a day in the room. grow back is not immediately helpful in maintaining the patient's self-esteem
c. The patient uses soap and shampoo to shower every other day.
d. The patient cleans with a warm washcloth after having a stool.
 Bleeding
Which factor increases the risk of developing​ leukemia? (Select all that​ apply.)
Decreased energy
Obesity
Recurrent infections
Cigarette smoking Splenomegaly is a clinical manifestation of
CML
Previous cancer treatment CLL
AML
Excessive caffeine ingestion Other manifestations of ALL include​
pallor, bone​ pain, weight​ loss, sore​ throat, and night sweats.
Diagnosis of Down syndrome The nurse caring for a client with neutropenia would assess for which​ disorder? (Select all
Cigarette smoking that​ apply.)

Previous cancer treatment Petechiae

Diagnosis of Down syndrome Hematuria

A client with chronic myeloid leukemia​ (CML) is admitted to a clinic. The nurse
understands the client is least likely to be part of which demographic​ group? Septicemia

Male Pneumonia

Younger than 20 years Mucous membrane ulceration

Septicemia
Female
Pneumonia
Older than 65 years
Younger than 20 years Mucous membrane ulceration
The nurse caring for a client with acute lymphoblastic leukemia​ (ALL) would assess for The nurse is completing an assessment on a client diagnosed with acute myeloid
which sign and​ symptom? (Select all that​ apply.) leukemia​ (AML). Assessment data include an altered level of​ consciousness, client
complaints of​ headache, and nausea and vomiting. The nurse anticipates this may be due
Weakness to which pathophysiological​ change?

Bleeding Reduced coagulation factors

Splenomegaly Inadequate production of RBCs

Decreased energy Leukemic cell infiltration

Recurrent infections Immature WBCs

Weakness Leukemic cell infiltration
Inadequate production of RBCs can lead to
Anemia nurse why the client is not being referred for chemotherapy or radiation. Which response
The nurse is teaching a client with chronic myeloid leukemia​ (CML) about ongoing needs. by the nurse provides the most accurate​ response?
Which intervention would the nurse include when educating this​ client? (Select all that​
apply.) ​ "Whether or not to treat is based on​ age; your mother is past the age where treatment
would be​ considered."
Avoid​ alcohol-based mouthwash.
​ "There is no effective treatment for CLL in older​ adults; they will usually die from other
Complete oral hygiene frequently. causes before the CLL causes​ death."

Drink five to eight glasses of water a day. ​ "Treatment will begin if your mother starts to exhibit​ symptoms; earlier treatment has
not been shown to improve​ outcomes."
Refrain from eating overly spicy foods.
​ "Your mother has too many comorbid​ conditions, thus treatment would not be​
Participate in strenuous exercise. effective."
Avoid​ alcohol-based mouthwash. ​ "Treatment will begin if your mother starts to exhibit​ symptoms; earlier treatment has
not been shown to improve​ outcomes."
Complete oral hygiene frequently. The nurse is discussing health promotion interventions with the parents of a child born with
Down syndrome. Which intervention would be most appropriate for the nurse to include in
Drink five to eight glasses of water a day. the education related to the increased risk for acute lymphocytic​ leukemia?

Refrain from eating overly spicy foods. ​ "You should be aware of the symptoms of acute lymphocytic​ leukemia, as they are
The nurse is teaching the parents of a child with acute lymphocyte leukemia​ (ALL) about very distinctive and can help diagnose it​ early."
the​ long-term effects of treatment for this disease. Which potential chronic health
challenge should the nurse discuss regarding what the child might face as an​ adult? ​ "You should make sure to complete screening tests for acute lymphocytic leukemia​
(Select all that​ apply.) annually."

Obesity ​ "Your child should have regular medical checkups and testing as recommended by the
healthcare​ provider."
Infertility
​ "You need to be aware of the increased​ risk, but​ unfortunately, there really are no
Pancreatitis interventions we can recommend to help reduce this​ risk."
​ "You need to be aware of the increased​ risk, but​ unfortunately, there really are no
Growth retardation interventions we can recommend to help reduce this​ risk."
The nurse is aware that the client with leukemia is at risk for bleeding. Which diagnostic test
Growth hormone deficiency should the nurse follow to manage​ risk?
Obesity
Platelet count
Infertility
Red blood cell count
Growth hormone deficiency
An​ 84-year-old client has been diagnosed with early stage chronic lymphocytic White blood cell count
leukemia​ (CLL). The client is not currently symptomatic. The​ client's daughter asks the
 Promote rest.
Bone marrow aspiration
Platelet count Perform blood transfusions.
The client has indicated that he will be treated with a biologic for his leukemia. The nurse
should expect that a drug from which group could be​ ordered? (Select all that​ apply.) Monitor coagulation studies.

Interferon Administer epoetin as prescribed.

Interleukin Administer preventive antimicrobials as prescribed.

Promote rest.
Imatinib mesylate
Perform blood transfusions.
Cyclophosphamide
Administer epoetin as prescribed.
​ Colony-stimulating factor Treatment options for a client diagnosed with acute myeloid leukemia​ (AML) is being
Interferon discussed. The nurse informs the client that the most likely treatment will include complete
and sustained replacement of their blood cell lines​ (WBCs, RBCs, and​ platelets) with
Interleukin cells derived from donor stem cells. Which treatment is the nurse referring​ to?

Colony-stimulating factor Radiation

The nurse is caring for a client newly admitted with suspected leukemia. The nurse
anticipates which test will be ordered to confirm the​ diagnosis? (Select all that​ apply.) Allogeneic stem cell transplant​ (SCT)

Platelet count Allogeneic bone marrow transplant​ (BMT)

Sedimentation rate Autologous bone marrow transplant​ (BMT)

Allogeneic stem cell transplant​ (SCT)
Red blood cell count When planning care for a client with acute lymphocytic leukemia​ (ALL), the nurse
addresses the problem of insufficient calorie intake. Which nursing intervention will assist
White blood cell count in addressing this​ problem?

Bone marrow aspiration Weigh the client weekly.

Platelet count
Medicate for pain 90 minutes before meals.
Red blood cell count
Provide mouth care before meals.
White blood cell count
Provide​ high-fat meals throughout the day.
Bone marrow aspiration Provide mouth care before meals.
Which nursing intervention would help to directly address the anemia that occurs with​ During chemotherapy treatment for​ leukemia, when should the nurse monitor urine
leukemia? (Select all that​ apply.) specific​ gravity? (Select all that​ apply.)
Every eight hours Assess body systems for bleeding every shift.

If a change occurs in urine pH Instruct the client to avoid forceful coughing or sneezing.
Avoid invasive procedures.
Before chemotherapy administration
Assess vital signs every four hours.
During chemotherapy administration
Assess body systems for bleeding every shift.
When IV fluids are reduced to maintenance levels
Every eight hours Instruct the client to avoid forceful coughing or sneezing.
The family members of a client being treated for leukemia ask the nurse if it is OK to give
Before chemotherapy administration the client a botanical​ medicine, which they have heard can be helpful for leukemia clients.
Which response by the nurse accurately answers this​ question?
During chemotherapy administration
​ "Botanicals interfere with the effectiveness of the chemotherapy drug and should not be
When IV fluids are reduced to maintenance levels given​ concurrently; you can use it once the chemotherapy is​ done."
The healthcare provider has informed the nurse that they have scheduled a biopsy for the
client with leukemia. The nurse reviews the client​ information, which​ includes: WBCs ​ "Please speak with your healthcare provider about what specifically you would like to​
57 x 103​ /µL; HCT​ 21%; platelets 29 x 103​ /µL; RBCs 2.41 x 103​ /mm3​ ; BP​ use, so they can make sure it will not interact with the chemotherapy the client is​
106/46; HR​ 96; RR 24. Which information would prompt the nurse to contact the receiving."
healthcare provider concerning this​ procedure?
​ "Complementary therapies such as botanicals do not have the value they claim and
WBCs 57 x 10^3​ /µµL should be​ avoided."

Platelets 29 x 10^3/µµL ​ "Botanical therapies are natural and should be fine to give to the​ client, as long as you
only give small​ amounts."
BP​ 106/46 mmHg ​ "Please speak with your healthcare provider about what specifically you would like to​
use, so they can make sure it will not interact with the chemotherapy the client is​
RBCs 2.41 x 10^3/mm3 receiving."
Platelets 29 x 10^3/µµL
The nurse is completing the care plan for a client admitted for treatment of injury. Which
intervention should the nurse include in the plan to decrease risk for injury related to​
bleeding? (Select all that​ apply.)

Monitor renal function.

Avoid invasive procedures.

Assess vital signs every four hours.

Carefully monitor intake and output.

 Brain Tumors following is an appropriate response by the nurse?

A nurse is caring for a client who is having surgery for the removal of an encapsulated A. It can spread to breasts and kidneys
acoustic tumor. Which of the following potential complications should the nurse monitor B. It can develop in your GI tract
for postoperatively? (Select all that apply) C. It is limited to brain tissue
D. It probably started in another area of your body and spread to your brain
A. Increased intracranial pressure C
B. Hemorrhagic shock A nurse is reviewing the health record of a client who has a malignant brain tumor and
C. Hydrocephalus notes the client has a positive Romberg sign. Which of the following actions should the
D. Hypoglycemia nurse take to assess for this sign?
E. Seizures
ACE A. Stroke the lateral aspect of the sole of the foot
A nurse is caring for a client who has just undergone a craniotomy for a suprtentorial tumor. B. Ask the client to blink his eyes
Which of the following postoperative prescriptions should the nurse clarify with the C. Observe for facial drooping
provider? D. Have the client stand erect with eyes closed
D
A. Dexamethasone (Decadron) 30 mg IV bolus BID Nurse admitting post-craniotomy client from PACU. Client's incision is supratentorial, nurse
B. Morphine sulfate 2 mg IV bolus PRN every 2 hours for pain will assist client into which position?
C. Ondansetron (Zofran) 4 mg IV bolus PRN every 4-6 hour for nausea
D. Phenytoin (Dilantin) 100 mg IV bolus TID A.Head of bed flat
B B.Supine
A nurse is completing an assessment of client who has increased intracranial pressure. C.Elevate HOB to 30 degrees.
Which of the following are expected findings? (Select all that apply) D.Lying on operative side
C
A. Disoriented to time and place Nurse is assessing neuro status of client who had craniotomy 3 days ago. Nurse should
B. Restlessness and irritability notify surgeon immediately if client exhibits which of the following?
C. Unequal pupils
D. ICP 15 mm/Hg A.Pupils equal and reactive at 4 mm in size
E. Headahe B.Pain with forward flexion of the neck onto the chest.
ABCE C.Mild headache relieved by codeine sulfate
A nurse is reviewing a prescription for dexamethasone (Decadron) with a client who has an D.Disorientation to date
expanding brain tumor. Which of the following are appropriate statements by the nurse? B
(Select all that apply) Client is 12 hours postoperative craniotomy. Nurse observes and increase in urine output
up to 220cc/hour for the past 2 hours. Increased UO may be indicative of ...
A. It is given to reduce swelling of the brain
B. You will need to monitor for low blood sugar A.Improved renal function
C. You may notice weight gain B.Hypovolemic shock
D. Tumor growth will be delayed C.Normal response post-craniotomy
E. It can cause you to retain fluids D.Diabetes Insipidus.
ACE D
A nurse is caring for a client who has a benign brain tumor. The client asks the nurse if he A nurse is caring for a client who is postoperative following a craniotomy to evacuate a
can expect this same type of tumor to occur in other areas of his body. Which of the subdural hematoma. The nurse notes the clients urine output is greater each hour than the
previous hour: from 8-9 the urine output was 200 mL, from 9-10 it was 400 mL, and from What action should you take as part of care for a patient who had a craniotomy?
10-11 it was 600 mL. the nurse informs the surgeon and anticipates that the lab values that
will be prescribed at this time is: A. Use promethazine (Phenergan) for nausea.
B. Position the patient on the operative side if a bone flap was removed.
A. BUN C. Administer phenytoin (Dilantin) by rapid intravenous push (IVP) every 6 hours.
B. Blood sugar D. Keep the head in alignment with the trunk.
C. urine ketones D
D. specific gravity The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs
D and symptoms would the nurse expect the child to demonstrate? Select all that apply.
The patient is diagnosed with a brain tumor. Which option is the correct understanding of
the preferred treatment? 1. Head tilt
2. Vomiting
A. Surgical removal is preferred, even if the tumor is not malignant. 3. Polydipsia
B. Chemotherapy is a common and effective treatment. 4. Lethargy
C. Stereotactic radiosurgery is the preferred treatment. 5. Increased appetite
D. A large dose of intravenous steroid therapy is preferred. 6. Increased pulse
A 124
You are answering questions at a class on brain tumors for nursing students. Which
information related to brain tumors should you include in this class?

A. Brain tumors are not removed unless than they cause headaches or seizures. The patient's magnetic resonance imaging revealed the presence of a brain tumor. The
B. Seizures are an uncommon symptom unless there is metastasis. nurse anticipates which treatment modality?
C. The most common type of brain tumor is from metastasis of cancer outside of the brain.
D. Brain tumors commonly metastasize to the lungs because of high vascularity. a. Surgery
C b. Chemotherapy
Nursing management of a patient with a brain tumor includes (select all that apply) c. Radiation therapy
d. Biologic drug therapy
A. discussing with the patient methods to control inappropriate behavior. a. Surgery
B. using diversion techniques to keep the patient stimulated and motivated.
C. assisting and supporting the family in understanding changes in behavior. Surgical removal is the preferred treatment for brain tumors. Chemotherapy and biologic
D. limiting self-care activities until the patient has regained maximum physical functioning. drug therapy are limited by the blood-brain barrier, tumor cell heterogeneity, and tumor
E. planning for seizure precautions and teaching the patient and caregiver about antiseizure cell drug resistance. Radiation therapy may be used as a follow-up measure after surgery.
drugs. A 32-yr-old female patient is diagnosed with diabetes insipidus after transsphenoidal
CE resection of a pituitary adenoma. What should the nurse consider as a sign of improvement?
What is most important finding for you to act on for a patient who had a craniotomy?
a. Serum sodium of 120 mEq/L
A. Sodium: 134 mEq/L b. Urine specific gravity of 1.001
B. While blood cell (WBC) count: 11,000/μL c. Fasting blood glucose of 80 mg/dL
C. Urine specific gravity: 1.001 d. Serum osmolality of 290 mOsm/kg
D. Blood urea nitrogen (BUN): 25 mg/dL d. Serum osmolality of 290 mOsm/kg
C
Laboratory findings in diabetes insipidus include an elevation in serum osmolality and
serum sodium and a decrease in urine specific gravity. Normal serum osmolality is 275 to c. Use strict aseptic technique with dressing changes.
295 mOsm/kg, normal serum sodium is 135 to 145 mEq/L, and normal specific gravity is d. Be aware of changes in ICP related to leaking cerebrospinal fluid (CSF).
1.003 to 1.030. Elevated blood glucose levels occur with diabetes mellitus. c. Use strict aseptic technique with dressing changes.
The nurse is caring for a patient admitted for evaluation and surgical removal of a brain
tumor. Which complications will the nurse monitor for (select all that apply.)? The priority nursing intervention is to use strict aseptic technique with dressing changes
Select all that apply. and any handling of the insertion site to prevent the serious complication of infection. IV
mannitol or hypertonic saline will be administered as ordered for increased ICP. Ventilators
a. Seizures may be used to maintain oxygenation. CSF leaks may cause inaccurate ICP readings, or CSF
b. Vision loss may be drained to decrease ICP, but strict aseptic technique to prevent infection is the
c. Cerebral edema nurse's priority of care.
d. Pituitary dysfunction The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a
e. Parathyroid dysfunction T1NXM0 classification. Which explanation does the nurse offer when the client asks what
f. Focal neurologic deficits the terminology means?
a. Seizures A "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is
b. Vision loss present."
c. Cerebral edema B "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no
d. Pituitary dysfunction distant metastasis."
f. Focal neurologic deficits C "This type of tumor in the brain is small with some lymph node involvement; another
tumor is present somewhere else in your body."
Brain tumors can cause a wide variety of symptoms depending on location such as seizures, D "Glioma means this tumor is benign, so I will have to ask your health care provider the
vision loss, and focal neurologic deficits. Tumors can put pressure on the pituitary, leading reason for the chemotherapy and radiation."
to dysfunction of the gland. As the tumor grows, clinical manifestations of increased ANS: B
intracranial pressure and cerebral edema appear. The parathyroid gland is not regulated by T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph
the cerebral cortex or the pituitary gland. nodes are present in the brain. M0 means that no distant metastasis has occurred. NX
The nurse prepares to administer temozolomide (Temodar) to a 59-yr-old white male means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the
patient with a glioblastoma multiforme (GBM) brain tumor. What should the nurse assess brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of
before giving the medication? the glial cells of the brain.
5.
a. Serum potassium and serum sodium levels The nurse manager in a long-term care facility is developing a plan for primary and
b. Urine osmolality and urine specific gravity secondary prevention of colorectal cancer. Which tasks associated with the screening plan
c. Absolute neutrophil count and platelet count will be delegated to nursing assistants within the facility?
d. Cerebrospinal fluid pressure and cell count A Testing of stool specimens for occult blood
c. Absolute neutrophil count and platelet count B Teaching about the importance of dietary fiber
C Referring clients for colonoscopy procedures
Temozolomide causes myelosuppression. The nurse should assess the absolute neutrophil D Giving vitamin and mineral supplements
count and the platelet count. The absolute neutrophil count should be greater than 1500/ìL ANS: A
and platelet count greater than 100,000/ìL. (see drug alert on p.1335) Testing of stool specimens for occult blood is done according to a standardized protocol and
The patient with a brain tumor is being monitored for increased intracranial pressure (ICP) can be delegated to nursing assistants. Client education is within the scope of practice of
with a ventriculostomy. What nursing intervention is priority? the RN, not of the LPN or nursing assistant. Referral for further care is best performed by
the RN. Administration of medications is beyond the nursing assistant's scope of practice
a. Administer IV mannitol and should be done by licensed nursing personnel.
b. Ventilator use to hyperoxygenate the patient
ANS: A
Testing of stool specimens for occult blood is done according to a standardized protocol and A. CN7
can be delegated to nursing assistants. Client education is within the scope of practice of B. CN5
the RN, not of the LPN or nursing assistant. Referral for further care is best performed by C. CN8
the RN. Administration of medications is beyond the nursing assistant's scope of practice D. CN11
and should be done by licensed nursing personnel. C. CN8
A client has a glioblastoma. The nurse begins to plan care for this client with which type of Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
cancer? currently unknown. You begin to think about the way brain tumors are classified Mr. Snyder
A Liver is scheduled for surgery in the morning, and you are surprised to find out that there is no
B Smooth muscle order for an enema. You assess the situation and conclude that the reason for this is:
C Fatty tissue
D Brain A. Mr. Snyder has had some mental changes due to the tumor and would find an enema
ANS: D terribly traumatic
The prefix "glio-" is used when cancers of the brain are named. The prefix "hepato-" is B. Straining to evacuate the enema might increase the intracranial pressure
included when cancers of the liver are named. The prefix "leiomyo-" is included when C. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is
cancers of smooth muscle are named. The prefix "lipo-" is included when cancers of fat or not necessary
adipose tissue are named. D. An oversight and you call the physician to obtain the order
Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is B. Straining to evacuate the enema might increase the intracranial pressure
currently unknown. You begin to think about the way brain tumors are classified Whether Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
Mr. Snyder's tumor is benign or malignant, it will eventually cause increased intracranial currently unknown. You begin to think about the way brain tumors are classified Potential
pressure. Signs and symptoms of increasing intracranial pressure may include all of the postintracranial surgery problems include all but which of the following?
following, except:
A. Increased ICP
A. Headache, nausea, and vomiting B. Extracranial hemorrhage
B. Papilledema, dizziness, mental status changes C. Seizures
C. Obvious motor deficits D.Leakage of cerebrospinal fluid
D. Increased pulse rate, drop in blood pressure B. Extracranial hemorrhage
D. Increased pulse rate, drop in blood pressure Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think about the way brain tumors are classified Whether
currently unknown. You begin to think about the way brain tumors are classified Glioma is Mr. Snyder's tumor is benign or malignant, it will eventually cause increased intracranial
an intracranial tumor. Which of the following statements about gliomas do you know to be pressure. Signs and symptoms of increasing intracranial pressure may include all of the
false? following, except:

A. 50% of all intracranial tumors are gliomas 1.Headache, nausea, and vomiting
B. Gliomas are usually benign 2. Papilledema, dizziness, mental status changes
C. They grow rapidly and often cannot be totally excised from the surrounding tissue 3. Obvious motor deficits
D. Most glioma victims die within a year after diagnosis 4. Increased pulse rate, drop in blood pressure
B. Gliomas are usually benign 4. Increased pulse rate, drop in blood pressure
Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
currently unknown. You begin to think about the way brain tumors are classified Acoustic currently unknown. You begin to think about the way brain tumors are classified
neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to Postoperatively Mr. Snyder needs vigilant nursing care including all of the following, except:
pressure and eventual destruction of:
1.Keeping his head flat
2. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
3.Helping him avoid straining at stool, vomiting, or coughing
4. Providing a caring, supportive atmosphere for him and his family
1.Keeping his head flat
 Leukemia and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections
are the primary clinical manifestations; therefore, answers A, C, and D are incorrect.
"In formulating a nursing diagnosis of risk for infection for a client with chronic lymphoid "What nursing diagnosis is seen with acute lymphocytic leukemia and thromocytopenia?
leukemia (CLL), nursing measures should include: (Select all that apply.) "A. potential for injury
"A. Maintaining a clean technique for all invasive procedures. B. self-care deficit
B. Placing the client in protective isolation. C. potential for self harm
C. Limiting visitors who have colds and infections. D. alteration in comfort"
D. Ensuring meticulous handwashing by all persons coming in contact with the client." "Answer: A potential for injury
"Correct Answers: B, C, D Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave
Rationale: Chronic lymphoid leukemia (CLL) is characterized by a proliferation and with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures
accumulation of small, abnormal mature lymphocytes in bone marrow, peripheral blood, (urinary drainage catheter or a nasogastric tube), side-rails up, remove sharp objects,
and body tissues. Infections and fever are frequent complications of CLL." frequently assess for signs of bleeding, bruising, hemorrhage. "
"The client diagnosed with leukemia has central nervous system involvement. Which of the following manifestations would be directly associated with Hodgkin's disease?
Whichinstructions should the nurse teach? "a. bone pain
"1.Sleep with the head of the bed elevated to prevent increased intracranial pressure. b. generalized edema
2.Take an analgesic medication for pain only when the pain becomes severe. c. petechiae and purpura
3.Explain that radiation therapy to the head may result in permanent hair loss. d. painless, enlarged lymph nodes"
4.Discuss end-of-life decisions prior to cognitive deterioration" "Correct answer: D
"Correct: 3 Rationale: Hodgkin's disease usually presents as painless enlarged lymph nodes. The
1.Sleeping with the head of the bed elevatedmight relieve some intracranial pressure, but it diagnosis is made by lymph node biopsy."
will not prevent intracranial pressure from occurring.2.Analgesic medications for clients "When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to:
with cancer are given on a scheduled basis with a fast-acting analgesic administered PRN for "a.Discourage the use of stool softeners
break-through pain.3.Radiation therapy to the head and scalp area is the treatment of b.Assess temperature readings every six hours
choice for central nervous system involvement of any cancer. If the radiation therapy c.Avoid invasive procedures
destroys the hair follicle, the hair will not grow back.4.Cognitive deterioration does not d.Encourage the use of a hard, brittle toothbrush
usually occur"
The nurse analyzes the laboratory values of a child with leukemia who is receiving "
chemotherapy . The nurse notes that the platelet count is 20,000/ul. Based on the laboratry "Answer: C
result, which intervention will the nurse document in the plan of care? Rationale:
1 Mointor closely for signs of infection 2. Mointor the temperature every 4hours 3. Initate
prptective isolation precautions 4. Use soft small toothbrush for mouth care Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to
Correct Ans 4 If a child is severely thrombocytopenic and has a platelet count less than hemmorrhage. For this reason, avoiding invasive procedures will limit the risk of
20,000/ul, bleeding precautions need to be initated because of increased risk of bleeding or hemorrhage. Stool softeners should be encouraged, while hard brittle toothbrushes should
hemorrhage. Options 1,2,3 are related to the prevention of infection rather than bleeding be avoided. Temperature is not the most important vital to track in this patient"
"A client with acute leukemia is admitted to the oncology unit. Which "Which statement is correct about the rate of cell growth in relation to chemotherapy?
of the following would be most important for the nurse to inquire? "1. Faster growing cells are less susceptible to chemotherapy.
"a. ""Have you noticed a change in sleeping habits recently?"" 2. Nondividing cells are more susceptible to chemotherapy.
b. ""Have you had a respiratory infection in the last 6 months?"" 3. Faster growing cells are more susceptible to chemotherapy.
c. ""Have you lost weight recently?"" 4. Slower growing cells are more susceptible to chemotherapy."
d. ""Have you noticed changes in your alertness?""" "Answer 3
Answer B is correct. The client with leukemia is at risk for infection and has often had The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy.
recurrent respiratory infections during the previous 6 months. Insomnolence, weight loss,
Slow-growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles 3. Involvement of lymph node regions on both sides of the diaphragm.
of chemotherapy are used to destroy nondividing cells as the begin active cell division." 4. Diffuse disease of one or more extralymphatic organs."
The client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Correct: 1. In the staging process, the designations A and B signify, respectively, that
Which assessment finding would the nurse expect to note specifically in the client? "a) symptoms were or were not present when Hodgkin's disease was found. The Roman
fatigue numerals I through IV indicate the extent and location of involvement of the disease. Stage I
b) weakness indicates involvement of a single lymph node; stage II, two or more lymph nodes on the
c) weight gain same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm;
d) enlarged lymph nodes" and stage IV, diffuse disease of one or more extralymphatic organs.
"D "Which medication is contraindicated for a client diagnosed with leukemia?
1. Bactrim, a sulfa antibiotic
- Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue 2. Morphine, a narcotic analgesic
characterized by the painless enlargement of lymph nodes with progression to 3. Epogen, a biologic response modifier
extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. 4. Gleevec, a genetic blocking agent"
Fatigue and weakness may occur but are not related significantly to the disease." "Correct: C
"The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assess-ment
data warrant immediate intervention? 1. Because of the ineffective or nonexistent WBCs characteristic of leukemia, the body
1.T 99, P 102, R 22, and BP 132/68. cannot fight infections, and antibiotics are given to treat infections.
2.Hyperplasia of the gums. 2. Leukemic infiltrations into the organs or the CNS cause pain. Morphine is the drug of
3.Weakness and fatigue. choice for most clients with cancer.
4.Pain in the left upper quadrant." 3. Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs.
"Correct: 4 The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow
1.These vital signs are not alarming. The vitalsigns are slightly elevated and indicate moni- would be generally ineffective for the desired results and would have the potential to
toring at intervals, but they do not indicate animmediate need. stimulate malignant growth.
2.Hyperplasia of the gums is a symptom of myeloid leukemia, but it is not an emergency. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the
3.Weakness and fatigue are symptoms of thedisease and are expected. BCR-ABL protein, preventing the cells from growing and dividing."
4.Pain is expected, but it is a priority, andpain control measures should be imple-mented." "A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic
A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is leukemia. She is admitted to the hospital for treatment. The nurse should assign the patient:
engaged to be married and is to begin a new job upon graduation. Which of the following "A. To a private room so she will not infect other patients and healthcare workers
diagnoses would be a priority for this client? B. To a private room so she will not be infected by other patients and healthcare workers
"a. Sexual dysfunction related to radiation therapy C. To a semiprivate room so she will have stimulation during her hospitalization
b. Anticipatory grieving related to terminal illness D. To a semiprivate room so she will have the opportunity to express her feelings about her
c. Tissue integrity related to prolonged bed rest illness"
d. Fatigue related to chemotherapy" "Correct Answer: B
Answer A is correct. Radiation therapy often causes sterility in male clients and would be of
primary importance to this client. The psychosocial needs of the client are important to A. To a private room so she will not infect other patients and health care workers — poses
address in light of the age and life choices. Hodgkin's disease, however, has a good little or no threat
prognosis when diagnosed early. Answers B, C, and D are incorrect because they are of B. To a private room so she will not be infected by other patients and health care workers
lesser priority — CORRECT: protects patient from exogenous bacteria, risk for developing infection from
"The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed others due to depressed WBC count, alters ability to fight infection
at stage 1A. Which of the following describes the involvement of the disease? C. To a semiprivate room so she will have stimulation during her hospitalization — should
"1. Involvement of a single lymph node. be placed in a room alone
2. Involvement of two or more lymph nodes on the same side of the diaphragm. D. To a semiprivate room so she will have the opportunity to express her feelings about her
illness — ensure that patient is provided with opportunities to express feelings about "Correct: 1.
illness" 1. YES! - A normal WBC count is approximately 4.5 mm3 - 11.0 mm3. In leukemia a high
"A 33-year-old male is being evaluated for possible acute leukemia. Which of the following WBC count is diagnostic and is usually confirmed by a blood smear.
would the nurse inquire about as a part of the assessment? 2-4. None of these indicate leukemia,"
"a. The client collects stamps as a hobby. The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which
b. The client recently lost his job as a postal worker. of the following strategies would be most appropriate for the nurse to use to increase the
c. The client had radiation for treatment of Hodgkin's disease as a teenager. patient's nutritional intake?
d. The client's brother had leukemia as a child." "A. Increase intake of liquids at mealtime to stimulate the appetite.
Answer C is correct. Radiation treatment for other types of cancer can result in leukemia. B. Serve three large meals per day plus snacks between each meal.
Some hobbies and occupations involving chemicals are linked to leukemia, but not the ones C. Avoid the use of liquid protein supplements to encourage eating at mealtime.
in these answers; therefore, answers A and B are incorrect. Answer D is incorrect because D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods."
the incidence of leukemia is higher in twins than in siblings. "Correct Answer: D
"A child with leukemia is complaining of nausea. A nurse suspects that the nausea is related
to the chemotherapy regimen. The nurse, concerned about the child's nutritional status, The nurse can increase the nutritional density of foods by adding items high in protein
most appropriately would offer which of the following during this episode of nausea? and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar)
"1. Cool, clear liquids to the foods that a patient will eat.
2. Low protein foods
3. Low-calorie foods Other Rationales: Increasing liquids at meals can cause a patient to feel full faster, leading
4. The child's favorite food" to eating fewer calories.
"Correct: 1. Eating three large meals isn't possible for a patient on chemotherapy due to the decreased
With nausea, cool and clear liquids are better tolerated. Do not offer foods when the child taste sensation.
is nauseated so he doesn't associate if with being sick. Support nutrition with oral Liquid protein supplements should when needed but they lead to less eating during
supplements and foods high in proteins and calories" mealtimes due to feeling of satiation."
"The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a A client has developed oral mucositis as a result of radiation to the head and neck. The
suspected malignant abdominal mass. The patient is awaiting the pathology report. She is nurse shouls teach the client to incorporate which of the following measures in his or her
tearful and says that she is scared to die. The most effective nursing intervention at this daily home care routine?
point is to use this opportunity to: a) oral hygiene should be performed in the morning and evening
"a. Motivate change in unhealthy lifestyles. b) high-protein foods, such as peanut butter, should be incorporated in the diet
b. Educate her about the seven warning signs of cancer. c) a glass of wine per day will not pose any further harm to the oral cavity
c. Instruct her about healthy stress relief and coping practices. d) a combination of a weak saline and water solution should be used to rinse the mouth
d. Allow her to communicate about the meaning of this experience." before and after each meal"
"Correct answer: D "2) D
Rationale: While the patient is waiting for diagnostic study results, the nurse should be Oral mucositis (irritation, inflammation, and/or ulceration of the mucosa) commonly occurs
available to actively listen to the patient's concerns and should be skilled in techniques that in clients receiving radiation to the head and neck. Measures need to be taken to soothe
can engage the patient and the family members or significant others in a discussion about the mucosa as well as provide effective cleansing of the oral cavity. A combination of a
their cancer-related fears." weak saline and water solution is an effective cleansing agent."
Which of the following laboratory values could indicate that a child has leukemia? "The nurse and the unlicensed assistive personnel (UAP) are caring for clients in a bone
"1. WBCs 32,000/mm3 marrow transplantation unit. Which nursing task should the nurse delegate?
2. Platelets 300,000/mm3 "A. Take the hourly vital signs on a client receiving blood transfusions.
3. Hemoglobin 15g/dL B. Monitor the infusion of antineoplastic medications.
4. Blood pH of 7.35" C. Transcribe the HCP's orders onto the Medication Administration Record.
D. Determine the client's reponse to the therapy."
"Correct: A. c. the drugs are more effective without causing side effects
Explanation: d. the drugs work by different mechanisms to maximize killing of malignant cells"
A. After the first 15 minutes during which the client tolerates the blood transfusion, it is "Correct answer: D
appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific Combination therapy is the mainstay of treatment for leukemia. The three purposes for
parameters for the vital signs. Any vital sign outside the normal parameters must have an using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to
intervention by the nurse. the patient by using multiple drugs with varying toxicities, and (3) interrupt cell growth at
B. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, multiple points in the cell cycle."
competent nurse. "The most common signs and symptoms of leukemia related to bone marrow involvement
C. This is the responsibility of the word secretary or the nurse, not the unlicensed personnel. are which of the following?
D. This represents the evaluation portion of the nursing process and cannot be delegated." "A. Petechiae, fever, fatigue
"The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her B. Headache, papilledema, irritability
prognosis. Which is the nurse's best response? C. Muscle wasting, weight loss, fatigue
"1.Survival for Hodgkin's disease is relatively good with standard therapy. D. Decreased intracranial pressure, psychosis, confusion"
2.Survival depends on becoming involved in an investigational therapy program. "Answer A is Correct.
3.Survival is poor, with more than 50% of clients dying within six (6) months. Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever
4.Survival is fine for primary Hodgkin's, but secondary cancers occur within a year." related to infection from the depressed number of effective leukocytes, and fatigue from
"Correct Answer: 1. the anemia."
1.Up to 90% of clients responds well to standard treatment with chemotherapy and "A client, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for
radiation therapy, and those that relapse usually respond to a change of chemotherapy treatment of hemolytic anemia. Which of the following measures, if incorporated into the
medications. Survival depends on the individual client and the stage of disease at diagnosis. nursing care plan, would best address the patient's needs?
2.Investigational therapy regimens would not be recommended for clients initially "1. Encourage activities with other patients in the day room.
diagnosed with Hodgkin's because of the expected prognosis with standard therapy. 2. Isolate him from visitors and patients to avoid infection.
3.Clients usually achieve a significantly longer survival rate than six (6) months. Many clients 3. Provide a diet high in Vitamin C
survive to develop long-term secondary complications. 4. Provide a quiet environment to promote adequate rest."
4.Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease "Correct: D.
has occurred." 1. does not meet need for rest
"The client asks the nurse, "They say I have cancer. How can they tell if 2. no info given about WBC or reverse isolation, on reverse isolation if neutrophil count is
I have Hodgkin'sdisease from a biopsy?" The nurse's answer is based on less than 500/mm3
which scientific rationale? 3. needed for wound healing and resistance to infection, not best choice
"A.Biopsies are nuclear medicine scans that can detect cancer. 4. primary problem activity intolerance due to fatigue. Correct"
B.A biopsy is a laboratory test that detects cancer cells. "A client diagnosed with leukemia is being admitted for an induction course of
C.It determines which kind of cancer the client has. chemotherapy. Which laboratory values indicate a diagnosis of leukemia?
D.The HCP takes a small piece out of the tumor and looks at the cells." 1. A left shift in the white blood cell count differential.
"D-COrrect: A biopsy is the removal of cells from a massand examination of the 2. A large number of WBCs that decrease after the administration of antibiotics.
tissue under amicroscope to determine if the cells arecancerous. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level.
Reed-Sternberg cells are diag-nostic for Hodgkin's disease. If these 4. Red blood cells that are larger than normal."
cellsare not found in the biopsy, the HCP can rebiopsy to make sure the "Correct answer is 1.
specimen pro- vided the needed sample or, depending on involvement of 1. A left shift indicates immature white blood cells are being produced and released into the
the tissue, diagnose a non-Hodgkin's lymphoma" circulating blood volume. This should be investigated for the malignant process of
"Multiple drugs are often used in combinations to treat leukemia and lymphoma because: leukemia."
"a. there are fewer toxic and side effects The nurse and licensed practical nurse (LPN) are caring for clients on an oncology floor.
b. the chance that one drug will be effective is increased Which client should not be assigned to the LPN?
"1.The client newly diagnosed with chronic lymphocytic leukemia. 3. Assess for signs and symptoms of infection
2.The client who is four (4) hours post-procedure bone marrow biopsy. 4. Provide skin care to irradiated areas"
3.The client who received two (2) units of PRBCs on the previous shift. "Answer: 2
4.The client who is receiving multiple intravenous piggyback medications" 1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal
(CORRECT: 1) The newly diagnosed client will need to betaught about the disease and about medication
treat-ment options. The registered nurse cannot delegate teaching to a an LPN. 2. Serum albumin is a measure of the protein content in the blood that is derived form food
A pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia eaten; albumin monitors nutritional status
with a class of nursing students. Which statement made by a nursing student indicates a 3. Assessment of the nutritional status is indicated for this problem, not assessment of the
lack of understanding of the pathophysiology of this disease? " s/sx of infections.
1. Normal bone marrow is replaced by blast cells 4. This addresses an altered skin integrity problem"
2. Red blood cell production is affected A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to
3. the platelet count is decreased assess circulation in the lower extremities every 2 hours. Which of the following outcome
4. the presence of a reed-sternberg cell is found on biopsy" criteria would the nurse use? "
4. Reed-sternberg Cell is found in Hodgkins a. Body temperature of 99°F or less
"A diagnosis of Hodgkin's disease is suspected in a 12 year old child seen in a clinic. Several b. Toes moved in active range of motion
diagnostic studies are performed to determine the presence of this disease. Which c. Sensation reported when soles of feet are touched
diagnostic test results confirm the diagnosis of Hodgkin's disease? d. Capillary refill of < 3 seconds"
"1. Elevated vanillylmandelic acid urinary levels. Answer D is correct. It is important to assess the extremities for blood vessel occlusion in
2. The presence of blast cells in the bone marrow. the client with sickle cell anemia because a change in capillary refill would indicate a change
3. The presence of Epstein-Barr virus in the blood. in circulation. Body temperature, motion, and sensation would not give information
4. The presence of Reed-Sternberg cells in the lymph nodes" regarding peripheral circulation; therefore, answers A, B, and C are incorrect.
"Correct answer: #4 "The mother of a 5-year-old child asks the nurse questions regarding the importance of
vigilant use of sunscreen. Which information is most important for the nurse to convey to
Hodgkin's disease is a malignancy of the lymph nodes. The presence of giant, the mother?
multinucleated cells (Reed-sternberg cells) is the classic characteristic of this disease. The "A. Appropriate use of sunscreen decreases the risk of skin cancer.
presence of blast cells in the bone marrow indicates leukemia. Epstein Barr virus is B. Repeated exposure to the sun causes premature aging of the skin.
associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the C. A child's skin is delicate, and burns easily.
urine may be found in children with neuroblastoma." D. In addition to causing skin cancer, repeated sun exposure predisposes the child to other
Which of the following findings yields a poor prognosis for a pediatric patient with leukemia? forms of cancer."
" "Correct: A.
1) Presence of a mediastinal mass Appropriate use of sunscreen decreases the risk of skin cancer.
2) Late CNS leukemia While all of the answer choices are correct, recommending the use of sunscreen to
3) Normal WBC count at diagnosis decrease the incidence of skin cancer is the best response.
4) Disease presents between age 2 and 10" Nursing Process: Implementation
1) Presence of a mediastinal mass indicates a poor prognosis. The rest of the choices refer Category of Client Need: Health Promotion and Maintenance
to diagnosis not prognosis. Cognitive Level: Application"
"The nurse writes a nursing problem of "altered nutrition" for a client diagnosed A 4 yo is admitted for abdominal pain. She has been pale and excessively tired and is
withleukemia who has received a treatment regimen of chemotherapy and radiation. bruising easily. On physical exam, lymphadenopathy and hepatosplenomaegaly are noted.
Which nursing intervention should be implemented? Diagnostic studies are being performed on the child because acute lymphocytic leukemia is
"1. Administer an antidiarrheal medication prior to meals suspected. Which diagnostic study would confirm this diagnosis
2. Monitor the client's serum albumin levels "1. Platelet count
2. LUmbar puncture
3. bone marrow biopsy replace normal hematopoietic elements preventing the formation of mature
4. wbc count" leukocytes. Neutrophil count would be decreased. Because of an
"Correct: 3. increased metabolism, weight loss may occur.
3 leukemia is a malignant increase in the number of leukocytes, usually at an immature Strategy: It is important to read every word in the question. Do not speed-read."
stage, in the bone marrow. The confirmatory test is microscopic exam of bone marrow "After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic
obtained by bone marrow aspirate and biopsy. a lumbar puncture may be done to look for leukemia, the laboratory test indicates that the client is neutropenic. The nurse should
blast cells in the scfluid that indicate CNS disease. The wbc count may be normal, high or perform which of the following?"
low in leukemia an altered platelet count occurs as a result of the disease but also may "A. advise the client to rest and avoid exertion
occur as a result of chemotherapy and does not confirm the diagnosis" B. prevent client exposure ot infections
"Nursing considerations related to the administration of chemotherapeutic drugs include C. monitor the blood pressure frequently
which of the following? "A. Anaphylaxis cannot occur, since the drugs are considered toxic D. observe for increased bruising"
to normal cells. "Answer: B
B. Infiltration will not occur unless superficial veins are used for the intravenous infusion. Rationale: Neutropenia is a decreased number of
C. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if neutrophil cells in the blood which are responsible for the body's
drug infiltrates. defense against infection. Rest and avoid exertion would be related to
D. Good hand washing is essential when handling chemotherapeutic drugs, but gloves are erythrocytes and oxygen carrying properties. Monitoring the blood
not necessary." pressure, and observing for bruising would be related to platelets and
"Correct: C 3. Chemotherapeutic agents can be extremely damaging to cells. Nurses sign and symptoms of bleeding.
experienced with the administration of vesicant drugs should be Objective: Describe the major types of leukemia and the most common treatment
responsible for giving these drugs and be prepared to treat modalities and nursing interventions."
extravasations if necessary. "A child with lymphoma is receiving extensive radiotherapy. Which of the following is the
1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. most common side effect of this treatment?
2. Infiltration and extravasations are always a risk, especially with peripheral veins. "A. malaise
4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be B. seizures
thoroughly washed afterward. C. neuropathy
D. lymphadenopathy"
Level of cognitive ability: Analysis "Correct Answer: A
Area of client needs: Physiologic Integrity/Pharmacologic and Parenteral Therapy
Integrated process: Teaching/Learning; Nursing Process: Implementation" 1. Malaise is the most common side effect of radiotherapy. For children, the fatigue may be
"After a client with a potential diagnosis of leukemia is admitted to the especially distressing because it means they cannot keep up with their peers.
hospital, the nurse should assess for which of the following? (Select 2. Seizures are unlikely because irradiation would not usually involve the cranial area for
all that apply.)" " treatment of lymphoma.
A. Reports of fatigue and weakness 3. Neuropathy is a side effect of certain chemotherapeutic agents.
B. An elevation in the leukocytes 4. Lymphadenopathy is one of the findings of lymphoma."
especially neutrophils "A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and
C. Signs of bruising easily chemotherapy is planned to begin immediately. The mother of the child asks the nurse why
D. Recent weight gain" radiation therapy was not prescribed as a part of the treatment. Which of the following is
"Correct: A, C the appropriate and supportive response to the mother?
ANSWER: Reports of fatigue and weakness Signs of bruising easily "1. I'm not sure. I'll discuss it with the physician.
Rationale: General manifestations of leukemia 2. The child is too young to have radiation therapy.
result from anemia, infection, and bleeding. The client would complain 3. It's very costly, and chemotherapy works just as well.
of fatigue and weakness and show signs of bruising. Leukemic cells 4. The physician would prefer that you discuss the treatment options with the oncologist."
"ANSWER: 2 3.) Excessive energy and high platelet counts.
Rationale: Radiation therapy is usually delayed until a child is 8 years of age, if posssible, to 4.) Cervical lymph node enlargement and positive acid-fast bacillus."
prevent retardation of bone growth and soft tissue development. Options 1,3, and 4 are "Correct: 1.
inappropriate responses to the mother." 1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone
A nurse is assessing a client newly diagnosed with Stage I Hodgkin's lymphoma. Which area marrow is unable to produce WBCs of the number and maturity needed to fight infection
of the body would the nurse most likely find involved? (CORRECT). 2. Nausea and vomiting are symptoms related to the treatment of cancer but
"1. Back not to the diagnosis of leukemia (omit #2). 3. The clients are frequently fatigued and have
2. Chest low platelet counts. The platelet count is low as a result of the inability of the bone marrow
3. Groin to produce the needed cells (omit #3). 4. Cervical lymph node enlargement is associated
4. Neck" with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis (omit
"(4. Neck is correct) #4)."
At the time of diagnosis of stage I Hodgkin's lymphoma, a painless cervical lesion is often "A bone marrow transplant is being considered
present. The back, chest, and groin areas may be involved in later stages." for treatment of a patient with acute leukemia that has not responded to chemotherapy. In
"The mother of a child diagnosed with a potentially life-threatening form of cancer says to discussing the treatment with the patient, the nurse explains that
the nurse, ""I don't understand how this could happen to us. We have been so careful to "a. hospitalization will be required for several weeks after the hematopoietic stem cell
make sure our child is healthy."" Which response by the nurse is most appropriate? transplant (HSCT).
"A. Why do you say that? Do you think that you could have prevented this?"" b. the transplant of the donated cells is painful because of the nerves in the tissue lining the
B. ""This must be a difficult time for you and your family. Would you like to talk about how bone.
you are feeling?"" c. donor bone marrow cells are transplanted immediately after an infusion of
C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" chemotherapy.
D.""Many children are diagnosed with cancer. It is not always life-threatening.""" d. the transplant procedure takes place in a sterile operating room to minimize the risk for
"Answer B infection."
Parents of children diagnosed with cancer require major emotional support, and should be "Correct Answer: A
allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is
telling the parents that there are many other children with cancer." The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after
a client has undergone a lymph node biopsy. the nurse anticipates that the report will HSCT while waiting for the transplanted marrow to start producing cells. The transplanted
reveal which result if the client has Hodgkin's lymphoma? cells are infused through an IV line, so the transplant is not painful, nor is an operating
"1. Reed-Sternberg cells. room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to
2. Philadelphia chromosome. the transplanted cells by the chemotherapy drug."
3. Epstein-Barr virus. "Which test is considered diagnostic for Hodgkin's lymphoma?
4. Herpes simplex virus." "1. A magnetic resonance image (MRI) of the chest.
CORRECT #1. RATIONALE: histological isolation of Reed-Sternberg cells in lymph node 2. A computed tomography (CT) scan of the cervical area.
biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia 3. An erythrocyte sedimentation rate (ESR).
chromosome is attribted to chronic myelogenous leukemia. viruses are much smaller than 4. A biopsy of the cervical lymph nodes."
can be visualized with cytology. STRATEGY: the core issue of the question is knowledge of "Correct: 4.
characteristic findings in the diagnosis of lymphoma. use nursing knowledge and the 1. An MRI of the chest area will determine
process of elimination to make a selection. numerous disease entities, but it cannot
The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment determine the specific morphology of
data support this diagnosis? Reed-Sternberg cells, which are diagnostic
"1.) Fever and infections. for Hodgkin's disease.
2.) Nausea and vomiting. 2. A CT scan will show tumor masses in the
area, but it is not capable of pathological
diagnosis. BMT or PBSCT may cure
3. ESR laboratory tests are sometimes usedto monitor the progress of the treatmentof chemo as palliative
Hodgkin's disease, but ESR levels canbe elevated in several disease processes. acute lymphocytic /lymphoid leukemia
4. Cancers of all types are definitively diagnosed through biopsy procedures.The pathologist uncontrolled proliferation of immature cells from lymphoid stem cell: B Lymph (75%) T
must identify ReedSternberg cells for a diagnosis ofHodgkin's disease (correct)" lymph 25% impeding myeloid cell
During history taking of a client admitted with newly diagnosed Hodgkin's disease, which of most common under 15 more in boys
the following would the nurse expect the client to report? manifested by leukemic cell infiltration, symptoms of meningeal involvement and liver,
"a) weight gain spleen and bone marrow pain
B) night sweats treat chemo (induction and corticosteroids)
C) Severe lymph node pain CNS irradiation
D) Headache with minor visual changes" imatinib mestylate if Philadelphia chromosome positive
"B - Assessment of a client with Hodgkin's disease most often reveals BMT or PBSCT monoclonal antibody therapy
enlarged, painless lymph nodes, fever, malaise, and night sweats. Weight chronic lymphocytic leukemia
loss may be present if metastatic disease occurs. Headache and visual most common in older men 3-15 yr survival
changes may occur if brain metastasis is present." malignant b lymphocytes, most are maure, may escape apoptosis, resulting in excess
leukemia accumulation of cells- keep growing
malignancy of the bone marrow resulting in unregulated proliferation and differentiation in manifestations- lymphadenopathy (pain) hepatomegaly, splenomegaly, in later stages
stem cells anemia and thrombocytopenia; autoimmune complications with ES destroying RBCs and
caused by genetic and viral links or bone marrow related to bone marrow suppression platelets B symptoms include fever, sweats, weightloss
acute myeloid leukemia (AML) early stage may require no treatment, chemo, monoclonal antibody therapy
chronic myeloid leukemia (CML) slower growing mucositis
acute lymphocytic leukemia (ALL) frequent gentle oral care
Chronic lymphocytic leukemia (CLL) slower soft toothbrush or if counts are low sponge tipped applicators
acute myeloid leukemia rinse with saline or saline and baking soda or prescribed solutions
most common non lymphocyic leukemia, defect in stem cells that differentiate myeloid perineal and rectal care
cells improving nutrition
affect all ages with peak at 60 oral care before and after meals
SS fever, infection, bleeding, weakness, fatigue, pain from enlarged liver or spleen, analgesia before meals
hyperplasia of gums, bone pain appropriate treatment of nausea
treament small frequent feeding
aggressive chemo (induction therapy) kill the bone marrow absolute neutrophil count is soft foods moderate temp
zero. risk infection. then retransfuse low microbial diet
chronic myeloid leukemia nutrition supplement
uncommon in people under 20 life expectancy 3-5 years lymphoma
acquired mutation in myeloid sem ccells (BCR ABL gene releases protein causing abn a group of blood cancers that develop in the lymphatic system involving the lymphocytes.
proliferation) marrow expands bone, spleen or liver can progress to spleen, GI, liver and bone marrow
initial may be asymptomatic, malaise, anorexia, weight loss, confusion, SOB due to hodgkins and non hodgkins
leukostasis, bone pain hodgkins
treat classic presence of malignant cells called reed Stenberg (viral etiology cure rate good)
imatinib mestylate (gleevec) block signals in leukemic cells that express BCR-ABL protein, painless lymph node enlargement, puritis, fever, sweat, fatigue, weight loss
halt proliferation non hodgkins
lymphoid tissue becomes largely infiltrated with malignant cells, spread is unpredicatable
and localized. disease is rare
increased risk with age
prognosis vary
treatment may include interferon, chemo, and or radiation
swollen painful nodes, fatigue, sweat
multiple myeloma
destruction of bone=bone pain
malignant disease of plasma cells in the bone marrow with destruction of bone
5yr survival
dx bone marrow biopsy, mri, protein electrophoresis (serum and urine) + for M protein and
Bencce- jones protein
most common sign is bone pain, osteoporosis, fracture, elevated serum protein,
hypercalcemia, renal damage, renal failure, anemia symptoms, fatigue, weak, increased
serum viscosity and increased risk of bleeding and infection
no cure- palliative
chemo, corticosteroids, radiation help relive bone pain
 Lymphoma sure the specimen provided the needed sample or, depending on involvement of the tissue,
diagnose a non-Hodgkin's lymphoma.
13. The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram.
Which information should the nurse teach? TEST-TAKING HINT: Option "1" can be eliminated if the test taker knows what the word
"biopsy" means. Option "3" does not answer the question and can be eliminated for this
1. The scan will identify any malignancy in the vascular system. reason.
2. Radiopaque dye will be injected between the toes. 15. The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which
3. The test will be done similar to a cardiac angiogram. assessment data support this diagnosis?
4. The test will be completed in about five (5) minutes.
1. The scan detects abnormalities in the lymphatic system, not the vascular system. 1. Night sweats and fever without "chills."
2. Edematous lymph nodes in the groin.
2. Dye is injected between the toes of both feet and then scans are performed in a few 3. Malaise and complaints of an upset stomach.
hours, at 24 hours, and then possibly once a day for several days. 4. Pain in the neck area after a fatty meal.
1. Clients with Hodgkin's disease experience drenching diaphoresis, especially at night;
3. Cardiac angiograms are performed through the femoral or brachial arteries and are fever without chills; and unintentional weight loss. Early-stage disease is indicated by a
completed in one session. painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is
also a common symptom.
4. The test takes 30 minutes to one (1) hour and then is repeated at intervals.
2. Lymph node enlargement with Hodgkin's disease is in the neck area.
TEST-TAKING HINT: The test taker must be aware of diagnostic tests used to diagnose
specific diseases. Options "1" and "3" could be eliminated because of the words "vascular" 3. Malaise and stomach complaints are not associated with Hodgkin's disease.
and "cardiac"; these words pertain to the cardiovascular system, not the lymphatic system.
14. The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's 4. Pain in the neck area at the site of the cancer occurs in some clients after the ingestion of
disease from a biopsy?" The nurse's answer is based on which scientific rationale? alcohol. The cause for this is unknown.

1. Biopsies are nuclear medicine scans that can detect cancer. TEST-TAKING HINT: The test taker must notice the descriptive words, such as "groin" and
2. A biopsy is a laboratory test that detects cancer cells. "fatty," to decide if these options could be correct.
3. It determines which kind of cancer the client has. 16. Which client is at the highest risk for developing a lymphoma?
4. The HCP takes a small piece out of the tumor and looks at the cells.
1. Biopsies are surgical procedures requiring needle aspiration or excision of the area; they 1. The client diagnosed with chronic lung disease who is taking a steroid.
are not nuclear medicine scans. 2. The client diagnosed with breast cancer who has extensive lymph involvement.
3. The client who received a kidney transplant several years ago.
2. The biopsy specimen is sent to the pathology laboratory for the pathologist to determine 4. The client who has had ureteral stent placements for a neurogenic bladder.
the type of cell. "Laboratory test" refers to tests of body fluids performed by a laboratory 1. Long-term steroid use suppresses the immune system and has many side effects, but it is
technician. not the highest risk for the development of lymphoma.

3. A biopsy is used to determine if the client has cancer and, if so, what kind. However, this 2. This client would be considered to be in late-stage breast cancer. Cancers are described
response does not answer the client's question. by the original cancerous tissue. This client has breast cancer that has metastasized to the
lymph system.
4. A biopsy is the removal of cells from a mass and examination of the tissue under a
microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for 3. Clients who have received a transplant must take immunosuppressive medications to
Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make prevent rejection of the organ. This immunosuppression blocks the immune system from
protecting the body against cancers and other diseases. There is a high incidence of client dies, but this is an independent nursing intervention.
lymphoma among transplant recipients.
3. Nurses can and do refer clients diagnosed with cancer to the American Cancer Society-
4. A neurogenic bladder is a benign disease; stent placement would not put a client at risk sponsored groups independently. Dialogue is a group support meeting that focuses on
for cancer. dealing with the feelings associated with a cancer diagnosis.

TEST-TAKING HINT: To answer this question, the test taker must be aware of the function of 4. Collaborative interventions involve other departments of the health-care facility. A
the immune system in the body and of the treatments of the disease processes. chaplain is a referral that can be made, and the two disciplines should work together to
17. The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about provide the needed interventions.
her prognosis. Which is the nurse's best response?
TEST-TAKING HINT: The stem of the question asks for a collaborative intervention, which
1. Survival for Hodgkin's disease is relatively good with standard therapy. means that another health-care discipline must be involved. Options "1," "2," and "3" are all
2. Survival depends on becoming involved in an investigational therapy program. interventions the nurse can do without another discipline being involved.
3. Survival is poor, with more than 50% of clients dying within six (6) months. 19. Which test is considered diagnostic for Hodgkin's lymphoma?
4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year.
1. Up to 90% of clients respond well to standard treatment with chemotherapy and 1. A magnetic resonance image (MRI) of the chest.
radiation therapy, and those who relapse usually respond to a change of chemotherapy 2. A computed tomography (CT) scan of the cervical area.
medications. Survival depends on the individual client and the stage of disease at diagnosis. 3. An erythrocyte sedimentation rate (ESR).
4. A biopsy of the cervical lymph nodes.
2. Investigational therapy regimens would not be recommended for clients initially 1. An MRI of the chest area will determine numerous disease entities, but it cannot
diagnosed with Hodgkin's disease because of the expected prognosis with standard therapy. determine the specific morphology of Reed-Sternberg cells, which are diagnostic for
Hodgkin's disease.
3. Clients usually achieve a significantly longer survival rate than six (6) months. Many
clients survive to develop long-term secondary complications. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological
diagnosis.
4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's
disease has occurred. 3. ESR laboratory tests are sometimes used to monitor the progress of the treatment of
Hodgkin's disease, but ESR levels can be elevated in several disease processes.
TEST-TAKING HINT: The test taker must have a basic knowledge of the disease process but
could rule out option "2" on the basis of the word "investigational." 4. Cancers of all types are definitively diagnosed through biopsy procedures. The
18. The nurse writes the problem of "grieving" for a client diagnosed with non-the pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin's disease.
lymphoma. Which collaborative intervention should be included in the plan of care?
TEST-TAKING HINT: The test taker can eliminate the first three (3) answer options on the
1. Encourage the client to talk about feelings of loss. basis these tests give general information on multiple diseases. A biopsy procedure of the
2. Arrange for the family to plan a memorable outing. involved tissues is the only procedure that provides a definitive diagnosis.
3. Refer the client to the American Cancer Society's Dialogue group. 20. Which client should be assigned to the experienced medical-surgical nurse who is in the
4. Have the chaplain visit with the client. first week of orientation to the oncology floor?
1. Encouraging the client to talk about his or her feelings is an independent nursing
intervention. 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation
treatments.
2. Discussing activities that will make pleasant memories and planning a family outing 2. The client diagnosed with Hodgkin's disease who is receiving combination
improve the client's quality of life and assist the family in the grieving process after the chemotherapy.
3. The client diagnosed with leukemia who has petechiae covering both anterior and
posterior body surfaces. TEST-TAKING HINT: Option "3" can be eliminated on the basis that it says "all" clients; if the
4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of test taker can think of one case where "all" does not apply, then the option is incorrect.
packed red blood cells. 22. Which clinical manifestation of Stage I non-Hodgkin's lymphoma would the nurse expect
1. This client is receiving treatments that can have life-threatening side effects; the nurse is to find when assessing the client?
not experienced with this type of client.
1. Enlarged lymph tissue anywhere in the body.
2. Chemotherapy is administered only by nurses who have received training in 2. Tender left upper quadrant.
chemotherapy medications and their effects on the body and are aware of necessary safety 3. No symptom in this stage.
precautions; this nurse is in the first week of orientation. 4. Elevated B-cell lymphocytes on the CBC.
1. Enlarged lymph tissue would occur in Stage III or IV Hodgkin's lymphoma.
3. This is expected in a client with leukemia, but it indicates a severely low platelet count; a
nurse with more experience should care for this client. 2. A tender left upper quadrant would indicate spleen infiltration and occurs at a later stage.

4. This client is receiving blood. The nurse with experience on a medical-surgical floor 3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not
should be able to administer blood and blood products. diagnosed until the later stages of lymphoma.

TEST-TAKING HINT: The key to this question is the fact, although the nurse is an 4. B-cell lymphocytes are the usual lymphocytes involved in the development of lymphoma,
experienced medical-surgical nurse, the nurse is not experienced in oncology. The client but a serum blood test must be done specifically to detect B cells. They are not tested on a
who could receive a treatment on a medical-surgical floor should be assigned to the nurse. CBC.
21. Which information about reproduction should be taught to the 27-year-old female
client diagnosed with Hodgkin's disease? TEST-TAKING HINT: Most cancers are staged from 0 to IV. Stage 0 is microinvasive and Stage
I is minimally invasive, progressing to Stage IV, which is large tumor load or distant disease.
1. The client's reproductive ability will be the same after treatment is completed. If the test taker noted the "Stage I," then choosing the option that presented with the least
2. The client should practice birth control for at least two (2) years following therapy. amount of known disease—option "3"— would be a good choice.
3. All clients become sterile from the therapy and should plan to adopt. 23. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone
4. The therapy will temporarily interfere with the client's menstrual cycle. marrow transplantation unit. Which nursing task should the nurse delegate?
1. This is a false promise. Many clients undergo premature menopause as a result of the
cancer therapy. 1. Take the hourly vital signs on a client receiving blood transfusions.
2. Monitor the infusion of antineoplastic medications.
2. The client should be taught to practice birth control during treatment and for at least two 3. Transcribe the HCP's orders onto the Medication Administration Record.
(2) years after treatment has ceased. The therapies used to treat the cancer can cause 4. Determine the client's response to the therapy.
cancer. Antineoplastic medications are carcinogenic, and radiation therapy has proved to 1. After the first 15 minutes during which the client tolerates the blood transfusion, it is
be a precursor to leukemia. A developing fetus would be subjected to the internal appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific
conditions of the mother. parameters for the vital signs. Any vital sign outside the normal parameters must have an
intervention by the nurse.
3. Some clients—but not all—do become sterile. The client must understand the risks of
therapy, but the nurse should give a realistic picture of what the client can expect. It is 2. Antineoplastic medication infusions must be monitored by a chemotherapy-certified,
correct procedure to tell the client the nurse does not know the absolute outcome of competent nurse.
therapy. This is the ethical principle of veracity.
3. This is the responsibility of the ward secretary or the nurse, not the unlicensed assistive
4. The therapy may interfere with the client's menses, but it may be temporary. personnel.
 Nonhodgskin
4. This represents the evaluation portion of the nursing process and cannot be delegated.
The nurse is aware that a major difference between Hodgkin's lymphoma and non-
TEST-TAKING HINT: The test taker must decide what is within the realm of duties of a UAP. Hodgkin's lymphoma is that
Three (3) of the options have the UAP doing some action with medications. This could
eliminate all of these. Option "1" did not say monitor or evaluate or decide on a nursing a. Hodgkin's lymphoma occurs only in young adults
action; this option only says the UAP can take vital signs on a client who is presumably
stable because the infusion has been going long enough to reach the hourly time span. b. Hodgkin's lymphoma is considered potentially curable
24. The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)-
year remission mark. Which information should the nurse teach the client? c. Non-Hodgkin's lymphoma can manifest in multiple organs

1. Instruct the client to continue scheduled screenings for cancer. d. Non-Hodgkin's lymphoma is treated only with radiation therapy
2. Discuss the need for follow-up appointments every five (5) years. C. Non-Hodgkin's lymphoma can manifest in multiple organs.
3. Teach the client that the cancer risk is the same as for the general population.
4. Have the client talk with the family about funeral arrangements. Rationale: Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of
1. The five (5)-year mark is a time for celebration for clients diagnosed with cancer, but the spread can be unpredictable, and most affected patients have widely disseminated disease.
therapies can cause secondary malignancies and there may be a genetic predisposition for Test plan: Physiological Integrity-Physiological Adaptation
the client to develop cancer. The client should continue to be tested regularly. Which of the following conditions is not a complication of Hodgkin's disease?

2. Follow-up appointments should be at least yearly. a. Anemia

3. The client's risk for developing cancer has increased as a result of the therapies b. Infection
undergone for the lymphoma.
c. Myocardial Infarction
4. This client is in remission, and death is not imminent.
d. Nausea
TEST-TAKING HINT: The test taker should look at the time frames in the answer options. It C. Myocardial Infarction
would be unusual for a client to be told to have a checkup every five (5) years. Option "4"
can be eliminated by the stem, which clearly indicates the client is progressing well at the Rationale: Complications of Hodgkin's are pancytopenia, nausea, and infection. Cardiac
five (5)-year remission mark. involvement usually doesn't occur. Test plan: Physiological Integrity-Physiological
adaptation
Which of the following manifestations would be directly associated with Hodgkin's disease?
a. bone pain
b. generalized edema
c. petechiae and purpura
d. painless, enlarged lymph nodes"
D. Painless, enlarged lymph nodes.

Rationale: Hodgkin's disease usually presents as painless enlarged lymph nodes. The
diagnosis is made by lymph node biopsy. Test plan: Physiological Integrity-Physiological
adaptation
A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is Bsta cancer
engaged to be married and is to begin a new job upon graduation. Which of the following As the nurse take the history of a 3 year old with neuroblastoma, what comments made by
diagnoses would be a priority for this client? the parents require follow-up and are consistent with the diagnosis?
a. Sexual dysfunction related to radiation therapy
b. Anticipatory grieving related to terminal illness "Her urine is dark yellow and in small amounts"
c. Tissue integrity related to prolonged bed rest "Clothes are becoming tighter across her abdomen"
d. Fatigue related to chemotherapy "We notice muscle weakness and some unsteadiness"
A. Sexual dysfunction r/t radiation therapy. "The child has been lethargic and had lost weight"
"Clothes are becoming tighter across her abdomen"
Radiation therapy often causes sterility in male clients and would be of primary importance The client with neuroblastoma is receiving vincristine (Vincasar) for management of the
to this client. The psychosocial needs of the client are important to address in light of the diagnosis. Which of the following indicates a side effect specific to this medication?
age and life choices. Hodgkin's disease, however, has a good prognosis when diagnosed
early. Alopecia
A client has undergone a lymph node biopsy. The nurse anticipates that the report will Numbness in the toes
reveal which result if the client has Hodgkin's Lymphoma? Chest heaviness
Weight gain
A. Reed-Sternberg cells Numbness in the toes
A patient undergoing external radiation has developed a dry desquamation of the skin in
B. Philadelphia chromosome the treatment area. The nurse knows that teaching about management of the skin reaction
has been effective when the patient says
C. Epstein-barr virus
"I can use ice packs to relieve itching in the treatment area"
D. Herpes simplex virus "I can buy a steroid cream to use on the itching area"
A. Reed-Sternberg Cells "I will expose the treatment area to a sun lamp daily"
"I will scrub the area with warm water to remove the scales"
Rational: Histologic isolation of Reed-Sternberg cells in lymph node biopsy examination is a "I can buy a steroid cream to use on the itching area"
diagnostic feature of Hodgkin's lymphoma. Philadelphia-chromosome is attributed to A female patient is admitted to the floor for fever-like symptoms and a temperature of
chronic myelogenous leukemia. Viruses are much smaller than can be visualized with 104.2℉. In the ED, they drew labs and the results came back. Which of the following would
cytology. be the MOST concerning?

Sodium of 143 mmol/L

WBCs of 30,000/L
Blood pH of 7.37
Blood glucose of 70 mg/dL
WBCs of 30,000/L
A nurse is assessing a patient diagnosed with Acute Lymphocytic Leukemia. The nurse
should consider it abnormal to see:

-Marked fatigue, pallor

-Multiple bruises, petechiae
-Enlarged lymph nodes, spleen, and liver
-Marked jaundice, generalized edema
Marked jaundice, generalized edema a.Blurred vision
A 4-year old is admitted to the hospital with abdominal pain. The mother reports that the b.Increased head circumference
child has been pale, been bruising very easily, and has been excessively tired after playing. c.Vomiting when getting out of bed
Upon physical examination, lymphadenopathy and hepatosplenomegaly are noted. d.Intermittent headache
Diagnostic studies are being performed on the child because acute lymphocytic leukemia is Declining academic performance
suspected. The nurse understands that which diagnostic study will confirm this diagnosis? -Blurred vision
-Vomiting when getting out of bed
White blood cell count -Intermittent headache
Lumbar puncture -Declining academic performance
Bone marrow biopsy Select all manifestations of Rhabdomyosarcoma:
A total platelet count -Exophthalmos
Bone marrow biopsy -Stribomsis
"The mother of a child diagnosed with a potentially life-threatening form of cancer says to -Range of motion limitation
the nurse, "I don't understand how this could happen to us. We have been so careful to -Headaches
make sure our child is healthy." Which response by the nurse is most appropriate? -Hearing loss
-Changes in Vision
A. "This must be a difficult time for you and your family. Would you like to talk about how Exophthalmos, Range of motion limitation, changes in vision
you are feeling?" When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most
B. "Why do you say that? Do you think that you could have prevented this?" important to avoid which of the following?
C. "You shouldn't feel that you could have prevented the cancer. It is not your fault." A. Measuring the child's chest circumference
D. "Many children are diagnosed with cancer. It is not always life-threatening." B. Palpating the child's abdomen
. "This must be a difficult time for you and your family. Would you like to talk about how C. Placing the child in an upright position
you are feeling?" D. Measuring the child's occipitofrontal circumference
The postoperative care of a preschool child who has had a brain tumor removed should B. Palpating the child's abdomen
include which of the following? What might report in a child with suspected retinoblastoma?

A.Colorless drainage is to be expected. Exophthalmos

B.Analgesics are contraindicated because of altered LOC. Leukocoria
C.Positioning is on the operative side in the Trendelenberg position. Red eyes in Photograph
D.Carefully monitor fluids due to cerebral edema. Sudden blindness
Carefully monitor fluids due to cerebral edema. Leukocoria
While completing an assessment on a six month old infant, which finding should the nurse A 15 year old patient comes into the doctor and has been complaining of feeling abnormally
recognize as a symptom of a brain tumor in an infant? tired and not wanting to eat. During the assessment, the nurse feels a lump on the patient's
neck. She suspects that the patient may have lymphoma. What are some warning signs of
A.Blurred vision lymphoma that the nurse will be looking for? Select all that apply.
B.Increased head circumference
C.Vomiting while getting out of bed Weight gain
D.Headache Swollen lymph node(s)
B.Increased head circumference Night sweats
What should the nurse recognize as symptoms of a brain tumor in a school-age child for Fatigue
whom she is caring? Select all that apply. Loss of appetite
Fever
Swollen lymph node(s) Bone cancer
Night sweats
Fatigue
Loss of appetite A 32-year-old woman meets with the nurse on her first official visit since undergoing a left
Fever mastectomy. When asked how she is doing, the woman states her appetite is still not good,
A 20 year old has Stage I Hodgkin's lymphoma. Which would the nurse expect to find when she is not getting much sleep because she doesn't go to bed until her husband is asleep,
assessing this client? and she is really anxious to get back to work. Which of the following nursing interventions
-Painless enlargement of a single lymph node should the nurse explore to support the client's current needs?
-Unexplained weight gain a) Ask open-ended questions about sexuality issues related to her mastectomy
-Hepatomegaly with tenderness b) Suggest that the client learn relaxation techniques to help with her insomnia
-Sudden onset of jaundice c) Call the physician to discuss allowing the client to return to work earlier
Painless enlargement of a single lymph node d) Perform a nutritional assessment to assess for anorexia
the nurse cares for the client who has been diagnosed with Hodgkin's lymphoma. Which a) Ask open-ended questions about sexuality issues related to her mastectomy
diagnostic test can the nurse expect to be performed? - Correct Answer: A. Ask open-ended questions about sexuality issues related to her
Hemoglobin electrophoresis mastectomy
Lymph node biopsy Option A: The content of the client's comments suggests that she is avoiding intimacy with
Chest X ray her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is
Bone marrow biopsy appropriate for a client who has undergone a mastectomy.
(Kaplan) Option B: Suggesting that she learn relaxation techniques to help her with her insomnia is
Lymph node biopsy appropriate; however, the nurse must first address the psychosocial and sexual issues that
When diagnosing osteosarcoma, which male would be most at risk? are contributing to her sleeping difficulties.
3 year old Option C: Rushing her return to work may debilitate her and add to her exhaustion.
11 year old Option D: A nutritional assessment may be useful, but there is no indication that she has
35 year old anorexia.
9 year old One of the most serious blood coagulation complications for individuals with cancer and for
11 year old those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The
A 15 year old male has just been diagnosed with osteosarcoma of the tibia. Lab testing has most common cause of this bleeding disorder is:
been done and the results are back. Which lab test would you expect to see elevated? a) Brain metastasis
CBC b) Sepsis
BMP c) Intravenous heparin therapy
Calcium d) underlying liver disease
Serum Potassium b) Sepsis
Calcium - Correct Answer: B. Sepsis
A teenage girl has just been diagnosed with Ewing Sarcoma of the fibula. She is getting Option B: Bacterial endotoxins released from gram-negative bacteria activate the Hageman
ready to be discharged home and seems withdrawn and upset. Which discharge teaching is factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of
priority? homeostasis, as well as stimulating fibrinolysis.
-The importance of follow up appointments Option D: Liver disease can cause multiple bleeding abnormalities resulting in chronic,
-Her level of acceptance due to how her body will change subclinical DIC; however, sepsis is the most common cause.
-The importance of going to physical therapy A pneumonectomy is a surgical procedure sometimes indicated for the treatment of non-
-Information about the ongoing treatment she will receive small-cell lung cancer. A pneumonectomy involves removal of:
Her level of acceptance due to how her body will change a) One lobe of a lung
b) An entire lung field
c) One or more segments of a lung lobe Options B and D: The use of antihistamines or topical steroids depends on the cause of
d) A small, wedge-shaped lung surface pruritus, and these agents should be used with caution.
b) An entire lung field A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent
- Correct Answer: B. An entire lung field breast cancer. She calls her health care provider to report that she has pain while
Option B: A pneumonectomy is the removal of an entire lung field indicated for the swallowing and burning and tightness in her chest. Which of the following complications of
treatment of non-small cell lung cancer that has not spread outside of the lung tissue. It is radiation therapy is A. Radiation enteritis likely responsible for her symptoms?
performed on patients who will have adequate lung function in the unaffected lung. a) Radiation enteritis
Option D: A wedge resection refers to the removal of a wedge-shaped section of lung tissue. b) Stomatitis
It may be used to remove a tumor and a small amount of normal tissue around it/ c) Esophagitis
Option A: A lobectomy is the removal of one lobe. d) Hiatal hernia
Option C: Removal of one or more segments of a lung lobe is called a partial lobectomy. c) Esophagitis
A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days - Correct Answer: C. Esophagitis
after chemotherapy. The nurse would expect which of the following to be present? Option C: Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis,
a) low-grade fever, chills, tachycardia which is a common complication of radiation therapy of the chest wall.
b) Elevated temperature, oliguria, hypotension Option A: Radiation enteritis is a damage to the intestinal lining caused by radiation therapy.
c) Flushing, decreased oxygen saturation, mild hypotension Symptoms include diarrhea, rectal pain, and bleeding or mucus from the rectum.
d) High-grade fever, normal blood pressure, increased respirations Option B: Stomatitis results from the local effects of radiation to the oral mucosa.
a) low-grade fever, chills, tachycardia Symptoms include mouth ulcers, red patches, swelling, and oral dysaesthesia.
- Correct Answer: A. Low-grade fever, chills, tachycardia Option D: Hiatal hernia may also cause symptoms of dysphagia and chest pain but is not
Option A: Nine days after chemotherapy, one would expect the client to be related to radiation therapy.
immunocompromised. The clinical signs of shock reflect changes in cardiac function, A male client has an abnormal result on a Papanicolaou test. After admitting, he read his
vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, chart while the nurse was out of the room, the client asked what dysplasia means. Which
tachycardia, and flushing may be early signs of shock. definition should the nurse provide?
Option B: Oliguria and hypotension are late signs of shock. Urine output can be initially a) Alteration in the size, shape, and organization of differentiated cells
normal or increased. b) Increase in the number of normal cells in a normal arrangement in a tissue or an organ
Options C and D: The client with impending signs of septic shock may not have decreased c) Presence of completely undifferentiated tumor cells that don't resemble cells of the
oxygen saturation levels and normal blood pressure. tissues of their origin
Which of the following represents the most appropriate nursing intervention for a client d) Replacement of one type of fully differentiated cell by another in tissues where the
with pruritus caused by cancer or the treatments? second type normally isn't found
a) Silk sheets a) Alteration in the size, shape, and organization of differentiated cells
b) Steroids - orrect Answer: A. Alteration in the size, shape, and organization of differentiated cells
c) Medicated cool baths Option A: Dysplasia refers to an alteration in the size, shape, and organization of
d) Administration of antihistamines differentiated cells.
c) Medicated cool baths Option B: An increase in the number of normal cells in a normal arrangement in a tissue or
- Correct Answer: C. Medicated cool baths an organ is called hyperplasia.
Option C: Nursing interventions to decrease the discomfort of pruritus include those that Option C: The presence of completely undifferentiated tumor cells that don't resemble cells
prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. of the tissues of their origin is called anaplasia.
Medicated baths with salicylic acid or colloidal oatmeal can be soothing as a temporary Option D: Replacement of one type of fully differentiated cell by another in tissues where
relief. the second type normally isn't found is called metaplasia.
Option A: Using silk sheets is not a practical intervention for the hospitalized client with For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis
pruritus. of anxiety related to the threat of death secondary to a cancer diagnosis. Which expected
outcome would be appropriate for this client?
a) "Client stops seeking information." the treatment site. Fatigue occurs when the treatment damages and destroys not only the
b) "Client uses any effective method to reduce tension." healthy cells but also the cancer cells.
c) "Client doesn't guess at prognosis." Options B, C, and D: Hair loss, stomatitis, and vomiting are site-specific, not generalized,
d) "Client verbalizes feeling of anxiety." adverse effects of radiation therapy.
d) "Client verbalizes feeling of anxiety." Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse
- Correct Answer: D. "Client verbalizes feelings of anxiety." instructs the client that a diagnosis of breast cancer is confirmed by:
Option D: Verbalizing feelings is the client's first step in coping with the situational crisis. It a) Breast self-examination
also helps the health care team gain insight into the client's feelings, helping guide b) Mammography
psychosocial care. c) Fine needle aspiration
Option A: Seeking information can help a client with cancer gain a sense of control over the d) chest x-ray
crisis. c) Fine needle aspiration
Option B: This is undesirable because some methods of reducing tension, such as illicit drug - Correct Answer: C. Fine needle aspiration
or alcohol use, may prevent the client from coming to terms with the threat of death as Option C: Fine needle aspiration and biopsy provide cells for histologic examination to
well as cause physiological harm. confirm a diagnosis of cancer. During the procedure, a needle is inserted into the lump and
Option C: Suppressing speculation may prevent the client from coming to terms with the a sample of tissue is taken for examination.
crisis and planning accordingly. Option A: A breast self-examination, if done regularly, is the most reliable method for
A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse detecting breast lumps early.
formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the Option B: Mammography is used to detect tumors that are too small to palpate.
nurse add to complete the nursing diagnosis statement? Option D: Chest X-rays can be used to pinpoint rib metastasis.
a) Related to psychomotor seizures A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client
b) Related to impaired balance how to care for the neck stoma, the nurse should include which instruction?
c) Related to visual field deficits a) "Keep the stoma dry."
d) Related to difficulty swallowing b) "Keep the stoma moist."
b) Related to impaired balance c) "Keep the stoma uncovered."
- Correct Answer: B. Related to impaired balance d) "Have a family member perform stoma care initially until you get used to the procedure
Option B: A client with a cerebellar brain tumor may suffer injury from impaired balance as b) "Keep the stoma moist."
well as disturbed gait and incoordination. - Correct Answer: B. "Keep the stoma moist."
Option A: Psychomotor seizures suggest temporal lobe dysfunction. Option B: The nurse should instruct the client to keep the stoma moist, such as by applying
Option C: Visual field deficits, difficulty swallowing, and psychomotor seizures may result a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated.
from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe Option A: Moisture is needed by the stoma to keep the airway moist. The skin around the
— not from a cerebellar brain tumor. stoma is kept clean and dry instead.
Option D: Difficulty swallowing suggests medullary dysfunction. Option C: The nurse should recommend placing a stoma bib over the stoma to filter and
A female client with cancer is scheduled for radiation therapy. The nurse knows that warm air before it enters the stoma.
radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse Option D: The client should begin performing stoma care without assistance as soon as
should prepare the client to expect: possible to gain independence in self-care activities.
a) Fatigue A female client is receiving chemotherapy to treat breast cancer. Which assessment finding
b) Vomiting indicates a fluid and electrolyte imbalance induced by chemotherapy?
c) Hair loss a) Serum potassium level of 3.6 mEq/L
d) Stomatitis b) Blood pressure of 120/64 to 130/72 mmHg
a) Fatigue c) Dry oral mucous membranes and cracked lips
- Correct Answer: A. Fatigue d) Urine output of 400 mL in 8 hours
Option A: Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of
c) Dry oral mucous membranes and cracked lips c) Wellcovorin (leucovorin or citrovorum factor or folinic acid)
- Correct Answer: C. Dry oral mucous membranes and cracked lips - Correct Answer: C. Wellcovorin (leucovorin or citrovorum factor or folinic acid)
Option C: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid Option C: Leucovorin is administered with methotrexate to protect normal cells, which
and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked methotrexate could destroy if given alone.
lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a Options A and B: Cytarabine and thioguanine aren't used to treat osteogenic carcinoma.
serum potassium level below 3.5 mEq/L. Option D: Probenecid should be avoided in clients receiving methotrexate because it
Options A, B, and D: These values are within the normal limits. reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity.
Nurse April is teaching a group of women to perform breast self-examination. The nurse The nurse is interviewing a male client about his past medical history. Which preexisting
should explain that the purpose of performing the examination is to discover: condition may lead the nurse to suspect that a client has colorectal cancer?
a) Fibrocystic masses a) polyps
b) Changes from previous self-examinations b) weight gain
c) Areas of thickness or fullness c) Hemorrhoids
d) Cancerous lumps d) Duodenal ulcers
b) Changes from previous self-examinations a) Polyps
- Correct Answer: B. Changes from previous self-examinations - Correct Answer: A. Polyps
Option B: Women are instructed to examine themselves to discover changes that have Option A: Colorectal polyps are common with colon cancer. These polyps can develop into
occurred in the breast. cancer over time depending on the type of polyps such as adenomatous polyps and sessile
Options A, C, and D: Only a physician can diagnose lumps that are cancerous, areas of serrated polyps.
thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic Option B: Weight loss — not gain — is an indication of colorectal cancer.
as opposed to malignant. Options C and D: Duodenal ulcers and hemorrhoids aren't preexisting conditions of
A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical colorectal cancer
cancer. The nurse reviews the client's history for risk factors for this disease. Which history Nurse Amy is speaking to a group of women about early detection of breast cancer. The
finding is a risk factor for cervical cancer? average age of the women in the group is 47. Following the American Cancer Society
a) Pregnancy complicated with eclampsia at age 27 guidelines, the nurse should recommend that the women:
b) Spontaneous abortion at age 19 a) Have a mammogram annually
c) ONset of sporadic sexual activity at age 17 b) Perform breast self-exams annually
d) Human papillomavirus infection at age 32 c) Have a hormonal receptor assay annually
d) Human papillomavirus infection at age 32 d) Have a physician conduct a clinical exam every 2 yrs
- Correct Answer: D. Human papillomavirus infection at age 32 a) Have a mammogram annually
Option D: Like other viral and bacterial venereal infections, human papillomavirus is a risk - Correct Answer: A. Have a mammogram annually
factor for cervical cancer. Other risk factors for this disease include multiple sex partners, Option A: The American Cancer Society guidelines state, "Women older than age 40 should
multiple pregnancies, long-term use of oral contraceptives and diethylstilbestrol (DES). have a mammogram annually and a clinical examination at least annually [not every 2
Options A and B: A spontaneous abortion and pregnancy complicated by eclampsia aren't years].
risk factors for cervical cancer. Option B: All women should perform breast self-examination monthly [not annually].
Option C: Risk factors for this disease include frequent sexual intercourse before age 16. Option C: The hormonal receptor assay is done on a known breast tumor to determine
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic whether the tumor is estrogen- or progesterone-dependent.
carcinoma. During methotrexate therapy, the nurse expects the client to receive which Option D: A physician checkup every 2 years will not detect early signs of breast cancer
other drug to protect normal cells? A male client with a nagging cough makes an appointment to see the physician after
a) Tabloid (thioguanine) reading that this symptom is one of the seven warning signs of cancer. What is another
b) Cytosar-U (cytarabine) warning sign of cancer?
c) Wellcovorin (leucovorin or citrovorum factor or folinic acid) a) rash
d) Benemid (probenecid) b) Indigestion
c) chronic ache or pain Which intervention is appropriate for the nurse caring for a male client in severe pain
d) Persistent nausea receiving a continuous I.V. infusion of morphine?
b) Indigestion a) Discontinuing the drug immediately if signs of dependence appear
- Correct Answer: B. Indigestion b) Assisting with a naloxone challenge test before therapy begins
Option B: Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. c) Obtaining baseline vital signs before administering the first dose
The other six are a change in bowel or bladder habits, a sore that does not heal, unusual d) Changing the administration route to P.O. if the client can tolerate fluids
bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change c) Obtaining baseline vital signs before administering the first dose
in a wart or mole, and a nagging cough or hoarseness. - Correct Answer: C. Obtaining baseline vital signs before administering the first dose
Options A and C: Rash and chronic ache or pain seldom indicate cancer. Option C: The nurse should obtain the client's baseline blood pressure and pulse and
Option D: Persistent nausea may signal stomach cancer but isn't one of the seven major respiratory rates before administering the initial dose and then continue to monitor vital
warning signs. signs throughout therapy.
For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse Option A: The nurse shouldn't discontinue a narcotic agonist abruptly because withdrawal
should include which intervention in the plan of care? symptoms may occur.
a) Inspecting the skin for petechiae once every shift Option B: A naloxone challenge test may be administered before using a narcotic antagonist,
b) Placing the client in strict isolation not a narcotic agonist.
c) Providing for frequent rest periods Option D: Morphine commonly is used as a continuous infusion in clients with severe pain
d) Administering aspirin if the temperature exceeds 102 degrees F (38.8 C) regardless of the ability to tolerate fluids.
a) Inspecting the skin for petechiae once every shift A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an
- Correct Answer: A. Inspecting the skin for petechiae once every shift antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that
Option A: Because thrombocytopenia impairs blood clotting, the nurse should inspect the interfere with various metabolic actions of the cell. The mechanism of action of
client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding antimetabolites interferes with:
gums. a) Cell division or mitosis during the M phase of the cell cycle
Option B: Strict isolation is indicated only for clients who have highly contagious or virulent b) Normal cellular processes during the S phase of the cell cycle
infections that are spread by air or physical contact. c) The chemical structure of deoxyribonucleic acid (DNA) and chemical binding between
Option C: Frequent rest periods are indicated for clients with anemia, not DNA molecules (cell cycle-nonspecific)
thrombocytopenia. d) One or more stages of ribonucleic acid (RNA) synthesis, or both (cell cycle-nonspecific)
Option D: The nurse should avoid administering aspirin because it may increase the risk of b) Normal cellular processes during the S phase of the cell cycle
bleeding. - Correct Answer: B. Normal cellular processes during the S phase of the cell cycle
Nurse Lucia is providing breast cancer education at a community facility. The American Option B: Antimetabolites act during the S phase of the cell cycle, contributing to cell
Cancer Society recommends that women get mammograms: destruction or preventing cell replication. They're most effective against rapidly
a) After the first menstrual period and annually thereafter proliferating cancers.
b) Yearly after age 40 Option A: Miotic inhibitors interfere with cell division or mitosis during the M phase of the
c) Every 3 years between ages 20 and 40 and annually thereafter cell cycle.
d) After the birth of the first child and every 2 years thereafter Option C: Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they
b) Yearly after age 40 may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells.
- Correct Answer: B. Yearly after age 40 Option D: Antineoplastic antibiotic agents interfere with one or more stages of the
Option B: Breast cancer is a common health problem for women ages 40-49 years old. The synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.
American Cancer Society recommends a mammogram yearly for women over age 40. The ABCD method offers one way to assess skin lesions for possible skin cancer. What does
Options A, C, and D: The other statements are incorrect. It's recommended that women the A stand for?
between ages 20 and 40 have a professional breast examination (not a mammogram) every a) Assessment
3 years. b) Arcus
c) Actinic b) Red, open sores on the oral mucosa
d) Asymmetry - Correct Answer: B. Red, open sores on the oral mucosa
d) Asymmetry Option B: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis,
- Correct Answer: D. Asymmetry resulting in ulcers on the oral mucosa that appear as red, open sores.
Option D: When following the ABCD method for assessing skin lesions, the A stands for Option A: Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
"asymmetry," the B for "border irregularity," the C for "color variation," and the D for Option C: Yellow tooth discoloration may result from antibiotic therapy, not cancer
"diameter." chemotherapy.
When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse Option D: White, cottage cheese-like patches on the tongue suggest a candidal infection,
expects to assess: another common adverse effect of chemotherapy.
a) Seizures During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous
b) Tactile agnosia membrane related to decreased nutrition and immunosuppression secondary to the
c) Short-term memory impairment cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease
d) Contralateral homonymous hemianopia the pain of stomatitis?
b) Tactile agnosia a) Monitoring the client's platelet and leukocyte counts
- Correct Answer: B. Tactile agnosia b) Checking regularly for signs and symptoms of stomatitis
Option B: Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe c) Recommending that the client discontinue chemotherapy
tumor. d) Providing a solution of hydrogen peroxide and water for use as a mouth rinse
Option A: Seizures may result from a tumor of the frontal, temporal, or occipital lobe. d) Providing a solution of hydrogen peroxide and water for use as a mouth rinse
Option C: Short-term memory impairment occurs with a frontal lobe tumor. - Correct Answer: D. Providing a solution of hydrogen peroxide and water for use as a
Option D: Contralateral homonymous hemianopia suggests an occipital lobe tumor. mouth rinse
A female client is undergoing tests for multiple myeloma. Diagnostic study findings in Option D: To decrease the pain of stomatitis, the nurse should provide a solution of
multiple myeloma include: hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially
a) A decreased serum creatinine level prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral
b) A low serum protein level mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as
c) Hypocalcemia prescribed.
d) Bence Jone protein in the urine Option A: Monitoring platelet and leukocyte counts may help prevent bleeding and
d) Bence Jones protein in the urine infection but wouldn't decrease pain in this highly susceptible client.
- Correct Answer: D. Bence Jones protein in the urine Option B: Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.
Option D: Bence-Jones protein is an antibody fragment called a light chain that is not Option C: Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping
detectable in the urine. A presence of Bence Jones may indicate excess light chain chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this
production of a single type of antibody by the bone marrow cells. potential problem to ensure prompt treatment.
Option A: The serum creatinine level may also be increased. What should a male client over age 52 do to help ensure early identification of prostate
Option B: Serum protein electrophoresis shows elevated globulin spike. cancer?
Option C: Serum calcium levels are elevated because calcium is lost from the bone and a) Have a transrectal ultrasound every 5 years
reabsorbed in the serum. b) Perform monthly testicular self-examinations, especially after age 50
A 35-year-old client has been receiving chemotherapy to treat cancer. Which assessment c) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly
finding suggests that the client has developed stomatitis (inflammation of the mouth)? d) Have a CBC and BUN and creatinine levels checked yearly
a) Rust-colored sputum c) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly
b) Red, open sores on the oral mucosa - Correct Answer: C. Have a digital rectal examination and prostate-specific antigen (PSA)
c) Yellow tooth discoloration test done yearly
d) White, cottage cheese-like patches on the tongue Option C: The incidence of prostate cancer increases after age 50. The digital rectal
examination, which identifies enlargement or irregularity of the prostate, and PSA test, a
tumor marker for prostate cancer, are effective diagnostic measures that should be done Jenny with an advanced breast cancer is prescribed Nolvadex (tamoxifen). When teaching
yearly. the client about this drug, the nurse should emphasize the importance of reporting which
Options A and D: A transrectal ultrasound, CBC, and BUN and creatinine levels are usually adverse reaction immediately?
done after diagnosis to identify the extent of the disease and potential metastases. a) Anorexia
Option B: Testicular self-examinations won't identify changes in the prostate gland due to b) Headache
its location in the body. c) Hearing loss
A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight d) Vision changes
loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, d) Vision changes
which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client? - Correct Answer: D. Vision changes
a) Chronic low self-esteem Option D: Tamoxifen, a selective estrogen receptor modulator (SERM) causes ocular side
b) Disturbed body image effects such as dryness, irritation, and cataracts. The client must report changes in visual
c) Anticipatory grieving acuity immediately because this adverse effect may be irreversible.
d) Impaired swallowing Options A and B: Although the drug may cause anorexia, headache, and hot flashes, the
c) Anticipatory grieving client need not report these adverse effects immediately because they don't warrant a
- Correct Answer: C. Anticipatory grieving change in therapy.
Option C: Anticipatory grieving is an appropriate nursing diagnosis for this client because Option C: Tamoxifen isn't associated with hearing loss.
few clients with gallbladder cancer live more than 1 year after diagnosis. A female client with cancer is being evaluated for possible metastasis. Which of the
Option A: Chronic low self-esteem isn't an appropriate nursing diagnosis at this time following is one of the most common metastasis sites for cancer cells?
because the diagnosis has just been made. a) Colon
Option B: Although surgery typically is done to remove the gallbladder and, possibly, a b) Liver
section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. c) Reproductive tract
Option D: Impaired swallowing isn't associated with gallbladder cancer. d) White blood cells (WBCs)
A male client is in isolation after receiving an internal radioactive implant to treat cancer. b) Liver
Two hours later, the nurse discovers the implant in the bed linens. What should the nurse - Correct Answer: B. Liver
do first? Option B: The liver is one of the five most common cancer metastasis sites. The others are
a) Leave the room and notify the radiation therapy department immediately the lymph nodes, lung, bone, and brain.
b) Put the implant back in place, using forceps and a shield for self-protection, and call for Options A, C, and D: The colon, reproductive tract, and WBCs are occasional metastasis sites.
help A 34-year-old female client is requesting information about mammograms and breast
c) Pick up the implant with long-handled forceps and place it in a lead-lined container cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this
d) Stand as far away from the implant as possible and call for help client?
c) Pick up the implant with long-handled forceps and place it in a lead-lined container a) She should have had a baseline mammogram before age 30
- Correct Answer: C. Pick up the implant with long-handled forceps and place it in a lead- b) When she begins having yearly mammograms, breast self-exams will no longer be
lined container necessary
Option C: If a radioactive implant becomes dislodged, the nurse should pick it up with long- c) She should perform breast self-exam during the first 5 days of each menstrual cycle
handled forceps and place it in a lead-lined container, then notify the radiation therapy d) She should eat a low-fat diet to further decrease her risk of breast cancer
department immediately. The highest priority is to minimize radiation exposure for the d) She should eat a low-fat diet to further decrease her risk of breast cancer
client and the nurse; therefore, the nurse must not take any action that delays implant - Correct Answer: D. She should eat a low-fat diet to further decrease her risk of breast
removal. cancer
Options A, B, and D: Standing as far from the implant as possible, leaving the room with the Option D: A low-fat diet (one that maintains weight within 20% of recommended body
implant still exposed, or attempting to put it back in place can greatly increase the risk of weight) has been found to decrease a woman's risk of breast cancer.
harm to the client and the nurse from excessive radiation exposure. Option A: A baseline mammogram should be done between ages 30 and 40.
Option B: The client should continue to perform monthly breast self-examinations even
when receiving yearly mammograms. Option A: A mastectomy may not be required if the tumor is small, confined, and in an early
Option C: Monthly breast self-examinations should be done between days 7 and 10 of the stage.
menstrual cycle. Option C: Lung cancer causes more deaths than breast cancer in women of all ages.
Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting Option D: The most reliable method for detecting breast cancer is monthly self-examination,
adverse reaction to floxuridine (FUDR). How long after drug administration does bone not mammography.
marrow suppression become noticeable? Nurse Mary is instructing a premenopausal woman about breast self-examination. The
a) 24 hours nurse should tell the client to do her self-examination:
b) 2 to 4 days a) On the 1st day of the menstrual cycle
c) 7 to 14 days b) On the same day each month
d) 21 to 28 days c) Immediately after her menstrual period
c) 7 to 14 days d) At the end of her menstrual cycle
- Correct Answer: C. 7 to 14 days c) Immediately after her menstrual period
Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. - Correct Answer: C. Immediately after her menstrual period
Bone marrow recovery occurs in 21 to 28 days. Option C: Premenopausal women should do their self-examination immediately after the
The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm menstrual period, when the breasts are least tender and least lumpy.
or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a Options A and D: On the 1st and last days of the cycle, the woman's breasts are still very
threat to the client? tender.
a) The client lies still Option B: Postmenopausal women because their bodies lack fluctuation of hormone levels,
b) The client asks questions should select one particular day of the month to do breast self-examination.
c) The client hears thumping sounds Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which
d) The client wears a watch and wedding band of the following points would be appropriate to make?
d) The client wears a watch and wedding band a) Testicular cancer is a highly curable type of cancer
- Correct Answer: D. The client wears a watch and wedding band b) Testicular cancer is very difficult to diagnose
Option D: During an MRI, the client should wear no metal objects, such as jewelry, because c) Testicular cancer is the number one cause of cancer deaths in males
the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to d) Testicular cancer is more common in older men
others. a) Testicular cancer is a highly curable type of cancer
Options A and B: The client must lie still during the MRI but can talk to those performing the - Correct Answer: A. Testicular cancer is a highly curable type of cancer
test by way of the microphone inside the scanner tunnel. Option A: Testicular cancer is highly curable, particularly when it's treated in its early stage.
Option C: The client should hear thumping sounds, which are caused by the sound waves Stage I of the disease, a radical inguinal orchiectomy (removal of testicles) is performed first
thumping on the magnetic field. then followed by chemotherapy or radiation therapy.
Nina, an oncology nurse educator, is speaking to a women's group about breast cancer. Option B: Self-examination allows early detection and facilitates the early initiation of
Questions and comments from the audience reveal a misunderstanding of some aspects of treatment.
the disease. Various members of the audience have made all of the following statements. Option C: The highest mortality rates from cancer among men are in men with lung cancer.
Which one is accurate? Option D: Testicular cancer is found more commonly in younger men.
a) Breast cancer requires a mastectomy Rhea has malignant lymphoma. As part of her chemotherapy, the physician prescribes
b) Men can develop breast cancer chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse
c) Breast cancer is the leading killer of women of childbearing age teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the
d) Mammography is the most reliable method for detecting breast cancer first administration of chlorambucil might this reaction occur?
b) Men can develop breast cancer a) Immediately
- Correct Answer: B. Men can develop breast cancer b) 1 week
Option B: Men can develop breast cancer, although they seldom do. It is common among c) 2 to 3 weeks
older men. d) 1 month
c) 2 to 3 weeks Options A, B, and D: The client is at risk of deep vein thrombosis or thrombophlebitis after
- Correct Answer: C. 2 to 3 weeks this surgery, as for any other major surgery. For this reason, the nurse implements
Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins. The medication measures that will prevent this complication. Range-of-motion exercises, anti-embolism
causes structural damage to the scalp hairs resulting in reduced hair growth and complete stockings, and pneumatic compression boots are helpful.
hair loss (alopecia). Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse
A male client is receiving the cell cycle-nonspecific alkylating agent Thioplex (thiotepa), 60 provides which pre-procedure instruction to the client?
mg weekly for 4 weeks by bladder installation as part of a chemotherapeutic regimen to a) Wear comfortable clothing and shoes for the procedure
treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa b) Maintain an NPO status before the procedure
exert its therapeutic effects? c) Drink six to eight glasses of water without voiding before the test
a) It interferes with deoxyribonucleic acid (DNA) replication only d) Eat a light breakfast only
b) It interferes with ribonucleic acid (RNA) transcription only c) Drink six to eight glasses of water without voiding before the test
c) It interferes with DNA replication and RNA transcription - Correct Answer: C. Drink six to eight glasses of water without voiding before the test
d) It destroys the cell membranes, causing lysis Option C: A pelvic ultrasound requires the ingestion of large volumes of water just before
c) It interferes with DNA replication and RNA transcription the procedure. A full bladder is necessary so that it will be visualized as such and not
- Correct Answer: C. It interferes with DNA replication and RNA transcription. mistaken for possible pelvic growth.
Option C: Thiotepa is an alkylating agent that works by crosslinking DNA strands by reacting Option A: Comfortable shoes and clothing is unrelated to this specific procedure.
with phosphate groups to stop protein synthesis, RNA, and DNA. Option B: An abdominal ultrasound may require that the client abstain from food or fluid
Options A, B, and D: Thiotepa interferes with DNA replication and RNA transcription. It for several hours before the procedure.
doesn't destroy the cell membrane. Option D: A patient may eat and drink on the day of the exam regardless of quantity.
Gio, a community health nurse, is instructing a group of female clients about breast self- A male client is diagnosed as having a bowel tumor and several diagnostic tests are
examination. The nurse instructs the client to perform the examination: prescribed. The nurse understands which test will confirm the diagnosis of malignancy?
a) At the onset of menstruation a) Magnetic resonance imaging
b) Every month during ovulation b) Computerized tomography scan
c) Weekly at the same time of day c) Abdominal ultrasound
d) 1 week after menstruation begins d) Biopsy of the tumor
d) 1 week after menstruation begins d) Biopsy of the tumor
- Correct Answer: D. 1 week after menstruation begins - Correct Answer: D. Biopsy of the tumor
Option D: The breast self-examination should be performed monthly 7 days after the onset Option D: A biopsy is done to determine whether a tumor is malignant or benign through
of the menstrual period when the breasts are less tender and lumpy. the examination of the sample of tissue taken into a body part.
Options A and B: At the onset of menstruation and during ovulation, hormonal changes Options A, B, and C: Magnetic resonance imaging, computed tomography scan, and
occur that may alter breast tissue. ultrasound will visualize the presence of a mass but will not confirm a diagnosis of
Option C: Performing the examination weekly is not recommended. malignancy.
Nurse Cindy is caring for a client who has undergone a vaginal hysterectomy. The nurse Vanessa, a community health nurse conducts a health promotion program regarding
avoids which of the following in the care of this client? testicular cancer to community members. The nurse determines that further information
a) Removal of anti-embolism stockings twice daily needs to be provided if a community member states that which of the following is a sign of
b) Checking placement of pneumatic compression boots testicular cancer?
c) Elevating the knee gatch on the bed a) back pain
d) Assisting with range-of-motion leg exercises b) alopecia
c) Elevating the knee gatch on the bed c) Heavy sensation in the scrotum
- Correct Answer: C. Elevating the knee gatch on the bed d) Painless testicular swelling
Option C: The nurse should avoid using the knee gatch in the bed, which inhibits venous b) Alopecia
return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis. - Correct Answer: B. Alopecia
Option B: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, Option C: The client with a cervical radiation implant should be maintained on bed rest in
however, as a result of radiation or chemotherapy. the dorsal position to prevent movement of the radiation source. The head of the bed is
Options A, C, and D: Back pain, heavy sensation in the scrotum, and painless testicular elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client
swelling are assessment findings in testicular cancer. Back pain may indicate metastasis to on the side. If turning is absolutely necessary, a pillow is placed between the knees and,
the retroperitoneal lymph nodes. with the body in straight alignment, the client is logrolled.
The male client is receiving external radiation to the neck for cancer of the larynx. The most The nurse is caring for a female client experiencing neutropenia as a result of
likely side effect to be expected is: chemotherapy and develops a plan of care for the client. The nurse plans to:
a) Diarrhea a) Teach the client and family about the need for hand hygiene
b) dyspnea b) Insert an indwelling urinary catheter to prevent skin breakdown
c) Constipation c) Restrict fluid intake
d) Sore throat d) Restrict all visitors
d) Sore Throat a) Teach the client and family about the need for hand hygiene
- Correct Answer: D. Sore throat - Correct Answer: A. Teach the client and family about the need for hand hygiene
Option D: In general, only the area in the treatment field is affected by the radiation. Skin Option A: In the neutropenic client, meticulous hand hygiene education is implemented for
reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other the client, family, visitors, and staff to avoid transmission-based infection.
side effects occur only when specific areas are involved in treatment. A client receiving Option B: Invasive measures such as an indwelling urinary catheter should be avoided to
radiation to the larynx is most likely to experience a sore throat. prevent infections.
Options A and C: May occur with radiation to the gastrointestinal tract. Option C: Fluids should be encouraged.
Option B: Dyspnea may occur with lung involvement. Option D: Not all visitors are restricted, but the client is protected from persons with known
Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, infections.
the nurse should observe which of the following principles?
a) Remove the dosimeter badge when entering the client's room
b) Individual's younger than 16 yr may be allowed to go in the room as long as they are 6
feet away from the client
c) Limit the time with the client to 1 hour per shift
d) Do not allow pregnant women into the client's room
d) Do not allow pregnant women into the client's room
- Correct Answer: D. Do not allow pregnant women into the client's room
Options B and D: Children younger than 16 years of age and pregnant women are not
allowed in the client's room to avoid radiation exposure that may harm the children and the
developing baby.
Option A: The dosimeter badge must be worn when in the client's room.
Option C: The time that the nurse spends in a room of a client with an internal radiation
implant is 30 minutes per 8-hour shift.
A cervical radiation implant is placed in the client for treatment of cervical cancer. The
nurse initiates what most appropriate activity order for this client
a) Out of bed ad lib
b) Ambulation to the bathroom only
c) Bed rest
d) Out of bed in a chair only
c) Bed Rest
- Correct Answer: C. Bed rest
 Onco meds D. "It is fine to receive a flu vaccine at the local health fair without HCP approval because
the flu is so contagious."
Chemotherapy dosage is frequently based on total body surface area (BSA), so it is C. "You need to consult with the HCP before receiving immunizations."
important for the nurse to perform which assessment before administering chemotherapy? A client with ovarian cancer is being treated with Vincristine. The nurse monitors the client,
knowing that which manifestation indicates an adverse effect specific to this medication?
A. Measure the client's abdominal girth
B. Calculate the client's body mass index A. Diarrhea
C. Measure the client's current weight and height B. Hair loss
D. Ask the client about his or her weight and height C. Chest pain
C. Measure the client's current weight and height D. Peripheral neuropathy
A client with squamous cell carcinoma of the larynx is receiving Bleomycin intravenously. D. Peripheral neuropathy
The nurse caring for the client anticipates that which diagnostic study will be prescribed? The nurse is reviewing the history and physical examination of a client who will be receiving
Asparaginase, an antineoplastic agent. The nurse contacts the HCP before administering the
A. Echocardiography medication if which disorder is documented in the client's history?
B. Electrocardiography
C. Cervical radiography A. Pancreatitis
D. Pulmonary function studies B. Diabetes mellitus
D. Pulmonary function studies C. Myocardial infarction
A client with acute myelocytic leukemia is being treated with Busulfan. Which laboratory D. COPD
value would the nurse specifically monitor during treatment with this medication? A. Pancreatitis
Tamoxifen Citrate is prescribed for a client with metastatic breast carcinoma. The client
A. Clotting time asks the nurse if her family member with bladder cancer can also take this medication. The
B. Uric acid level nurse most appropriately responds by making which statement?
C. Potassium level
D. Blood glucose level A. "This medication can be used only to treat breast cancer."
B. Uric acid level B. "Yes, your family member can take this medication for bladder cancer as well."
A client with small cell lung cancer is being treated with Etoposide. The nurse monitors the C. "This medication can be taken to prevent and treat clients with breast cancer."
client during administration, knowing that which adverse effect is specifically associated D. "This medication can be taken by anyone with cancer as long as their HCP approves it."
with this medication? C. "This medication can be taken to prevent and treat clients with breast cancer."
A client with metastatic breast cancer is receiving Tamoxifen. The nurse specifically
A. Alopecia monitors which laboratory value while the client is taking this medication?
B. Chest pain
C. Pulmonary fibrosis A. Glucose level
D. Orthostatic hypotension B. Calcium level
D. Orthostatic hypotension C. Potassium level
A clinic nurse prepares a teaching plan for a client receiving an Antineoplastic medication. D. Prothrombin time
When implementing the plan, the nurse should make which statement to the client? B. Calcium level
Megestrol Acetate, an antineoplastic medication, is prescribed for a client with metastatic
A. "You can take aspirin as needed for headache." endometrial carcinoma. The nurse reviews the client's history and should contact the HCP if
B. "You can drink beverages containing alcohol in moderate amounts each evening." which diagnosis is documented in the client's history?
C. "You need to consult with the HCP before receiving immunizations."
A. Gout
B. Asthma C. Complaints of nausea and vomiting
C. Myocardial infarction D. Crackles on auscultation of the lungs
D. Venous thromboembolism D. Crackles on auscultation of the lungs
D. Venous thromboembolism The nurse is monitoring the laboratory results of a client receiving an Antineoplastic
The nurse is monitoring the IV infusion of an antineoplastic medication. During the infusion, medication by the IV route. The nurse plans to initiate bleeding precautions if which
the client complains of pain at the insertion site. On inspection of the site, the nurse notes laboratory result is noted?
redness and swelling and that the infusion of the medication has slowed in rate. The nurse
suspects extravasation and should take which actions? [select all that apply] A. Clotting time of 10 minutes
B. Ammonia level of 10 mcg/dL
A. Stop the infusion C. Platelet count of 50,000
B. Notify the HCP D. White Blood Cell count of 5,000
C. Prepare to apply ice or heat to the site C. Platelet count of 50,000
D. Restart the IV at a distal part of the same vein
E. Prepare to administer a prescribed antidote into the site The nurse is caring for a client who has been placed on neutropenic precautions. The nurse
F. Increase the flow rate of the solution to flush the skin and subcutaneous tissue knows that this includes which of the following? Select all that apply.
A. Stop the infusion a. No suppositories
B. Notify the HCP b. No flowers
C. Prepare to apply ice or heat to the site c. No cooked meat
E. Prepare to administer a prescribed antidote into the site d. No fresh vegetables
The nurse is analyzing the laboratory results of a client with leukemia who has received a e. No salt
regimen of chemotherapy. Which laboratory value would the nurse specifically note as a a, b, d
result of the massive cell destruction that occurred from the chemotherapy? No suppositories
Neutropenic precautions include thorough hand washing, a low microbial diet (no fresh
A. Anemia salads, fruits, vegetables, uncooked meats), a daily room cleaning, nothing per rectum,
B. Decreased platelets dedicated equipment for the client, and a private room.
C. Increased uric acid levels No flowers
D. Decreased leukocyte count This is not allowed for a client on neutropenic precautions.
C. Increased uric acid levels No cooked meat
The nurse is providing medication instructions to a client with breast cancer who is Uncooked meat is not allowed, but cooked meat is allowed.
receiving Cyclophosphamide. The nurse should tell the client to take which action? No fresh vegetables
This is not allowed for a client on neutropenic precautions.
A. Take the medication with food No salt
B. Increase fluid intake to 2,000-3,000 mL daily Salt is allowed with neutropenic precautions.
C. Decrease sodium intake while taking the medication Which is the most common reason a client cannot receive chemotherapy?
D. Increase potassium intake while taking the medication a. Absolute neutrophil count
B. Increase fluid intake to 2,000-3,000 mL daily b. Nausea and vomiting
A client with non-Hodgkin's lymphoma is receiving Daunorubicin. Which finding would c. Fatigue
indicate to the nurse that the client is experiencing an adverse effect related to the d. Mucositis
medication? a. Absolute neutrophil count
This is the most common reason a client is not cleared for chemotherapy. The absolute
A. Fever neutrophil count (ANC) must be above 1,000 in order for the provider to allow the client to
B. Sores in the mouth and throat go ahead with chemotherapy.
Nausea and vomiting A client with a neutrophil count of 490 is immunocompromised, and should be placed on
Nausea and vomiting are a side-effect of chemotherapy, but are not typically a reason that neutropenic precautions. The nurse caring for this client cannot care for clients with
chemotherapy is delayed. The neutrophil count is the most common reason for a client to transmittable diseases at the same time.
have to wait for a dose of chemotherapy. A client with glaucoma
Fatigue This client is appropriate because glaucoma is not a transmittable disease.
Excessive fatigue is an expected outcome of chemotherapy treatments. While it is not a A nurse is teaching a client with cancer about safety when receiving chemotherapy drugs.
reason to forego chemotherapy, it will prompt the nurse to talk to the client about getting The nurse wants the client to understand about how chemotherapy can be harmful to
enough rest and nutrition. healthy people who live with the client. Which action should the nurse counsel the client to
Mucositis perform after receiving chemotherapy that would most likely protect those who live with
Mucositis, or inflammation of the mucous membranes, is a side effect of chemotherapy. the client?
This does not lead to a delay in chemotherapy administration, but may require frequent a. Flush the toilet twice with the lid down after using
medicated rinses of the oral cavity, increased brushing with a soft toothbrush, and actions b. If the client vomits, close the door to the area and allow it to dry before cleaning
to keep the mouth from becoming too dry. c. Wash all clothes that have body fluids on them by hand
A client who has to start chemotherapy for a new diagnosis of cancer becomes very anxious d. Use a separate set of flatware and dishes that are not used by others in the family
and upset about the thought of the new treatment. Which type of referral could the nurse a. Flush the toilAet twice with the lid down after using
make in this situation? Select all that apply.
a. A referral for a new oncologist Chemotherapy, which is a treatment for clients with cancer, can be harmful for others who
b. a referral to a doctor of homeopathy live with the client. Chemotherapy can cause abnormalities in the DNA of healthy people
c. A referral to an integrative health care provider when they are exposed to the substance. The nurse should teach the client to take
d. A referral to a cancer support group measures to protect others living in the home from being exposed. An example is to close
e. A referral to have a diagnostic test done the lid of the toilet and flush it twice after using it to reduce the risk of contamination when
c, d chemotherapy agents are eliminated from the body.
The infusion nurse is reviewing the schedule of chemotherapy clients for the day. The nurse
Referrals that would be helpful for the client with anxiety are focused on relaxation, knows that chemotherapy is given for which of the following scenarios? Select all that apply.
support, and stress reduction. Natural homeopathic remedies do not address the client's a. To prevent cancer
anxiety, nor does switching oncologists or more diagnostic tests. b. To cure the client of cancer
c. To delay the progression of cancer
A nurse has the capability of making some types of referrals, particularly those that are for d. To make a client with cancer more comfortable
supportive care for the client. The nurse cannot write orders or prescribe but can make a e. To eliminate BRCA-1 and BRCA-2
referral for such services as complementary therapies, use of assistive devices, or b, c, d
information about support groups and community resources. To cure the client of cancer
The charge nurse is making assignments for the next shift. Which of the following clients If a client has cancer, chemotherapy is a treatment modality, usually used in combination
can be assigned to the same nurse as the client with a neutrophil count of 490? Select all with other treatments, to cure cancer.
that apply. To delay the progression of cancer
a. A client with a broken hip In a client with advanced age or illness, chemotherapy may be used to delay the
b. A client with glaucoma progression of cancer rather than cure it.
c. A client with MRSA To make a client with cancer more comfortable
d. A client with HIV In some clients, chemotherapy is used as a palliative treatment to reduce the size of a
e. a client with pneumonia tumor rather than cure it.
a, b
A client with a broken hip
In order to protect against exposure to chemotherapy drugs when caring for patients (Zinecard) is a cytoprotective (chemoprotective) agent that may be given to help prevent
receiving intravenous (IV) therapy, what will the nurse do? cardiac toxicities associated with doxorubicin administration.
a. Wear gowns, gloves, masks, and headgear when administering all chemotherapy drugs. When teaching a patient receiving paclitaxel (Taxol), the nurse plans to instruct the patient
b. Wear a disposable gown when administering IV chemotherapy. to monitor for which side effect?
c. Wear a mask when receiving the drug from the pharmacist. a. Arthralgias
d. Administer IV chemotherapy only under the direct observation of the health care b. Hypertension
provider. c. Vertigo
b. d. Weight gain
A disposable gown should be worn when administering IV chemotherapy. The combination a.
of gowns, gloves, masks, and headgear is not necessary for all chemotherapy drugs. A mask Myalgias (muscle pains) and arthralgias (joint pains) are a common side effect of paclitaxel
is not necessary when the pharmacist prepared the drug. Nurses can administer that the patient should be prepared to expect.
chemotherapy without the observation of the health care provider. A patient is nauseated and vomiting after receiving chemotherapy. How will the nurse best
The nurse is caring for several patients receiving chemotherapy. What patient will the nurse intervene?
assess first? a. Tell the patient to avoid eating any food during chemotherapy treatments.
a. The patient receiving doxorubicin (Adriamycin) with a history of angina b. Inform the patient that the nausea will pass with time.
b. The patient receiving fluorouracil (5-FU, Adrucil) with an elevated platelet count c. Maintain hydration and nutrition and administer antinausea medications.
c. The patient taking cyclophosphamide (Cytoxan) who is urinating 100 mL/hr d. Use antacids to relieve the irritation to the stomach, which should stop the nausea.
d. The patient receiving mechlorethamine (Mustargen) with pain at the IV insertion site c.
d. It is very important for patients undergoing chemotherapy to maintain adequate nutrition
Mechlorethamine (nitrogen mustard [Mustargen]) is a severe vesicant and can cause tissue and hydration. Several antiemetic drugs are available that are very successful in controlling
necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible this side effect. The patient will most likely remain nauseated even without food intake.
infiltration and needs to be addressed. History of angina is a concern because Adriamycin is The nurse is caring for a patient receiving high-dose methotrexate (MTX) (Rheumatrex,
cardiotoxic; however, this patient is not the priority. Trexall) therapy. What intervention is a priority for this patient?
The nurse is caring for a patient with a hemoglobin of 15 g/dL, platelet count of a. Administering bleomycin immediately after treatment with MTX
450,000/mm3, and thrombocyte count of 8000/mm3 who is to receive cyclophosphamide b. Infusing IV dextrose at 100 mL/hr throughout the drug therapy
(Cytoxan) therapy. What is the nurse's priority intervention? c. Encouraging oral fluids to 4 L/day while being treated with MTX
a. Hold the Cytoxan therapy. d. Administering leucovorin within 2 days of treatment with MTX
b. Isolate the patient. d.
c. Start platelet transfusion. Leucovorin calcium (folinic acid) is given within the first 24 to 42 hours of starting
d. Teach patient effects of chemotherapy. methotrexate to block the systemic toxic effect of high-dose MTX. It is a form of folic acid
a. that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to
Cyclophosphamide (Cytoxan) causes bone marrow suppression, which is evidenced by a prevent or treat toxicity induced by methotrexate, a folic acid antagonist. Bleomycin is not
decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of administered with MTX; IV dextrose is not necessary with MTX therapy, and increased fluids
8000/mm3 is Awarded 0.0 points out of 1.0 possible points. to this degree are not necessary with MTX.
The nurse is monitoring a patient receiving doxorubicin (Adriamycin). What intervention is a The nurse is caring for a patient receiving cyclophosphamide (Cytoxan). What is a priority
priority for this patient? intervention for this patient?
a. Administering dexrazoxane (Zinecard) a. Assessing blood pressure hourly
b. Encouraging fluids to 3 L/day b. Encouraging fluids before, during, and after drug administration
c. Keeping patient away from crowds c. Drawing peak and trough levels
d. Administering antiemetic 60 minutes before infusion d. Keeping patient isolated until drug is excreted
a.
Patients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane
b.
Patients receiving cyclophosphamide (Cytoxan) should drink at least 2 to 3 L of fluid before,
during, and after administration to prevent hemorrhagic cystitis.
A patient asks, "Why am I getting three drugs for my cancer if they all do the same thing?"
What is the nurse's best response?
a. "Administering more than one drug prevents drug resistance."
b. "More than one drug is administered in case you don't respond to one of them."
c. "This makes your treatment more cost-effective."
d. "We are not sure what drug will be the most effective, so this combination ensures
success."
a.
Administering a combination of antineoplastic agents allows for smaller doses of each,
which can minimize the severity of side effects and help prevent drug resistance.
The nurse is completing an admission assessment for a patient admitted for treatment with
doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the patient
is taking which supplement?
a. Goldenrod leaves
b. Grapefruit juice
c. Green tea Correct
d. Vitamin D
c.
Green tea (Camellia sinensis) may enhance antitumor effects of doxorubicin (Adriamycin).
Use of green tea should be reported to the health care provider.
A patient is receiving IV cyclophosphamide (Cytoxan). Which intervention is a priority for
this patient?
a. Ensuring that the patient is well hydrated
b. Monitoring the white blood cell count
c. Administering an antianxiety agent
d.Running IV dextrose with the chemotherapy
a.
The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis
(bleeding as a result of severe bladder inflammation). Normal saline is used as the
maintenance IV when administering chemotherapy. Although it is important to monitor the
patient's white blood cell count while receiving chemotherapy, avoiding hemorrhagic
cystitis is the priority because it can be life-threatening. Antianxiety agents can be used if
needed for the patient ut on an individual basis, not routinely.