Oncology NCLEX Questions – Flashcards
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A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."
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D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill.
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Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back.
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C. Radiation therapy that is directed in or around the oral cavity has a variety of actions that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are affected, which changes the composition of the person's saliva and often causes "dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In addition, the radiation damages the integrity of the enamel and also damages some of the living cells in the tooth. All contribute to an increased risk for dental infections and cavities.
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A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)
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C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.
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Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.
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B. When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO.
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A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm
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C. The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.
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The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammography every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A CT scan will be done every year after I turn 50."
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A. A strong family history of breast cancer indicates a risk for breast cancer. Annual screening may be indicated for a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. An annual mammography is performed after age 40 or in younger clients with a strong family history.
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The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."
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D. Pain in the back of the legs could indicate prostate cancer in an older man.
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A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles 4x/wk C. A history of cardiac disease D. Advancing age
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D. Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.
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The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."
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B. T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.
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The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. A. Brain B. Bone C. Lymph nodes D. Kidneys E. Liver
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a-c, e. as well as the pancreas.
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The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements
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A. Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.
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The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? Select all the apply. A. Limit sodium intake. B. Avoid beef and processed meats. C. Increase consumption of whole grains. D. Eat "colorful fruits and vegetables," including greens. E. Avoid gas-producing vegetables such as cabbage.
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B-D. Eating cruciferous vegetables such as broccoli, cauliflower, brussels sprouts, and cabbage may reduce cancer risk.
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The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.
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D. Tobacco is the single most important source of preventable carcinogenesis.
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The nurse is teaching a group of clients about cancers related to tobacco or tobacco smoke. Identify the common cancers related to tobacco use. Select all that apply. A. Cardiac cancer B. Lung cancer C. Cancer of the tongue D. Skin cancer E. Cancer of the larynx
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B,C,E: The heart does not contain cells that divide; therefore cardiac cancer is unlikely.
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The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? A. Vomiting B. Back pain C. Frequent urination D. Cyanosis of the toes
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B. Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control.
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The nurse explains to the client that which risk factor most likely contributed to his primary liver carcinoma? A. Infection with hepatitis B virus B. Consuming a diet high in animal fat C. Exposure to radon D. Familial polyposis
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A. Hepatitis B and C are risk factors for primary liver cancer. Consuming a diet high in animal fat may predispose to colon or breast cancer. Exposure to radon is a risk factor for lung cancer. Familial polyposis is a risk factor for colorectal cancer.
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The nurse is caring for an adult client with Down syndrome who reports fatigue and shortness of breath. Which type of cancer has been identified in clients with Down syndrome? A. Breast cancer B. Colorectal cancer C. Malignant melanoma D. Leukemia
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D. Leukemia is associated with Down syndrome and Turner syndrome.
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The nurse includes which of the following in teaching regarding the warning signs of cancer? Select all that apply. A. Persistent constipation B. Scab present for 6 months C. Curdlike vaginal discharge D. Axillary swelling E. Headache
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A,B,D: Change in bowel habit, A sore that does not heal, A lump or thickening in the breast or elsewhere is a warning signal of cancer.
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The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound
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B. Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.Night sweats is a symptom of the lymphomas.
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Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual (Pap) smears
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B. Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. all the other options are secondary levels of prevention.
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A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? A. "Don't worry, most lumps are discovered by women during breast self-examination." B. "Does anyone in your family have breast cancer?" C. "Finding a cancer in the early stages increases the chance for cure." D. "Have you noticed a lump or thickening in your breast?"
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C. Providing truthful information addresses the client's concern.
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Which information must the organ transplant nurse emphasize before each client is discharged? A. Taking immune suppressant medications increases your risk for cancer and the need for screenings. B. You are at increased risk for cancer when you reach 60 years of age. C. Immunosuppressant medications will decrease your risk for developing cancers. D. After 6 months, you may stop immune suppressant medications, and your risk for cancer will be the same as that of the general population.
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A. Use of immune suppressant medications to prevent organ rejection increases the risk for cancer. Immune suppressant medications must be taken for the life of the organ; the risk for developing cancer remains.
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The home health RN is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment data would be most important to communicate to the transplant team? A. The temperature is 96.6° F. B. The client reports joint pain. C. The oral mucosa appears pink and dry. D. A lump is palpable in the client's axilla.
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D. Clients taking immune suppressive drugs to prevent rejection are at increased risk for development of cancer; any lump should be reported to the physician.
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A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."
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C. Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.
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When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? A. Tobacco use B. Ethnicity C. Gender D. Increased age
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A. lthough all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change.
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The registered nurse is teaching a group of nursing students about malignant transformation. Which statement about the process of malignant transformation is true? A. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. B. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. C. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.
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B. These promoters increase cell division. If cell division is halted, this does not lead to cancer development in the initiation phase.In the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latent phase occurs between initiation and tumor formation. promotion phase consists of progression when the blood supply changes from diffusion to TAF.
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The nurse receives report on a client with a glioblastoma. Recognizing that cancers are classified by their tissue of origin, the nurse begins to plan care for a client with which type of cancer? A. Liver B. Smooth muscle C. Fatty tissue D. Brain
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D. The prefix "glio-" is used when cancers of the brain are named.
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Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time
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B. The focus of palliative surgery is to improve quality of life during the survival time.
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Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."
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C. Brachytherapy refers to short-term insertion of a radiation source.
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Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? select all that apply. A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing
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a,c,d,e: Radiation therapy to any site produces fatigue,may cause clients to report changes in taste. Radiation side effects are site specific; the larynx is in this area, therefore changes in the skin may occur and dysphagia may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair.
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The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period? A. Peak B. Trough C. Nadir D. Adjuvant
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C. The lowest point of bone marrow function is referred to as the nadir. The peak of bone marrow function occurs when the client's blood levels are at their highest.Trough, which means low, is typically used in reference to drug levels.
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The nurse teaches the client that intraperitoneal chemotherapy will be delivered where? A. Into the veins of the legs B. Into the lung C. Into the heart D. Into the abdominal cavity
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D. Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.
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The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression. A. Client with hemoglobin of 7.4 and hematocrit of 21.8 B. Client with diarrhea and potassium level of 2.9 mEq/L C. Client with 250,000 platelets D. Client with 5000 white blood cells/mm3
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A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.
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The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.
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C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.
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Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply. A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor
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A,C,D: Fever is a sign of infection secondary to neutropenia.Pallor is a sign of anemia.
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Which intervention will be most helpful for the client with mucositis? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved
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C. Mouth swabs are soft and disposable and therefore clean. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa.
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A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Encourage the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.
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D. Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.
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Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Risk for Injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction
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B. The highest priority is safety.
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The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills
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B. Allergy is the most common side effect. Although fever & chills are side effect of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.
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Which intervention will be most helpful in preventing disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest
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C. Sepsis is a major cause of DIC, especially in the oncology client. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.
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When caring for a client with suspected SIADH, the nurse reviews the medical record to uncover which signs and symptoms consistent with this syndrome? (select all that apply) A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness
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a,b,e: ADH is secreted or produced ectopically, resulting in water retention and sodium dilution which causes confusion and changes in mental status and weakness. Tachycardia may result from fluid volume excess.
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The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)? A.Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine 131
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B. Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS.
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When caring for a client with cachexia, the nurse expects to note which symptom? A. Weight loss B. Anemia C. Bleeding tendencies D. Motor deficits
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A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.
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When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply. A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns
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B,D,E
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The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.
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A,C,D,F: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms, as well as Flowers and plants. Thrombocytopenia cause bleeding, not low neutrophils.The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.
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Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day
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C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia.
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Which teaching is most appropriate for a client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.
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C. A high-fiber diet will assist with constipation due to neuropathy. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns
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The nurse is teaching a client who is receiving an anti-estrogen drug about the side effects she may encounter. Which of these should the nurse include in the discussion? Select all that apply. A. Heavy menses B. Smooth facial skin C. Hyperkalemia D. Breast tenderness E. Weight loss F. Deep vein thrombosis (DVT)
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D,F: Breast tenderness and shrinking breast tissue, Venous thromboembolism, Irregular menses or no menstrual period, Acne may develop, Hypercalcemia, not hyperkalemia, is typical and Fluid retention with weight gain may occur.
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Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)
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B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.
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A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr
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C. A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow. the other options are too complex
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The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. A client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. A client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. A client with xerostomia associated with laryngeal cancer who needs oral care before breakfast
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A. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first.
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The outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light
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D. Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties. Drugs should be stored according to the recommendations, but this is not the primary concern for this client. The client will be homebound for 1 to 3 months after the treatment and should not go outside.
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Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain
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B. Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.
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The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia
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B. TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
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The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
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D. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat.
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Which of the following items would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
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D. A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy.
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Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
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D. Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.
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Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
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A. Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
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A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer A. Is in situ. B. Has metastasized. C. Has spread locally. D. Has spread extensively.
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C. Stage II cancer is associated with local spread. Stage 0 denotes cancer in situ; stage III denotes extensive regional spread, and stage V denotes metastasis.
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A client newly diagnosed with acute leukemia asks why he is at such extreme risk for infection when his white blood cell count is so high. What is the nurse's best response? A. "Even though you have many white blood cells, they are too immature to fight infection." B. "For now, your risk is low; however, when the chemotherapy begins, your risk for infection will be high." C. "These white blood cells are cancerous and live longer than normal white blood cells, so they are too old to fight infection." D. "It is not the white blood cells that provide protection; it is the red blood cells, which are very low in your blood right now."
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A. For clients who understand that white blood cells are a great protection against infection, being at great risk for infection even when WBC counts are sometimes ten times normal is confusing. These are leukemic cells that overgrow at a very immature level. Therefore even though there can be huge numbers of circulating WBCs, these cells are so immature that they are nonfunctional. In addition, the heavy production of immature leukemic cells prevents normal WBCs, RBCs, and platelets from forming and maturing into functional cells.
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Which precaution is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination? A. Take antibiotics exactly as prescribed. B. Perform mouth care three times daily. C. Avoid the use of pepper and raw foods. D. Report any burning on urination immediately.
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B. Autocontamination is the overgrowth of the client's own normal flora or the translocation of his or her normal flora from its normal location to a different one. Performing frequent mouth care can reduce the number of normal flora organisms in the mouth and decrease the risk for developing an infection from autocontamination. Taking antibiotics does not prevent autocontamination, nor does reporting symptoms of an infection. Avoiding exposure to environmental organisms does not prevent autocontamination.
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Six weeks after hematopoietic stem cell transplantation for leukemia, the client's white blood cell (WBC) count is 8200/mm3. What is the nurse's best action in view of this laboratory result? A. Notify the health care provider immediately. B. Assess the client for other symptoms of infection. C. Document the laboratory report as the only action. D. Remind the client to avoid crowds and people who are ill.
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C. The WBC count is now within the normal range (5000 to 10,000/mm3) and is an indicator of successful engraftment. The client is not at any particular risk for infection at this time, nor is there reason to believe an infection is present. (At any post-transplantation check-up, the client is assessed for infection.)
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Which assessment is most important for the nurse to perform for the client receiving one unit of packed red blood cells from an autologous donation? A. Temperature B. Blood pressure C. Oxygen saturation D. IV site for hives
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A. In an autologous blood transfusion, the client receives his or her own blood components. Therefore the chances for an incompatibility type reaction do not exist. The main problems that can come from autologous transfusion are fluid overload and infection from blood contamination during the collection, storage, or infusion processes. Fluid overload is very unlikely when only one unit is being transfused. Contamination and infection are just as likely with an autologous transfusion as they are with a transfusion of donated blood products. The most important assessment is for signs of infection, including temperature.
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When teaching women about the risk of breast cancer, which risk factor does the nurse know is the most common for the development of the disease? A. Having an aunt with breast cancer B. Being an older adult C. Being a Euro-American D. Consuming a low-fat diet
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B. There is no single-known cause for breast cancer. Being an older woman or man is the primary risk factor, although some people are at higher risk than others. Having a first-degree relative (mother, sister, or daughter) with breast cancer can increase the risk; an aunt is not considered a first-degree relative. Although Euro-American women older than 40 years are at a more increased risk than other racial/ethnic groups, the greater risk is being an older adult. Consuming a high-fat diet is considered a risk factor.
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The nurse is assigned to care for a client immediately after breast-conserving surgery for cancer. What is the priority for care of the client at this time? A. Teach the client to sleep in the prone position each night. B. Empty wound drains and record the output amount. C. Remind the client how to perform breast self-examination. D. Monitor the incision and flap for adequate tissue perfusion.
answer
D. Assess the incision and flap for duskiness and decreased capillary refill during dressing changes, which are signs of poor tissue perfusion. The client should avoid sleeping in the prone position. Emptying drains, documenting output, and encouraging BSE are important but are not the priority in the immediate postoperative phase.
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A client had a transurethral resection of the prostate (TURP) yesterday. The staff nurse notes that the hemoglobin is 8.2 g/dL. What is the nurse's best action? A. Notify the charge nurse as soon as possible. B. Irrigate the catheter with 30 mL normal saline. C. Document the assessment in the medical record. D. Prepare for a blood transfusion.
answer
D. Blood transfusions are commonly given after a TURP surgery; a blood transfusion is warranted for a hemoglobin reading of 8.2 g/dL. The nurse is capable of managing this situation with the physician, especially since blood transfusions after a TURP are common. Irrigating the catheter is necessary only if the color of the drainage indicates bleeding or there is a presence of clots. Documentation should be done, but it is not the first priority.
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A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102 deg. F or higher D. Wheezes or crackles
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D. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.
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A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first? A. Hydrates the client with 1000 mL of IV normal saline B. Initiates the administration of prescribed antibiotics C. Obtains requested cultures D. Places the client on Bleeding Precautions
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C. Obtaining cultures to identify the infectious agent correctly is the priority for this client.
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The client who has recently had breast cancer surgery requests a volunteer to visit her home to help with recovery. Which community resource will the nurse recommend? A. National Breast Cancer Coalition B. Reach for Recovery C. Susan G. Komen for the Cure D. Young Survival Coalition
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B. The American Cancer Society's program "Reach for Recovery" provides volunteers who visit clients in the hospital or at home. They bring personal messages of hope, informational materials on breast cancer recovery, and a soft, temporary breast form.
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The client has been diagnosed with breast cancer. Which treatment option chosen by the client requires the nurse to discuss with the client the necessity of considering additional therapy? A. Chemotherapy B. Complementary and alternative therapy (CAM) C. Hormonal therapy D. Neoadjuvant therapy
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B. No proven benefit has been found with using complementary and alternative therapy alone as a cure for breast cancer. The nurse must ensure that the client's choices can be safely integrated with conventional treatment for breast cancer.
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A client asks the nurse about early detection of breast masses. Which statement by the nurse about early detection of breast masses is correct? A. "A yearly breast examination by a health care provider can substitute for breast self-examination (BSE)." B. "Detection of breast cancer before axillary node invasion yields the same survival rate." C. "Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age." D. "The goal of screening for breast cancer is early detection because BSE does not prevent breast cancer."
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D. The purpose of screening is early detection. BSE does not prevent breast cancer.
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The nurse is instructing a client on how to perform breast self-examination (BSE). Which techniques will the nurse include in teaching the client about BSE? Select all that apply. A. Instruct the client to keep her arm by her side while performing the examination. B. Ensure that the setting in which BSE is demonstrated is private and comfortable. C. Ask the client to remove her shirt. The bra may be left in place. D. Ask the client to demonstrate her own method of BSE. E. Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts.
answer
B,D: The setting should be private and comfortable to promote an environment conducive to learning and to prevent potential client embarrassment. Before teaching breast palpation, ask the client to demonstrate her own method, so that the nurse can assess the client's understanding of BSE. For better visualization, the arm should be placed over the head.The client should undress from the waist up. The finger pads, which are more sensitive than the fingertips, are used when palpating the breasts.
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A client with a high genetic risk for breast cancer asks the nurse about options for prevention and early detection. Which option for prevention and early detection is the option of choice? A. Breast self-examination (BSE) beginning at 20 years of age B. Hormone replacement therapy combining estrogen and progesterone C. Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 D. Prophylactic mastectomy
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C. The American Cancer Society recommends that high-risk women (greater than 20% lifetime risk) have an MRI and mammography every year beginning at age 30.
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The nurse suspects that which client has the highest risk for breast cancer? A. Older adult woman with high breast density B. Nullipara older adult woman C. Obese older adult male with gynecomastia D. Middle-aged woman with high breast density
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A. People at high increased risk for breast cancer include women aged 65 years and older with high breast density.
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The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about side effects of doxorubicin (Adriamycin). Which side effect will the nurse instruct the client to report to the physician? A. Diaphoresis B. Dysphagia C. Edema D. Hearing loss
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C. Doxorubicin (Adriamycin) is an anthracycline, and clients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue.
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The client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client's concerns? A. Allow the client to bring up the topic first. B. Remind the client to avoid sexual intercourse for 2 months after the surgery. C. Suggest that the client wear a bra during intercourse. D. Teach the client that birth control is a priority.
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C. Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to prevent contact with the surgical site during intercourse.
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The client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client is maladaptive? A. Avoiding eye contact with staff B. Saying, "I feel like less of a woman" C. Requesting a temporary prosthesis immediately D. Saying, "This is the ugliest scar ever"
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A. Avoiding eye contact may be an indication of decreased self-image.
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Which assessment finding indicates to the nurse that the client is at high risk for a malignant breast lesion? A. 1-cm freely mobile rubbery mass discovered by the client B. Ill-defined painful rubbery lump in the outer breast quadrant C. Backache and breast fungal infection D. Nipple discharge and dimpling
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D. Nipple discharge and dimpling are high-risk assessment findings for a malignant breast lesion.
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The large-breasted client reports discomfort, backaches, and fungal infections because of her excessive breast size. The nurse plans to provide information to the client about which breast treatment option? A. Augmentation B. Compression C. Reconstruction D. Reduction mammoplasty
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D. Breast reduction mammoplasty surgery removes excess breast tissue and repositions the nipple and remaining skin flaps to produce the best cosmetic effect.
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The nurse is teaching postmastectomy exercises to the client. Which statement made by the client indicates that teaching has been effective? A. "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." B. "In rope turning, I'll hold the rope with my arms flexed." C. "In rope turning, I'll start by making large circles." D. "With hand wall climbing, I'll walk my hands up the wall and back down until they are at waist level."
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A. This is a correct description of how to perform the pulley exercise properly.
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The nurse is discussing treatment options with the client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching? A. "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of it." B. "I might have chemotherapy before surgery." C. "If I get radiation, I am not radioactive to others." D. "Radiation will remove the cancer, so I might not need surgery."
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D. Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation therapy plays a critical role in the therapeutic regimen and is effective treatment for almost all sites where breast cancer can metastasize. The purpose of radiation therapy is to reduce the risk for local recurrence of breast cancer.
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The client is receiving chemotherapy treatment for breast cancer and asks for additional support for managing the associated nausea and vomiting. Which complementary therapy will the nurse suggest? A. Ginger B. Journaling C. Meditation D. Yoga
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A. It has long been believed that ginger helps alleviate nausea and vomiting. Current studies are being done on the effect of ginger on chemotherapy-induced nausea.
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The client who has had a mastectomy asks the nurse about breast reconstructive surgery. Which statement by the nurse about breast reconstruction is true? A. "Many women want breast reconstruction using their own tissue immediately after mastectomy." B. "Placement of saline- or gel-filled prostheses is not recommended because of the nature of the surgery." C. "Reconstruction of the nipple-areola complex is the first stage in the reconstruction of the breast." D. "The surgeon should offer the option of breast reconstruction surgery once healing has occurred after the mastectomy."
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A. Many women want autogenous reconstruction after mastectomy.
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Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)? A. Recent radical mastectomy client who requires chemotherapy administration B. Modified radical mastectomy client who needs discharge teaching C. Stage III breast cancer client who is requesting information about radiation and chemotherapy D. A client with a Jackson-Pratt drain in place who has just arrived from the postanesthesia care unit (PACU) after a quadrantectomy
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D. A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains.
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Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy? A. Assess anxiety level about the surgery. B. Monitor the vital signs after surgery. C. Obtain data about breast cancer risk factors. D. Teach about postoperative routine care.
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B. Vital sign assessment is included in nursing assistant education and usually is part of the job description for UAP working in a hospital setting.
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A client who has just been discharged from the hospital after a modified radical mastectomy is referred to a home health agency. Which nursing action will be most appropriate to delegate to an experienced home health aide? A. Assessing the safety of the home environment B. Developing a plan to decrease lymphedema risk C. Monitoring pain level and analgesic effectiveness D. Reinforcing the guidelines for hand and arm care
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D. Reinforcement of previously taught information about hand and arm care should be done by all caregivers.
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A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, "I just don't know how this could have happened to me." Which of these responses by the nurse will be most appropriate? A. "Tell me what you mean when you say you don't know how this could have happened to you." B. "Do you have a family history that might make you more likely to develop breast cancer?" C. "Would you like me to help you find more information about how breast cancer develops?" D. "Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it."
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A. The client's statement may indicate shock and denial or a request for more information. To provide appropriate care, further assessment is needed about the client's psychosocial status. The first action by the nurse in this situation is to obtain more data by asking open-ended questions.
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A premenopausal client diagnosed with breast cancer will be receiving hormonal therapy. The nurse anticipates that the physician will request which medication for this client? A. Anastrazole (Arimdex) B. Fulvestrant (Faslodex) C. Leuprolide (Lupron) D. C. Trastuzumab (Herceptin)
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C. Leuprolide (Lupron) is used in premenopausal women whose main estrogen source is the ovaries and who may benefit from luteinizing hormone-releasing hormone (LH-RH) agonists that inhibit estrogen synthesis.
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The client with prostate cancer asks the nurse for more information and counseling. Which resources will the nurse suggest? Select all that apply. A. American Cancer Society's Man to Man program. B. Us TOO International. C. American Prostate Cancer Society. D. National Prostate Cancer Coalition. E. The client's church, synagogue, or place of worship.
answer
A,B,D,E: American Cancer Society's Man to Man program helps the client and partner cope with prostate cancer. This program provides one-on-one education, personal visits, educations presentations, and the opportunity to engage in open and candid discussions. Us TOO International is a prostate cancer support group that is sponsored by the Prostate Cancer Education and Support Network. The National Prostate Cancer Coalition provides prostate cancer information.The client's church, synagogue or place of worship is a community support service that may be important for many clients.
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The client with prostate cancer asks why he must have surgery instead of radiation, even if it is the least invasive type. What is the nurse's best response? A."It is because your cancer growth is large." B. "Surgery is the most common intervention to cure the disease." C. "Surgery slows the spread of cancer." D. "The surgery is to promote urination."
answer
B. Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure.
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With which male client will the nurse conduct prostate screening and education? A. Young adult with a history of urinary tract infections. B. Client who has sustained an injury to the external genitalia. C. Adult who is older than 50 years. D. Sexually active client.
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C. A man who is 50 years or older is at higher risk for prostate cancer.
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The issue that is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse is the alteration of which factor? A. Comfort because of surgical pain. B. Mobility because of treatment. C. Nutrition because of radiation treatment. D. Sexual function after treatment.
answer
D. : Altered sexual function is one of the biggest concerns of men after cancer treatment.
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The client with benign prostatic hyperplasia (BPH) is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? Select all that apply. A. Avoid drugs used to treat erection problems. B. Be careful when changing positions. C. Keep all appointments for follow-up laboratory testing. D. Hearing tests will need to be conducted periodically. E. Take the medication in the afternoon.
answer
A-C: Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension, can cause liver damage, do not affect hearing and should be taken in the evening to decrease the risk of problems related to hypotension.
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The client has undergone transurethral resection of the prostate (TURP). Which intervention will the nurse incorporate in this client's postoperative care? A. Administer antispasmodic medications. B. Encourage the client to urinate around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place the client in a supine position, with his knees flexed.
answer
A. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur after TURP.
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The nurse understands that hormone treatment for prostate cancer works by which action? A. Decreases blood flow to the tumor. B. Destroys the tumor. C. Shrinks the tumor. D. Suppresses growth of the tumor.
answer
D. Hormone therapy, particularly anti-androgen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Anti-androgens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation).
