2. Which of the following laboratory values is expected for a client just diagnosed with chronic lymphocytic leukemia? 3. At the time of diagnosis of Hodgkin’s lymphoma, which of the following areas is often involved? 4. According to a standard staging classification of Hodgkin’s disease, which of the following criteria reflects stage II? 5. Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? 6. Which of the following foods should a client with leukemia avoid? 7. A client with leukemia has neutropenia. Which of the following functions must be
frequently assessed? 8. Which of the following clients is most at risk for developing multiple myeloma? 9. Which of the following substances has abnormal values early in the course of multiple myeloma
(MM)? 10. For which of the following conditions is a client with multiple myeloma (MM) monitored? 11. Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? 12. During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease? 13. The client
with which of the following types of lung cancer has the best prognosis? 14. Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? 15. A centrally located tumor would produce which of the
following symptoms? 16. Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? 17. A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? 18. When a client has a lobectomy, what fills the space where the lobe was? 19. Which of the following
is the primary goal for surgical resection of lung cancer? 20. If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes how
the extent of that can be performed? 21. The client with a benign lung tumor is treated in which of the following ways? 22. In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions?
23. What are the three most important prognostic factors in determining long-term survival for children with acute leukemia?
24. Which of the following complications are three main consequences of leukemia?
25. A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia?
26. Which of the following assessment findings in a client with leukemia would indicate that the cancer has invaded the brain?
27. Which of the following types of leukemia carries the best prognosis?
28. Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia?
29. Which of the following tests in performed on a client with leukemia before initiation of therapy to evaluate the child’s ability to metabolize chemotherapeutic agents?
30. Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia?
31. Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia?
32. In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client?
33. Which of the following treatment measures should be implemented for a child with leukemia who has been exposed to the chickenpox?
34. Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics?
35. Parents of pediatric clients who undergo irradiation involving the central nervous system should be warned about postirradiation somnolence. When does this neurologic syndrome usually occur?
36. The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client:
37. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions?
38. The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care?
39. A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder?
40. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder?
41. The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care?
42. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin’s disease. The nurse determines that further education is needed if a nursing staff member states that which of the following is characteristic of the disease?
43. The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following?
44. The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery?
45. A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate?
46. Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient?
47. The nurse is teaching a 17-year old client and the client’s family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client?
48. A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following?
49. When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply.
50. A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:
51. A 32-year-old woman meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesn’t go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client’s current needs?
52. One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is:
53. A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-cell lung cancer. A pneumonectomy involves removal of:
54. A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present?
55. Which of the following represents the most appropriate nursing intervention for a client with pruritis caused by cancer or the treatments?
56. A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is most likely responsible for her symptoms?
10. 1. Calcium is released when the bone is destroyed. This causes an increase in serum calcium levels. MM doesn’t affect potassium, sodium, or magnesium levels. 11. 4. Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important. 12. 4. Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable. 13. 3. Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize. 14. 4. Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren’t typically considered warning signals, but may occur in advanced stages of cancer. 15. 1. Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow, producing such symptoms as coughing, wheezing, and stridor. Small cell tumors tend to be located in the lower airways and often cause hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain. Pancoast tumors that occur in the apices may cause shoulder pain. 16. 2. Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it’s detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose chemotherapy has minimal effect on long-term survival. Smoking cessation won’t reverse the process but may help prevent further decompensation. 17. 3. A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy. 18. 4. The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. The space can’t remain “empty” because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. The surgeon doesn’t use a gel to fill the space. Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift. 19. 2. The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what’s absolutely necessary is removed. 20. 4. If the client’s preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with on;t chemotherapy and radiation. 21. 4. The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead to respiratory decompensation. If for some reason it can’t be removed, then radiation or chemotherapy may be used to try to shrink the tumor. 22. 3. The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort. Preparing the client and his family for the impending death and providing emotional support is also important but shouldn’t be the primary focus until the pain is under control. Nutritional support may be provided, but as the terminal phase advances, the client’s nutritional needs greatly decrease. Nursing care doesn’t focus on helping the client prepare the will. 23. 3. The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a better prognosis because age 2 or after 10. 24. 2. The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone deformities don’t occur with leukemia although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn’t a feature in leukemia. Mature cells aren’t produced in adequate numbers. Hirsutism and growth delay can be a result of large doses of steroids but isn’t common in leukemia. Anemia, not polycythemia, occurs. Clotting times would be prolonged. 25. 4. The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Increased appetite can occur but it usually isn’t a presenting symptom. Abdominal pain may be caused by areas of inflammation from normal flora within the GI tract or any number of other causes. 26. 1. The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain. The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache, vomiting, irritability, lethargy, increased blood pressure, decreased heart rate, and eventually, coma. Often children with a variety of illnesses are hypervigilant and anxious when hospitalized. 27. 1. Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children. Basophillic and eosinophillic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis. 28. 4. A spinal tap is performed to assess for central nervous system infiltration. It wouldn’t be done to decrease ICP nor does it aid in the classification of the leukemia. Spinal taps can result in brain stem herniation in cases of ICP. A spinal tap can be done to rule out meningitis but this isn’t the indication for the test on a leukemic client. 29. 2. Liver and kidney function studies are done before initiation of chemotherapy to evaluate the child’s ability to metabolize the chemotherapeutic agents. A CBC is performed to assess for anemia and white blood cell count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells. A lumbar puncture is performed to assess for central nervous system infiltration. 30. 4. OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be indicated because it isn’t a live virus and wouldn’t pose the threat of infection. DTP, Hib, and hepatitis B vaccines can be given accordingly to the recommended schedule. 31. 1. The most frequent cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn’t an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent. 32. 1. For the first episode of acute lymphocytic anemia, conventional therapy is superior to bone marrow transplantation. In severe combined immunodeficiency and in severe aplastic anemia, bone marrow transplantation has been employed to replace abnormal stem cells with healthy cells from the donor’s marrow. In myeloid leukemia, bone marrow transplantation is done after chemotherapy to infuse healthy marrow and to replace marrow stem cells ablated during chemotherapy. 33. 4. Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the course of the disease. Giving the vaccine at the onset of symptoms wouldn’t likely decrease the severity of the illness. Acyclovir may be given if the child develops the disease but not if the child has been exposed. 34. 1. Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed. 35. 3. Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3 to 15 days. It’s characterized by somnolence with or without fever, anorexia, nausea, and vomiting. Although the syndrome isn’t thought to be clinically significant, parents should be prepared to expect such symptoms and encourage the child needed rest. 36. 2. The testicular-self examination is recommended monthly after a warm shower or bath when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps. 37. 3. Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer. 38. 3. Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if leukopenia is present. Options 1 and 4, although important in the plan of care are not related directly to thrombocytopenia. 39. 4. Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Option 1 describes the leukemic process. Options 2 and 3 are not characteristics of multiple myeloma. 40. 3. Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma. 41. 2. Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options 1, 3, and 4 may be components in the plan of care but are not the priority in this client. 42. 3. Hodgkin’s disease is a disorder of young adults. Options 1, 2, and 4 are characteristics of this disease. 43. 1. A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection. 44. 4. Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. The other options are expected occurrences. 45. 4. A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided. 46. 3. For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion. Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder. Administering cough suppressants will not help respiratory effort. A low semi-Fowlers position does not encourage lung expansion. Lung expansion is enhanced in the upright position. 47. 1. Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function. 48. 1. There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins. 49. 1, 2, 4, 5. A major concern with intravenous administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent evaluation of blood return when administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is questionable and may require a declotting regimen. 50. 3. The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29 mEq/L. 51. 4. The content of the client’s comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first address the psychosocial and sexual issues that are contributing to her sleeping difficulties. A nutritional assessment may be useful, but there is no indication that she has anorexia. 52. 4. Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinic DIC; however, sepsis is the most common cause. 53. 1. A pneumonectomy is the removal of an entire lung field. A wedge resection refers to removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of one lobe. Removal of one or more segments of a lung lobe is called a partial lobectomy. 54. 2. Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased. 55. 4. Nursing interventions to decrease the discomfort of pruitus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicyclic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for the hospitalized client with pruritis. 56. 4. Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall. Which of the following complications are three main consequences of leukemia *?The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production.
Which of the following food should a client with leukemia avoid?raw or undercooked seafood and shellfish, including sushi and sashimi. unpasteurized drinks, such as fruit juice, milk, or raw milk yogurt. soft cheese made from unpasteurized milk. uncooked or unpasteurized egg, and foods that contain it.
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