Med-Surg II Exam #4

A client asks the nurse why his colorectal cancer is being tested for genetic mutations even though no one else in the family has ever had cancer. What is the nurse's best response?
A. "Colorectal cancer is rare and most cases are caused by a genetic mutation."
B. "The results of this testing will indicate what caused your cancer so you can avoid further exposure."
C. "Many tumors have one or more genetic differences that can help determine the most effective treatment options."
D. "Genetic testing of tumor cells can help determine the stage of your cancer and whether it has spread to other organs."

C. "Many tumors have one or more genetic differences that can help determine the most effective treatment options."

Rationale:
Genetic testing of tumor cells (not the client with cancer) can indicate genetic mutations that would increase the susceptibility of the tumor to being killed off or having its growth controlled by targeted therapy. It does not indicate cause, stage, or degree of metastasis. Colorectal cancer is very common. Although some colorectal cancers are caused by a genetic mutation, these cancers "run in families."

An older client reports all of the following changes since his last checkup. Which changes alerts the nurse to the possibility of prostate cancer? Select all that apply.
A. Bloody urine
B. Constipation intermittent with diarrhea
C. Erectile dysfunction
D. Night sweats and fever
E. Persistent pain in the lower back and legs
F. Reduced urine stream

D. Night sweats and fever
E. Persistent pain in the lower back and legs
F. Reduced urine stream

Rationale:
Bloody urine is most associated with bladder cancer. Constipation/diarrhea and erectile dysfunction are not common signs or symptoms of prostate cancer. Reduced urine stream is associated with both prostate cancer and benign prostatic hyperplasia and is considered a red flag for prostate cancer when associated with other prostate cancer symptoms. Persistent pain in the lower back and legs, as well as night sweats and fever are associated with late stage prostate cancer.

How does a mutation is a suppressor gene, such as BRCA1, increase the risk for cancer development?
A. Converting a proto-oncogene into an oncogene
B. Removing the control over proto-oncogene expression
C. Reducing the amount of cylins produced by the oncogenes
D. Inhibiting the recognition of abnormal cells through immunosurveillance

B. Removing the control over proto-oncogene expression

Rationale:
Suppressor genes make products that control proto-oncogenes and prevent them from being over expressed, which would increase cell division. Thus when suppressor genes are mutated cellular regulation is lost and the increased cell division can result in cancer development. Conversion of a proto-oncogene to an oncogene requires a mutation in the proto-oncogene, not the suppressor gene. Health suppressor genes do control the amount of cyclins produced by either oncogenes or proto-oncogenes, so a mutated suppressor gene would lose this function. Suppressor genes do not interfere with the immunosurveillance performed by certain immune system cells to detect the presence of abnormal cells.

A client's cancer is staged as T1, N2, M1 by the TNM classification system. How does the nurse interpret this report?
A. The client has two tumors that are nonresponsive to treatment.
B. The client has leukemia confined to the bone marrow.
C. The client has a 2 cm tumor with one regional lymph node involved and no distant metastasis.
D. The client has a small primary tumor extension into 3 lymph nodes and one site of distant metastasis.

D. The client has a small primary tumor extension into 3 lymph nodes and one site of distant metastasis.

Rationale:
T = primary tumor. A T1 indicates a primary tumor is detectable but still relatively small. N = regional lymph nodes. An N2 indicates regional lymph nodes are involved. M = distant metastasis. M1 indicates there is evidence of distant metastasis in at least one site.

Which statements made by a 62-year old client alerts the nurse to the possibility that the he may be at increased genetic risk for cancer development? Select all that apply.
A. An older aunt died from a brain tumor while she had breast cancer
B. He had two benign colon polyps removed during his most recent routine colonoscopy
C. His sister died from cancer of the appendix
D. His brother is being treated for breast cancer
E. His daughter 32-year-old daughter has been recently diagnosed with cervical cancer
F. One person in each of the previous three generations of his family has died from lung cancer

C. His sister died from cancer of the appendix
D. His brother is being treated for breast cancer

Rationale:
Lung cancer and cervical cancers are considered environmentally-induced cancers and really do not have a specific genetic predisposition. The fact that one person in each of three family generations developed lung cancer is not considered excessive. Breast cancer in older women is common and often spreads to the brain. Two benign colon polyps are common for the age group and do not indicate a genetic predisposition. The brother has a cancer that is rare for the gender and the sister has an extremely rare cancer type. Both of these cancers in first degree relatives are "red flags" for the possibility of an increased genetic risk for cancer.

A client with prostate cancer is receiving external beam radiation for treatment. What teaching will the nurse provide following the radiation treatment?
A. "After the treatment, there is no radiation hazard to others."
B. "Do not share a bathroom with your spouse for 2 days."
C. "Visitors should be limited to 30 minutes to avoid prolonged radiation exposure."
D. "Report a temperature of 99.1F to the healthcare provider."

A. "After the treatment, there is no radiation hazard to others."

Rationale:
External beam is radiation delivered from a source outside of the patient. Since the radioactive source is external, the patient is not radioactive, and there is no hazard to others around the patient once the treatment is complete. Temperature greater than 100.4 should be reported.

A client receiving radiation for head and neck cancer reports that the skin in the radiation field is itching and painful. Which nursing education will the nurse provide?
A. "This is likely from medication, not the radiation treatment."
B. "Cover the area with soft clothing."
C. "Be sure to wash your hands well before touching the area."
D. "Sunlight to the radiated area can help the skin heal."
E. "Use a washcloth to thoroughly clean the area with soap and water."
F. "Do not remove the ink markings on the skin."

B. "Cover the area with soft clothing."
C. "Be sure to wash your hands well before touching the area."
F. "Do not remove the ink markings on the skin."

Rationale:
The skin is likely irritated from the radiation and priority care is to teach the client to protect the radiated skin. The area can be covered with soft, non-irritating clothing and the client should wash the hands with soap and water before touching the skin to prevent infection. Skin in the radiation path is photosensitive. As such, the nurse will teach the client to avoid the sun. The skin is very fragile and friction from a washcloth should be avoided. Wash the skin, gently with the hand. The nurse will teach the client to leave the markings on the skin as those markings are used to ensure that the radiation path is consistent with each treatment.

The nurse is observing the unlicensed assistive personnel (UAP) provide care to a client who is neutropenic. Which action by the UAP requires the nurse to intervene?
A. Performing a bed bath because the client is too tired to get in the shower.
B. Using the unit mobile blood pressure machine to assess the client's vitals.
C. Using alcohol-based hand foam before touching the client.
D. Cleaning the client's bathroom with disinfectant.

B. Using the unit mobile blood pressure machine to assess the client's vitals.

Rationale:
The hospitalized client who is neutropenic should have dedicated equipment that is not shared with other clients. The nurse would intervene if the UAP attempted to use the mobile blood pressure cuff that is used for all clients and teach the UAP to use a dedicated blood pressure cuff and stethoscope that is at the bedside in the client's room. All other options are correct actions for the UAP.

The nurse is teaching about infection prevention to a client with cancer who is neutropenic. Which client statement requires additional teaching?
A. "I will call the healthcare provider if I get a temperature of 100.4 or greater.
B. "I will wash my hands after attending church."
C. "I will wear a condom when having intercourse."
D. "I will not drink anything that has been at room temperature for more than an hour."

B. "I will wash my hands after attending church."

Rationale:
The client with cancer who is actively experiencing neutropenia should avoid crowds and large gatherings until the white blood cell count recovers. While washing hands is appropriate, attending church should be avoided while neutropenic to decrease the risk of infection. All other responses are appropriate for the neutropenic client.

The nurse is assessing a client that has advanced bone cancer. Which client assessment data causes the nurse to suspect spinal cord compression? Select all that apply.
A. Reports of a headache for the past 7 hours.
B. Decreased breath sounds in the left lung.
C. Worsening mid-thoracic back pain.
D. Tingling in the right lower extremity.
E. Unsteady gait when ambulating to the bathroom.
F. Reports of difficulty sleeping.

C. Worsening mid-thoracic back pain.
D. Tingling in the right lower extremity.
E. Unsteady gait when ambulating to the bathroom.

Rationale:
Spinal cord compression can occur if a tumor invades the spinal column or when the vertebrate collapses due to degradation of the bone from cancer. Back pain is often a first symptom. The nurse should assess for worsening low back pain, numbness and tingling in the extremities, unsteady gait and neurologic changes. A headache, decreased breath sounds, and difficulty sleeping are not indicators of spinal cord compression.

1. A client with chemotherapy induced neutropenia is prescribed filgrastim. The client states, "The bones in my legs are aching so bad." What nursing response is appropriate?
A. "The pain in your legs is likely from the cancer."
B. "Bone pain is a side effect of filgrastim that improves with time."
C. "Increasing activity will help with the bone pain."
D. "Have you had any fever or nausea?"

B. "Bone pain is a side effect of filgrastim that improves with time."

Rationale:
Filgrastim is a colony stimulating factor that is used as supportive therapy during chemotherapy. Bone pain is a common side effect that is usually managed with ibuprofen, and occasionally requires opioid prescriptions. However, the pain is usually short lived and improves with time.

1. The nurse is caring for a client with a sealed radiation implant for the treatment of cancer. Which nursing intervention is appropriate? Select all that apply.
A. Place a caution sign on the door of the client's room.
B. Wear a dosimeter badge for protection when providing care.
C. Allow the client's spouse to stay with the client at least 6 feet away for 4 hours.
D. Do not allow children to visit the client for any length of time.
E. Keep the door to the client's room closed.

A. Place a caution sign on the door of the client's room.
D. Do not allow children to visit the client for any length of time.
E. Keep the door to the client's room closed.

Rationale:
A sealed radiation implant emits radiation near the tumor bed continuously. The nurse will place a caution sign on the client's door warning of radioactive material. The nurse will wear a dosimeter. However, this does not provide protection, only detection of exposure to radiation. The nurse can allow the client's spouse to visit for a total of 30 minutes per day at a distance of 6 feet away from the client. Children and pregnant women are not allowed to visit. The nurse should keep the door to the client's room closed as much as possible.

1. The nurse is teaching a client who has been prescribed an oral chemotherapy agent. What teaching will the nurse include?
A. "Oral chemotherapy drugs are not as toxic as IV chemotherapy."
B. "Do not crush, split, break, or chew the oral chemotherapy drug."
C. "You may dispose of unused oral chemotherapy drugs in the trash."
D. "Oral chemotherapy drugs are not absorbed through the skin."

B. "Do not crush, split, break, or chew the oral chemotherapy drug."

Rationale:
The nurse will teach the client that oral chemotherapy agents cannot be broken, chewed, split, or crushed. The nurse will teach the client that oral chemotherapy drugs are just as toxic as IV chemotherapy, cannot be disposed of in the trash, and can be absorbed through the skin.

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome will the nurse teach the client is the goal of palliative surgery?
A. Prolonging the client's survival time
B. Relief of symptoms or improved quality of life
C. Allowing other therapies to be more effective
D. Cure of the cancer

B. Relief of symptoms or improved quality of life

Rationale:
The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time.

Which client statement allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment?
A. "I may lose my hair during this treatment."
B. "I will have a radioactive device in my body for a short time."
C. "I must be positioned in the same way during each treatment."
D. "I will be placed in a semiprivate room for company."

B. "I will have a radioactive device in my body for a short time."

Rationale:
Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific. Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?
A. Infection
B. Drug toxicity
C. Polycythemia
D. Dose-limiting side effects

A. Infection

Rationale:
The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?
A. Lung
B. Veins of the legs
C. Abdominal cavity
D. Heart

C. Abdominal cavity

Rationale:
Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?
A. Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%
B. 5000 white blood cells/mm3 (5 × 109/L)
C. 250,000 platelets/mm3 (250 × 109/L)
D. Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea

A. Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%

Rationale:
Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels.The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L), and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
A. Providing oral care with a disposable mouth swab
B. Maintaining NPO until the lesions have resolved
C. Encouraging oral care with commercial mouthwash
D. Administering a biological response modifier

A. Providing oral care with a disposable mouth swab

Rationale:
The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?
A. Explain that this occurs in some clients and is usually permanent.
B. Inform 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.

D. Allow the client an opportunity to express her feelings.

Rationale:
Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
A. Potential for injury related to sensory and motor deficits
B. Altered sexual function related to erectile dysfunction
C. Potential for lack of understanding related to side effects of chemotherapy
D. Potential for ineffective coping strategies related to loss of motor control

A. Potential for injury related to sensory and motor deficits

Rationale:
The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

The nurse is caring for a client who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect?
A. Alopecia
B. Fever
C. Allergy
D. Chills

C. Allergy

Rationale:
Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit. Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

Which intervention will the oncology nurse use to prevent disseminated intravascular coagulation (DIC)?
A. Monitoring platelets
B. Using strict aseptic technique to prevent infection
C. Administering packed red blood cells
D. Administering low-dose heparin therapy for clients on bedrest

B. Using strict aseptic technique to prevent infection

Rationale:
Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being prescribed?
A. Radioactive iodine-131
B. Allopurinol
C. Recombinant erythropoietin
D. Potassium chloride

B. Allopurinol

Rationale:
The nurse expects allopurinol to be prescribed, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous because the client is already hyperkalemic. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?
A. Observe for motor deficits.
B. Monitor weight.
C. Monitor platelets.
D. Trend red blood cells and hemoglobin and hematocrit.

B. Monitor weight.

Rationale:
Cachexia results in extreme body wasting, malnutrition, and severe weight loss. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

Which instruction is appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy?
A. Consume a diet high in fiber.
B. Bathe in cold water.
C. Wear cotton gloves when cooking.
D. Make sure shoes are snug.

A. Consume a diet high in fiber.

Rationale:
A high-fiber diet will assist with constipation related to neuropathy. The client should bathe in warm not cold water, not hotter than 96° F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?
A. Naloxone
B. Ondansetron
C. Diazepam
D. Morphine

B. Ondansetron

Rationale:
Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea. Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.

The RN working on an oncology unit has just received report on these clients. Which client will the nurse assess first?
A. Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy.
B. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour.
C. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast.
D. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

D. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

Rationale:
The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

The nurse is teaching a client undergoing radiation therapy for laryngeal cancer. Which potential side effects will the nurse include? (Select all that apply.)
A. Fatigue
B. Difficulty urinating
C. Change in taste
D. Difficulty swallowing
E. Changes in hair color
F. Changes in skin of the neck

A. Fatigue
C. Change in taste
D. Difficulty swallowing
F. Changes in skin of the neck

Rationale:
Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific. The larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair, but this does not normally occur with radiation therapy. Difficulty urinating is not a side effect of radiation for laryngeal cancer.

When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.)
A. Bruises
B. Fever
C. Epistaxis
D. Pallor
E. Petechiae

A. Bruises
C. Epistaxis
E. Petechiae

Rationale:
Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia).Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.)
A. Encourage the client to participate in changing the ostomy.
B. Encourage the client and family members to express their feelings and concerns.
C. Offer to have a person who is coping with a colostomy visit with the client.
D. Explain to the client that the colostomy is only temporary.
E. Obtain a psychiatric consultation.

A. Encourage the client to participate in changing the ostomy.
B. Encourage the client and family members to express their feelings and concerns.
C. Offer to have a person who is coping with a colostomy visit with the client.

Rationale:
Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication. Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? (Select all that apply.)
A. Do not permit fresh flowers or plants in the room.
B. Do not allow the client's 16-year-old son to visit.
C. Observe for bleeding.
D. Teach the client to omit raw fruits and vegetables from the diet.
E. Administer pegfilgrastim.
F. Assess for fever.

A. Do not permit fresh flowers or plants in the room.
D. Teach the client to omit raw fruits and vegetables from the diet.
E. Administer pegfilgrastim.
F. Assess for fever.

Rationale:
Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim and pegfilgrastim, is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms. Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). 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.

The nurse is teaching the client about skin protection during radiation therapy. What teaching will the nurse include? (Select all that apply.)
A. Protect the area by wearing clothing.
B. Avoid all lotions to the area.
C. Avoid exposure to sun and heat.
D. Do not remove the ink markings on your skin.
E. Try to take walks in the early morning or later evening.
F. Do not wash the irradiated area.

A. Protect the area by wearing clothing.
C. Avoid exposure to sun and heat.
D. Do not remove the ink markings on your skin.
E. Try to take walks in the early morning or later evening.

Rationale:
The client can wash the irradiated area daily with either water or a mild soap. Ink or dye used to mark the radiation area should not be removed. The area should be protected by wearing soft clothing over the site, avoiding exposure to the sun and heat. Lotions can be used as long as they are approved by the radiation team. Walking in the early morning or late evening is a good way to avoid more intense sun.

A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided?
A. "Nearly 1/3 of cancers in the United States are related to tobacco use."
B. "Red meat helps to prevent cancer development."
C. "If I eat a healthy diet and exercise I will not develop cancer."
D. "Most cancer is hereditary."

A. "Nearly 1/3 of cancers in the United States are related to tobacco use."

Rationale:
Tobacco can be linked directly to the development of about 30% of all cancers in North America. Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop

How will the nurse interpret the finding on a client's pathology report that indicates a cancerous tumor is aneuploid?
A. The tumor is completely undifferentiated.
B. The tumor is fast growing.
C. Metastasis has already occurred.
D. The tumor has an abnormal number of chromosomes.

D. The tumor has an abnormal number of chromosomes.

Rationale:
A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition.

Which cancer type does the nurse interpret from a client's pathology report that indicates "stage 2 rhabdomyosarcoma"?
A. Muscle
B. Brain
C. Bone
D. Breast

C. Bone

Rationale:
The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma.

What effect does a "passenger" mutation in a gene have on cancer development?
A. Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies.
B. These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development.
C. These mutations protect against cancer development by reversing the effects of initiation.
D. Passenger mutations are another term for proto-oncogene gene mutations.

A. Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies.

Rationale:
Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies.

When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma?
A. Human lymphotrophic virus type II
B. Human papilloma virus
C. Epstein-Barr virus
D. Hepatitis B virus

C. Epstein-Barr virus

Rationale:
The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma

How will the nurse interpret the finding on a client's pathology report that a cancerous tumor has a mitotic index of 8%?
A. The tumor has not yet undergone carcinogenesis.
B. The tumor is slow-growing.
C. Metastasis has already occurred.
D. The tumor has an abnormal number of chromosomes.

B. The tumor is slow-growing.

Rationale:
A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer?
A. Smoked for 20 years but quit 5 years ago
B. Personal history of excessive sun exposure
C. Most family adult members are overweight
D. Strong family history of breast cancer

D. Strong family history of breast cancer

Rationale:
Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk.

The nurse recognizes that a client's hemangiosarcoma originated in which tissue?
A. Epithelial tissue
B. Blood vessel
C. Skeletal muscle
D. Cartilage

B. Blood vessel

Rationale:
The prefix "hemangio-" is included when cancers of the blood vessel are named.The prefix "rhabdo-" is used when cancers of the skeletal muscle are named.The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named

A 74-year-old client recovering from lung cancer surgery tells the nurse, "I don't understand why I have lung cancer. I have never even touched a cigarette." Which factor may explain the cause?
A. A history of cardiac disease
B. Advancing age
C. A history of military service
D. A diagnosis of diabetes

B. Advancing age

Rationale:
Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases. Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service.

A 40-year-old man who has a mother who was diagnosed with breast cancer at age 45, a father who was diagnosed with smoking-related lung cancer at age 55, a 33-year-old sister with breast cancer, and a 38-year-old sister with ovarian cancer, asks if he should be concerned for his cancer risk. What is the nurse's best response?
A. "You have two first-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer."
B. "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history."
C. "Your risk for cancer is affected by your parents' cancer development; your sisters' cancers have no bearing on your risk."
D. "Your risk is not affected by this family history because most of the cancers arose in female sex-associated tissues."

B. "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history."

Rationale:
This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association.

Which cancer screening or prevention activity is most important for the nurse to include when assessing a 20-year-old client who has Down syndrome?
A. Assessing his skin for bruises and petechaie
B. Teaching him how to perform self-testicular examination
C. Testing his stool for occult blood
D. Encouraging him to eat more fruit and leafy, green vegetables

A. Assessing his skin for bruises and petechaie

Rationale:
All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia.

An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse's best response?
A. "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased."
B. "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age."
C. "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you."
D. "Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history."

B. "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age."

Rationale:
The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.

Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.)
A. Eating a diet high in fiber and low in animal fat
B. Having a health checkup, including chest x-ray, annually
C. Obtaining a colonoscopy every 5 years
D. Electing to have both ovaries removed a person who has a BRCA2 mutation
E. Getting a mammogram or breast MRI annually
F. Having a mole removed from the neck

B. Having a health checkup, including chest x-ray, annually
E. Getting a mammogram or breast MRI annually

Rationale:
Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.

Which conditions does the nurse teach a client are some of the seven warning signs of cancer? (Select all that apply.)
A. Heavy nosebleeds independent of trauma to the nasal mucosa
B. Menstrual bleeding that has decreased
C. Increased pigmentation with deeper coloring in a mole
D. Difficulty starting the stream of urine for the past 6 months
E. Indigestion regardless of food type eaten
F. Thickening of breast tissue in one area

A. Heavy nosebleeds independent of trauma to the nasal mucosa
C. Increased pigmentation with deeper coloring in a mole
D. Difficulty starting the stream of urine for the past 6 months
E. Indigestion regardless of food type eaten
F. Thickening of breast tissue in one area

Rationale:
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Which common cancers will the nurse inform clients are related to tobacco use? (Select all that apply.)
A. Lung cancer
B. Cancer of the larynx
C. Bladder cancer
D. Cancer of the tongue
E. Skin cancer
F. Cardiac cancer

A. Lung cancer
B. Cancer of the larynx
C. Bladder cancer
D. Cancer of the tongue

Rationale:
Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

Which client assessment findings indicate to the nurse that leukemia may be present? (Select all that apply.)
A. Multiple bruises
B. Night sweats
C. Severe epistaxis
D. Fever
E. Frequent colds
F. Fatigue

A. Multiple bruises
B. Night sweats
C. Severe epistaxis
D. Fever
E. Frequent colds
F. Fatigue

Rationale:
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? (Select all that apply.)
A. Persistent hoarseness
B. Severe heartburn
C. Chronic diarrhea
D. Loss of skin turgor
E. Curd-like vaginal discharge
F. Difficulty swallowing with meals

A. Persistent hoarseness
B. Severe heartburn
C. Chronic diarrhea
F. Difficulty swallowing with meals

Rationale:
Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client's tumor might metastasize? (Select all that apply.)
A. Kidneys
B. Liver
C. Gastrointestinal tract
D. Lymph nodes
E. Brain
F. Lungs

C. Gastrointestinal tract
D. Lymph nodes
E. Brain
F. Lungs

Rationale:
Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

The nurse is caring for a patient with diarrhea resulting from chemotherapy. Which nursing action does the nurse take?
A. Encourages ingestion of foods high in magnesium
B. Weighs the patient every day
C. Assesses bowel sounds hourly
D. Lets the patient drink only fluids that are slightly chilled

B. Weighs the patient every day

Rationale:
Patients with diarrhea from chemotherapy should be weighed daily as a means of monitoring weight loss caused by fluid loss and inadequate nutrition. Patients should be encouraged to eat high protein, high-calorie foods and may need vitamin and mineral supplements. Magnesium is not encouraged. Bowel sounds do not need to be assessed hourly because the number of stools per day with their color and consistency provides objective data about the problem. Patients need to drink fluids to make up for water loss resulting from diarrhea, but temperature is not a key issue.

A patient diagnosed with cancer asks the nurse to "explain combination therapy." Which concept does the nurse use to base the response?
A. It involves the use of both chemotherapy and radiation.
B. It is the pairing of chemotherapeutic drugs with antioxidant herbal preparations.
C. It consists of an immunomodulator and a cytotoxic agent.
D. It is the administration of two types of chemotherapeutic drugs: cell cycle-specific and cell cycle-nonspecific agents.

D. It is the administration of two types of chemotherapeutic drugs: cell cycle-specific and cell cycle-nonspecific agents.

Rationale:
Combination therapy is the use of both cell cycle-specific and cell cycle-nonspecific agents. This is more effective than the use of one type because it allows for cell destruction at different stages of the cell cycle and thus has the potential to destroy more cells at any time it is administered. Combination therapy does not include radiation. Combination therapy does not refer to the use of specific classifications of chemotherapeutic agents. Combination therapy does include the use of antioxidants, but this is not the correct answer in this instance.

Which instruction does the nurse give to the caregiver of a patient receiving outpatient chemotherapy?
A. Wear protective gloves when cleaning household areas contaminated with emesis or other body secretions.
B. Add chlorine bleach to the toilet bowl after each use.
C. Keep the patient's soiled linens separate and wash twice.
D. Dispose of used tissues, napkins, and other items in contact with mucous membranes in sealed plastic bags.

C. Keep the patient's soiled linens separate and wash twice.

Rationale:
While receiving chemotherapy, the patient's soiled linens should be kept separate from other household linens (placed in washable pillowcases) and washed twice. Because most chemotherapy drugs are excreted in the urine or feces, toilets should be flushed two or three times; chlorine bleach does not need to be added. There is no need for precautions related to mucous membranes. If vomiting occurs, the emesis should be dumped in the toilet, which should then be flushed two or three times.

Which principle guides the dosage of chemotherapeutic agents?
A. The dose administered is that which is necessary to eradicate all neoplastic cells.
B. The dose should be high enough to have side effects but too low to have toxic effects.
C. The dose is the highest dose the patient can take without potentially lethal effects.
D. The dose should be sufficient to kill cancer cells but able to be tolerated by normal cells.

D. The dose should be sufficient to kill cancer cells but able to be tolerated by normal cells.

Rationale:
The goal of chemotherapy is to destroy cancer cells. However, there is no chemotherapeutic drug that will affect cancer cells only, so chemotherapeutic agents also are potentially deleterious to normal body cells. Thus, the dose of a chemotherapeutic agent is the amount that will kill the greatest number of cancer cells without irreversibly destroying normal cells and tissues. The dose is not guided by the amount required to eradicate all neoplastic cells because of the potential destruction of normal cells essential to life. The presence of side effects does not guide dosage because different agents have different types and intensities of side effects and there is not a useful correlation between side effects and drug effectiveness. The highest dose the patient can tolerate without potentially lethal effects does not guide dosage; it is the effectiveness of tumor control that is the concern. All tumors do not necessarily require the largest dose a patient can tolerate.

Which adverse effect may cause decreased food intake in a patient receiving methotrexate (MTX)?
A. Oral and gastrointestinal (GI) ulceration
B. Increased hemoglobin and hematocrit
C. Renal failure
D. Constipation

A. Oral and gastrointestinal (GI) ulceration

Rationale:
MTX causes oral and GI ulceration, which will cause discomfort for the patient when eating. The discomfort will affect whether the patient eats, as well as what the patient eats to obtain proper nutrition. MTX does not cause renal failure, so this would not cause decreased food intake. MTX causes diarrhea, not constipation, and does not increase hemoglobin and hematocrit.

Which factor increases when a patient is taking filgrastim (Neupogen)?
A. Sargramostim
B. Neutrophils
C. Trastuzumab
D. Red blood cells

B. Neutrophils

Rationale:
Filgrastim is known as a human granulocyte colony-stimulating factor. It stimulates the production of neutrophilic white blood cells. It is used to reduce the neutropenia interval in patients undergoing bone marrow transplantation, to stimulate white cell production in patients receiving myelosuppressive chemotherapy, and to treat neutropenia in acute myelogenous leukemia. Filgrastim does not affect red blood cell production. Trastuzumab is an engineered monoclonal antibody that binds to the human epidermal growth factor receptor 2 protein, inhibiting growth of tumor cells. Sargramostim is a granulocyte-macrophage colony-stimulating factor. It stimulates the production of granulocytes and macrophages, increases the cytotoxicity of monocytes toward certain neoplastic cell lines, and activates polymorphonuclear neutrophils to inhibit the growth of tumor cells.

Which factor's production is stimulated when a patient is taking oprelvekin (Neumega) during chemotherapy treatment?
A. Platelets at the stem cell level
B. Colony-stimulating factor
C. Macrophages
D. Red blood cells

A. Platelets at the stem cell level

Rationale:
Oprelvekin is used to prevent severe chemotherapy-induced thrombocytopenia in nonmyeloid malignancies and decrease the need for platelet transfusions. Oprelvekin does not stimulate the production of colony-stimulating factor, red blood cells, or macrophages.

A patient who is undergoing postoperative radiation treatment for neck cancer developed dryness in the mouth. Which drug would be appropriate for treating this condition?
A. Dexrazoxane (Zinecard)
B. Leucovorin (Leucovorin)
C. Amifostine (Ethyol)
D. Mesna (Mesnex)

C. Amifostine (Ethyol)

Rationale:
Xerostomia (dryness of the mouth) can be reduced with the use of amifostine, especially in patients who are undergoing postoperative radiation treatment for head and neck cancer. Mesna (Mesnex) is a prophylactic agent used to reduce incidences of hemorrhagic cystitis induced by ifosfamide (Ifex) and cyclophosphamide (Cytoxan). Dexrazoxane (Zinecard) is used to reduce the incidence and severity of cardiomyopathy. Leucovorin (Leucovorin) is used to prevent methotrexate toxicity.

Which drug is used to minimize injury from extravasation of doxorubicin?
A. Leucovorin (Leucovorin)
B. Dexrazoxane (Totec)
C. Amifostine (Ethyol)
D. Mesna (Mesnex)

B. Dexrazoxane (Totec)

Rationale:
Dexrazoxane (Totec) is used to minimize injury from extravasation of doxorubicin and daunorubicin. Mesna (Mesnex) is used to reduce incidences of hemorrhagic cystitis related to ifosfamide (Ifex) and cyclophosphamide (Cytoxan). Amifostine (Ethyol) is used to reduce xerostomia related to radiation therapy for head and neck cancer. Leucovorin (Leucovorin) is used as an antidote for an overdose of methotrexate.

The primary healthcare provider is providing instructions to a patient who is undergoing chemotherapy. Which statement made by the patient indicates the need for further education?
A. "I will perform activities of daily living."
B. "I will eat a large amount of my favorite dishes."
C. "If I experience dry mouth, I will use sugarless gum as a lubricating and moisturizing agent."
D. "I will use a soft brush or soft cloth and mouthwash with viscous lidocaine."

B. "I will eat a large amount of my favorite dishes."

Rationale:
A patient who is undergoing chemotherapy should eat his or her favorite foods but should avoid overconsumption. Performing activities of daily living will encourage self-care activities. The patient should perform oral care by using a soft brush or soft cloth and mouthwash with viscous lidocaine. Lubricating and moisturizing the mouth with sugarless gum should be done to relieve dry mouth.

Which statements regarding care of the client receiving radiotherapy in the form of unsealed radioactive isotopes guide the nurse's care planning? (Select all that apply.)
A. The client may have restrictions on who can visit and for how long.
B. The client must be in total isolation while the isotopes are in place.
C. When "seeds" are used for prostate cancer therapy, the client must have them removed before he leaves the hospital.
D. The client's urine and stool must be handled as radioactive material.
E. The nurse must ensure that all personnel entering the client's room use appropriate precautions.
F. Only those female nurses who are past menopause can be assigned to care for this client.

A. The client may have restrictions on who can visit and for how long.
D. The client's urine and stool must be handled as radioactive material.
E. The nurse must ensure that all personnel entering the client's room use appropriate precautions.

Rationale:
While the radioactive elements are within the client, he or she does emit radiation and is a hazard to others. Children and pregnant women may not visit. Other visitors are limited to 30 minutes or less daily.
With an unsealed source, the isotopes enter body fluids and are excreted in the urine and stool as radioactive substances.
Because the client does emit radiation, all personnel entering the room can be exposed and must use the appropriate precautions, regardless of how short a time period they are present in the room.

The client who received combination chemotherapy 7 days ago for breast cancer calls the oncology clinic to report a temperature of 100.5°F (38.06°C) and has no other symptoms of infection. What is the nurse's best response?
A. "This is a normal immune-related response to the chemotherapy."
B. "Please go to the nearest emergency room for a full workup for infection."
C. "You are most likely dehydrated. Come to the clinic now for IV fluids."
D. "There is no concern at this time but call if your temperature reaches 101.5°F (38.6°C)."

B. "Please go to the nearest emergency room for a full workup for infection."

Rationale:
Clients with neutropenia, and with this being the 7th day after chemotherapy for breast cancer this client is very likely to be neutropenic, have so few white blood cells that they often do not have the typical symptoms of inflammation and infection. Anti-infective therapy is started when the client's temperature reaches 100°F (37.8°C) to prevent sepsis.

Which assessment findings in a client who has neutropenia from cancer chemotherapy indicate to the nurse that severe disseminated intravascular coagulation (DIC) is present? (Select all that apply.)
A. The client is bleeding from the nose, IV sites, and rectum.
B. The client's temperature is 99°F (37.2°C).
C. The client's pulse rate is 130 beats per minute.
D. The client's respiratory rate is 24 breaths per minute.
E. The client's white blood cell count is 3200/mm3 (3.2 × 109/L)
F. The client's hourly urine output is 100 mL.

A. The client is bleeding from the nose, IV sites, and rectum.
C. The client's pulse rate is 130 beats per minute.
D. The client's respiratory rate is 24 breaths per minute.

Rationale:
DIC is a condition in which widespread microthrombi form and use all available circulating clotting factors. When these factors are gone, clotting cannot occur and the client bleeds from any site of trauma, no matter how minor the trauma. Spontaneous bleeding can also occur.
The elevated pulse rate is consistent with the hypovolemic shock phase of DIC, as is the increased respiratory rate. Both are attempting to maintain oxygenation to vital organs.

Which client report indicates to the nurse that spinal cord compression may be present?
A. The client reports having a headache for the past 7 hours.
B. The client has reduced breath sounds in the left lung.
C. The client has worsening mid-thoracic back pain.
D. Pedal edema is now present bilaterally.

C. The client has worsening mid-thoracic back pain.

Rationale:
One of the first symptoms of spinal cord compression in a patient with cancer is new onset or worsening back pain as the disintegrating bones press and compress spinal nerves. Headache is not associated with spinal cord compression.

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is 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

C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit)

Rationale:
A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia. The clients with acute lymphocytic leukemia and chemotherapy-induced nausea are complex clients requiring a nurse certified in chemotherapy administration. The client with tumor lysis syndrome has complicated needs for assessment and care and should be cared for by an RN with more oncology experience.

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3 (17 × 109/L)?
A. Increasing shortness of breath
B. Diminished bilateral breath sounds
C. Change in mental status
D. Weight gain of 4 pounds (1.8 kg) in 1 day

C. Change in mental status

Rationale:
A change in mental status could result from spontaneous bleeding and, in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which are not related to thrombocytopenia. A large weight gain in a short period may be related to kidney or heart failure; bleeding is the major complication of thrombocytopenia.

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

B. Edema of arms and hands

Rationale:
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. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly, but because it is an early manifestation, and not the priority. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone (SIADH). Although this should be addressed, it is an early sign so it is not the priority.