Cancer And Oncology | NCLEX Quiz 141 - Quiz, Flashcards & Trivia

1. 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?

Fever

Chills

Tachycardia

Dyspnea

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.

Explanation

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.

2. A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate?

Apply sunscreen only after going in the water.

Avoid peak exposure hours from 9am to 1pm

Wear loosely woven clothing for added ventilation

Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

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.

Explanation

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.

3. 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?

“Chemotherapy affects all rapidly dividing cells.”

“The molecular structure of the DNA is altered.”

“Cancer cells are susceptible to drug toxins.”

“Chemotherapy encourages cancer cells to divide.”

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.

Explanation

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.

4. 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?

Sanguineous drainage in the Jackson-Pratt drain

Pain at the incisional site

Complaints of decreased sensation near the operative site

Arm edema on the operative side

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.

Explanation

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.

5. 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:

Respiratory alkalosis

Respiratory acidosis

Metabolic alkalosis

Metabolic acidosis

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.

Explanation

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.

6. 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?

Assess level of consciousness

Assess temperature

Assess bowel sounds

Assess skin turgor

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.

Explanation

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.

7. Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient?

Teaching the client diaphragmatic breathing techniques

Administering cough suppressants as ordered

Teaching and encouraging pursed-lip breathing

Placing the client in a low semi-Fowlers position

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.

Explanation

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.

8. 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?

Presence of Reed-Sternberg cells

Involvement of lymph nodes. spleen. and liver

Occurs most often in the older client

Prognosis depends on the stage of the disease

Hodgkin’s disease is a disorder of young adults. Options 1. 2. and 4 are characteristics of this disease.

Explanation

Hodgkin’s disease is a disorder of young adults. Options 1. 2. and 4 are characteristics of this disease.

9. 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?

Coughing and deep breathing

Encouraging fluids

Monitoring red blood cell count

Providing frequent oral care

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.

Explanation

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.

10. 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.

Verify patency of the line by the presence of a blood return at regular intervals.

Inspect the insertion site for swelling. erythema. or drainage.

Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present.

If unable to aspirate blood. reposition the client and encourage the client to cough.

Contact the health care provider about verifying placement if the status is questionable.

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.

Explanation

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.

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