Exam 2 (Ch. 14, 16, & 34) PPT

Question 1

The incidence of cancer increases significantly with age, with most cases diagnosed in individuals over 55. However, cancer can develop at any age, and 1.7 million people in the US are diagnosed with invasive cancers annually. What is the most likely explanation for the observation that both the incidence and mortality rates of cancer are declining overall?

A. Improvements in early detection and treatment
B. A decrease in environmental risk factors
C. Increased use of preventative measures and healthier lifestyles
D. All of the above

Answer 1

D. All of the above.
- A. Screening can catch cancers at earlier, at more treatable stages. Advances have also improved survival rates.

• B. Public health campaigns have raised awareness about risks e.i. smoking, excessive sun exposure, and exposure to carcinogens. This has led to changes in behaviors & policies that reduce exposure to risks.
• C. More people are adopting healthier lifestyles, including regular exercise, a balanced diet, and maintaining a healthy weight. Preventative measures like vaccinations and chemoprevention are also contributing to lower cancer rates.

Question 2

Overall, cancer inicdence is higher in which gender?

Answer 2

Males

More men than women dies from cancer-related death each year.
Men more likely to develop liver cancer
Prostate cancer is the highest incidence
Head & neck cancers are more common in men

Question 3

Which cancer has the highest death rate in both men & women?

Answer 3

Lung

Question 4

What are some biologic sex considerations for cancer in women?

Answer 4

• Highest incidence is breast cancer
• Thyroid cancer is more prevalent in women
• Women are less likely to have colon cancer screenings

Question 5

What are the 2 major dysfunction present in the process of cancer developement?

Answer 5

Defective cell proliferation (growth) & defective cell differentiation

Question 6

What does metastasis mean?

Answer 6

Abnormal cells invade surrounding tissue & gain access to lymph & blood vessels carrying them to other areas of the body

Question 7

What does benigin mean?

Answer 7

Cells that are not cancerous

Question 8

What are the 3 stages of cancer?

Answer 8

1. Initiation: Involves a mutation in cell structure
2. Promtion: is characterized by the reversible proliferation of altered cells (an increase in the altered cell population further increases the likelihood of more mutations)
3. Progression: increased growth rate of the tumor, increased invasiveness and metastasis

Question 9

Which of the following statements BEST describes the current understanding of cancer development?

A. Cancer arises from a rapid, haphazard event leading to uncontrolled cell growth.
B. Cancer development is typically an orderly, multi-stage process involving genetic changes.
C. Cancer cells develop spontaneously without any changes in normal cellular processes.
D. Cancer is primarily caused by external factors and does not involve genetic alterations.

Answer 9

B. Cancer development is typically an orderly, multi-stage process involving genetic changes.

Question 10

Which of the following statements BEST describes the role of tumor suppressor genes in cancer development?

A. Tumor suppressor genes promote cell growth and division.
B. Mutations in tumor suppressor genes can lead to uncontrolled cell growth.
C. Inherited mutations in tumor suppressor genes account for the majority of cancers.
D. Tumor suppressor genes are responsible for repairing damaged DNA.

Answer 10

B. Mutations in tumor suppressor genes can lead to uncontrolled cell growth.

Question 11

Where do most cancers result from?

Answer 11

From damage to genes occurring during one’s lifetime

Not from inherited genes

Question 12

What are the 3 types of carcinogens?

Answer 12

1. Chemical (e.g., benzene, arsenic, formaldehyde, acetone)
2. Radiation (e.g. UV rays, X-ray)
3. Viral (DNA or RNA viruses) (e.g. HPV, HBV, HIV, Epstein-Barr)

Question 13

Cell growth, protein synthesis, and preparation for DNA replication.
Describes what phase of the cell cycle?

Answer 13

G1 Phase

Question 14

DNA replication and synthesis of sister chromatids
Describes what phase of the cell cycle?

Answer 14

S Phase

Question 15

Post-DNA replication growth and preparation for mitosis
Describes what phase of the cell cycle?

Answer 15

G2 Phase

Question 16

Cell division and separation of chromosomes
Describes what phase of the cell cycle?

Answer 16

M Phase

Question 17

Quiescent phase; non-dividing state
Describes what phase of the cell cycle?

Answer 17

G0 Phase

Question 18

Which of the cell cycle checkpoints is MOST critical in ensuring that damaged DNA is not passed on to daughter cells?

Answer 18

G2 Checkpoint

Question 19

Where does DNA replication primarily occurs?

Answer 19

The S phase

Question 20

A client asks the nurse about factors that can initiate cancer development. Which of the following factors should the nurse identify as potential initiators of cellular mutations? (Select all that apply.)

A. High-fiber diet
B. Exposure to radiation
C. Infection with certain viruses
D. Regular exercise
E. Genetic predisposition

Answer 20

B, C, & E
* Radiation (B) and certain viruses (C) can directly damage DNA and initiate mutations. Genetic predisposition (E) refers to inherited mutations that increase cancer susceptibility. A high-fiber diet (A) and regular exercise (D) are generally considered protective against cancer.

Question 21

What happens to a cell during each stage of cancer?

Answer 21

Initiation: A normal cell experiences DNA damage or mutation.
Promotion: Altered cells are stimulated to proliferate.
Progression: Cancer cells spread to distant sites.

Question 22

Describe the general characteristic of bengin cells.

Answer 22

Encapsulated: Usually
Differentiated: Normally
Metastasis: Absent
Recurrence: Rare
Vascularity: Slight
Mode of growth: Expansive
Cell characteristics: Fairly normal, like parent cells

Table 16.3, pg. 271

Protective sac (encapsulated)
Slow growing
Locoalized
Non invasive

Question 23

Describe the general characteristic of malignant cells.

Answer 23

Encapsulated: Rarely
Differentiated: Poorly
Metastasis: Capable
Recurrence: Possible
Vascularity: Moderate to marked
Mode of growth: Infiltrative & expansive
Cell characteristics: Cells abnormal, become more unlike parent cells

Table 16.3, pg. 271

No sac (non-capsulated)
Fast growing
Invasive & infiltrates
Matastasize

Question 24

What are the main sites of metastasis?

5

Answer 24

1. Brain & cerebrospinal fluid
2. Lung
3. Liver
4. Adrenals
5. Bone

Question 25

What is angiogenesis?

Answer 25

The formation of new blood vessels. * Normal Process: It's a vital process for growth and healing in the body. For example, it helps in: Embryonic development, Wound healing, & Growth of organs and tissues * In Cancer: Angiogenesis plays a critical role in cancer growth and spread (metastasis). Tumors need a blood supply to: Bring in nutrients and oxygen, Remove waste products, & Allow cancer cells to travel to other parts of the body | Angio: blood vessels. Genesis: the creation or origin of something.

Question 26

What are tumor-associated antigens (TAAs)?

Answer 26

Substances produced by tumor cells that can trigger an immune response ## Footnote Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens (TAAs). We think the immune system responds to TAAs through a process termed immunologic surveillance.

Question 27

What is immunologic escape?

Answer 27

The process by which cancer cells evade the immune system. ## Footnote Possible mechanisms: Suppression of factors that stimulate T cells to react to cancer cells Weak surface antigens allowing cancer cells to “sneak through” immunologic surveillance Development of tolerance of the immune system to some tumor antigens Suppression of the immune response by products secreted by cancer cells Induction of suppressor T cells by the tumor Blocking antibodies that Bind TAAs, thus preventing recognition by T cells.

Question 28

What are the 3 types of nursing cancer preventions?

Answer 28

1. Primary 2. Secondary 3. Tertiary

Question 29

What is primary cancer prevention?

Answer 29

Reducing risks of disease through health promotion and risk reduction Vaccines (HBV) Public Education

Question 30

What is secondary cancer prevention?

Answer 30

Involves Screening and early detection. Mammography (age 40-54) Colon Fecal occult test Both genders 50+ age

Question 31

What is tertiary cancer prevention?

Answer 31

Improved screening, diagnosis, and treatment Focus on monitoring for preventing recurrence of the primary cancer and screening for development of a secondary cancer

Question 32

What is personalized medicine? | Cancer

Answer 32

An emerging trend in cancer treatment. It involves using the patient’s genetic information to guide decisions about cancer prevention, diagnosis, and treatment. Many diagnostic studies (tumor markers, genetic markers, molecular receptor status) are useful in determining treatment options. ## Footnote Recent development of biologic databases Technologic advances that can identify unique characteristics of individual persons Computer-driven systems that can mine and analyze datasets This is an exciting time for oncology as the immediate goal of the precision medicine initiative is to focus on preventing and curing cancers

Question 33

What are the steps of diagonsis of cancer? | 5

Answer 33

1. Understand Nurses need to understand how cancer is diagnosed!! 2. Determine Determine presence, extent of tumor 3. Identify Identify possible disease metastasis 4. Evaluate Evaluate functions of involved and uninvolved body systems and organs 5. Obtain Obtain tissue and cells for analysis, including evaluation of tumor stage and grade

Question 34

How are bone marrow aspirations from the posterior iliac crest preformed?

Answer 34

The skin over the puncture site is cleansed with bactericidal agent, local anesthetic agent, the needle is inserted through the cortex of the bone. The stylet of the needle is then removes, the hub is attached to a 10 mL syringe and 0.2-0.5 mL of fluid marrow is aspirated. The patient will have pain when the periosteum is penetrated and with aspiration, this lasts only a few seconds and can be quite uncomfortable. Pressure is applied over the site with a pressure dressing (complications hemorrhage and infection)

Question 35

What is the sufix for bengin tumors?

Answer 35

-oma

Question 36

What is the suffix for malignant epithelial tissue tumors?

Answer 36

-Carcinoma

Question 37

What is the suffix for malignantc connective tissue tumors?

Answer 37

-Sarcoma

Question 38

What class are plasma cells in? | Classification of cancer by tissue of origin

Answer 38

Myeloma

Question 39

What class is Hodgkin & non-Hodgkin in? | Classification of cancer by tissue of origin

Answer 39

Lymphoma

Question 40

What class is bone marrow cells, WBC's, RBC's, & Lymphocytes in? | Classification of cancer by tissue of origin

Answer 40

Leukemia

Question 41

What does tumor staging determine?

Answer 41

Determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis

Question 42

What do each letter in TNM classification system stand for?

Answer 42

T: Primary tumor N:Regional Lymph Nodes M: Distant Metastases

Question 43

What is tumor grading?

Answer 43

pathologic classification of tumor cells: I-IV | The higher the number the more undifferentiated the cell is.

Question 44

What does Stage 0 indicate? | Clinical tumor staging

Answer 44

Cancer in situ | Group of abnormal cells that have not done anything

Question 45

What does Stage I indicate? | Clinical tumor staging

Answer 45

Tumor limited to the tissue of origin | localized tumor growth

Question 46

What does Stage II indicate? | Clinical tumor staging

Answer 46

Limited local spread

Question 47

What does Stage III indicate? | Clinical tumor staging

Answer 47

Extensive local and regional spread

Question 48

What does Stage IV indicate? | Clinical tumor staging

Answer 48

Metastasis

Question 49

What is the most common cancer of the urinary system?

Answer 49

Bladder Cancer ## Footnote ~81,190 new cases of bladder cancer diagnosed annually and ~17, 240 deaths reported every year related to bladder cancer.

Question 50

At what age do 90% of bladder cancers occur?

Answer 50

Age 55 | More common in men than women

Question 51

What is the most frequent type of bladder cancer?

Answer 51

Transitional cell carcinoma (TCC) is the most common type, with tumors often appearing as papillomatous growths within the bladder.

Question 52

What are some risk factors of bladder cancer?

Answer 52

1. Smoking: Accounts for about half of all cases. 2. Occupational Exposures: Dyes used in rubber and other industries. 3. Radiation Treatment: Women treated with radiation for cervical cancer. 4. Certain Chemotherapy Drugs: Cyclophosphamide, docetaxel, or gemcitabine. 5. Chronic Irritation: Long-term use of indwelling catheters, chronic UTIs, and urinary tract stones (especially in the bladder) increase the risk of squamous cell carcinoma specifically.

Question 53

# Prioritization - Nursing Assessment Scenario: A nurse is caring for a client with bladder cancer. Which of the following assessments should the nurse prioritize? Rank the following in order of priority (most important first). A. Assess for gross or microscopic hematuria (blood in urine). B. Inquire about a history of smoking. C. Monitor for changes in bowel habits. D. Evaluate the client's emotional state and coping mechanisms.

Answer 53

1. A. Assess for gross or microscopic hematuria (blood in urine). (Most common sign) 2. B. Inquire about a history of smoking. (Major risk factor) 3. D. Evaluate the client's emotional state and coping mechanisms. (Important, but lower priority than physical symptoms and risk factors) 4. C. Monitor for changes in bowel habits. (Not directly related to bladder cancer)

Question 54

# Match the bladder cancer with the factor that it's MOST associated with. Bladder Cancer Type Transitional Cell Carcinoma (TCC) Squamous Cell Carcinoma Adenocarcinoma (rare in bladder) Factor/Characteristic a) Chronic irritation of the bladder lining (e.g., from long-term catheter use) b) Papillomatous growths within the bladder c) Arises from glandular epithelium; may originate elsewhere and metastasize to the bladder

Answer 54

Transitional Cell Carcinoma (TCC): B Squamous Cell Carcinoma: A Adenocarcinoma (rare in bladder): C

Question 55

What is used to detect bladder cancer?

Answer 55

CT, ultrasounds, & MRI ## Footnote When cancer is suspected, obtain urine specimens to identify any cancer or atypical cells. (Exfoliated cells from the bladder’s epithelial surface can be detected in voided specimens.)

Question 56

What is the most common manifestation of bladder cancer?

Answer 56

Microscopic or gross, painless hematuria (chronic or intermittent) is the most common manifestation of bladder cancer

Question 57

How is the presence of bladder cancer confirmed?

Answer 57

By cystoscopy and biopsy.

Question 58

What is a biopsy?

Answer 58

The removal of a tissue sample for microscopic examination to confirm a diagnosis of cancer and determine its type and grade. Types include: * Excisional biopsy: Removal of the entire tumor or suspicious area. * Needle biopsy: Removal of a small tissue sample using a needle. * Incisional biopsy: Removal of a portion of the tumor for diagnosis.

Question 59

What is the difference of wide excision & local excision tumor removal?

Answer 59

Wide excision: Removal of the tumor along with a margin of surrounding normal tissue. Local excision: Removal of the tumor only, without a wide margin.

Question 60

What is prophylactic surgery in regards to cancer treatment?

Answer 60

Removal of tissue or organs to prevent cancer development in individuals at high risk.

Question 61

What is palliative surgery in regards to cancer treatment?

Answer 61

Performed to relieve symptoms and improve quality of life in advanced cancer cases, but not intended to cure the cancer.

Question 62

What is reconstructive surgery in regards to cancer treatment?

Answer 62

Performed to restore function or appearance after cancer surgery.

Question 63

# Prioritization - Postoperative Nursing Care A client is recovering from a wide excision of a skin cancer. Which of the following nursing actions should be prioritized in the immediate postoperative period? Rank in order of priority (most important first). A. Administering pain medication. B. Educating the client about long-term wound care. C. Assessing the wound for signs of infection. D. Encouraging the client to express their feelings about the diagnosis.

Answer 63

1. C. Assessing the wound for signs of infection. (Risk of infection is highest immediately post-op) 2. A. Administering pain medication. (Pain management is important for comfort and healing) 3. B. Educating the client about long-term wound care. (Important, but can be addressed slightly later) 4. D. Encouraging the client to express their feelings about the diagnosis. (Psychosocial support is important, but physical needs take priority initially)

Question 64

# cancer What should the nurse monitor for postaperatice complications?

Answer 64

Infection Impaired Wound Healing (Factors like malnutrition, obesity, and diabetes can increase risk) Altered Pulmonary Function Altered Renal Function Deep Vein Thrombosis (DVT) (Assess for calf pain, swelling, and redness.)

Question 65

# Prioritization - Postoperative Assessments A nurse is caring for a patient immediately after abdominal surgery. Which assessments should be prioritized? Rank in order of priority (most important first). A. Assessing the surgical incision for redness and drainage B. Auscultating lung sounds C. Administering pain medication D. Reviewing preoperative teaching materials with the patient

Answer 65

1. A. Assessing the surgical incision for redness and drainage (Risk for infection is highest immediately post-op) 2. B. Auscultating lung sounds (Risk for pulmonary complications post-op) 3. C. Administering pain medication (Important for comfort, but airway and infection risks take priority) 4. D. Reviewing preoperative teaching materials with the patient (Important for long-term recovery, but not the immediate priority)

Question 66

What are some postop complications?

Answer 66

Infection Bleeding (Monitor vital signs for signs of shock (low blood pressure, rapid heart rate), and check for internal bleeding (e.g., distended abdomen).) Thrombophlebitis (Assess for calf pain, swelling, redness, and warmth, which are signs of a blood clot (usually in the leg).) Wound Dehiscence (If evisceration (organs protruding) occurs, cover with sterile dressings and notify the surgeon immediately.) Fluid and Electrolyte Imbalances Organ Dysfunction (For example, after lung surgery, monitor respiratory function. After kidney surgery, monitor renal function.)

Question 67

# Prioritization - Postoperative Nursing Actions A nurse is caring for a patient immediately after surgery. Which actions should be prioritized? Rank in order of priority (most important first). A. Administering pain medication. B. Assessing the surgical incision. C. Auscultating lung sounds. D. Reviewing discharge instructions.

Answer 67

1. C. Auscultating lung sounds (Airway and breathing are top priorities) 2. B. Assessing the surgical incision (Risk for infection and bleeding is highest immediately post-op) 3. A. Administering pain medication (Important for comfort, but airway and wound assessment take priority) 4. D. Reviewing discharge instructions (Important, but not the immediate priority)

Question 68

What are some purposes of radtioan therapy?

Answer 68

Curative: To eliminate the cancer and achieve a cure. Control: To shrink the tumor and/or stop its growth, even if a cure isn't possible. Palliative: To relieve symptoms caused by the cancer, such as pain or obstruction, and improve quality of life.

Question 69

What is external radiation?

Answer 69

Radiation is delivered from a machine outside the body, like a giant X-ray. The patient lies still while the machine aims radiation at the tumor.

Question 70

What is internal radiation (Brachytherapy)

Answer 70

A radioactive substance is placed directly into or near the tumor. This can be in the form of seeds, wires, or liquids.

Question 71

What is the nurse's role in Brachytherapy?

Answer 71

Patient Education: Explain the procedure, its purpose, and what to expect. Safety Precautions: Implement safety measures to protect themselves, visitors, and other patients from radiation exposure (e.g., time and distance limits, wearing dosimeter badges). Patient Comfort: Provide comfort and support to the patient during the procedure. Monitoring for Side Effects: Observe for any side effects related to brachytherapy, such as localized skin reactions or fatigue.

Question 72

What are some types of radiation reactions?

Answer 72

These are typically localized to the area being treated and can include: Skin changes (redness, dryness, peeling) (does not necessarily depend on location of radiation) Fatigue Hair loss (in the treated area) Mucositis (inflammation of mucous membranes, if radiation is directed at those areas)

Question 73

A client is receiving radiation therapy. Match the purpose of the radiation therapy with the appropriate client scenario. (Curative, Control, & Palliative) 1. A client with localized prostate cancer 2. A client with metastatic bone cancer 3. A client with a tumor pressing on the spinal cord 4. A client with newly diagnosed Hodgkin's lymphoma

Answer 73

1. Curative 2. Palliatvie 3. Control & Palliative 4. Curative

Question 74

# Prioritization - Nursing Care for Brachytherapy A client is undergoing brachytherapy for cervical cancer. Which of the following nursing actions should be prioritized? Rank in order of priority (most important first). A. Providing patient education about the procedure. B. Implementing safety precautions for radiation exposure. C. Managing the patient's pain. D. Addressing the patient's anxiety about the procedure.

Answer 74

1. B. Implementing safety precautions for radiation exposure. (Protecting staff and visitors from radiation is paramount) 2. A. Providing patient education about the procedure. (Informed consent and patient understanding are crucial) 3. C. Managing the patient's pain. (Comfort is important, but safety and education take precedence) 4. D. Addressing the patient's anxiety about the procedure. (Important, but physical and safety needs are higher priorities)

Question 75

Scenario: A client is diagnosed with a carcinoma. The nurse is educating the client about the characteristics of carcinomas compared to sarcomas. Question: Which of the following statements BEST describe(s) characteristics of carcinomas? (Select all that apply.) A. They originate from connective tissue. B. They are the most common type of cancer. C. They include adenocarcinomas and squamous cell carcinomas. D. They often arise in tissues that line surfaces, such as skin or organ linings. E. They are less common than sarcomas. F. They can originate in bone, muscle, or blood vessels.

Answer 75

B, C, and D

Question 76

What are some specific nursing interventions for cancer pt.?

Answer 76

Skin Care: Teach patients to avoid harsh soaps, perfumes, lotions, or rubbing the treated area. Recommend gentle cleansing and moisturizing as needed. Nutritional Support: Encourage a balanced diet, manage nausea or vomiting, and provide nutritional supplements if necessary. Fatigue Management: Help patients manage fatigue by encouraging rest periods, pacing activities, and exploring energy-conserving techniques. Emotional Support: Provide a safe space for patients to express their feelings and concerns. Offer resources for counseling or support groups. Patient Education: Educate patients about potential side effects, self-care strategies, and when to notify the healthcare team.

Question 77

# Prioritization - Nursing Assessments for Radiation Therapy A client is receiving radiation therapy to the chest. Which assessments should the nurse prioritize? Rank in order of priority (most important first). A. Assessing the skin in the treated area. B. Evaluating the client's emotional well-being. C. Assessing the client's nutritional intake. D. Monitoring the client's complete blood count.

Answer 77

1. A. Assessing the skin in the treated area. (Skin reactions are common and require prompt intervention) 2. C. Assessing the client's nutritional intake. (Radiation can affect appetite and nutrition) 3. B. Evaluating the client's emotional well-being. (Important, but physical needs take priority) 4. D. Monitoring the client's complete blood count. (Important, but less immediate than the other assessments)

Question 78

# Trend Question - Monitoring for Radiation Toxicity A patient is several weeks into radiation therapy. The nurse notices the patient's red blood cell count is decreasing. Which of the following BEST explains this trend? A. This is a normal side effect of radiation therapy. B. The patient is likely experiencing radiation pneumonitis. C. The patient may be developing bone marrow suppression. D. The patient is not adhering to their nutritional plan.

Answer 78

C. The patient may be developing bone marrow suppression. Rationale: Radiation can affect the bone marrow, leading to decreased production of blood cells, including red blood cells. This is a form of radiation toxicity. The other options are less likely explanations for a decreasing red blood cell count specifically.

Question 79

Scenario: A client is diagnosed with adenocarcinoma of the lung. The nurse is providing education about the characteristics of adenocarcinomas. Question: Which of the following statements BEST describe(s) characteristics of adenocarcinomas? (Select all that apply.) A. They originate from epithelial tissue. B. They are a subtype of sarcoma. C. They are the most common type of lung cancer. D. They often arise in glandular tissues. E. They are associated with smoking but can also occur in non-smokers. F. They typically manifest as skin lesions.

Answer 79

A, C, D, and E

Question 80

# Skin Care What should we tell are patients who are receiving external radiation?

Answer 80

Skin Care: Avoid creams, lotions, deodorants, perfumes, and talcum powder in the treatment area. Use lukewarm water to cleanse the area. Avoid tape on the treated area. Protect the area from exposure to cold or sunlight.

Question 81

What should healthcare works in the radiation department wear?

Answer 81

A dosimeter badge to monitor radiation exposure.

Question 82

A client is undergoing external radiation therapy to the chest. Indicate whether the following actions are appropriate (Yes) or inappropriate (No) for skin care in the treated area. Applying a fragrance-free lotion Cleansing the area with lukewarm water Using tape to secure a dressing over the area Exposing the treated area to sunlight Leaving the radiation markings intact

Answer 82

Applying a fragrance-free lotion NO Cleansing the area with lukewarm water YES Using tape to secure a dressing over the area NO Exposing the treated area to sunlight NO Leaving the radiation markings intact YES

Question 83

# Prioritization - Brachytherapy Safety A client is receiving brachytherapy. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first). A. Educating the client about potential side effects. B. Limiting visitor time and distance. C. Ensuring a lead container and long forceps are in the room. D. Administering anti-emetics for nausea.

Answer 83

1. C. Ensuring a lead container and long forceps are in the room. (This is crucial for safety in case of implant dislodgement.) 2. B. Limiting visitor time and distance. (Reduces radiation exposure to others.) 3. A. Educating the client about potential side effects. (Important, but safety takes precedence.) 4. D. Administering anti-emetics for nausea. (Manages symptoms, but not the highest priority in terms of radiation safety.)

Question 84

A nurse is caring for a client with a sealed radiation implant. Which of the following actions is MOST important for the nurse to take to minimize radiation exposure? A. Wear a lead apron when in the room. B. Limit the time spent in the client's room. C. Encourage the client to ambulate frequently. D. Keep the head of the bed elevated at 45 degrees.

Answer 84

B. Limit the time spent in the client's room.

Question 85

What type of foods should the nurse emphasize the importance of in cancer patients?

Answer 85

Protein: Essential for tissue repair and immune function. Good sources include lean meats, poultry, fish, eggs, beans, and nuts. Fruits and Vegetables: Provide vitamins, minerals, and antioxidants. Aim for a variety of colors. (cooked) Whole Grains: Offer fiber and complex carbohydrates for energy. Choose whole-wheat bread, brown rice, and quinoa. Healthy Fats: Support cell growth and hormone production. Include sources like avocados, nuts, seeds, and olive oil.

Question 86

A client undergoing chemotherapy is experiencing nausea and loss of appetite. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No). Encourage the client to eat three large meals a day Suggest trying ginger ale or crackers for nausea Advise the client to avoid spicy or greasy foods Recommend drinking plenty of fluids between meals Suggest using a mouthwash with alcohol for sores

Answer 86

Encourage the client to eat three large meals a day NO Suggest trying ginger ale or crackers for nausea YES Advise the client to avoid spicy or greasy foods YES Recommend drinking plenty of fluids between meals YES Suggest using a mouthwash with alcohol for sores NO

Question 87

# Prioritization - Nutritional Needs A client is receiving radiation therapy to the head and neck area. Which nutritional needs should the nurse prioritize? Rank in order of priority (most important first). A. Maintaining adequate hydration B. Ensuring sufficient protein intake C. Managing taste changes D. Addressing potential swallowing difficulties

Answer 87

1. A. Maintaining adequate hydration (Hydration is crucial, especially with radiation to this area) 2. D. Addressing potential swallowing difficulties (Radiation to the head and neck can impact swallowing) 3. B. Ensuring sufficient protein intake (Important for healing and energy, but hydration and swallowing take precedence) 4. C. Managing taste changes (Can affect appetite, but not as critical as the other needs)

Question 88

A nurse is providing discharge instructions to a client who has completed cancer treatment. Which of the following statements by the client indicates a need for further education regarding diet? A. "I will focus on eating a variety of fruits and vegetables." B. "I will make sure to include a good source of protein at each meal." C. "I will avoid drinking fluids with my meals to prevent feeling full too quickly." D. "I will check with my doctor before taking any vitamin or mineral supplements."

Answer 88

C. "I will avoid drinking fluids with my meals to prevent feeling full too quickly."

Question 89

What are the purposes of chemotherapy?

Answer 89

Curative: To eliminate the cancer and achieve a cure. Control: To shrink the tumor and/or slow its growth, even if a cure isn't possible. Palliative: To relieve symptoms caused by the cancer and improve quality of life.

Question 90

How is chemotherapy dosage calculated?

Answer 90

Carefully calculated based on factors like body surface area, type of cancer, and the patient's overall health. ## Footnote Extravasation: This occurs when chemotherapy leaks out of the vein and into surrounding tissues, causing damage. Hypersensitivity Reactions: Allergic reactions to chemotherapy drugs can occur, ranging from mild to severe (anaphylaxis).

Question 91

What are some common side effects of chemotherapy?

Answer 91

Bone marrow suppression: Decreased production of blood cells (red blood cells, white blood cells, platelets), leading to anemia, increased risk of infection, and bleeding problems. Nausea and vomiting: Mucositis: Inflammation of mucous membranes, causing mouth sores. Alopecia: Hair loss. Fatigue | Other side effects: Can vary depending on the specific drug and the pt.

Question 92

# Prioritization - Managing Chemotherapy Side Effects A client is receiving chemotherapy and is experiencing nausea, vomiting, and mucositis. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first). A. Administering antiemetics as prescribed. B. Assessing the client's oral mucosa. C. Encouraging the client to eat small, frequent meals. D. Providing emotional support and reassurance.

Answer 92

1. A. Administering antiemetics as prescribed. (Controlling nausea and vomiting is crucial for patient comfort and preventing complications.) 2. B. Assessing the client's oral mucosa. (Mucositis can lead to serious complications if not managed.) 3. C. Encouraging the client to eat small, frequent meals. (Helps manage nausea and maintain nutrition.) 4. D. Providing emotional support and reassurance. (Important, but physical needs take precedence.)

Question 93

A nurse is administering chemotherapy intravenously. The client reports pain at the insertion site, and the nurse notices swelling and redness. What is the nurse's FIRST action? A. Slow down the infusion rate. B. Apply a warm compress to the area. C. Stop the infusion immediately. D. Administer an antihistamine.

Answer 93

C. Stop the infusion immediately.

Question 94

What are some common chemotherapy toxicities?

Answer 94

Gastrointestinal: Manifestations: Nausea, vomiting, diarrhea, constipation, mucositis (inflammation of the mucous membranes), anorexia (loss of appetite), and weight loss. Hematopoietic (Bone Marrow Suppression): Manifestations: Anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets).   Renal: Manifestations: Decreased kidney function, electrolyte imbalances, and potential kidney damage.   Cardiopulmonary: Manifestations: Can vary depending on the specific drug. Some drugs can damage the heart (cardiotoxicity) or lungs (pulmonary toxicity).   Reproductive: Manifestations: Infertility (both male and female) and potential harm to a developing fetus if pregnant.   Neurologic: Manifestations: Peripheral neuropathy (numbness, tingling, pain in hands and feet), cognitive changes ("chemo brain"), and seizures (less common).  Cognitive Manifestations: Difficulty with memory, concentration, and multitasking. Fatigue: Manifestations: Persistent and overwhelming tiredness that is not relieved by rest.  

Question 95

What labs should the nurse mointor when Managing in chemotherapy?

Answer 95

CBC (Complete Blood Count): BUN (Blood Urea Nitrogen) and Creatinine ## Footnote Bone Marrow Suppression: Chemotherapy can damage bone marrow, leading to decreased production of blood cells: Thrombocytopenia (Low Platelets): Increases risk of bleeding. Neutropenia (Low White Blood Cells): Increases risk of infection. Anemia (Low Red Blood Cells): Causes fatigue and shortness of breath.

Question 96

How can the nurse modify the risks of infection & bleeding that come with chemotherapy?

Answer 96

Infection: Implement neutropenic precautions (hand hygiene, avoiding crowds, etc.) to minimize infection risk. Bleeding: Monitor for signs of bleeding (bruising, nosebleeds, gum bleeding) and take precautions to prevent falls or injuries.

Question 97

A nurse is providing discharge instructions to a client who has received chemotherapy. Which statement by the client indicates a need for further education? A. "I will call the doctor if I have a fever over 100.4°F (38°C)." B. "I will avoid crowded places to reduce my risk of infection." C. "I will use a soft toothbrush and avoid flossing." D. "I will take aspirin for my headache."

Answer 97

D. "I will take aspirin for my headache."

Question 98

Goals of curative chemotherapy? What types of cancer are most responsive?(6)

Answer 98

Goal: To completely eradicate the cancer and achieve long-term remission or a cure. Cancers Often Responsive: * Burkitt's lymphoma * Wilms' tumor * Neuroblastoma * Acute lymphocytic leukemia (ALL) * Hodgkin's lymphoma * Testicular cancer

Question 99

Goals of controlive chemotherapy? What cancers is control often the focus of? (4)

Answer 99

Goal: To stop cancer growth and/or spread, prolonging life and improving quality of life, even if a complete cure is not achievable. Cancers Where Control is Often the Focus: * Breast cancer * Non-Hodgkin's lymphoma * Small cell lung cancer * Ovarian cancer

Question 100

Goals of palliation chemotherapy? What are the main focuses? (4)

Answer 100

Goal: To alleviate symptoms and improve quality of life in cases where the cancer is advanced and not curable. Focus: * Relieve pain * Relieve obstruction * Improve the sense of well-being

Question 101

A client undergoing chemotherapy for ovarian cancer experiences severe nausea and vomiting. The healthcare provider prescribes an antiemetic medication. Which of the following potential outcomes of chemotherapy align with the overall goal of "palliation" in this client's situation? Select all that apply. A. Eradication of all cancer cells B. Shrinking of the tumor C. Relief of nausea and vomiting D. Improvement in the client's sense of well-being E. Prolongation of life by several years

Answer 101

C. Relief of nausea and vomiting D. Improvement in the client's sense of well-being

Question 102

A patient is receiving chemotherapy for Burkitt's lymphoma. What is the expected outcome of this treatment?

Answer 102

Cure of the cancer

Question 103

A patient with advanced lung cancer is receiving chemotherapy. The primary goal of the treatment in this scenario is most likely: A. To eradicate the cancer completely. B. To slow the growth of the cancer and alleviate symptoms. C. To prevent the cancer from recurring in the future. D. To boost the patient's immune system to fight the cancer.

Answer 103

B. To slow the growth of the cancer and alleviate symptoms.

Question 104

# Bone Marrow Suppression Match the therapy with the type of effect. System Effect & Localized Effect Radiation & Chemotherapy ## Footnote Bone marrow suppression, also known as myelosuppression, is a common and significant side effect of chemotherapy (and sometimes radiation). It occurs because these treatments target rapidly dividing cells, including those in the bone marrow responsible for producing blood cells.

Answer 104

Systemic Effect: Chemotherapy's impact on bone marrow is systemic, affecting blood cell production throughout the body. Localized Effect: Radiation's impact is more localized, affecting bone marrow within the treatment field.

Question 105

What are some serious consequences to bone marrow suppression?

Answer 105

Bone marrow suppression can lead to life-threatening complications, including hemorrhage (bleeding) and overwhelming infection due to a weakened immune system. Profound fatigue also results from anemia.

Question 106

What mointoring is crucial with bone marrow suppression?

Answer 106

CBC Monitoring: Regular monitoring of the Complete Blood Count (CBC) is crucial, paying close attention to: Neutrophils (a type of white blood cell): Low neutrophils (neutropenia) significantly increase the risk of infection. Platelets: Low platelets (thrombocytopenia) increase the risk of bleeding. Red Blood Cells (RBCs): Low RBCs (anemia) cause fatigue and reduce oxygen-carrying capacity. ## Footnote Timing of Lowest Counts (Nadir): Blood cell counts often reach their lowest point (nadir) 7-10 days after starting chemotherapy. This is important to anticipate and plan care.

Question 107

What are some types of nursing interventions that should be set in place for pts with bone marrow suppression? (4) | List some methods for each type.

Answer 107

Infection Prevention: Implement neutropenic precautions (strict hand hygiene, avoid crowds and sick individuals, meticulous personal hygiene). Bleeding Precautions: Monitor for signs of bleeding (bruising, petechiae, nosebleeds, gum bleeding, blood in stool or urine), avoid invasive procedures if possible, and handle patients gently. Fatigue Management: Encourage rest, prioritize activities, assist with daily tasks, and address underlying anemia if present. Patient Education: Teach patients about the signs and symptoms of infection, bleeding, and anemia, and when to report them to the healthcare provider.

Question 108

# Prioritization - Nursing Care for Myelosuppression A client receiving chemotherapy has a WBC count of 2,500 cells/mm3 (normal range: 4,500-11,000 cells/mm3), a platelet count of 90,000 cells/mm3 (normal range: 150,000-400,000 cells/mm3), and a hemoglobin level of 9 g/dL (normal range: 12-16 g/dL). Which nursing actions should be prioritized? Rank in order of priority (most important first). A. Encouraging rest periods and assisting with activities. B. Monitoring for signs of bleeding. C. Administering blood transfusions as ordered. D. Implementing neutropenic precautions.

Answer 108

D. Implementing neutropenic precautions. (Risk for infection due to low WBC count is the highest priority.) B. Monitoring for signs of bleeding. (Risk for bleeding due to low platelet count is the next highest priority.) A. Encouraging rest periods and assisting with activities. (Important for managing fatigue due to anemia, but infection and bleeding risks are more immediate.) C. Administering blood transfusions as ordered. (May be necessary to treat severe anemia, but not an immediate action unless the anemia is symptomatic or life-

Question 109

What is neutropenia?

Answer 109

Neutropenia, a low count of neutrophils (a type of white blood cell), is a serious risk factor for life-threatening infection and sepsis. This is especially critical in patients undergoing cancer treatment, as their bone marrow may be suppressed. ## Footnote Definition: A condition in which the Absolute Neutrophil Count (ANC) is less than 1000 cells/μL. Severe Neutropenia: ANC less than 500 cells/μL. Risk: High risk for infection and death from sepsis.

Question 110

What are 2 of the high risk for neutropenia?

Answer 110

1. Infection Risk: Neutropenia significantly impairs the immune system, making individuals highly susceptible to bacterial, fungal, and even viral infections. What might be a minor infection in someone with a healthy immune system can quickly become life-threatening in a neutropenic patient. 2. Sepsis Risk: Sepsis, a severe and potentially fatal reaction to infection, is a major concern in neutropenic patients.

Question 111

What is crucial to monitor in neutropenic patients?

Answer 111

Temperature Monitoring: Routine temperature monitoring is essential. A fever in a neutropenic patient is considered a medical emergency and requires immediate intervention. | Pt. should report any temp change immediately.

Question 112

What are some infection prevention measures that should be taken with neutropenic patients? | 4

Answer 112

1. Hand Hygiene: Strict and frequent hand hygiene by healthcare providers, patients, and visitors is paramount. 2. Reverse Isolation: This may include measures like limiting visitors, prohibiting fresh fruits, vegetables, and flowers (which can harbor bacteria or mold), and ensuring a clean environment. 3. WBC Growth Factors: Medications like Filgrastim (Neupogen) may be used to stimulate the bone marrow to produce more neutrophils. 4. Avoidance of Crowds and Sick Individuals: Patients should be educated to avoid crowds and contact with people who have colds, flu, or other infections.

Question 113

What are some nursing interventions for neutropenia?

Answer 113

Early Detection: Promptly recognize signs and symptoms of infection (fever, chills, redness, swelling, drainage, cough, sore throat). Immediate Reporting: Report any temperature elevation immediately to the healthcare provider. Infection Prevention: Implement all prescribed infection control measures diligently. Patient Education: Educate patients and their families/visitors about the risks of infection, preventive measures, and the importance of prompt reporting of any signs of illness.

Question 114

A client with neutropenia is at high risk for infection. Indicate whether the following nursing actions are appropriate (Yes) or inappropriate (No). 1. Encourage frequent hand washing by the client 2. Allow fresh flowers in the room Monitor temperature every 4 hours 3. Administer Filgrastim (Neupogen) as ordered 4. Encourage the client to eat raw fruits & veggies

Answer 114

1. Encourage frequent hand washing by the client YES 2. Allow fresh flowers in the room NO Monitor temperature every 4 hours YES 3. Administer Filgrastim (Neupogen) as ordered YES 4. Encourage the client to eat raw fruits & veggies NO

Question 115

# Prioritization - Managing Neutropenia A client with neutropenia has a temperature of 100.8°F (38.2°C). Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first). A. Administering antibiotics as prescribed. B. Notifying the healthcare provider immediately. C. Implementing neutropenic precautions. D. Obtaining cultures (blood, urine, sputum) as ordered.

Answer 115

1. B. Notifying the healthcare provider immediately. (A fever in a neutropenic patient is a medical emergency.) 2. A. Administering antibiotics as prescribed. (Prompt treatment is crucial once the provider is notified.) 3. D. Obtaining cultures (blood, urine, sputum) as ordered. (To identify the source of the infection.) 4. C. Implementing neutropenic precautions. (These should already be in place, but if not, they are important to initiate.)

Question 116

A nurse is providing discharge instructions to a client with neutropenia. Which statement by the client indicates a need for further teaching? A. "I will avoid fresh fruits and vegetables." B. "I will take my temperature daily." C. "I will avoid contact with people who have colds or the flu." D. "I will take my temperature once a week."

Answer 116

D. "I will take my temperature once a week."

Question 117

What is thrombocytopenia?

Answer 117

Thrombocytopenia, a low platelet count, is a common side effect of cancer treatment, particularly chemotherapy. Platelets are essential for blood clotting, so a deficiency can lead to serious bleeding problems. Definition: Platelet counts below 100,000/μL. Spontaneous Hemorrhage Risk: Possible once counts fall below 10,000/μL. ## Footnote Spontaneous Bleeding/Hemorrhage: Severe thrombocytopenia can result in spontaneous bleeding, such as nosebleeds, gum bleeding, or internal bleeding. Major hemorrhage is a life-threatening complication.

Question 118

What is the platelet counts indicate bleeding risk and a need for platelet transfusion?

Answer 118

Bleeding Risk Threshold: The risk of bleeding generally increases significantly when the platelet count falls below 50,000/μL. Platelet Transfusions: Platelet transfusions may be necessary to prevent or treat bleeding, particularly when the platelet count falls below 20,000/μL or if the patient is actively bleeding.

Question 119

What are some nursing interventions for thrombocytopenia?

Answer 119

**Monitor Platelet Count** **Assess for Bleeding**: Frequently assess for any signs of bleeding, including petechiae (small red spots), bruising, nosebleeds, gum bleeding, hematuria (blood in urine), melena (blood in stool), or heavy menstrual bleeding. **Implement Bleeding Precautions:** Use a soft-bristled toothbrush, Avoid IM injections, rectal temperatures, and enemas, Handle patients gently, Minimize blood draws., & Instruct patients to avoid activities that could cause injury. **Patient Education:** Educate patients and families about the signs and symptoms of bleeding, when to report them to the healthcare provider, and safety measures to prevent bleeding. ## Footnote Invasive Procedures: Invasive procedures, like injections or biopsies, should be avoided whenever possible to minimize the risk of bleeding. Activities to Avoid: Patients should be taught to avoid activities that could increase their risk of injury or bleeding, including contact sports, vigorous exercise, and straining during bowel movements.

Question 120

# Prioritization - Managing Thrombocytopenia A client receiving chemotherapy has a platelet count of 40,000/μL. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first). A. Assessing for signs of active bleeding. B. Instructing the client to avoid activities that could cause injury. C. Administering a platelet transfusion as ordered. D. Educating the client about the signs and symptoms of bleeding.

Answer 120

1. A. Assessing for signs of active bleeding. (Active bleeding requires immediate intervention.) 2. C. Administering a platelet transfusion as ordered. (May be necessary if the platelet count is very low or if the patient is actively bleeding.) 3. B. Instructing the client to avoid activities that could cause injury. (Important for preventing bleeding, but assessment and treatment of active bleeding take priority.) 4. D. Educating the client about the signs and symptoms of bleeding. (Important for ongoing self-care, but immediate assessment and interventions are higher priorities.)

Question 121

A nurse is caring for a client with a platelet count of 15,000/μL. Which of the following actions should the nurse anticipate? A. Administering a unit of packed red blood cells. B. Preparing the client for a platelet transfusion. C. Implementing neutropenic precautions. D. Monitoring for signs of infection.

Answer 121

B. Preparing the client for a platelet transfusion.

Question 122

What is Hematopoietic Stem Cell Transplantation (HSCT)?

Answer 122

HSCT is a procedure that replaces damaged or destroyed blood-forming stem cells with healthy ones. These stem cells can come from the bone marrow, peripheral blood, or umbilical cord blood. ## Footnote Uses of HSCT: Malignant Diseases: Leukemia, Lymphoma, &Multiple myeloma Non-Malignant Diseases: Aplastic anemia, Thalassemia, & Sickle cell anemia **Risks:** HSCT has significant risks, including infection, bleeding, anemia, graft-versus-host disease (in allogeneic transplants), and even death. **Nursing Care: **Nurses play a crucial role in patient education, managing side effects, preventing complications, and providing emotional support throughout the HSCT process.

Question 123

# Hematopoietic Stem Cell Transplantation (HSCT) What is Allogeneic?

Answer 123

Stem cells are donated from another person (a donor). The donor is usually a close relative (like a sibling) but can also be an unrelated person. ## Footnote Matching: For allogeneic transplants, the donor's tissue type needs to be closely matched to the recipient's to reduce the risk of complications like graft-versus-host disease (GVHD).

Question 124

# Hematopoietic Stem Cell Transplantation (HSCT) What is Autologous?

Answer 124

Stem cells are collected from the patient's own body before treatment (like chemotherapy or radiation) and then transplanted back.

Question 125

# Hematopoietic Stem Cell Transplantation (HSCT) What is syngeneic?

Answer 125

Stem cells are donated from an identical twin

Question 126

# Hematopoietic Stem Cell Transplantation (HSCT) What is Myeloablative?

Answer 126

High doses of chemotherapy and/or radiation are given before transplant to kill cancer cells and bone marrow. This allows the new stem cells to engraft but has significant risks.

Question 127

# Hematopoietic Stem Cell Transplantation (HSCT) What is Nonmyeloblative?

Answer 127

Lower doses of chemotherapy and/or radiation are given. This approach may be better tolerated but may be associated with a higher risk of relapse in some cancers.

Question 128

# Prioritization - Post-HSCT Complications A client is 10 days post-allogeneic HSCT. Which of the following potential complications should the nurse prioritize in their assessment? Rank in order of priority (most important first). A. Providing emotional support and addressing anxiety.Monitoring for signs and symptoms of infection. B. Monitoring for signs and symptoms of infection. C. Managing pain and fatigue. D. Assessing for skin changes suggestive of graft-versus-host disease (GVHD).

Answer 128

B. Monitoring for signs and symptoms of infection. (Infection is a major and potentially life-threatening complication in the immediate post-transplant period due to immunosuppression.) D. Assessing for skin changes suggestive of graft-versus-host disease (GVHD). (GVHD is a significant risk in allogeneic transplants and often presents with skin manifestations.) C. Managing pain and fatigue. (Important for comfort and quality of life, but infection and GVHD take priority.) A. Providing emotional support and addressing anxiety. (Essential for overall well-being, but physical complications are the priority.)

Question 129

Which of the following BEST describes a myeloablative conditioning regimen before HSCT? A. It uses lower doses of chemotherapy and/or radiation. B. It is associated with a lower risk of graft-versus-host disease. C. It aims to completely destroy the patient's bone marrow. D. It is typically used for autologous HSCT.

Answer 129

C. It aims to completely destroy the patient's bone marrow.

Question 130

# Prioritization - Pre-HSCT Evaluation A client is being evaluated for HSCT. Which assessments/diagnostic tests should the nurse prioritize in this evaluation process? Rank in order of priority (most important first). A. Assessing the client's emotional and psychological status. B. Tissue typing and crossmatching for potential donors. C. Obtaining a detailed medical history, including past infections and treatments. D. Evaluating the client's understanding of the HSCT procedure and potential risks.

Answer 130

1. B. Tissue typing and crossmatching for potential donors. (Essential for allogeneic HSCT, which is a common type.) 2. C. Obtaining a detailed medical history, including past infections and treatments. (Identifies potential risks and complications.) 3. A. Assessing the client's emotional and psychological status. (Important for support and coping, but physical factors take precedence.) 4. D. Evaluating the client's understanding of the HSCT procedure and potential risks. (Important for informed consent, but physical assessments are the priority.)

Question 131

What is the steps to autologous hematopoietic stem cell transplantation (HSCT)? (6)

Answer 131

1. Harvest Stem Cells or Bone Marrow 2. Treat Stem Cells or Bone Marrow 3. Chemotherapy 4. Patient's Remaining Bone Marrow and Cancer Cells are Destroyed. 5. IV Injection of Purified Stem Cells 6. Stem Cells "Home" to Bone Marrow and Produce New Blood Cells

Question 132

What is Graft-versus-Host Disease (GVHD)?

Answer 132

GVHD is a serious complication that can occur after an allogeneic hematopoietic stem cell transplant (HSCT), where a patient receives stem cells from a donor. ## Footnote Immune Response: GVHD happens when the donor's T lymphocytes (a type of white blood cell) recognize the recipient's tissues as foreign and attack them. Target Organs: The most commonly affected organs are the skin, gastrointestinal tract, and liver.

Question 133

What are some symptoms of GVHD?

Answer 133

Skin: Rash, itching, redness, blistering Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain Liver: Jaundice, elevated liver enzymes

Question 134

What are the treatment and prevention methods for GVHD?

Answer 134

Prevention: Immunosuppressant drugs, such as cyclosporine, are given to prevent GVHD. Treatment: Treatment for GVHD often involves corticosteroids and other immunosuppressive medications.

Question 135

What are some nursing considerations for GVHD?

Answer 135

Assessment: Monitor patients closely for signs and symptoms of GVHD, especially skin changes, gastrointestinal symptoms, and liver function abnormalities. Patient Education: Educate patients about the risk of GVHD, signs and symptoms to watch for, and the importance of reporting any changes promptly. Medication Management: Administer immunosuppressant medications as prescribed and monitor for side effects. Supportive Care: Provide supportive care to manage symptoms, such as skin care for rashes, antiemetics for nausea, and nutritional support for diarrhea.

Question 136

# Prioritization - Managing Acute GVHD Scenario: A client post-allogeneic HSCT develops a skin rash, diarrhea, and elevated liver enzymes within the first 100 days. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first). A. Administering immunosuppressive medications as prescribed. B. Monitoring the client's skin for changes and providing skin care. C. Assessing the frequency and severity of diarrhea and managing fluid balance. D. Educating the client about the signs and symptoms of GVHD.

Answer 136

1. A. Administering immunosuppressive medications as prescribed. (Essential to suppress the immune response causing GVHD.) 2. C. Assessing the frequency and severity of diarrhea and managing fluid balance. (Diarrhea can lead to dehydration and electrolyte imbalances.) 3. B. Monitoring the client's skin for changes and providing skin care. (Important for comfort and preventing infection, but immunosuppression and diarrhea take priority.) 4. D. Educating the client about the signs and symptoms of GVHD. (Important for long-term management, but immediate interventions are the priority.)

Question 137

Which medication is MOST commonly used to prevent GVHD after allogeneic HSCT? A. Cyclosporine B. Filgrastim C. Ondansetron D. Loperamide

Answer 137

A. Cyclosporine

Question 138

What is some nursing management in HSCT for the 1st step of Implementing Pre-Transplantation Care?

Answer 138

Assessment: Thorough physical and psychosocial assessment of the recipient. Education: Educate the recipient and family about the HSCT process, risks, benefits, and expected outcomes. Preparation: Prepare the recipient for the conditioning regimen (chemotherapy and/or radiation), which may include administering medications, ensuring hydration, and managing side effects. Donor Evaluation (Allogeneic): In allogeneic transplants, assess the donor's eligibility and ensure informed consent.

Question 139

What is some nursing management in HSCT for the 2nd step of Providing Care During Treatment?

Answer 139

Monitoring: Closely monitor the recipient for complications related to the conditioning regimen, such as infection, bleeding, mucositis, nausea/vomiting, and fatigue. Supportive Care: Provide supportive care to manage side effects and complications, including administering medications, providing nutritional support, and managing pain. Protecting Recipient: Implement measures to prevent infection and bleeding, especially during periods of low blood cell counts (neutropenia and thrombocytopenia). Emotional Support: Provide emotional and psychosocial support to both the recipient and family throughout the transplant process.

Question 140

What is some nursing management in HSCT for the 3rd step of Providing Post-Transplantation Care?

Answer 140

Monitoring for Engraftment: Monitor for signs of engraftment (when the transplanted stem cells start producing blood cells). Managing Complications: Manage post-transplant complications, such as infection, graft-versus-host disease (GVHD), and organ toxicity. Patient Education: Educate the recipient about long-term follow-up care, potential late effects, and strategies for maintaining health and well-being. Donor Follow-up (Allogeneic): In allogeneic transplants, ensure appropriate follow-up care for the donor. ## Footnote Caring for Recipients vs. Caring for Donors: Recipients: Focus is on managing complications, supporting recovery, and achieving long-term health. Donors: Focus is on ensuring their safety during the donation process and monitoring their health post-donation.

Question 141

# Prioritization - Post-Transplant Assessments A client is 7 days post-allogeneic HSCT. Which assessments should the nurse prioritize? Rank in order of priority (most important first). A. Assessing for signs and symptoms of infection. B. Monitoring for signs of engraftment (rising blood cell counts). C. Evaluating the client's emotional state and coping mechanisms. D. Assessing for signs and symptoms of graft-versus-host disease (GVHD).

Answer 141

1. A. Assessing for signs and symptoms of infection. (Risk of infection is highest in the immediate post-transplant period.) 2. B. Monitoring for signs of engraftment (rising blood cell counts). (Engraftment is crucial for recovery and indicates the transplant's success.) 3. D. Assessing for signs and symptoms of graft-versus-host disease (GVHD). (GVHD is a significant risk in allogeneic transplants.) 4. C. Evaluating the client's emotional state and coping mechanisms. (Important, but physical needs take priority.)

Question 142

A nurse is providing discharge instructions to a client who has undergone HSCT. Which statement by the client indicates a need for further education? A. "I will need to continue to follow neutropenic precautions at home." B. "I should expect to feel fatigued for several weeks or months after the transplant." C. "I will avoid contact with anyone who has a cold or infection." D. "I can resume all my normal activities as soon as I get home."

Answer 142

D. "I can resume all my normal activities as soon as I get home."

Question 143

# Notes on Nursing Care: Maintaining Tissue Integrity in Cancer Patients What is stomatitis?

Answer 143

Inflammation of the oral mucosa, often a side effect of chemotherapy and radiation therapy. Nursing Interventions: * Regular oral assessments * Gentle oral hygiene (soft toothbrush, non-alcoholic mouthwash) * Pain management (topical anesthetics, systemic analgesics) * Dietary modifications (avoid spicy, acidic, or hot foods) * Patient education on oral care

Question 144

# Notes on Nursing Care: Maintaining Tissue Integrity in Cancer Patients What is alopecia?

Answer 144

Hair loss, often a side effect of chemotherapy. Nursing Interventions: * Emotional support and counseling * Education about the temporary nature of hair loss * Suggestions for coping (wigs, scarves) * Scalp care to prevent irritation

Question 145

A client is experiencing stomatitis due to chemotherapy. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No). 1. Encourage the use of an alcohol-based mouthwash 2. Offer soft, bland foods 3. Apply a topical anesthetic to oral lesions 4. Suggest the client brush their teeth vigorously 5. Recommend the client drink hot liquids

Answer 145

1. Encourage the use of an alcohol-based mouthwash NO 2. Offer soft, bland foods YES 3. Apply a topical anesthetic to oral lesions YES 4. Suggest the client brush their teeth vigorously NO 5. Recommend the client drink hot liquids NO

Question 146

# Prioritization - Skin Care for Radiation Therapy A client is undergoing radiation therapy to the chest. Which nursing actions are the HIGHEST priority regarding skin care in the treatment area? Rank in order of priority (most important first). A. Instructing the client to avoid using any lotions or creams on the treated skin. B. Assessing the skin for signs of redness, blistering, or breakdown. C. Educating the client about the potential for long-term skin changes. D. Encouraging the client to wear loose-fitting, cotton clothing.

Answer 146

1. B. Assessing the skin for signs of redness, blistering, or breakdown. (Early detection of skin reactions is crucial for prompt intervention.) 2. A. Instructing the client to avoid using any lotions or creams on the treated skin. (This is important to prevent skin irritation during radiation therapy.) 3. D. Encouraging the client to wear loose-fitting, cotton clothing. (This helps minimize friction and irritation.) 4. C. Educating the client about the potential for long-term skin changes. (Important for the client to know, but immediate skin care needs take precedence.)

Question 147

A client undergoing chemotherapy is experiencing alopecia. Which nursing action is MOST appropriate? A. Reassure the client that hair loss is permanent. B. Encourage the client to avoid talking about their hair loss. C. Suggest the client wear a wig or head covering if desired. D. Instruct the client to wash their hair daily with a gentle shampoo.

Answer 147

C. Suggest the client wear a wig or head covering if desired.

Question 148

Instructions: A client with cancer is experiencing anorexia and malabsorption. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No). 1. Encourage large, infrequent meals 2. Offer small, frequent meals 3. Provide high-calorie, high-protein foods 4. Restrict fluids to minimize feelings of fullness 5. Collaborate with a registered dietitian

Answer 148

1. Encourage large, infrequent meals NO 2. Offer small, frequent meals YES 3. Provide high-calorie, high-protein foods YES 4. Restrict fluids to minimize feelings of fullness NO 5. Collaborate with a registered dietitian YES

Question 149

# Prioritization - Managing Cancer-Related Fatigue A client with cancer is experiencing significant fatigue. Which nursing actions should be prioritized? Rank in order of priority (most important first). A. Encouraging rest periods and energy conservation techniques. B. Assessing for contributing factors such as anemia or pain. C. Discussing the impact of fatigue on the client's quality of life. D. Recommending a vigorous exercise program to combat fatigue.

Answer 149

1. B. Assessing for contributing factors such as anemia or pain. (Addressing underlying causes is crucial.) 2. A. Encouraging rest periods and energy conservation techniques. (Helps manage fatigue.) 3. C. Discussing the impact of fatigue on the client's quality of life. (Important for emotional support and planning care.) 4. D. Recommending a vigorous exercise program to combat fatigue. (Exercise can be beneficial, but it should be moderate and tailored to the individual's energy levels.)

Question 150

A client with cancer is experiencing mucositis and has difficulty eating. Which dietary modification is MOST appropriate? A. Serving hot, spicy foods. B. Offering foods high in citric acid (e.g., orange juice). C. Providing soft, bland foods at room temperature. D. Encouraging the use of a straw for all beverages.

Answer 150

C. Providing soft, bland foods at room temperature.

Question 151

Palliative Care Focus? Timing? Life Expectancy? Covered by? Treatment?

Answer 151

Focus: Provides relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.   Timing: Can be provided at any stage of a serious illness, alongside curative treatment. Life Expectancy: Not tied to a specific life expectancy. Covered by: Traditional medical insurance or Medicare. Treatment: Can involve more aggressive treatment of symptoms without compromising quality of life.

Question 152

Hospice Care Focus? Timing? Life Expectancy? Covered by? Treatment?

Answer 152

Focus: Provides comfort care for patients with a terminal illness when a cure is no longer possible. Timing: Elegible when a physician certifies that life expectancy is 6 months or less if the illness runs its normal course. Life Expectancy: Requires a limited life expectancy of 6 months or less. Covered by: Medicare, Medicaid, and most private insurers. Treatment: Focuses on managing pain and other symptoms to allow the patient to die with dignity. ## Footnote Timely Referral: Patients should be referred to hospice in a timely fashion to maximize the benefits of care. Comprehensive Approach: Hospice care involves a multidisciplinary team (doctors, nurses, social workers, chaplains, aides, volunteers). Focus Areas: Quality of life Palliation of symptoms Psychosocial and spiritual care for the patient and family.

Question 153

What are some shared aspects of palliative & hospice care?

Answer 153

Quality of Life: Both emphasize improving quality of life. Emotional, Physical, and Spiritual Support: Both provide holistic support for patients and families.

Question 154

What is hematology?

Answer 154

The study of blood and blood-forming tissues. Includes bone marrow, blood, spleen, and lymph system.

Question 155

What are the 2 types of bone marrow?

Answer 155

Yellow (adipose) - inactive in blood cell production. Red (hematopoietic) - actively produces blood cells. ## Footnote Red blood cells (RBCs), white blood cells (WBCs), and platelets develop from a common hematopoietic stem cell in the bone marrow. The bone marrow uses a negative feedback system to regulate blood cell production based on the body's needs.

Question 156

# Prioritization - Blood Cell Production The body needs more red blood cells due to chronic blood loss. Which action should the bone marrow prioritize? Rank in order of priority (most important first). A. Increasing platelet production. B. Increasing red blood cell production. C. Increasing white blood cell production.

Answer 156

1. B. Increasing red blood cell production. (The body has a specific need for more RBCs.) 2. C. Increasing white blood cell production. (Important for immune function, but not the immediate priority.) 3. A. Increasing platelet production. (Also important, but not the immediate priority.)

Question 157

What is hemostasis?

Answer 157

Hemostasis: The arrest of bleeding. A complex process involving multiple factors and steps. Hemostasis involves both platelet and coagulation factors. The process is tightly regulated to ensure clot formation only when needed and to prevent excessive clotting. ## Footnote 1. Vascular Injury and Subendothelial Exposure: Damage to a blood vessel leads to a brief vasoconstrictive response (narrowing of the vessel) to reduce blood flow. The underlying tissue (subendothelium) is exposed. 2. Adhesion: Platelets adhere to the exposed subendothelium. This process is aided by adhesive glycoproteins like collagen and von Willebrand factor (vWF). 3. Activation:Platelets are activated, changing shape and becoming sticky. They release factors that promote further platelet activation and aggregation. 4. Aggregation: Activated platelets clump together, forming a platelet plug. This process is reinforced by the formation of fibrin strands, creating a visible fibrin clot. 5. Platelet Plug Formation: The initial platelet plug is stabilized by the fibrin clot, forming the final blood clot. 6. Clot Retraction and Dissolution: The clot retracts, pulling the edges of the damaged vessel together. The clot is eventually dissolved (fibrinolysis) to restore blood flow and prevent blockage. Counter-mechanisms, such as anticoagulants and antithrombin activity, help keep blood in its fluid state and prevent excessive clotting.

Question 158

A patient experiences a minor injury with some bleeding. Which step of hemostasis occurs first? A. Platelet aggregation. B. Vasoconstriction. C. Fibrin clot formation.

Answer 158

B. Vasoconstriction.

Question 159

# Prioritization - Subjective Data for Thrombocytopenia A client is being evaluated for possible thrombocytopenia (low platelet count). Which subjective data should the nurse prioritize collecting? Rank in order of priority (most important first). A. Reports of easy bruising or prolonged bleeding. B. History of recent infections or fever. C. Description of fatigue or weakness. D. Information about current medications or supplements.

Answer 159

1. A. Reports of easy bruising or prolonged bleeding. (Directly related to thrombocytopenia.) 2. D. Information about current medications or supplements. (Some can affect platelet function.) 3. B. History of recent infections or fever. (Infections can sometimes cause thrombocytopenia.) 4. C. Description of fatigue or weakness. (Can be present in thrombocytopenia but less specific than bleeding-related symptoms.)

Question 160

A client who is a Jehovah's Witness is scheduled for surgery. Which action by the nurse is MOST appropriate regarding the client's religious beliefs and potential blood transfusions? A. Assume the client will accept blood transfusion in a life-threatening situation. B. Respect the client's refusal of blood products and explore alternative treatment options. C. Attempt to persuade the client to accept blood transfusion, as it is a life-saving procedure. D. Inform the surgical team that the client's religious beliefs should be disregarded in case of emergency.

Answer 160

B. Respect the client's refusal of blood products and explore alternative treatment options.

Question 161

What do each part of the complete blood count measure? Hemoglobin Hematocrit Total RBC Count RBC Morphology Reticulocyte Count WBC Count Platelet Count

Answer 161

Hemoglobin (Hb): Measures the amount of hemoglobin in red blood cells (RBCs), which carries oxygen. Low levels indicate anemia. Hematocrit (Hct): Measures the percentage of RBCs in the blood. Low levels also indicate anemia. Total RBC Count (Erythrocyte Count): Measures the number of RBCs in a given volume of blood. RBC Morphology: Examines the size, shape, and appearance of RBCs, which can provide clues to specific conditions. Reticulocyte Count: Measures the number of young, immature RBCs (reticulocytes). Useful for assessing bone marrow's response to anemia. WBC Count: Measures the total number of white blood cells (WBCs) in the blood. Increased levels can indicate infection; decreased levels can indicate immune suppression. WBC Differential: Measures the percentage of each type of WBC (neutrophils, lymphocytes, monocytes, eosinophils, basophils). Useful for diagnosing infections, allergies, and other conditions. Platelet Count: Measures the number of platelets in the blood. Low levels increase the risk of bleeding.

Question 162

What do the following clotting studies measure? Activated Clotting Time (ACT) Activated Partial Thromboplastin Time (aPTT) Antithrombin Bleeding Time D-Dimer

Answer 162

Activated Clotting Time (ACT): Measures the time it takes for blood to clot under specific conditions. Used to monitor heparin therapy. Activated Partial Thromboplastin Time (aPTT): Measures the time it takes for blood to clot via the intrinsic pathway. Used to monitor heparin therapy and detect clotting disorders. Antithrombin: Measures the level of antithrombin, a natural anticoagulant. Deficiency increases the risk of clotting. Bleeding Time: Measures the time it takes for bleeding to stop after a small puncture wound. Assesses platelet function. D-Dimer: Measures the level of cross-linked fibrin, a product of clot breakdown. Elevated levels can indicate clotting disorders like DIC or DVT.

Question 163

What do the following clotting studies measure? Fibrinogen (Factor I) International Normalized Ratio (INR) Plasminogen Prothrombin Time (PT) Thrombin Time

Answer 163

Fibrinogen (Factor I): Measures the level of fibrinogen, a protein essential for clot formation. Low levels can increase the risk of bleeding. International Normalized Ratio (INR): A standardized ratio calculated from the prothrombin time (PT). Used to monitor warfarin therapy. Plasminogen: Measures the level of plasminogen, a protein that is converted to plasmin, which breaks down clots. Prothrombin Time (PT): Measures the time it takes for blood to clot via the extrinsic pathway. Used to monitor warfarin therapy and assess liver function. Thrombin Time: Measures the time it takes for fibrinogen to be converted to fibrin. Used to detect heparin and other clotting abnormalities.

Question 164

A client's hemoglobin level is 10 g/dL (normal range: 12-16 g/dL). Which condition is MOST likely indicated by this result? A. Polycythemia (excess RBCs) B. Anemia (low RBCs or hemoglobin) C. Infection (elevated WBCs) D. Thrombocytopenia (low platelets)

Answer 164

B. Anemia (low RBCs or hemoglobin)

Question 165

What is pancytopenia?

Answer 165

A condition where the entire CBC is suppressed, resulting in a marked decrease in all three blood cell types: * Red blood cells (RBCs) * White blood cells (WBCs) * Platelets ## Footnote WBC Count > 10,000/μL: Associated with infection, tissue injury or death, and certain cancers (leukemia, lymphoma). Extremely High WBC Counts (e.g., > 25,000/μL): Occur with certain types of leukemia. WBC Count < 5,000/μL (Leukopenia): Associated with bone marrow depression, severe or chronic illness, and other types of leukemia.

Question 166

What is thrombocytosis?

Answer 166

Too many platelets

Question 167

What is a more precise measure of infection risk than the total WBC count, as it specifically looks at neutrophils?

Answer 167

The absolute neutrophil count (ANC)

Question 168

# Prioritization - Managing Neutropenia Scenario: A client has an ANC of 400 cells/μL. Which nursing actions should be prioritized? Rank in order of priority (most important first). A. Implementing neutropenic precautions. B. Monitoring for signs of infection. C. Administering antibiotics as ordered. D. Educating the client about infection prevention.

Answer 168

1. A. Implementing neutropenic precautions. (Protecting the client from potential sources of infection is paramount.) 2. B. Monitoring for signs of infection. (Early detection of infection is crucial in neutropenic patients.) 3. C. Administering antibiotics as ordered. (Prompt treatment is necessary if infection develops.) 4. D. Educating the client about infection prevention. (Important for self-care, but immediate interventions take precedence.)

Question 169

At what platelet count does the risk of spontaneous hemorrhage significantly increase? A. Below 100,000/μL B. Below 50,000/μL C. Below 20,000/μL D. Below 10,000/μL

Answer 169

D. Below 10,000/μL

Question 170

What is Leukemia?

Answer 170

A type of cancer that affects the blood-forming tissues, hindering the body's ability to fight infection. Here's what we know about its causes and development: * No Single Cause: Leukemia doesn't have one specific cause. It's believed to develop from a combination of factors. * Genetic and Environmental Influences: Both genetic predispositions and environmental exposures can increase the risk of developing leukemia. * Oncogenes: Abnormal genes, called oncogenes, can contribute to the development of leukemia and other cancers. These genes normally regulate cell growth and division but can become disrupted. ## Footnote Pathophysiology leukemia involves the uncontrolled proliferation of abnormal blood cells, usually white blood cells (WBCs). These abnormal cells don't function properly and crowd out healthy blood cells, leading to various complications like anemia, increased risk of infection, and bleeding problems.

Question 171

What are some risk factors of leukemia?

Answer 171

Chemical Agents: Exposure to certain chemicals like benzene. Chemotherapy Drugs: Ironically, some chemotherapy drugs used to treat other cancers can increase the risk of secondary leukemia. Viruses: Certain viruses, such as the Epstein-Barr virus (EBV) and human T-cell leukemia virus (HTLV-1). Radiation: Exposure to high levels of radiation. Immunologic Factors: Weakened immune systems may increase the risk.

Question 172

Which statement BEST describes the current understanding of leukemia development? A. It is caused by a single, identifiable factor. B. It is primarily an inherited genetic disorder. C. It likely involves a combination of genetic and environmental influences. D. It is solely caused by exposure to high levels of radiation.

Answer 172

C. It likely involves a combination of genetic and environmental influences.

Question 173

# Types of Leukemia What is Acute Myeloid Leukemia (AML)?

Answer 173

Rapidly progressing cancer of myeloid cells. Myeloid cells are a type of blood cell that normally develops into red blood cells, platelets, or some types of white blood cells. ## Footnote Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.

Question 174

# Types of Leukemia What is Acute Lymphocytic Leukemia (ALL)?

Answer 174

Rapidly progressing cancer of lymphoid cells. Lymphoid cells are a type of white blood cell that normally develops into lymphocytes. ## Footnote Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.

Question 175

# Types of Leukemia What is Chronic Myelogenous Leukemia (CML)?

Answer 175

Slowly progressing cancer of myeloid cells. ## Footnote Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.

Question 176

# Types of Leukemia What is Chronic Lymphocytic Leukemia (CLL)?

Answer 176

Slowly progressing cancer of lymphoid cells. ## Footnote Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.

Question 177

# Prioritization - Leukemia Types A client is diagnosed with leukemia. Which information is MOST critical for the nurse to know to understand the expected disease progression and treatment plan? Rank in order of priority (most important first). A. The client's age and overall health. B. The specific type of leukemia (AML, ALL, CML, CLL). C. The client's emotional and psychological state. D. The client's access to social support and resources.

Answer 177

1. B. The specific type of leukemia (AML, ALL, CML, CLL). (This determines the disease course and treatment approach.) 2. A. The client's age and overall health. (These factors influence treatment options and prognosis.) 3. C. The client's emotional and psychological state. (Important for support but less critical than disease-specific information.) 4. D. The client's access to social support and resources. (Important for long-term care but less immediate than disease and patient factors.)

Question 178

A client is diagnosed with a rapidly progressing cancer that affects lymphoid cells. Which type of leukemia is this MOST likely to be? A. Acute Myeloid Leukemia (AML) B. Acute Lymphocytic Leukemia (ALL) C. Chronic Myelogenous Leukemia (CML) D. Chronic Lymphocytic Leukemia (CLL)

Answer 178

B. Acute Lymphocytic Leukemia (ALL)

Question 179

What are some acute/immediate blood transfusion reactions?

Answer 179

Allergic: Hives, itching, flushing, anaphylaxis (rare). Febrile, Non-Hemolytic: Fever, chills, headache. Hemolytic: Fever, chills, back pain, nausea, vomiting, dark urine, shock, DIC (Disseminated Intravascular Coagulation). Transfusion-Related Acute Lung Injury (TRALI): Respiratory distress, hypoxia, pulmonary edema.

Question 180

What are some delayed blood transfusion reactions?

Answer 180

Delayed Hemolytic Reactions: Anemia, jaundice. Infections: Hepatitis B, Hepatitis C, HIV, other bacterial or parasitic infections (risk is low due to screening). Graft-versus-Host Disease (GVHD): Fever, rash, diarrhea, liver dysfunction (occurs in immunocompromised individuals).

Question 181

What are the 10 nursing steps of action for suspect blood transfusion reaction?

Answer 181

1. Stop the transfusion immediately. 2. Stay with the patient and monitor closely. 3. Maintain a patent IV line with normal saline solution. 4. Notify the blood bank and healthcare provider promptly. 5. Recheck identifying tags and numbers on the blood bag and patient's wristband to ensure correct match. 6. Monitor vital signs and urine output. 7. Treat symptoms as ordered by the healthcare provider. 8. Save the blood bag and tubing and send them back to the blood bank for investigation. 9. Collect required blood and urine specimens as ordered to evaluate the reaction. 10. Document the reaction thoroughly in the patient's medical record.