Oncology/Hematology HW Qs Flashcards
1
Q
Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia?
A. Increasing citrus foods
B. Providing frequent oral hygiene
C. Encouraging activity
D. Administering medications parenterally
A
B. Providing frequent oral hygiene
2
Q
Which clinical finding indicates that doxorubicin toxicity may have occurred?
A. Fever
B. Blue tinge to the urine
C. Alteration in cardiac rhythm
D. Increasing anxiety
A
C. Alteration in cardiac rhythm
3
Q
A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care?
A. Adding citrus juices to meals
B. Offering warm saline mouthwash
C. Scheduling booster immunizations
D. Reporting red-orange colored urine
A
B. Offering warm saline mouthwash
4
Q
A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child?
A. Hair loss
B. Vomiting
C. Red urine
D. Stomatitis
A
C. Red urine
5
Q
A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care?
A. Administering aspirin for pain
B. Offering citrus juices with meals
C. Ensuring meticulous oral hygiene
D. Eliminating spicy foods from the diet
A
C. Ensuring meticulous oral hygiene
6
Q
A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect?
A. Toxic epidermal necrolysis
B. Heart failure
C. Pulmonary fibrosis
D. Ototoxicity
A
B. Heart failure
7
Q
A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately?
A. Nausea
B. Sore throat
C. Loss of hair
D. Constipation
A
B. Sore throat
8
Q
A client with Hodgkin’s disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication?
A. Cease taking any medication that contains vitamin D.
B. Keep the doxorubicin in a dark place protected from light.
C. Expect urine to turn red for a few days after taking this medication.
D. Take the doxorubicin on an empty stomach with large amounts of fluids.
A
C. Expect urine to turn red for a few days after taking this medication.
9
Q
A client with stage III Hodgkin’s disease is started on a multiple-drug regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine. Why are so many drugs necessary?
A. Using smaller doses of several drugs reduces the likelihood of serious side effects.
B. Each drug destroys the cancer cell at a different time in the cell cycle.
C. Several drugs are used to destroy cells that are not susceptible to radiation therapy.
D. Because there are stages of Hodgkin’s disease, if one drug is ineffective, another will work.
A
B. Each drug destroys the cancer cell at a different time in the cell cycle.
10
Q
A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred?
A. Alopecia
B. Dyspnea
C. Metallic taste to food
D. Cardiac rhythm abnormalities
A
D. Cardiac rhythm abnormalities
11
Q
A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity?
A. Neurotoxicity
B. Cardiotoxicity
C. Ototoxicity
D. Nephrotoxicity
A
B. Cardiotoxicity
12
Q
A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred?
A. Fever
B. Blue tinge to the urine
C. Alteration in cardiac rhythm
D. Increasing anxiety
A
C. Alteration in cardiac rhythm
13
Q
A client diagnosed with breast cancer is prescribed doxorubicin. Which assessment finding would the nurse recognize as a toxic effect of this medication?
A. Paralytic ileus
B. Red-tinged urine
C. Cardiac dysrhythmias
D. Increased serum magnesium
A
C. Cardiac dysrhythmias
14
Q
Which anticipatory guidance would the nurse include when teaching an adolescent about side effects of dactinomycin and doxorubicin therapy?
A. Wear a baseball cap.
B. Eat three meals daily.
C. Avoid dairy products.
D. Dress in light clothing.
A
A. Wear a baseball cap.
15
Q
A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement?
A. Assess for erythema.
B. Administer the antidote.
C. Apply warm compresses.
D. Discontinue the IV fluids.
A
D. Discontinue the IV fluids.
16
Q
A nurse is preparing to administer doxorubicin to a client with bladder carcinoma. How will the nurse prepare this medication?
A. While wearing sterile gloves
B. In a biological safety cabinet
C. Inside a temperature-controlled room
D. By withdrawing into a syringe undiluted
A
B. In a biological safety cabinet
17
Q
A nurse is preparing to administer reconstituted doxorubicin (Myocet) to a client with thyroid carcinoma. Nuclear medicine calls for the client, and the nurse is unable to administer the medication. Which action should the nurse perform with the medication?
A. Save the medication in a syringe with an aluminum needle
B. Store the medication in the refrigerator inside the syringe
C. Discard the medication in the hazardous waste container
D. Add the medication to the intravenous fluids in the client room
A
B. Store the medication in the refrigerator inside the syringe
18
Q
A client is prescribed epoetin injections. To ensure the client’s safety, which laboratory value would the nurse assess before administration?
A. Hematocrit
B. Platelet count
C. Prothrombin time
D. Partial thromboplastin time
A
A. Hematocrit
19
Q
Which step would the nurse include during the administration of epoetin prescribed to a client with acquired immunodeficiency syndrome (AIDS)?
A. Administer the medication via the Z-track technique.
B. Shake the vial before withdrawing the solution.
C. Obtain the client’s pulse rate before administration.
D. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.
A
D. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.
20
Q
The nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated?
A. 2+ pedal pulses
B. Decreased pallor
C. Decreased jaundice
D. 2+ deep tendon reflexes
A
B. Decreased pallor
21
Q
A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery?
A. Chemotherapy interferes with cell growth and delays wound healing.
B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area.
C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue.
D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.
A
A. Chemotherapy interferes with cell growth and delays wound healing.
22
Q
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. One, some, or all responses may be correct.
A. Fever
B. Diarrhea
C. Melena
D. Hematuria
E. Ecchymosis
A
C. Melena
D. Hematuria
E. Ecchymosis
23
Q
A client receiving cancer chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy will the nurse consider when formulating a response?
A. Liver
B. Blood
C. Bone marrow
D. Lymph nodes
A
C. Bone marrow
24
Q
For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be correct.
A. Diarrhea
B. Leukocytosis
C. Bleeding tendencies
D. Lowered sedimentation rate
E. Increased hemoglobin levels
A
A. Diarrhea
C. Bleeding tendencies
25
A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct.
A. Deep vein thrombosis
B. Melena
C. Purpura
D. Emboli
E. Hematuria
B. Melena
C. Purpura
E. Hematuria
26
A client is diagnosed with stage IV Hodgkin’s disease. Which therapy option is indicated?
A. Radiation therapy
B. Combination chemotherapy
C. Radiation with chemotherapy
D. Surgical removal of the affected nodes
B. Combination chemotherapy
27
A client is receiving combination chemotherapy for the treatment of metastatic carcinoma. For which systemic side effect would the nurse monitor the client?
A. Ascites
B. Nystagmus
C. Leukopenia
D. Polycythemia
C. Leukopenia
28
An adolescent is prescribed an antineoplastic agent. Which instruction would the nurse give to the parents before discharge?
A. Limit contact with all peers and family members.
B. Withhold medications when nausea occurs to prevent vomiting.
C. Schedule laboratory blood tests to evaluate response to the medication.
D. Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.
C. Schedule laboratory blood tests to evaluate response to the medication.
29
An adolescent with leukemia is to be given a chemotherapeutic agent. Which time is best for the nurse to administer the prescribed antiemetic?
A. As nausea occurs
B. An hour before meals
C. Just before each meal is eaten
D. Before each dose of chemotherapy
D. Before each dose of chemotherapy
30
The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to the bone. What should the nurse keep in mind when planning for effective pain management?
A. High doses of opioid analgesics will be required.
B. Pain therapy is based on the client's report of pain.
C. Relief of pain will be achieved quickly.
D. The client will most likely become addicted.
B. Pain therapy is based on the client's report of pain.
31
The nurse is developing a plan of care for a client who has developed blisters and sores in the mouth after receiving chemotherapy. Which interventions should the nurse include? Select all that apply.
A. Examine your mouth frequently.
B. Use strong mouthwashes to kill bacteria.
C. Drink 2 or more liters of water per day.
D. Suck on ice chips during chemotherapy.
E. Visit a dental hygienist weekly.
F. Avoid spicy or acidic foods.
A. Examine your mouth frequently.
C. Drink 2 or more liters of water per day.
D. Suck on ice chips during chemotherapy.
F. Avoid spicy or acidic foods.
32
The nurse is caring for a client who recently received an allogeneic bone marrow transplant for the treatment of leukemia. Which nursing intervention is a priority for this client?
A. Provide education on infection prevention in the community
B. Assist the client with ambulation every 2 hours
C. Monitor the client for signs of infection
D. Introduce the client to another bone marrow recipient
C. Monitor the client for signs of infection
33
Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine?
A. Color-blindness
B. Anuria
C. Constipation
D. Hyperphosphatemia
C. Constipation
34
Which toxic effect would a nurse monitor for in a client who is prescribed vincristine?
A. Peripheral paresthesia
B. Anginal-type chest pain
C. Ophthalmic papilledema
D. Bilateral crackles in the lung
A. Peripheral paresthesia
35
Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine?
A. Urine pH of 6
B. Urine specific gravity of 1.020
C. Blood uric acid level of 7.5 mg/dL
D. Blood urea nitrogen level of 15 mg/dL
C. Blood uric acid level of 7.5 mg/dL
36
The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be correct.
A. Respiratory
B. Neurological
C. Reproductive
D. Hematologic
E. Gastrointestinal
B. Neurological
D. Hematologic
E. Gastrointestinal
37
Which side effect would the nurse assess for in a child receiving vincristine?
A. Hemolytic anemia
B. Irreversible alopecia
C. Hyperglycemia
D. Neurological complications
D. Neurological complications
38
An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication?
A. 'It is a neurological side effect.'
B. 'It is caused by an autoimmune reaction.'
C. 'The skin becomes sensitive with chemotherapy.'
D. 'The central nervous system has become hyperactive.'
A. 'It is a neurological side effect.'
39
An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation?
A. It is a side effect of the vincristine.
B. The spleen is compressing the bowel.
C. It is a toxic effect from the prednisone.
D. The leukemic mass is obstructing the bowel.
A. It is a side effect of the vincristine.
40
A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause?
A. Diet, which lacks bulk
B. Inactivity, which results from illness
C. Vincristine, which decreases peristalsis
D. Prednisone, which causes gastric irritability
C. Vincristine, which decreases peristalsis
41
A client with Hodgkin's disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. Which mechanism of action would the nurse associate with this medication?
A. Arresting mitosis in metaphase
B. Inhibiting the synthesis of thymidine
C. Alkylating nucleic acids needed for mitosis
D. Inactivating DNA while inhibiting RNA synthesis
A. Arresting mitosis in metaphase
42
To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise?
A. Low in fat
B. High in iron
C. High in fluids
D. Low in residue
C. High in fluids
43
A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence?
A. Vincristine acts on enlarged lymph nodes in the groin.
B. Vincristine affects peripheral vascular circulation.
C. Vincristine increases the risk for vascular occlusion.
D. Peripheral neuropathies can result from vincristine chemotherapy.
D. Peripheral neuropathies can result from vincristine chemotherapy.
44
An adolescent is to begin a chemotherapeutic medication regimen. Which side effect of vincristine is most important for the nurse to prepare the adolescent to expect?
A. Alopecia
B. Constipation
C. Loss of appetite
D. Peripheral neuropathy
A. Alopecia
45
A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for?
A. Diarrhea
B. Alopecia
C. Hemorrhagic cystitis
D. Peripheral neuropathy
D. Peripheral neuropathy
46
A nurse is administering vincristine to a client with cancer. The client asks the nurse how the medication works. Which statement by the nurse is appropriate?
A. It stops the synthesis of proteins in cancer cells
B. It prevents cell division of cancer cells
C. It interrupts the S-phase of cancer cell reproduction
D. It alters the DNA structure of cancer cells
B. It prevents cell division of cancer cells
47
The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply.
A. Apply pressure to the injection site if extravasation occurs.
B. Monitor liver function tests regularly.
C. Monitor for numbness or tingling in the fingers and toes.
D. Select the appropriate catheter for intrathecal administration.
E. Verify blood return before, during, and after intravenous administration.
B. Monitor liver function tests regularly.
C. Monitor for numbness or tingling in the fingers and toes.
E. Verify blood return before, during, and after intravenous administration.
48
A client is receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy for Hodgkin's disease. When the client reports burning and tingling of the feet, which medication would the nurse determine is the likely cause?
A. Neurotoxicity caused by vinblastine
B. Hypersensitivity caused by dacarbazine
C. Endocrine alterations caused by doxorubicin
D. Peripheral vasoconstriction caused by bleomycin
A. Neurotoxicity caused by vinblastine
49
Which nursing assessment is most important for a child receiving cyclophosphamide?
A. Extent of alopecia
B. Changes in appetite
C. Hyperplasia of gums
D. Daily intake and output
D. Daily intake and output
50
The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication?
A. Irritability
B. Pain with urination
C. Unpredictable nausea
D. Hyperplasia of the gums
B. Pain with urination
51
Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct.
A. Use an electric razor when shaving.
B. Institute neutropenic precautions.
C. Place client on airborne precautions.
D. Transfuse two units of packed red blood cells (RBCs).
E. Instruct nursing staff to wear a dosimeter badge.
B. Institute neutropenic precautions.
52
The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed?
A. "I will probably need to plan on using a wig to cover my hair loss."
B. "I should limit the amount of fluids I drink while taking this medication."
C. "I will need to stay away from children when my white blood cell count is low."
D. "I may have trouble getting pregnant due to the damaging effects of the medication."
B. "I should limit the amount of fluids I drink while taking this medication."
53
A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component?
A. Platelets
B. Erythrocytes
C. Lymphocytes
D. White blood cells
D. White blood cells
54
The nurse is reviewing the laboratory results for a client with cancer who is being treated with chemotherapy and recently started prescribed filgrastim. Which laboratory value indicates the treatment is effective?
A. Hemoglobin level of 9.8 g/dL
B. White blood cell count (WBC) of 5,200/mm3
C. Platelet count of 200,000/mm
D. Red blood cell count (RBC) of 4 million/mm
B. White blood cell count (WBC) of 5,200/mm3
55
A client with a diagnosis of anemia is receiving packed red blood cells. Which nursing action is important when administering the transfusion?
A. Assessing the client for fluid overload
B. Monitoring the client’s response, particularly within the first 10 minutes
C. Assuring that the transfusion flows at a consistent rate during the procedure
D. Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion
B. Monitoring the client’s response, particularly within the first 10 minutes
56
A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child. Which intervention should be included in the teaching?
A. Stop the medication if the stools become tarry green
B. Add the medicine to a bottle of formula
C. Give the medicine with orange juice and through a straw
D. Administer the iron with your child's meals
C. Give the medicine with orange juice and through a straw
57
A client with anemia has a new prescription for ferrous sulfate. When teaching the client about diet and iron supplements, what should the nurse emphasize about taking an iron supplement?
A. Lie down for about 10 minutes after taking the pill
B. Take the iron tablet with a glass of orange juice
C. Take an antacid with the iron supplement to reduce stomach upset
D. Take the iron tablet with a glass of low-fat milk
B. Take the iron tablet with a glass of orange juice
58
The nurse receives an order to administer intravenous (IV) iron sucrose to a client with anemia. Which statement best describes the purpose of administering this medication using the IV route?
A. To ensure that the entire dose of medication is given
B. To prevent the drug from causing tissue irritation
C. To provide more even distribution of the drug
D. To enhance absorption of the medication
B. To prevent the drug from causing tissue irritation
59
A client is being discharged with a prescription for an iron supplement. Which client statement indicates the need for further teaching by the nurse?
A. "I will have greenish-black stools from the medication."
B. "I will not take antacids with my iron supplement."
C. "I will take the iron supplement with a full glass of milk."
D. "I will take vitamin C along with the iron supplement."
C. "I will take the iron supplement with a full glass of milk."
60
A client with severe iron-deficiency anemia is prescribed a parenteral form of iron. Which intervention does the nurse prepare to implement before administering the medication?
A. Obtain the client's vital signs.
B. Use the Z-track administration method.
C. Administer a small test dose.
D. Obtain informed consent.
C. Administer a small test dose.
61
A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication?
A. 'Monitor the stools for diarrhea.'
B. 'Administer with meals to improve absorption.'
C. 'Avoid giving the child orange juice with the iron preparation.'
D. 'Have the child drink the diluted iron preparation through a straw.'
D. 'Have the child drink the diluted iron preparation through a straw.'
62
Which information would the nurse include when teaching parents about the side effects of iron supplements?
A. The urine may turn red.
B. The skin will turn yellow.
C. The teeth may become stained.
D. The stools will take on a clay color.
C. The teeth may become stained.
63
Which technique would the nurse use to administer ferrous sulfate to a 12-month-old infant?
A. Through a straw
B. Crushed in applesauce
C. In an intramuscular injection
D. Syringe directed toward the back of the mouth
D. Syringe directed toward the back of the mouth
64
Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. How will the nurse respond?
A. Taking supplements will not help with this condition.
B. It is advised that iron be taken with orange juice to aid in absorption.
C. An over-the-counter multivitamin with iron should meet the needs of the child.
D. It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.
A. Taking supplements will not help with this condition.
65
A client with upper gastrointestinal (GI) bleeding develops mild anemia. Which agent is indicated for treatment of this condition?
A. Dextran
B. Iron salts
C. Vitamin B12
D. Erythropoietin
B. Iron salts
66
A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary?
A. 'I realize it is important to take this medication because it will cure my anemia.'
B. 'Because I am at risk for seizures, I need to avoid hazardous activities.'
C. 'I recognize that I may still need blood transfusions if my hemoglobin is very low.'
D. 'I understand that I will still have to take supplemental iron therapy with this medication.'
A. 'I realize it is important to take this medication because it will cure my anemia.'
67
Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption?
A. Water
B. Skim milk
C. Orange juice
D. A strawberry milkshake
C. Orange juice
68
The nurse would counsel a pregnant client to take her iron supplement at which time of the day for efficient absorption?
A. Bedtime
B. After lunch
C. Dinnertime
D. Before breakfast
D. Before breakfast
69
The nurse instructs a postpartum client on the administration of an iron supplement. Which drink selected by the client indicates the teaching was effective?
A. Milk
B. Water
C. Cream soda
D. Cranberry juice
D. Cranberry juice
70
Which action would the nurse take when administering iron dextran?
A. Use a transdermal needle.
B. Massage the injection site.
C. Use the Z-track method.
D. Apply a local anesthetic first.
C. Use the Z-track method.
71
A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement?
A. Administering iron supplements through a straw
B. Administering iron supplements with whole cow’s milk
C. Administering iron supplements along with orange juice
D. Administering iron supplements at the back of the mouth
B. Administering iron supplements with whole cow’s milk
72
A child with iron-deficiency anemia is prescribed oral iron therapy. Anticipatory guidance regarding which side effect would the nurse provide?
A. Bloody stool
B. Orange urine
C. Greenish-black stool
D. Staining of the mouth
C. Greenish-black stool
73
Which instructions would the nurse include when teaching parents how to administer liquid iron to their child? Select all that apply. One, some, or all responses may be correct.
A. Protect the child from sunlight.
B. Administer the medication with food.
C. Anticipate that stools tend to be blackish-green.
D. Give the medication with a glass of orange juice.
E. Have the child drink it through a straw.
C. Anticipate that stools tend to be blackish-green.
D. Give the medication with a glass of orange juice.
E. Have the child drink it through a straw.
74
Which client statement demonstrates an understanding of cyanocobalamin (vitamin B12) prescribed for pernicious anemia?
A. "I should have a vitamin B12 injection every month."
B. "I’ll take vitamin B12 supplements every morning with my breakfast."
C. "I’ll eat a diet high in green vegetables."
D. "I will increase my intake of processed foods fortified with vitamin B12."
A. "I should have a vitamin B12 injection every month."
75
When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, which teaching would the nurse provide?
A. Weekly Z-track injections provide needed control.
B. Daily intramuscular injections are required for control.
C. Intramuscular injections once a month will maintain control.
D. Oral vitamin B12 tablets taken daily will provide symptom control.
C. Intramuscular injections once a month will maintain control.
76
The nurse provides teaching regarding vitamin B12 injections to a client with pernicious anemia. Which statement by the client indicates that teaching was understood?
A. 'I must take this medication for the rest of my life.'
B. 'I should take this vitamin, as needed, when feeling fatigued.'
C. 'Once my symptoms subside, I can stop taking this vitamin.'
D. 'I need to have this available for use during exacerbations of anemia.'
A. 'I must take this medication for the rest of my life.'
77
The health care provider prescribes cisplatin for a client with metastatic cancer. Which action will the nurse take to prevent toxic effects?
A. Ask the client’s health care provider about prescribing leucovorin.
B. Encourage regular vigorous oral care.
C. Increase hydration to promote diuresis.
D. Assist the client in selecting foods appropriate for a high-protein, low-residue diet.
C. Increase hydration to promote diuresis.
78
Allopurinol is prescribed for a child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, 'Why do I have to take this pill?' Which response by the nurse is most appropriate?
A. 'It protects your body from getting new problems after your treatment is over.'
B. 'It stops your sick white cells from going to other parts of your body.'
C. 'The health care provider wouldn’t prescribe anything for you unless it was important.'
D. 'With the other medicines, it helps you get rid of the things that are making you sick.'
D. 'With the other medicines, it helps you get rid of the things that are making you sick.'
79
The nurse teaches an adolescent who has completed chemotherapy for acute lymphocytic leukemia (ALL) about the administration of mercaptopurine. Which statement by the adolescent indicates teaching has been effective?
A. 'This will help prevent a relapse.'
B. 'I guess I’ll need an intravenous line for this medication.'
C. 'I guess this medication is a substitute for brain radiation.'
D. 'This will stop the cancer from spreading to my stomach.'
A. 'This will help prevent a relapse.'
80
Which statement by a client with metastatic melanoma who is being treated with interferon gamma 1b indicates that teaching was understood?
A. "I will increase my fluid intake to several liters (quarts) every day."
B. "I need to discard any reconstituted solution at the end of the week."
C. "I can continue driving my car as before as long as I have the stamina."
D. "I should be able to continue my usual activity while taking this medication."
A. "I will increase my fluid intake to several liters (quarts) every day."
81
A nurse is reviewing laboratory data of a client taking paclitaxel for ovarian cancer. Which finding would the nurse report to the healthcare provider before administering the next dose of medication?
A. Platelet count of 475,000/mm3
B. Eosinophil level of 400/mm3
C. Red blood cell count of 6.5 million/mm3
D. Neutrophil count of 1,200/mm3
D. Neutrophil count of 1,200/mm3
82
A nurse is providing care to a client with ovarian cancer prescribed intravenous topotecan. The nurse expects to administer the medication via which venous access site?
A. Implanted port
B. PICC
C. Central line
D. Peripheral
A. Implanted port
83
The nurse understands that megestrol is most often used to treat which issue?
A. Menopause
B. Birth control
C. Premenstrual syndrome (PMS)
D. Palliative management of cancer
D. Palliative management of cancer
84
A client with cancer experiences severe nausea and vomiting from chemotherapy. The client wants to know if it is true that smoking marijuana will help. How will the nurse respond?
A. 'Nurses are not allowed to discuss illegal substances with clients.'
B. 'Marijuana is effective for nausea and vomiting if it is injected.'
C. 'Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting.'
D. 'There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people.'
D. 'There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people.'
85
A client is receiving imatinib for chronic myelogenous leukemia (CML). The nurse will assess for which complication of this protein-tyrosine kinase inhibitor? Select all that apply. One, some, or all responses may be correct.
A. Hair loss
B. Stomatitis
C. Dehydration
D. Signs of infection
E. Bleeding tendencies
D. Signs of infection
E. Bleeding tendencies
86
Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
A. Hydrate the client with IV fluids before and after infusion.
B. Assess the client for numbness and tingling of extremities.
C. Inspect the client's oral mucosa for ulcerations.
D. Monitor the client's urine pH for increased acidity.
C. Inspect the client's oral mucosa for ulcerations.
87
Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. One, some, or all responses may be correct.
A. Provide low-carbohydrate meals.
B. Decrease fluid intake at mealtime
C. Encourage the intake at mealtime
D. Promote the intake of small, frequent meals
E. Administer prescribed antiemetics before meals
C. Encourage the intake at mealtime
D. Promote the intake of small, frequent meals
E. Administer prescribed antiemetics before meals
88
Which information will the nurse share about alopecia characteristics to a client who is to receive chemotherapy after surgery for cancer?
A. Usually rare
B. Not permanent
C. Frequently prolonged
D. Usually preventable
B. Not permanent
89
Which benefit is provided by intraarterial chemotherapy for cancer of the liver?
A. It reduces systemic toxicity
B. It provides for rapid dilution of chemotherapy
C. The medication bypasses the blood brain barrier
D. The chemotherapy is delivered to the peritoneal cavity
A. It reduces systemic toxicity
90
Which concept is important to teach a client in relation to why medication cocktails are more effective than a single medication in cancer therapy?
A. Medication
B. Tumor doubling time
C. Cellular growth time
D. Retained radioactive particles
C. Cellular growth time
91
Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells?
A. Interference of the cellular protein synthesis
B. Inhibition of the synthesis of purine and pyrimidine
C. Binding with DNA to interfere with RNA production
D. Combining with DNA strands and interfering with cell replication
D. Combining with DNA strands and interfering with cell replication
92
Which systemic side effects would the nurse monitor for in a client receiving combination chemotherapy for the treatment of metastatic carcinoma?
A. Ascitis
B. Nystagmus
C. Leukopenia
D. Polycythemia
C. Leukopenia
93
Which response would the nurse give to a client receiving chemotherapy who develops sores in the mouth and asks the nurse why this happened?
A. “The sores occur because of the direct irritating effects of the medications”
B. “These tissues are poorly nourished because you have a decreased appetite”
C. “The frequently dividing cells of the gastrointestinal tract are damaged by the medication”
D. “This side effect occurs because it targets the cells of the gastrointestinal system”
C. “The frequently dividing cells of the gastrointestinal tract are damaged by the medication”
94
The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate?
A. Epistaxis
B. Tachycardia
C. Flushed skin
D. Increased temperature
A. Epistaxis
95
The nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time?
A. At scheduled intervals
B. When the child asks for it
C. When pain becomes severe
D. Before the pain becomes severe
A. At scheduled intervals
96
The nurse observes bloody expectorant after a 4-year-old child with leukemia brushed his or her teeth. Which action should the nurse take next?
A. Secure a smaller toothbrush for the child to use.
B. Document and report the incident.
C. Tell the child to be more careful when brushing the teeth
D. Rinse the child’s mouth with half strength hydrogen peroxide
B. Document and report the incident.
97
Chemotherapy via regional perfusion is the treatment of choice for a client’s malignant sarcoma of the liver. Which reason would the nurse provide to explain to the client why this method of medication administration probably was selected?
A. Medication therapy can be continued at home with little difficulty
B. Larger doses of medications can be delivered to the actual site of the tumor.
C. Toxic effects of the chemotherapeutic medications are confined to the area of the tumor
D. Combinations of medications are used to attack neoplastic cells at various stages of the cell cycle
B. Larger doses of medications can be delivered to the actual site of the tumor.
98
A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client’s teaching?
A. Be prepared to experience alopecia
B. Increase fluids to at least 3 liters per day
C. Use a soft toothbrush for oral hygiene
D. Monitor your intake and output of fluids
C. Use a soft toothbrush for oral hygiene
99
A client is admitted to the hospital with pancytopenia as a result of chemotherapy. Which information will the nurse provide to minimize the risk for complications?
A. Avoid activities that risk traumatic injuries and exposure to infection.
B. Perform frequent mouth care with a firm toothbrush.
C. Increase oral fluid intake to a minimum of 3 L daily.
D. Report any unusual muscle cramps or tingling sensations in the extremities.
A. Avoid activities that risk traumatic injuries and exposure to infection.
100
A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy?
A. Platelets
B. Hemoglobin level
C. Red blood cell count
D. White blood cell count
D. White blood cell count
101
A client with Hodgkin’s disease is started on chemotherapy. The nurse teaches the client to notify the health care provider for which adverse response to chemotherapy?
A. Hair loss
B. Sores in the mouth
C. Moderate diarrhea after treatment
D. Nausea for 6 hours after treatment
B. Sores in the mouth
102
A client is diagnosed with multiple myeloma. Which intervention would the nurse expect the plan of care to include?
A. Radiotherapy on an outpatient basis
B. Human leukocyte interferon therapy
C. Surgery to remove the invasive lesions
D. Chemotherapy employing a combination of medications
D. Chemotherapy employing a combination of medications
103
The nurse administers erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response demonstrates a therapeutic effect?
A. Increase in band cells
B. Elevated hematocrit
C. Normalization of platelets
D. Increase in the white blood cell (WBC) count
B. Elevated hematocrit
104
A client has surgery for the insertion of an implanted infusion port for chemotherapy. How often will the port to be flushed when not in use?
A. Every day
B. Once a week
C. Every month
D. Twice a year
C. Every month
105
A complete blood count is prescribed before each round of a client’s cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse?
Α. Platelets
B. Hematocrit
C. Red blood cells (RBCs)
D. White blood cells (WBCs)
D. White blood cells (WBCs)
106
The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention?
A. Maintaining an acidic urine
B. Restricting intravenous fluids
C. Providing a diet high in folic acid
D. Monitoring plasma levels of the medication
D. Monitoring plasma levels of the medication
107
A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which medication in relation to which changes in fluid intake?
A. Allopurinol and restricting the fluid intake
B. Methotrexate and restricting fluid intake
C. Allopurinol and encouraging increased fluid intake
D. Methotrexate and encouraging increased fluid intake
C. Allopurinol and encouraging increased fluid intake
108
Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective?
A. Potassium level normalizes
B. Folic acid level within normal limits
C. Improved white blood cell count
D. Decreased methotrexate level
D. Decreased methotrexate level
109
A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve?
A. Potentiating the effect of alkylating agents
B. Diminishing toxicity of folic acid antagonists
C. Limiting vomiting associated with chemotherapy
D. Preventing alopecia
B. Diminishing toxicity of folic acid antagonists
110
The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate?
A. "That's a fine suggestion, and I'll ask for a prescription."
B. "Vitamin supplements won't help him feel any better right now."
C. "He'll benefit from a vitamin supplement and will be getting it soon."
D. "Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
D. "Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
111
A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication?
A. ALT of 55 IU/mL
B. WBC of 12,000/mm3
C. AST of 34 U/L
D. HGB of 11.5 g/dL
A. ALT of 55 IU/mL
112
A client with follicular non-Hodgkin's lymphoma is to be treated with rituximab, a targeted monoclonal antibody. The nurse will monitor the client for which common side effect of rituximab?
A. Polyphagia
B. Leukopenia
C. Constipation
D. Hypertension
B. Leukopenia
113
A 32-year-old female with human epidermal growth factor receptor 2-positive (HER2-positive) metastatic breast cancer is scheduled to begin therapy with pertuzumab. What information is important for the nurse to reinforce and discuss with the client? Select all that apply.
A. Other therapies for cancer treatment are no longer needed.
B. Use contraception during and for 6 months following the use of this drug.
C. Take the medication at the same time every day on an empty stomach.
D. Report shortness of breath, lightheadedness, dizziness, cough, or swelling of the feet.
E. Report chills, fatigue, or headache during treatment.
B. Use contraception during and for 6 months following the use of this drug.
D. Report shortness of breath, lightheadedness, dizziness, cough, or swelling of the feet.
E. Report chills, fatigue, or headache during treatment.
114
The oncology nurse is caring for a female client who is being treated for metastatic breast cancer. The client is scheduled to receive their first dose of trastuzumab. Which assessment finding is most important to notify the health care provider of?
A. Absolute neutrophil count 2.5 (2,500 mm3)
B. Intermittent nausea and vomiting
C. Blood glucose 130 mg/dL
D. Irregular apical pulse
D. Irregular apical pulse
115
The nurse is teaching a 68-year-old, postmenopausal, female client about adverse effects of newly prescribed tamoxifen for breast cancer with bone metastases. Which information should the nurse include in the teaching?
A. Stroke-like symptoms
B. Insomnia
C. Seizures
D. Symptoms of hypocalcemia
A. Stroke-like symptoms
116
The client asks the nurse how long she will have to take tamoxifen for breast cancer treatment. Which response by the nurse is appropriate?
A. "You'll have to take it for the rest of your life."
B. "You'll need to take it for 10 days, like an antibiotic."
C. "You'll need to take it for 5 years, after which it will be discontinued."
D. "You'll need to take it for several months, until the bone pain subsides."
C. "You'll need to take it for 5 years, after which it will be discontinued."
117
Which nursing intervention is a priority for a school-aged child with lead poisoning undergoing chelation therapy?
A. Scrupulous skin care
B. Provision of a high-protein diet
C. Careful monitoring of intake and output
D. Daily blood sampling for liver function tests
C. Careful monitoring of intake and output
118
Which nursing action is the priority when administering chelation therapy for a toddler?
A. Assessing vital signs
B. Monitoring urine output
C. Conducting a behavioral assessment
D. Providing education to reduce lead exposure
B. Monitoring urine output
119
Which medications would the nurse plan to use when administering chelation therapy to a toddler-aged client to decrease the pain associated with intramuscular administration? Select all that apply. One, some or all responses may be correct.
A. LMX-4
B. Fentanyl
C. Procaine
D. Ibuprofen
E. Acetaminophen
A. LMX-4
C. Procaine
120
Which side effect would the nurse anticipate in a child receiving chelation therapy?
A. Hypocalcemia
B. Hyperkalemia
C. Hypoglycemia
D. Hypernatremia
A. Hypocalcemia
121
A child with plumbism is prescribed edetate calcium disodium (calcium EDTA). Which assessment would be the most appropriate for the nurse to conduct before administering EDTA?
A. Reviewing laboratory results for hypocalcemia
B. Checking for protein in the urine
C. Looking for signs of bone marrow depression
D. Monitoring for increased intracranial pressure
B. Checking for protein in the urine
122
A child is treated with succimer for lead poisoning. Which of these assessments is the priority?
A. Check the client's serum potassium level
B. Check the client's blood calcium level
C. Test the client's deep tendon reflexes
D. Check the client's complete blood count with differential
D. Check the client's complete blood count with differential
123
Which medication would the nurse expect to administer to control bleeding in a child with hemophilia A?
A. Albumin
B. Fresh frozen plasma
C. Factor VIII concentrate
D. Factors II, VII, IX, X complex
C. Factor VIII concentrate
124
The nurse teaches the parents of a child with classic hemophilia how to administer plasma component Factor VIII prescribed three times a week. Which instruction would the nurse give the parents about administration time?
A. Whenever a bleed is suspected
B. Give in the morning on scheduled days
C. At bedtime while the child is lying quietly in bed
D. On a regular schedule at the parents' convenience
B. Give in the morning on scheduled days
125
A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate?
A. 'That’s an excellent idea. I’ll try to get a prescription for her.'
B. 'Unfortunately, vitamins won’t make her feel any better now.'
C. 'That won’t be possible. Vitamins interfere with the action of methotrexate.'
D. 'After we receive the laboratory reports, your daughter will be getting vitamins.'
C. 'That won’t be possible. Vitamins interfere with the action of methotrexate.'
126
A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client?
A. Hirsutism
B. Leukopenia
C. Constipation
D. Photosensitivity
B. Leukopenia
