Quiz 1

Question 1

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client’s skin appears yellow. Which blood tests should be done to further explore this clinical sign?
Liver function tests (LFTs)
Complete blood count (CBC)
Platelet count
Blood urea nitrogen and creatinine

Answer 1

A: LFTs
Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count, and tests of renal function would not directly assess for liver disease.

Question 2

A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?
Pruritis (itching)
Nausea and vomiting
Altered glucose metabolism
Confusion

Answer 2

A: N/V
Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and pruritus are less common adverse effects.

Question 3

A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia?
Interrupted sleep pattern
Hot flashes
Epistaxis
Increased weight

Answer 3

A: Epistaxis
Clients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Clients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

Question 4

Which intervention should the nurse teach a client who is at risk for hypercalcemia?
Avoid the use of stool softeners.
Take laxatives daily.
Consume 2 to 4 L of fluid daily.
Restrict calcium intake.

Answer 4

A: Consume 2-4L of fluid daily
Rationale: The nurse should encourage clients at risk for hypercalcemia to consume 3 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease to address the constipation and dehydration that results from this condition. Dietary and pharmacologic interventions for constipation such as stool softeners and laxatives may be appropriate for the client, although daily laxative use may not be. The nurse should advise clients to maintain nutritional intake without restricting normal calcium intake.

Question 5

Which is the most common type of cancer in pediatric patients?

Acute Lymphocytic Leukemia (ALL)
Acute Myeloid Leukemia (AML)
Chronic Lymphocytic Leukemia (CLL)
Chronic Myeloid Leukemia (CML)

Answer 5

ALL

Question 6

There are four kinds of leukemia which are categorized based on:

a. How aggressive they are AND whether they mostly affect adults or children
b. What cell line is involved AND whether they are slow or fast-growing
c. Whether they are managed inpatient or outpatient AND whether they are curable or not
d. What cell line is involved AND whether they are curable or not

Answer 6

B
Leukemias are classified by the involved cell line (myeloid or lymphoid AND whether they are slow or fast-growing (acute or chronic).

Question 7

In ALL, we will commonly provide extra treatment directly to the CNS and testes. The rationale for this is:

a. Testicular relapse of ALL is the most common form of relapse
b. Extra therapy to these areas will decrease the side effects of chemotherapy, which damages healthy cells that are rapidly dividing
c. Conventional chemotherapy does not reach ALL in these areas, called “sanctuary sites” because these are areas where leukemic cells can hide
d. Direct treatment to the CNS and testes can prepare patients better for hematopoietic stem cell transplantation (HSCT) by priming these sites for stem cell infusion

Answer 7

C
CNS and testicular treatment can be necessary to clear ALL from these sanctuary sites where chemotherapy would not reach.

Question 8

Which best explains induction and consolidation chemotherapy?

a. Induction chemotherapy is given over months to years to ensure long-term remission and consolidation chemotherapy is given before stem cell transplant to prepare the body for the stem cell infusion

b. Induction chemotherapy is given outpatient and consolidation chemotherapy is given inpatient

c. Induction chemotherapy is given for leukemias, and consolidation chemotherapy is given for lymphomas and multiple myeloma

d. Induction chemotherapy is given at diagnosis to attempt to induce remission and consolidation chemotherapy is given in planned cycles to ensure that the remission is durable

Answer 8

D
Induction chemotherapy induces and consolidation chemotherapy consolidates remission.

Question 9

The best way to explain the difference between HL and NHL is:

a HL only affects young people whereas NHL generally affects people over age 60

b. HL is curable with stem cell transplant
HL is a certain kind of lymphoma arising from a B-cell mutation that results in a hallmark Reed-Sternberg cell

c. HL is a more heterogenous disease, with many presentations based on the lymph nodes affected whereas NHL is a more homogenous disease with classic features

Answer 9

B
HL features the hallmark Reed-Sternberg cell, a mutated B cell

Question 10

Which of the following would most likely be included in the plan for nursing care of the hospitalized patient with multiple myeloma? Select all that apply.

A. Monitor intake and output, daily weights, and creatinine

b. Ensure a calcium-rich diet with calcium supplements and enforce a fluid restriction
Correct!

c. Patient teaching about the risk for falls

d. Administer anti-emetics if the patient has nausea

Answer 10

A, C, D
Kidney damage is a hallmark of MM, so monitoring kidney function is expected. Patients with MM are more at risk of falling, and more at risk for
injury with falls so patient education about fall prevention is important. Treating nausea with anti-emetics is important for all cancer patients.

Question 11

The nurse is working with a young adult who is starting ABVD chemotherapy for Hodgkin Lymphoma. Which of the following statements by the patient indicates they have understood patient education about alopecia?

a. “There is a 50-50 chance that I will lose my hair, and I sure hope I am one of the lucky ones”

b. “My hair will come out after the first cycle of chemotherapy, and it should start growing back about a month or two after all my chemotherapy cycles are complete”

c. “My hair should come back the same way it looks now; since I am blonde, my hair will come back blonde”

d. “I will lose my hair, and I will need to get a well-fitting wig since it will never come back”

Answer 11

B
Hair loss follows a fairly predictable pattern with
chemotherapy and it is important to provide anticipatory guidance.

Question 12

The rationale for watchful waiting for a slow-growing hematologic malignancy is based on:

a. The expense of targeted therapies which causes a burden for many patients

b. The need for people to adjust emotionally over time to their cancer before they can fully invest in the treatment regimen

c. The low risk of the disease causing morbidity and mortality and the risk of toxicities from the available treatments

d. The need to allocate scarce medical resources to more aggressive malignancies

Answer 12

C
We only use watchful waiting when the risk of giving therapy is higher than the risk of waiting to treat, i.e. in slow-growing diseases where the
therapies can cause some risk of harm.

Question 13

One of the most painful expected effects from chemotherapy used to treat hematologic malignancies is:

Mucositis
Nausea
Alopecia
Dyspnea

Answer 13

M

Question 14

Which of the following is NOT the role of the registered nurse in managing central venous access devices (CVADs)?

Monitoring CVAD sites for s/sx infection
Troubleshooting lines that will not draw blood
Teaching patients how to flush their lines at home
All of these are the role of the RN in managing CVAD

Answer 14

All of the above

Question 15

You are caring for a 68-year-old man with AML who has relapsed after a stem cell transplant and subsequent salvage chemotherapy. He also has significant cardiac disease made worse by cardiotoxic chemotherapy. He and his family have decided he will go home on Hospice. While the Hospice discharge is being arranged, he has transitioned to “comfort care” on your unit. You know that the goals of comfort care are: (Select all that apply)

a. Ensure that the patient’s physical symptoms are well-managed

b. Provide the patient with the opportunity to spend time with family and friends

c. Continue chemotherapy but in lower doses to minimize side effects

d. Search for a cure

Answer 15

A, B
Managing the patient’s physical symptoms and creating time for special relationships provide comfort at end of life

Question 16

Understanding the normal values on a CBC with differential, and knowing the expected
alterations in different disease states and with cancer treatments will help the nurse:

Provide a medical diagnosis to the patient
Plan priorities for patient care and education
Understand the patient’s kidney function
Gauge the effectiveness of anti-emetic medications

Answer 16

Plan priorities for patient care and education

Understanding the CBC-D is essential to plan patient care and education.

Question 17

You are starting your day shift (0700-1930) on a hematology oncology unit. Which patient should you see first?

a. Your patient with AML here for consolidation chemotherapy, who is stable and sleeping, and is not due for another dose until 1000

b. Your patient with HL admitted 2 days ago for neutropenic fever who is on IV antibiotics, next due at 0900 and has his mom in the room with him overnight

c. Your patient with new ALL who is having a CVAD placed this morning with a procedure time of 0800

d. Your patient with MM who is day 22 of a stem cell transplant and will be discharging home early this afternoon

Answer 17

C
The other patients can wait until your procedural patient is off to surgery. You will then have three patients on the unit and can see them in turn.

Question 18

You are starting your night shift (1900-0730) on a hematology oncology unit. Which patient should you see first?

a. Your older patient with AML who needs help to the bathroom and has her call light on

b. Your young patient with HL who is day -3 of his stem cell transplant and is playing video games with his brother

c. Your patient with sickle cell anemia here for pain crisis who is on a PCA and reported to be finally comfortable and watching TV

d. Your patient with ALL here for neutropenic fevers and fungal sinus infection due for the next dose of antifungal at 2000

Answer 18

A
Safety first—helping this patient to the bathroom without making her wait will help her comfort and dignity—and prevent her from trying to get up on her own and potentially falling

Question 19

Providing holistic care to a patient with hematologic malignancies requires that the nurse attend to the patient’s mental, relational, and spiritual health. Which of the following actions of the nurse best demonstrates their knowledge of holistic care?

a. Ensuring that a patient with NHL has a planned block of time with their clergy person so they can engage in their spiritual practices without interruption

b. Asking a patient with multiple myeloma about their grandchildren, helping them hang up photos of their grandkids on their bulletin board, and remembering their names when they come to visit

c. Asking an anxious patient with ALL what has helped them in the past with their anxiety, and then modifying those tools with them for the hospital environment

d. All of the actions listed demonstrate holistic care

Answer 19

D

Question 20

An experienced nurse preceptor is orienting a new nurse to the oncology unit. When reviewing the safe administration of chemotherapeutic agents, which action should the preceptor emphasize?

a. The new nurse will not administer chemotherapeutic agents until they are specially trained to practice safe handling as these agents can cause harm.

b. The new nurse will need to wear gloves when administering chemotherapeutic agents.

c. The new nurse will need to wash hands with an alcohol-based hand gel after administering any chemotherapeutic agents.

d. The new nurse should adjust the chemotherapeutic dose based on the patient’s current symptoms

Answer 20

A
Chemotherapy drugs are mutagenic, carcinogenic,
teratogenic, and can cause reproductive toxicity. Until new RNs are specially trained to
practice safe handling with these agents, they will not administer chemotherapy
themselves.

Question 21

A nurse in a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident’s care, the nurse should include which action?

Housing the resident in a private room
Implementing a passive ROM program
Implementing of a plan for fall prevention
Providing the client with a high-fiber diet

Answer 21

Fall prevention
To prevent bleeding episodes, the nurse should ensure that an older adult with a bleeding disorder does not suffer a fall. Activity limitation is not necessarily required, however. A private room is not necessary and there is no reason to increase fiber intake.

Question 22

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. Which nursing diagnosis should the nurse prioritize in the client’s plan of care?

a. Risk for disuse syndrome related to ineffective peripheral circulation
b. Functional urinary incontinence related to urethral occlusion
c. Ineffective tissue perfusion related to thrombosis
d. Ineffective thermoregulation related to hypothalamic dysfunction

Answer 22

c. Ineffective tissue perfusion related to thrombosis
Rationale: There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crises are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.

Question 23

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron-deficiency anemia in recent weeks. When providing the client with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman’s iron stores?

Salmon accompanied by whole milk
Mixed vegetables and brown rice
Beef liver accompanied by orange juice
Yogurt, almonds, and whole grain oats

Answer 23

Beef liver with OJ
Rationale: Food sources high in iron include organ meats, other meats, beans (e.g., black and pinto), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit to iron stores.

Question 24

A client has been living with a diagnosis of anemia for several years and has experienced recent declines in hemoglobin levels despite active treatment. Which assessment finding would signal complications of anemia?

Venous ulcers and visual disturbances
Fever and signs of hyperkalemia
Epistaxis and gastroesophageal reflux
Shortness of breath and jaundice

Answer 24

Shortness of breath and jaundice

A significant complication of anemia is heart failure from chronic diminished blood volume and the heart’s compensatory effort to increase cardiac output. Clients with anemia should be assessed for signs and symptoms of heart failure, including dyspnea and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.

Question 25

An adult client has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this client’s health status?

Risk for deficient fluid volume related to impaired erythropoiesis
Risk for infection related to tissue hypoxia
Acute pain related to uncontrolled hemolysis
Fatigue related to decreased oxygen-carrying capacity

Answer 25

Fatigue related to decreased oxygen-carrying capacity

Rationale: Fatigue is the major assessment finding common to all forms of anemia. Anemia does not normally result in acute pain or fluid deficit. The client may have an increased risk of infection due to impaired immune function, but fatigue is more likely.

Question 26

A client with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to prescribe for this client?

Packed red blood cells (PRBCs)
Vitamin K
Oral anticoagulants
Heparin infusion

Answer 26

PRBCs

Rationale: Clients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh-frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be prescribed once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the client’s bleeding.

Question 27

A client is admitted to the hospital with new neurological changes and a beefy, red tongue. After the provider diagnoses a vitamin deficiency, the nurse should prepare to administer which of the following medications?

Folic acid
Vitamin B12
Lactulose
Magnesium sulfate

Answer 27

B12

Rationale: Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.

Question 28

A client comes into the clinic reporting fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. Which condition should the nurse most suspect the client has?

A hypoproliferative anemia
A leukemia
Thrombocytopenia
A hemolytic anemia

Answer 28

Hemolytic anemia

Rationale: In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.

Question 29

A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client’s complete blood count, the nurse will expect which of the following results?

An increased hemoglobin and decreased hematocrit

A decreased hemoglobin and hematocrit

A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW)

An increased mean corpuscular volume (MCV) and red cell distribution width (RDW)

Answer 29

A decreased hemoglobin and hematocrit

Rationale: The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The client will have normal MCV and RDW because the erythrocytes are normal in appearance.

Question 30

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. Since iron is black, what should the nurse include in health education?

Take the iron with dairy products to enhance absorption.
Increase the intake of vitamin E to enhance absorption.
Iron will cause the stools to darken in color.
Limit foods high in fiber due to the risk for diarrhea.

Answer 30

Iron will cause the stools to darken in color.

Rationale: The nurse will inform the client that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Clients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.

Question 31

A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. The nurse explains to this client that this condition occurs due to which factor?

An attack on the platelets by antibodies

Decreased production of platelets

Impaired communication between platelets

An autoimmune process causing platelet malfunction

Answer 31

Decreased production of platelets

Rationale: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.

Question 32

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching?

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body.

Treat upper respiratory infections with over-the-counter medication.

Suggest the child participate in sports activities without restriction.

Answer 32

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine health care such as immunizations should be provided in order to prevent common childhood illnesses.