Hogan Chapter 65 - Comprehensive Review NCLEX-RN PDF

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Comprehensive Review NCLEX-RN...

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Chapter 65 Oncologic Disorders 1. A 4-year-old child is receiving postoperative care for surgical resection of a Wilms tumor. In addition to urinary functioning, the nurse should make which priority postoperative assessment? 1. Bowel function 2. Neurologic status 3. Presence of bone pain 4. Activity level Rationale: There is great risk for altered bowel function (adynamic ileus) because of surgery and possible radiation to the abdominal area and use of chemotherapeutic agents. Wilms tumor is an intrarenal tumor, so neurologic status is not a related manifestation. Bone pain is not associated with Wilms tumor. Activity level would not be a specific assessment to make with this diagnosis. 2. A child with a brain tumor has shown symptoms of diabetes insipidus. What should the nurse monitor to provide ongoing assessment of this condition? 1. Blood glucose level 2. Urine specific gravity 3. Adrenocorticotropic hormone (ACTH) levels 4. Serum amylase Rationale: Diabetes insipidus presents with symptoms of increased urinary output and very dilute urine. Urine specific gravity will measure the concentration of the urine. Blood glucose is unrelated to a pituitary gland problem. ACTH levels are not routinely monitored in any client. Serum amylase would be monitored with a pancreatic disorder such as pancreatitis 3. The nurse determines that the client with Ewing’s sarcoma understands instruction about side effects of radiation therapy when the client states to be concerned about which problem? 1. Infection 2. Constipation 3. Metallic taste in mouth 4. Blood in urine Rationale: Bone marrow suppression occurs with radiation therapy, which can lead to risk of infection when white blood cells are affected, bleeding when platelets are affected, and anemia when red blood cells are affected. Diarrhea would be more likely than constipation as a side effect of cancer therapy. Metallic taste in the mouth is not of concern. Hemorrhagic cystitis, noted by blood in the urine, occurs after chemotherapy 4. A 6-month-old infant being treated with chemotherapy for neuroblastoma feeds poorly and vomits frequently. The nurse would use which assessment to best determine the infant’s fluid status? 1. Daily weight 2. Urinary output 3. Specific gravity of urine 4. Hemoglobin and hematocrit Rationale: Weight loss can be directly tied to fluid loss because 1 kilogram of weight is approximately equal to 1 liter of fluid. Although intake and output is commonly measured, urine output is a less reliable indicator of fluid status than changes in daily weight. Because infant kidneys do not concentrate urine as well as the kidneys of adults, urine specific gravity may not reflect urine

concentration or dilution accurately. Hemoglobin and hematocrit could rise and fall with large changes in fluid status but are not specific fluid balance measurements. 5. A child being treated for acute lymphocytic leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3 . The nursing care plan identifies measures being taken to reduce the child’s exposure to infection. The nurse determines that the plan has been successful when which outcome has been met? 1. Child’s WBC count goes up. 2. Child’s neutrophil count goes down. 3. Child’s temperature remains within normal range. 4. Parents and visitors demonstrate proper hand hygiene. Rationale: The reliable outcome measure that indicates the child is infection-free is a temperature that remains in the normal range. An increase in the number of WBCs from the baseline normal value presented could be expected as part of the disease process and might not solely represent a response to infection. A decrease in the neutrophil count could indicate the client is experiencing immunosuppression as a result of therapy. The use of proper hand hygiene is a measure or intervention used to meet a desired outcome but is not an outcome itself 6. A child with neuroblastoma will be started on total parenteral nutrition (TPN) because of cancer cachexia. The nurse would question which new healthcare provider prescription? 1. Add 10 units NPH insulin to the TPN solution. 2. Monitor blood glucose level every 4 hours. 3. Monitor intake and output (I&O). 4. Begin a regular diet. Rationale: Only regular insulin is administered in solutions administered by the IV route. Monitoring blood glucose will detect excessive elevations in blood glucose caused by the TPN. Monitoring I&O is appropriate to ensure the client is receiving sufficient nutrition and fluid intake. The child is usually anorexic but will be allowed to eat any food that appeals to him or her 7. A child has been diagnosed with a brain tumor, but surgery cannot be scheduled for several days. The mother asks what she can do to ease her child’s headaches. What suggestion should the nurse give the mother? 1. Help the child to drink plenty of liquids. 2. Discourage the child from having a bowel movement. 3. Encourage the child to sleep in a semi-Fowler position. 4. Encourage the child to blow the nose when headaches become severe. Rationale: When a client is lying flat, the blood flow to the brain is greater, increasing intracranial pressure. If the client sleeps in a semi-Fowler position, less pressure will develop, which in turn should ease headaches. Excess liquids could aggravate headache. Discouraging bowel movements will reduce straining but is not a helpful measure from a gastrointestinal perspective. Blowing the nose could aggravate headache by further increasing intracranial pressure 8. A child is being treated with corticosteroids for acute lymphocytic leukemia (ALL). On a follow-up visit, the pediatric home health nurse assesses for which side effects of corticosteroid use? 1. Decreased blood pressure 2. Alopecia

3. Weight gain 4. Anorexia Rationale: Clients taking corticosteroids may experience weight gain because of fluid retention as a drug side effect. Corticosteroids may increase blood pressure rather than decrease blood pressure because of retained fluid. Alopecia could result from chemotherapeutic agents used to treat leukemia, but is not a side effect of corticosteroids. Anorexia can be a systemic sign of cancer but would not indicate a side effect of corticosteroid therapy. 9. A client with squamous cell carcinoma of the lung comes to the emergency department with shortness of breath and respiratory difficulty. The nurse notes cyanosis and edema of the face and arms. Based on these findings, the nurse suspects the client is probably experiencing which oncologic emergency? 1. Spinal cord compression 2. Syndrome of inappropriate antidiuretic hormone (SIADH) 3. Superior vena cava syndrome 4. Sepsis complicated by disseminated intravascular coagulopathy Rationale: While all identified problems are potential risks to clients with cancer depending on site, edema of the face and arms results from obstruction of blood flow, which is indicative of superior vena cava syndrome. Spinal cord compression would give rise to neurologic symptoms. SIADH would result in general fluid overload. Sepsis and disseminated intravascular coagulopathy would be noted by signs of infection and bleeding, respectively. 10. The nurse reads in the medical record that a client’s tumor is at stage T2, N0, M0. The nurse should draw which conclusion about the client’s status? 1. There is an advanced tumor with metastasis. 2. The client has a measurable tumor with no indication of metastasis or involvement of nodes. 3. There is an advanced tumor with indication of involvement of lymph nodes but no indication of metastasis. 4. The client has an advanced tumor with indication of metastasis but no indication of involvement of lymph nodes. Rationale: Using the TNM staging system for cancer, a T2 indicates a measurable tumor, N0 indicates no regional node involvement, and M0 indicates no evidence of distant metastasis. An advanced tumor would have a higher number such as T3 or T4, and metastasis would not be associated with a M0 staging. If there was a large tumor and lymph node involvement, there would be a larger number associated with the “T” and there would also be a number rather than a zero associated with the “N.” A tumor that was associated with metastasis but not lymph node involvement would have a designation of N0 but would have a number associated with “M.” 11. A client with lung cancer is admitted to the oncology clinic for radiation therapy to treat spinal cord compression. The client’s spouse asks why radiation is being done. The nurse’s response would include that radiation therapy should have which effect? 1. To eradicate the tumor 2. To reduce the size of the tumor 3. To effectively treat all oncologic emergencies 4. Provide an alternative to chemotherapy for the lung tumor

Rationale: Radiation is palliative treatment for spinal cord compression to reduce the tumor size and relieve compression. Radiation therapy will not eradicate the tumor. Radiation therapy is not effective for all oncologic emergencies. Radiation is not a new modality to treat lung cancer. 12. A client with esophageal cancer arrives in the emergency department with shortness of breath, tachycardia, hypotension, and cyanosis. Cardiac tamponade is diagnosed. Which intervention would the nurse expect to include in this client’s care? Select all that apply. 1. Administer a vasodilator agent intravenously. 2. Insert an intravenous catheter for IV access. 3. Prepare to assist healthcare provider with a thoracentesis. 4. Prepare the client for radiation therapy. 5. Initiate oxygen therapy. Rationale: Inserting an IV catheter for IV access is an immediate intervention for the client with cardiac tamponade. The client requires immediate oxygen therapy to treat the respiratory symptoms and relieve the cyanosis. Vasopressor agents will be administered to manage hypotension. A pericardiocentesis is performed, not a thoracentesis. Radiation therapy is not indicated for cardiac tamponade 13. The nurse is assigned to a client admitted for cystectomy as treatment for bladder cancer. Which clinical manifestation does the nurse expect to assess during the care of this client? 1. Urge incontinence 2. Postvoid dribbling of urine 3. Painful urination 4. Hematuria Rationale: Hematuria is a classic sign of bladder cancer. The client would not experience urge incontinence, which is often associated with urinary tract infection. The client would not experience postvoid dribbling of urine. The client who has bladder cancer does not experience pain during voiding 14. A new nurse on the unit is admitting a severely immunosuppressed client who is receiving radiation therapy. The preceptor determines that the new nurse understands necessary precautionary measures when the new nurse admits the client to which room? 1. A semiprivate room with a client who has pneumonia 2. A private room with contact isolation 3. A private room with neutropenic precautions 4. A private room with no isolation precautions Rationale: Because of the immunosuppression, the client is at severe risk of infection. Precautionary measures such as a private room and neutropenic precautions must be instituted to protect the client from sources of infection. The client with pneumonia poses a risk of infection. Contact isolation is not necessary. A private room alone does not provide the client with the necessary neutropenic precautions 15. After completing a health risk assessment on an adult client, the nurse determines health education is necessary because of an increased risk for laryngeal cancer caused by which risk factors? Select all that apply.

1. Past infection with Epstein-Barr virus 2. Past exposure to asbestos 3. Cigarette smoking 4. Heavy daily alcohol consumption 5. Recreational use of marijuana Rationale: Cigarette smoking increases the risk of upper airway, esophageal and lung cancers. Drinking large quantities of alcohol daily increase the risk of several cancers. Epstein-Barr virus does not increase the risk of laryngeal cancer. Past exposure to asbestos increases risk of mesothelioma. Recreational use of marijuana is not associated with increased risk of laryngeal cancer. 16. A client newly diagnosed with breast cancer is scheduled for lymph node biopsy and asks the nurse why it is necessary when cancer has already been diagnosed. The nurse’s response is based on which purpose? 1. It will determine what types of cancer cells are present. 2. It is performed on all females with cancer. 3. It is performed to determine if the cancer has metastasized. 4. It is performed to determine what type of chemotherapy is indicated. Rationale: The lymph node biopsy is performed to assess any metastasis from the primary site of cancer, and a common metastatic site for breast cancer is regional lymph nodes. The biopsy of the tumor itself will determine the type(s) of cancer cells that are present. The lymph node biopsy is performed when indicated regardless of gender. The types of cancer cells determine what cancer chemotherapy drugs will be used. 17. A 65-year-old postmenopausal client tells the nurse that she has recently experienced painless vaginal bleeding. What is the appropriate interpretation by the nurse? 1. Not be concerned because postmenopausal bleeding is normal 2. Be concerned because painless uterine bleeding is a sign of uterine cancer 3. Be concerned because the client may develop anemia 4. Not be concerned because the client does not complain of pain Rationale: The nurse should be concerned because painless bleeding not related to the menstrual cycle is often the only symptom of uterine cancer. Postmenopausal bleeding is not normal. Anemia is not an immediate concern. Pain is often considered to be a late sign related to the diagnosis of cancer. 18. A client transferred to the surgical unit after a suprapubic prostatectomy has a three-way urinary catheter. The nurse notices a very dark red output via the catheter. What is the priority nursing intervention? 1. Report the finding to the healthcare provider. 2. Increase the irrigation flow rate. 3. Check the latest hemoglobin and hematocrit count. 4. Chart the observation in the medical record. Rationale: A very dark red output following prostatectomy may indicate venous bleeding or inadequate dilution of the urine. The three-way urinary catheter is at risk for occlusion. Increasing the irrigation flow will prevent the formation of blood clots and occlusion of the catheter. If the urine does not clear after increasing the rate of bladder irrigation, then it would be appropriate to notify the healthcare provider. Although reviewing the latest hemoglobin and hematocrit may be

appropriate, it is not the most pressing intervention the nurse must do for this client. Charting is a routine care activity but further action to clear the urine is indicated immediately. 19. The nurse who is screening female clients for cancer anticipates which of the following in relation to the early signs of ovarian cancer? 1. Painful urination is a common complaint. 2. Pelvic pain radiating to thighs may occur. 3. Usually no symptoms are seen. 4. Low back pain is a common complaint. Rationale: Ovarian cancer generally causes no warning signs or symptoms in the early stages, which is why screening is important. Painful urination, pelvic pain radiating to the thighs, and low back pain are not associated with this health problem 20. A client has stage II ovarian cancer documented as a diagnosis on the medical record. The nurse plans care based on which characteristic of this tumor at this stage? 1. Tumor growth is limited to the ovaries. 2. Tumor growth involves one or both ovaries, with pelvic extension. 3. Tumor growth involves the ovaries and peritoneum, with positive lymph nodes. 4. Tumor growth involves distant metastasis Rationale: In stage II ovarian cancer, tumor growth involves one or both ovaries with pelvic extension. In stage I, tumor growth is limited to the ovaries. In stage III, lymph nodes become positive. In stage IV, there is distant metastasis 21. A client is scheduled for a modified radical mastectomy. When reinforcing the surgeon’s explanation of the procedure, the nurse would include that the surgery involves removal of which tissue? 1. Breast tissue and lymph nodes under the arm 2. Entire breast, underlying chest muscles, and lymph nodes 3. Breast tissue but no lymph node resection 4. Tumor and surrounding margin of tissue Rationale: A modified radical mastectomy involves removal of breast tissue and lymph nodes under the arm. A radical mastectomy includes removal of the entire breast, underlying chest muscles, and lymph nodes. A simple mastectomy involves removal of the breast tissue only, without any lymph node removal. A lumpectomy involves removal of the tumor and a margin of the surrounding tissues 22. A client with cervical cancer is going to have internal radiation therapy (brachytherapy). The nurse should provide what explanation about what to expect during this therapy? 1. “The head of bed cannot be raised more than about 15 degrees while the implant is in place.” 2. “You will be able to have frequent visitors such as friends and family.” 3. “It will be helpful to increase your intake of high-fiber foods during therapy.” 4. “You can walk only in your room, not in the hallway, during therapy.” Rationale: The head of bed cannot be raised more than about 15 degrees while the implant is in place to reduce the risk of dislodging the device from the effects of pressure and gravity. Visitors are restricted with respect to time and distance to avoid exposure to the radiation. Highfiber foods are

discouraged during this time because bowel movements increase intra-abdominal pressure and could increase the risk of dislodging the implant. The client must remain on bedrest to avoid dislodging the device because of the effect of gravity 23. The client who underwent prostate cancer surgery is approaching the time of discharge from the hospital. What instruction should the nurse provide to this client as part of discharge teaching? Select all that apply. 1. “Maintain a high fluid intake after you go home.” 2. “Call the healthcare provider immediately if you notice blood in your urine.” 3. “You may drive yourself home.” 4. “Avoid strenuous activity for 4–8 weeks.” 5. “Avoid heavy lifting for 2–4 weeks.” Rationale: Continued increased fluid intake will help the urine to remain dilute and reduce the risk of clot formation. The healing period after prostate surgery is 4–8 weeks, and the client should avoid strenuous activity during this period. Blood in the urine is fairly common after surgery but only needs to be reported if it increases in amount instead of decreasing. The client should not drive for 2 weeks, except for short rides. The client should avoid heavy lifting for 4–8 weeks after surgery while healing continues. 24. The nurse should write which interventions in the care plan of a client following left mastectomy for breast cancer? Select all that apply. 1. Use warm, moist compresses on left arm for comfort. 2. Start intravenous lines on left arm only in the antecubital area. 3. Wait for the third postoperative day to begin any arm exercises. 4. Keep left arm elevated above heart level. 5. Take blood pressures on the right arm only Rationale: The arm should be elevated above heart level following mastectomy to reduce the risk of edema after lymph node removal on the affected side. Blood pressures and lab draws should be performed on the unaffected side. Warm, moist compresses could enhance edema formation. IV lines should not be used on the affected side at any location. Gentle, simple range-of-motion exercises can be started immediately after surgery 25. A client has a continuous bladder irrigation running after prostatectomy. During the shift, 600 mL of one bag of irrigant infused and 1500 mL of the next also infused. Upon draining the urine bag three times during the shift, the nurse measures volumes of 800 mL, 1050 mL, and 950 mL. The nurse records the client’s true urine output as ______ mL. Provide a numerical answer. Answer: 700 mL Rationale: The total infused is 600 + 1500 = 2100 mL. The total drained was 800 + 1050 + 950 = 2800 mL. Subtract 2100 from 2800 to obtain 700 mL, the true urine output for the shift....