Exam Two Flashcards
The nurse is caring for a client diagnosed with HIV-II. The client’s CD4+ cell count is 399/mm3 (0.399 × 109/L). What action by the nurse is best?
a. Counsel the client on safer sex practices/abstinence
b. Encourage the client to abstain from alcohol.
c. Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors.
d. Help the client plan high-protein/iron meals.
ANS: A
This client is in the Centers for Disease Control and Prevention HIV-II case definition group. He or she remains highly infectious and would be counseled on either safer sex practices or abstinence. Abstaining from alcohol is healthy but not required, although some medications may need to be taken while abstaining. Genetic testing is not commonly done, but an
alteration on the CCR5/CXCR4 co-receptors is seen in long-term nonprogressors. High-protein/iron meals are important for people who are immunosuppressed, but helping to plan them does not take precedence over stopping the spread of the disease.
The nurse is presenting information to a community group on safer sex practices. The nurse would teach that which sexual practice is the riskiest?
a. Anal intercourse
b. Masturbation
c. Oral sex
d. V aginal intercourse
ANS: A
Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating a portal of entry for human immune deficiency virus in addition to providing mucus membrane contact with the virus.
The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV) from clients. Which practice is most effective?
a. Consistent use of Standard Precautions
b. Double-gloving before body fluid exposure
c. Labeling charts and armbands “HIV+”
d. Wearing a mask within 3 feet of the client
ANS: A
According to The Joint Commission, the most effective preventative measure to avoid HIV
exposure is consistent use of Standard Precautions. Standard Precautions are required by the
CDC. Double-gloving is not necessary. Labeling charts and armbands in this fashion is a
violation of the Health Information Portability and Accountability Act (HIPAA). Wearing a
mask within 3 feet (1 m) of the client is not necessary with every client contact.
A client with known HIV-II is admitted to the hospital with fever, night sweats, and severe cough. Laboratory results include a CD4+ cell count of 180/mm and a negative tuberculosis
(TB) skin test 4 days ago. What action would the nurse take first?
a. Initiate Droplet Precautions for the client.
b. Notify the primary health care provider about the CD4+ results.
c. Place the client under Airborne Precautions.
d. Use Standard Precautions to provide care.
ANS: C
Since this client’s CD4+ cell count is so low, he or she may have energy, or the inability to
mount an immune response to the TB test. The client also appears to have progressed to
HIV-III. The nurse would first place the client on Airborne Precautions to prevent the spread
of TB if it is present. Next the nurse notifies the primary health care provider about the low CD4+ count and requests alterative testing for TB. Droplet Precautions are not used for TB. Standard Precautions are not adequate in this case.
A nurse is talking with a client about a negative enzyme-linked immunosorbent assay
(ELISA) test for human immune deficiency virus (HIV). The test is negative and the client
important?
a. Assess the client’s sexual activity and patterns.
states “Whew! I was really worried about that result.” What action by the nurse is most
b. Express happiness over the test result.
c. Remind the client about safer sex practices.
d. Tell the client to be retested in 3 months.
ANS: A
The ELISA test can be falselyanbegiartbive.cifotesmting/toeccsurts after the client has become infected but prior to making antibodies to HIV. This period of time is known as the window period and can last up to 21 days. The confirmatory Western Blot test takes an additional 7 days, so using
that testing algorithm, the client’s status may not truly be known for up to 28 days. The client
may have had exposure that has not yet been confirmed. The nurse needs to assess the client’s sexual behavior further to determine the proper response. The other actions are not the most important, but discussing safer sex practices is always appropriate. Testing would be recommended every 3 months for someone engaging in high risk behaviors.
A client with HIV-II has had a sudden decline in status with a large increase in viral load. What action would the nurse take first?
a. Ask the client about travel to any foreign countries.
b. Assess the client for adherence to the drug regimen.
c. Determine if the client has any new sexual partners.
d. Request information about new living quarters or pets.
ANS: B
Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time to be effective. Since this client’s viral load has increased dramatically, the nurse would first assess this factor. After this, the other assessments may or may not be needed.
A client is hospitalized with Pneumocystis jiroveci pneumonia. The client reports shortness of breath with activity and extreme fatigue. What intervention is best to promote comfort?
a. Administer sleeping medications
b. Perform most activités for the client
c. Increase the client’s oxygen during activity.
d. Pace activities, allowing for adequate rest.
ANS: D
This client has two major reasons for fatigue: decreased oxygenation and systemic illness. The
nurse would not do everything for the client but rather let the client do as much as possible within limits and allow for adequate rest in between. Sleeping medications may be needed but not as the first step, and only with caution. Increasing oxygen during activities may or may not be warranted, but first the nurse must try pacing the client’s activity.
A client with HIV-III and wasting syndrome has inadequate nutrition. What assessment finding by the nurse best indicates that goals have been met for this client problem?
a. Chooses high-protein food.
b. Has decreased oral discomfort.
c. Eats 90% of meals and snacks.
d. Has a weight gain of 2 lb (1 kg)/1 mo.
ANS: D
The weight gain is the best indicator that goals for this client problem have been met because
it demonstrates that the client not only is eating well but also is able to absorb the nutrients.
Choosing high-protein food is important, but only if the client eats and absorbs the nutrients.
A client with HIV-III is hospitalized and has weeping Kaposi sarcoma lesions. The nurse
dresses them with sterile gauze. When changing these dressings, which action is most important for the nurse’s safety?
a. Adhering to Standard Precautions
b. Assessing tolerance to dressing changes
c. Performing hand hygiene before and after care
d. Disposing of soiled dressings properly
ANS: A
All of the actions are important, but due to the infectious nature of this illness, the nurse would ensure he or she is following Standard Precautions (and Transmission-Based Precautions when necessary) to avoid a potential exposure.
A client with HIV-III is admitted to the hospital with Toxoplasma gondii infection. Which action by the nurse is most appropriate?
a. Initiate Contact Precautions.
b. Conduct frequent neurologic assessments.
c. Conduct frequent respiratory assessment test
d. Initiate Protective Precautions.
ANS: D
Toxoplasma gondii infection is an opportunistic infection that causes an encephalitis but poses
only a rare threat to immunocompetent individuals The nurse would perform ongoing
neurologic assessments. Contact and Protective Precautions are not needed. Good respiratory
assessments are important to the client, but toxoplasmosis will demonstrate neurologic signs
and symptoms.
A client has just been informed of a positive HIV test. The client is distraught and does not
know what to do. What intervention by the nurse is best?
a. Assess the client for support systems.
b. Determine if a clergy member would help.
c. Explain legal requirements to tell sex partners.
d. Offer to tell the family for the client.
ANS: A
This client needs the assistance of support systems. The nurse would help the client identify
them and what role they can play in supporting him or her. A clergy member may or may not
be welcome. Positive HIV test results are reportable in all 50 states, Washington, D.C., and
Canada but the nurse works with the client to support his or her choices in disclosure. The
nurse would not tell the family for the client.
A nurse is caring for a client with HIV-III who was admitted with HAND. What sign or symptom would be most important for the nurse to report to the primary health care provider?
a. Nausea
b. Change in pupil size
c. Weeping open lesions
d. Cough
ANS: B
HIV-associated neurocognitive disorder (HAND) is a sign of neurologic involvement. The nurse would report any sign of increasing intracranial pressure immediately, including change in pupil size, level of consciousness, vital signs, or limb strength. The other signs and symptoms are not life threatening and would be documented and reported appropriately.
A client has been hospitalized with an opportunistic infection secondary to HIV-III. The client’s partner is listed as the emergency contact, but the client’s mother insists that she should be listed instead. What action by the nurse is best?
a. Contact the social worker to assist the client with advance directives
b. Ignore the mother; the client does not want her to be involved.
c. Let the client know, gently, that nurses cannot be involved in these disputes.
d. Tell the client that, legally, the mother is the emergency contact.
ANS: A
The client should make his or her wishes known and formalize them through advance directives. The nurse would help the client by contacting someone to help with this process. Ignoring the mother or telling the client that nurses cannot be involved does not help the situation. Legal statutes vary by state, but the nurse would be the client’s advocate and help ensure his or her wishes are met.
A client with HIV-II is hospitalized for an unrelated condition, and several medications are prescribed in addition to the regimen already being used. What action by the nurse is most important?
a. Consult with the pharmacy about drug interactions.
b. Ensure that the client understands the new medications.
c. Give the new drugs without considering the old ones.
d. Schedule all medications at standard times.
ANS: A
The drug regimen for someone with HIV/AIDS is complex and consists of many medications
that must be given at specific times of the day, and that have many interactions with other
drugs and food. The nurse would consult with a pharmacist about possible interactions. Client
teaching is important but does not take precedence over ensuring the medications do not
interfere with each other, which could lead to drug resistance or a resurgence of symptoms.
A client with HIV-III has been hospitalized with suspected cryptosporidiosis. What physical assessment would be most important with this condition?
a. Auscultating the lungs
b. Assessing mucous membranes
c. Listening to bowel sounds
d. Performing a neurological examination
ANS: B
Cryptosporidiosis can cause diarrhea and wasting with extreme loss of fluids and electrolytes.
The nurse would assess signs of hydration/dehydration as the priority, including checking the
client’s mucous membranes for dryness. The nurse will perform the other assessments as part of a comprehensive assessment.
A client with HIV-III asks the nurse why gabapentin is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best?
a. “Gabapentin can be used as an antidepressant too.”
b. “I have no idea why you would be taking this drug.”
c. “This drug helps treat the pain from nerve irritation.”
d. “You are at risk for seizures due to fungal infections.”
ANS: C
Many classes of medications are used for neuropathic pain, including tricyclic antidepressantsand anticonvulsants such as gabapentin. It is not being used to prevent seizures from fungal infections. If the nurse does not know the answer, he or she would find out for the client.
An HIV-negative client who has an HIV-positive partner asks the nurse about receiving tenofovir/emtricitabine. What information is most important to teach the client about this drug?
a. Does not reduce the need for safe sex practices.
b. Has been taken off the market due to increases in cancer.
c. Reduces the number of HIV tests you will need.
d. Is only used for postexposure prophylaxis.
ANS: A
Tenofovir/emtricitabine is a newer drug used for preexposure prophylaxis and appears to
reduce transmission of human immune deficiency virus (HIV) from known HIV-positive
people to HIV-negative people. The drug does not reduce the need for practicing safe sex.
Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3
months. This drug has not been taken off the market and is not used for postexposure
prophylaxis.
A nurse is learning about human immune deficiency virus (HIV) infection. Which statements about HIV infection are correct? (Select all that apply.)
a. CD4+ cells begin to create new HIV virus particles.
b. Antibodies produced are incomplete and do not function well.
c. Macrophages stop functioning properly.
d. Opportunistic infections and cancer are leading causes of death.
e. People with HIV-I disease are not infectious to others.
f. The CD4+ T-cell is only affected when the disease has progressed to HIV-III
ANS: A,B,C,D
In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produce are
incomplete and do not function well. Macrophages also stop functioning properly.
Opportunistic infections and cancer are the two leading causes of death in client’s with HIV
infection. People infected with HIV are infectious in all stages of the disease. The CD4+ T-cell is the immune system cell most affected by infection with the HIV virus.
Which findings are AIDS-defining characteristics? (Select all that apply.)
a. A CD 4+ cell count less than 200/mm3 or less than 14%
b. Infections with P. jiroveci
c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV)
d. Presence of HIV wasting syndrome
e. Taking antiretroviral medications
f. Confusion, dementia, or memory loss
ANS: A,B,D,F
count of less than 200 cells/mamb(i0r.2b×.c10o/Lm) o/rtless tthan 14% (even if the total CD4+ count
is above 200 cells/mm3) or an opportunistic infection such as P. jiroveci and HIV wasting
syndrome. Confusion, dementia, and memory loss are central nervous system indications.
Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining
characteristics.
The nurse is teaching a client about medications for HIV-II treatment. What drugs are paired
with the correct information? (Select all that apply.)
a. Abacavir: avoid fatty and fried foods.
b. Efavirenz: take 1 hour before or 2 hours after antacids.
c. Atazanavir: check pulse daily and report pulse greater than 100 beats/min.
d. Dolutegravir: do not take this medication if you become pregnant.
e. Enfuvirtide: teach client how to operate syringe infusion pump for administration. f. All drugs: you must adhere to the drug schedule at least 90% of the time for
effectiveness.
ANS: A,B,F
Abacavir is a nucleoside reverse transcriptase inhibitor and clients are taught to avoid fried
and fatty foods because they can lead to digestive upsets and even pancreatitis. Efavirenz is a nonnucleoside reverse transcriptase inhibitor and clients are taught to take them (doraverene) all except spaced 1 hour before or 2 hours after antacids to avoid inhibiting drug absorption. Atazanavir is a protease inhibitor and can cause bradycardia which should be reported. Dolutegravir is an integrate inhibitor and can cause birth defects. Enfuvirtide is a fusion inhibitor and is given subcutaneously. All drugs must be taken as scheduled 90% of the time in order to remain effective.
A client with HIV-III is hospitalized with P. jiroveci pneumonia and is started on the drug of choice for this infection. What laboratory values would be most important for the nurse report to the primary health care provider? (Select all that apply.)
a. Aspartate transaminase, alanine transaminase: elevated
b. CD4+ cell count: 180/mm3
c. Creatinine: 1.0 mg/dL (88 mcmol/L)
d. Platelet count: 80,000/mm3 (80 × 109/L)
e. Serum sodium: 120 mEq/L (120 mmol/L) f. Serum potassium: 3.4 mEq/L (3.4 mmol/L)
ANS: A,D,E
The drug of choice to treat P. jiroveci pneumonia is trimethoprim with sulfamethoxazole. Side
effects of this drug include hepatitis, hyponatremia, and thrombocytopenia. The elevated liver
enzymes, low platelet count, and low sodium would all be reported. The CD4+ cell count is
within the expected range for a client with an AIDS-defining infection. The creatinine level is normal and the potassium is just below normal.
A client with HIV-III has oral thrush and difficulty eating. What actions does the nurse
delegate to the assistive personnel (AP)? (Select all that apply.)
a. Apply oral anesthetic gels before meals.
b. Assist the client with oral care every 2 hours.
c. Offer the client frequent sips of cool drinks
d. Provide the client with alcohol-based mouthwash.
e. Remind the client to use only a soft toothbrush.
f. Offer the client soft foods like gelatin or pudding.
ANS: B,C,E,F
The AP can help the client with oral care, offer fluids, and remind the client of things the
nurse (or other professional) has already taught. Soft foods and liquids are tolerated better
than harder foods. Applying medications is performed by the nurse. Alcohol-based mouthwashes are harsh and drying and would not be used.
A client with HIV-III is in the hospital with severe diarrhea. What actions does the nurse delegate to assistive personnel (AP)? (Select all that apply.)
a. Assessing the client’s fluid and electrolyte status
b. Assisting the client to get out of bed to prevent falls
c. Obtaining a bedside commode if the client is weak
e. Reporting any perianal abnormalities
d. Providing gentle perianal cleansing after stools
ANS: B,C,D,E
The AP can assist the client with getting out of bed, obtain a bedside commode for the client’s
use, cleanse the client’s perianal area after bowel movements, and report any abnormal
observations such as redness or open areas. The nurse assesses fluid and electrolyte status.
The nurse is educating a client with HIV-II and the partner on self-care measures to prevent infection when blood counts are low. What information does the nurse provide? (Select all that apply.)
a. Do not work in the garden or with houseplants.
b. Do not empty the kitty litter boxes.
c. Clean your toothbrush in the dishwasher daily.
d. Bathe daily using antimicrobial soap.
e. Avoid people who are sick and large crowds.
f. Make sure meat, fish, and eggs are cooked well
ANS: A,B,D,E,F
Ways to avoid infection when immunocompromised include not working in the garden or with houseplants; not emptying litter boxes; running the toothbrush through the dishwasher at least weekly; bathing daily using antimicrobial soap; avoiding sick people and large crowds; and making sure meat, fish, and eggs are cooked well prior to eating them.
A nurse is providing education about HIV risks at a health fair. What groups would the nurse include as needing to be tested for HIV on an annual basis? (Select all that apply.)
a. Anyone who received a blood product in 1989
b. Couples planning on getting married
c. Those who are sexually active with multiple partners d. Injection drugs users
e. Sex workers and their customers
f. Adults over the age of 65 years
ANS: B,C,D,E
The CDC recommends that HIV testing would be performed on those who receive a transfusion between 1978 and 1985 only. People planning on getting married should be tested and all sexually active people should know their HIV status. Those engaged in sex work and their customers should also be tested, as well as injection drug users. Those over the age of 65 years need a one time screen.
A nurse begins a job at a Veterans Administration Hospital and asks why so much emphasis is on HIV testing for the veterans. What reasons is this nurse given? (Select all that apply.)
a. Veterans have a high prevalence of substance abuse.
b. Many veterans may engage in high risk behaviors.
c. Many older veterans may not know their risks.
d. Everyone should know their HIV status.
e. Belief that the VA has tested them and would notify them if positive.
ANS: A,B,C,D,E
All options are correct for the veteran population. The nurse interacting with veteran would
ensure they know about the HIV testing offered by the VA.
The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient:
a. has an increased risk of transmitting the HIV infection.
b. is less likely to develop AIDS than younger persons with HIV infection.
c. is less likely to respond to antiretroviral agents.
d. may have comorbid illnesses that can complicate HIV.
ANS: D
Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.
A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing which of the following?
a. acute retroviral syndrome.
b. AIDS.
c. an increased viral load.
d. an opportunistic infection.
ANS: A
Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.
A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Today’s lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patient’s results?
a. A drug-resistant strain is likely.
b. The patient is progressing as expected.
c. The patient’s treatment goals have been met.
d. Treatment failure has occurred.
ANS: B
The treatment goal would be a VL of <20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.
A pregnant patient is HIV-positive. Which of the following is true of antiretroviral therapy during pregnancy?
a. To avoid toxicity to the fetus, antiretroviral therapy is discontinued during
pregnancy
b. To minimize toxicity to the fetus, antiretroviral monotherapy is used
c. Combination antiretroviral drug therapy is the standard of care during pregnancy
d. Intravenous antiretroviral therapy is absolutely contraindicated
ANS: C
To prevent mother-to-child transmission of HIV, ART is recommended in all pregnant patients who test positive for HIV infection, regardless of virologic, immunologic, or clinical parameters. Combination drug therapy is considered the standard of care for both treatment of maternal HIV infection and prophylaxis to reduce the risk for perinatal HIV transmission. The goal of ART is to achieve maximal and sustained viral suppression during pregnancy to prevent perinatal transmission of HIV. If viral load is greater than or equal to 400 copies/mL, IV zidovudine is recommended regardless of current ART.
A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient’s creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action?
a. Instruct the patient to take the medication 60 minutes prior to meals.
b. Notify the provider to discuss dose adjustments.
c. Request an order for once-daily dosing of this medication.
d. Suggest that the patient increase fluid intake.
ANS: B
Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily. Increasing fluid intake will not affect this patient’s symptoms.
A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in combination with other antiretrovirals in order to:
a. avoid development of psychiatric comorbidities.
b. prevent dizziness, sedation, and nightmares.
c. reduce viral resistance.
d. prevent severe rash and hepatotoxicity.
ANS: C
Efavirenz is optimally given in combination with other antiretroviral agents. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.
A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir:
a. allows decreasing the dosing from 3 times daily to twice daily.
b. can lead to increased cholesterol and triglycerides.
c. may worsen insulin resistance.
d. will require increased dietary restrictions.
ANS: A
Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as wNell as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.
A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes?
a. Consume a low-cholesterol diet.
b. Consume more acidic foods.
c. Take the pill on an empty stomach.
d. Take the pill with fatty foods.
ANS: A
Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.
A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will recommend next?
a. Administration of a high dose of corticosteroids
b. Changing the regimen to a single antiretroviral drug
c. Temporarily discontinuing the antiretroviral therapy
d. Treating an underlying opportunistic infection
ANS: D
IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.
A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take?
a. Ask the patient’s family members to administer the medications.
b. Avoid discussing adverse effects to prevent focus on negative aspects of ART.
c. Give a detailed list of medications and stress the need to adhere to the schedule.
d. Offer written and verbal information about each drug’s purpose.
ANS: D
Patients often are more motivated to adhere to a drug regimen if they understand the purpose of the medications. Patients should be encouraged to take responsibility for their medications. Side effects need to be discusseNd so patients can plan ways to manage these before they occur.
The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient’s blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond?
a. “No treatment is necessary since the patient is receiving antiretroviral therapy.”
b. “We will treat you if the patient’s VL is greater than 20 copies/mL.”
c. “You will require 4 weeks of antiretroviral therapy.”
d. “You will undergo HIV testing and will be treated if you are positive.”
ANS: C
Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.
A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct?
a. “The drugs may be given in less toxic doses if two drugs are used.”
b. “Two agents used together can have synergistic effects.”
c. “Use of two drugs will increase tumoricidal activity in the G0 phase of the cell.”
d. “Using two agents will shorten the length of time chemotherapy is needed.”
ANS: B
Using two or more chemotherapeutic agents can have a synergistic effect. Combination therapy typically uses two drugs with different dose-limiting toxicities, but the use of more than one drug does not allow for using less toxic doses. Combination therapy allows cell kill in all phases of the cell cycle. Combination therapy does not shorten the length of time chemotherapy is needed.
A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point?
a. A week to 10 days after each chemotherapy dose
b. During the week immediately after chemotherapy
c. Immediately prior to each dose of chemotherapy
d. When the patient’s temperature is elevate by 1 degree F
ANS: A
Following chemotherapy administration, the time at which the blood count, including white blood cells, is lowest is typically 7 to 10 days after treatment.
The nurse is caring for a patient who is receiving a third dose of high-dose cyclophosphamide (Cytoxan). The nurse notes hematuria. The nurse will notify the provider and will perform which action?
a. Ask whether the patient takes allopurinol (Lopurin).
b. Assess the patient’s skin and fingernails for darkening.
c. Question the patient about fluid intake.
d. Reassure the patient that this is an expected side effect.
ANS: C
Hemorrhagic cystitis is a common adverse effect of high-dose cyclophosphamide and can be mitigated by increasing fluid intake. Allopurinol is given to treat gout, which is characterized by uric acid crystalluria. Darkening of the fingernails and skin is a common adverse effect of cyclophosphamide but is unrelated to hemorrhagic cystitis.
A patient is prescribed raloxifene as a cancer prophylactic agent. Which type of cancer is this being used to prevent?
a. Prostate cancer.
b. Colon cancer.
c. Multiple myeloma.
d. Breast cancer.
ANS: D
Selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene have both estrogenic and antiestrogenic effects on various tissues. Tamoxifen is primarily used for breast cancer in both men and women. Raloxifene produces estrogenic effects in bone and lipids and has an antiestrogenic property in mammary tissues. It is used as a prophylactic against breast cancer in high-risk postmenopausal women with osteoporosis.
The nurse is teaching a patient who will take oral cyclophosphamide (Cytoxan). Which statement by the patient indicates understanding of the teaching?
a. “I should follow a diet high in organ meats and beans while taking this drug.”
b. “I should brush my teeth and gums vigorously twice daily.”
c. “I should report any low-grade temperature elevation immediately.”
d. “I should take the drug at bedtime to minimize side effects.”
ANS: C
Even a low-grade temperature should be reported because it can indicate significant infection in immunocompromised patients. Patients should eat a low-purine diet while taking this medication. Patients should brush teeth and gums with a soft bristle toothbrush. Patients should take the medication early in the day to avoid accumulation in the bladder.
A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During IV administration of this drug, what will the nurse observe the patient closely for?
a. Hypotension and visual disturbances
b. Pain and blistering at the IV site
c. Pink to red urine
d. Shortness of breath and wheezing
ANS: D
Bleomycin can cause anaphylaxis, so patients should be monitored for respiratory distress. Pain and blistering at the IV site is common to antitumor antibiotics, except for bleomycin. Urine color changes occur with doxorubicin. Vincristine causes hypotension and visual disturbances.
A patient is receiving the antitumor antibiotic doxorubicin (Adriamycin) to treat lung cancer. The patient is experiencing shortness of breath and palpitations. The nurse is concerned that the patient has developed which condition?
a. Anemia
b. Cardiotoxicity
c. Hypersensitivity
d. Pulmonary infection
ANS: B
Cardiotoxicity is a known adverse effect of this drug and is manifested in shortness of breath, edema, and palpitations.
The nurse is caring for a patient who is receiving vincristine (Oncovin), a plant alkaloid chemotherapeutic agent, to treat non-Hodgkin lymphoma. The nurse observes that the patient
has difficulty walking. What action will the nurse take?
a. Ask about numbness or tingling in the fingers and toes.
b. Assess heart rate and blood pressure to evaluate for orthostatic hypotension.
c. Assess the temperature to evaluate for infection.
d. Request an order for a complete blood count and electrolytes.
ANS: A
Peripheral neuropathy can occur with this drug and is manifested by difficulty in walking and numbness and tingling in the fingers and toes. Orthostatic hypotension is not a side effect. Infection is always a concern, and regular evaluation of complete blood count and electrolytes is performed but not related to signs of peripheral neuropathy.
A woman who has advanced breast cancer will begin receiving androgen therapy. The nurse will explain to the patient that androgen therapy is used to:
a. enhance her own estrogen production.
b. give her a sense of well-being.
c. minimize hot flashes.
d. oppose the activity of estrogen.
ANS: D
Androgen is used to treat breast cancer to promote regression of tumors by opposing the activity of estrogen. Exogenous androgen therapy is most effective for palliative treatment of breast cancer among postmenopausal women. Other hormonal therapies are used in other circumstances to promote well-being and treat hot flashes.
The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient?
a. “If you experience numbness of your hands, it will eventually resolve.”
b. “If your IV starts to hurt, you should pull the IV out immediately.”
c. “You should ask for anti-nausea medication at the first sign of nausea.”
d. “You should report difficulty buttoning your clothes to your provider.”
ANS: D
Difficulty buttoning clothing is a sign of peripheral neuropathy and should be reported. Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve. If the IV infiltrates, the infusion should be stopped and the needle left in until attempts to aspirate residual vesicant are performed. Anti-nausea medication should be given prior to beginning the infusion.
The nurse is caring for a patient who is receiving 5-fluorouracil (5-FU) to treat pancreatic cancer. Which interventions are included in the nurse’s plan of care for this patient? (Select all that apply.)
a. Apply ice to the IV site if the patient reports pain.
b. Administer antiemetics when the patient reports nausea.
c. Counsel the patient to use waxed dental floss.
d. Discourage visits with people who have respiratory infections.
e. Offer ice chips frequently.
f. Restrict to nothing by mouth during IV drug administration.
ANS: A, C, D, E
If the patient reports pain at the IV site, the nurse should apply ice and notify the provider. Patients should use waxed dental floss to avoid bleeding of the gums. Advise patient not to visit anyone who has a respiratory infection. Ice chips help with oral pain. Antiemetics should be given prior to administration of the drug. Patients do not need to be nothing per os (NPO) during the IV infusion.
The nurse is teaching a patient who will begin receiving targeted therapy for cancer. The patient asks how targeted therapy differs from other types of chemotherapies. The nurse will explain that targeted therapy:
a. damages cancer cell DNA to prevent cell replication.
b. directly kills or damages cancerous cells.
c. interferes with specific molecules in cancer cells.
d. prevents metastasis of cancer cells.
ANS: C
Targeted therapy differs from traditional cancer chemotherapy by taking advantage of biologic features particular to cancer cells and targeting specific mechanisms. They block the growth and spread of cancer by interfering with specific molecules within the cancer cells. Traditional chemotherapeutic agents damage cell DNA of cancer cells as well as normal cells. Targeted therapies do not directly kill or damage cancer cells or prevent metastasis.
A patient who has metastatic colorectal cancer tells the nurse that a cousin who had colorectal cancer received bevacizumab (Avastin) and wonders how the drug works. The nurse will explain that bevacizumab works by targeting which of the following?
a. HER2 receptors.
b. epidermal growth factor receptor-tyrosine kinase.
c. the BRCA1 suppressor gene.
d. vascular endothelial growth factor (VEGF) proteins.
ANS: D
Bevacizumab acts by blocking VEGF (vascular endothelial growth factor); blocking VEGF may prevent the growth of new blood vessels, including those that may feed the tumor. Gefitinib is used when epidermal growth factor receptor (EGFR)-TK are present. Trastuzumab is used when significant HERS receptors are present.
The nurse is performing a history on a patient who will begin taking bevacizumab (Avastin). Which aspect of the patient’s history should be reported to the oncologist treating this patient?
a. History of hepatitis
b. Hypertension
c. Recent treatment for a GI obstruction
d. Weight loss
ANS: C
Bevacizumab carries a warning for gastrointestinal obstruction or perforation.
The patient asks the nurse what apoptosis means. The nurse will explain that apoptosis refers to:
a. alteration of cellular functions.
b. inhibition of cell division.
c. prevention of cell phase progression.
d. slow, planned cellular death.
ANS: D
Apoptosis is programmed cell death, designed to ensure that tissues contain only healthy and optimally functional cells.
Which of the following agents is NOT an epidermal growth factor receptor (EGFR) inhibitor?
a. Alectinib
b. Erlotinib
c. Gefitinib
d. Osimertinib
ANS: A
Alectinib is a tyrosine kinase inhibitor. Erlotinib, gefitinib and osimertinib are all EGFR inhibitors.
The nurse performs a medication history on a patient who will begin targeted therapy for cancer with gefitinib (Iressa). The nurse learns that the patient is taking carbamazepine, a histamine2 blocker, and warfarin. The nurse will anticipate that the provider will make which change to the medication regimen?
a. decrease the gefitinib dose.
b. decrease the warfarin dose.
c. increase the histamine2 blocker dose.
d. increase the carbamazepine dose.
ANS: B
When patients taking warfarin take gefitinib, the effectiveness of the warfarin is greatly increased, and bleeding risks increase. Carbamazepine and histamine2 blockers decrease the effectiveness of gefitinib, so decreasing the gefitinib dose or decreasing the carbamazepine or histamine2 blocker is not recommended.
The nurse is preparing to administer intravenous temsirolimus (Torisel). To prevent a common adverse drug effect, the nurse will expect to administer which type of drug?
a. An antibiotic
b. An anticoagulant
c. An antiemetic
d. An antihistamine
ANS: D
Hypersensitivity reactions to temsirolimus are common, and pretreatment with antihistamines is recommended. Other drugs are given as needed but not prophylactically.
A patient who is taking the tyrosine kinase inhibitor sunitinib (Sutent) calls to report red, painful, and swollen palms and soles of feet. The nurse will perform which action?
a. Notify the patient’s provider of this adverse reaction.
b. Reassure the patient that these are common side effects.
c. Recommend taking acetaminophen for discomfort.
d. Suggest taking diphenhydramine to help with the swelling.
ANS: A
The nurse should notify the provider if the patient reports these symptoms, since they may
indicate erythrodysesthesia. Reassuring the patient or recommending over-the-counter
treatments is not indicated.
What action is most important for the nurse to teach the patient taking imatinib?
a. “The medication will cause the stool to be black; do not worry about that.”
b. “Acetaminophen can be used for headaches.”
c. “Limit your fluid intake to 1 liter each day.”
d. “Be diligent about using birth control while you are on this medication.”
ANS: D
Women should avoid pregnancy throughout treatment and for up to 12 months after treatment is complete. Black stools should be reported immediately. Acetaminophen is metabolized in the liver and should be avoided while on this drug. Fluids are encouraged.
A patient is receiving interferon alpha (Roferon-A) subcutaneously. The patient experiences chills, fatigue, and malaise, and the nurse assesses a temperature of 102° F. The nurse will notify the provider of the temperature and will anticipate which order?
a. Administer acetaminophen (Tylenol).
b. Change to intravenous (IV) interferon alpha.
c. Give diphenhydramine (Benadryl).
d. Obtain a serum blood urea nitrogen (BUN) and creatinine level.
ANS: A
The major side effects of interferon are flulike symptoms with chills, fever, fatigue, malaise, and myalgia. Acetaminophen is given to treat this initially. Changing to an IV form does not alter the side effects. Diphenhydramine is given to reduce histamine effects. It is not necessary to obtain laboratory work when these symptoms initially occur.
Prior to administration of interferon alpha, the nurse will administer which medications?
a. Acetaminophen and diphenhydramine
b. Heparin and meperidine
c. Lorazepam and furosemide
d. Narcotic analgesics and loratadine
ANS: A
Patients receiving these drugs should be premedicated with acetaminophen to reduce chills and fever and with diphenhydramine to reduce histamine effects.
Which of the following is an indication for use of IFN-ß?
a. Chronic granulomatous disease.
b. Hairy cell leukemia.
c. Multiple sclerosis.
d. Kaposi sarcoma.
ANS: C
Interferon beta is indicated for treatment of relapsing-remitting forms of multiple sclerosis. Interferon gamma is used to treat chronic granulomatous disease. Interferon alfa-2b is indicated to treat hairy call leukemia and Kaposi sarcoma.
A patient who has cancer will begin treatment with a colony-stimulating factor. The patient verbalizes understanding of why the drug is being used with which statement?
a. “This drug permit use of higher doses of chemotherapy.”
b. “This drug has antitumor activity.”
c. “This drug has cytotoxic effects.”
d. “This drug has antiviral effects.”
ANS: A
Colony-stimulating factors permit the delivery of higher doses of drugs because they counter myelosuppression. They do not have antitumor activity, cytotoxic effects, or antiviral effects.
A patient is receiving the erythropoietin-stimulating agent (ESA) epoetin alfa (Procrit). Which assessment finding would cause the nurse to notify the patient’s provider?
a. Blood pressure of 90/65 mm Hg
b. Headache and nausea
c. Hemoglobin >11 g/dL
d. Infiltration of the IV
ANS: C
There is an increased risk of death and serious cardiovascular events when hemoglobin is greater than 11 g/dL. There is no need to notify the provider of the other findings.
A patient who is receiving cancer chemotherapy has been ordered to receive epoetin alfa (Procrit) 150 units/kg 3 times weekly. The nurse reviews the patient’s chart and notes a hemoglobin level of 10.9 g/dL. The nurse will perform which action?
a. Administer the medication as ordered.
b. Hold the dose and notify the provider.
c. Reduce the dose by 25%.
d. Request an order for an increased dose.
ANS: B
For patients receiving cancer chemotherapy, ESAs should not be initiated at a hemoglobin level greater than or equal to 11 g/dL. Because the patient has a hemoglobin of 10.9 g/dL it would be prudent to hold the dose and notify the provider to determine next steps.
A patient has been receiving an ESA for 8 weeks. The nurse reviews the patient’s chart and notes no increase in hemoglobin levels from 8 g/dL on week 3 of therapy. The nurse will request an order for which of the following?
a. a complete blood count and serum iron levels.
b. an increased dose of the ESA.
c. more frequent dosing of the ESA.
d. packed red blood cell infusions.
ANS: A
If there is no response, ESAs should be discontinued after 8 weeks of therapy. If a patient does not respond, iron deficiency or underlying hematologic disease should be considered and evaluated.
A patient is receiving bone marrow transplantation for cancer and receives filgrastim (Neupogen). The patient reports severe abdominal pain in the left upper quadrant. The nurse will perform which action?
a. Administer acetaminophen 650 mg.
b. Administer an antiemetic medication.
c. Report a potentially life-threatening event.
d. Request an order for cardiac enzyme levels.
ANS: C
Splenic rupture can occur with this drug and is manifested by pain in the left upper quadrant. The nurse should report the abdominal pain to the provider so the patient can be evaluated for splenic rupture.
A patient with cancer is receiving aldesleukin. The patient reports black stools, which the nurse recognizes as:
a. a sign of cancer metastasis.
b. an indication of gastrointestinal bleeding.
c. caused by inadequate hydration.
d. renal failure.
ANS: B
Black stools suggest gastrointestinal bleeding, an absolute contraindication for aldesleukin. It is not a sign of cancer metastasis, inadequate hydration, or renal failure.
The nurse is preparing to give sargramostim to a patient who has acute myelogenous leukemia. The nurse assesses a heart rate of 78 beats per minute and a blood pressure of 120/70 mm Hg. The patient reports shortness of breath and has a cough and bilateral crackles. What will the nurse do next?
a. Contact the provider; discuss giving a lower dose.
b. Contact the pharmacist; request a bronchodilator.
c. Contact the pharmacist; request an order for furosemide.
d. Contact the provider; suggest administration of antibiotics.
ANS: A
Patients receiving this drug can experience sequestration of granulocytes in the pulmonary circulation and may experience dyspnea. The sargramostim infusion should be reduced by half if this occurs. Bronchospasm, pulmonary edema, and infection are not common side effects. Calling the pharmacist to request medication is an incorrect nursing action; antibiotics are not warranted in this situation.
The nurse is preparing to administer interleukin-2 (aldesleukin) to a patient who has cancer. The patient reports shortness of breath. The nurse assesses clear breath sounds, a respiratory rate of 22 breaths per minute, a heart rate of 80 beats per minute, an oxygen saturation of 88% on room air, and a blood pressure of 92/68 mm Hg. The nurse will perform which action?
a. Administer the dose as ordered.
b. Administer oxygen while giving the dose.
c. Discuss permanently discontinuing this treatment with the provider.
d. Hold the dose and notify the provider.
ANS: D
Because of the pulmonary symptoms associated with aldesleukin, the drug should be held if the patient has an oxygen saturation <90% on room air. It may be given when the patient’s oxygen saturation improves. The drug does not need to be permanently discontinued unless the patient requires intubation for more than 72 hours.
The nurse learning about cellular regulation understands that which process occurs during the S phase of the cell cycle?
a. Actual division (mitosis)
b. Doubling of DNA
c. Growing extra membrane
d. No reproductive activity
ANS: B
During the S phase, the cell must double its DNA content through DNA synthesis. Actual
division, or mitosis, occurs during the M phase. Growing extra membrane occurs in the G1
phase. During the G0 phase, the cell is working but is not involved in any reproductive activity.
A nurse asks the staff development nurse what “apoptosis” means. What response best?
a. Growth by cells enlarging
b. Having the normal number of chromosomes
c. Inhibition of cell growth
d. Programmed cell death
ANS: D
Apoptosis is programmed cell death. With this characteristic, organs and tissues function with
cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition.
A nurse is learning the difference between normal cells and benign tumor cells. What
information does this include?
a. Benign tumors grow through invasion of other tissue.
b. Benign tumors have lost their cellular regulation from contact inhibition.
c. Growing in the wrong place or time is typical of benign tumors.
d. The loss of characteristics of the parent cells is called anaplasia.
ANS: C
Benign tumors are basically normal cells growing in the wrong place or at the wrong time.
Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact
inhibition. Anaplasia is a characteristic of cancer cells.
A nurse learns that which of the following is the single biggest risk factor for developing cancer?
a. Exposure to tobacco
b. Advancing age
c. Occupational chemicals
d. Oncovirus infection
ANS: B
The single biggest risk factor for developing cancer is advancing age. As one ages, immunity decreases and exposures increase. Tobacco use is the single most preventable cause of cancer. Exposure to chemicals and oncoviruses cause fewer cancers.
Which statement about carcinogenesis is accurate?
a. An initiated cell will always become clinical cancer.
b. Cancer becomes a health problem once it is 1 cm in size.
c. Normal hormones and proteins do not promote cancer growth.
d. Tumor cells need to develop their own blood supply
ANS: D
Tumors need to develop their own blood supply through a process called angiogenesis. An
initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.
The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow
ANS: A
Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and
lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads,
although cancer can occur in the bone marrow.
A nurse is assessing a client with glioblastoma. What assessment is most important?
a. Abdominal palpation
b. Abdominal percussion
c. Lung auscultation
d. Neurologic examination
ANS: D
A glioblastoma arises in the brain. The most important assessment for this client is the
neurologic examination.
A nurse has taught a client about dietary changes that can reduce the chances of developing
cancer. What statement by the client indicates the nurse needs to provide additional teaching?
a. “Foods high in vitamin A and vitamin C are important.”
b. “I’ll have to cut down on the amount of bacon I eat.”
c. “I’m so glad I don’t have to give up my juicy steaks.”
d. “Vegetables, fruit, and high-fiber grains are important.”
ANS: C
To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct.
A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse
reads in the client’s chart that the cancer classification is TISN0M0. What does the nurse conclude about this client’s cancer?
a. The primary site of the cancer cannot be determined.
b. Regional lymph nodes could not be assessed.
c. There are multiple lymph nodes involved already.
d. There are no distant metastases noted in the report
ANS: D
TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasais.
A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best?
a. “Maybe; preservatives, dyes, and preparation methods may be risk factors.”
b. “No; research studies have never shown those things to cause cancer.”
c. “There are other things you can do that will more effectively lower your risk.”
d. “Yes; preservatives and dyes are well known to be carcinogens
ANS: A
Dietary factors related to cancer development are poorly understood, although dietary
practices are suspected to alter cancer risk. Suspected dietary risk factors include low-fiber
intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and
additives (dyes, flavorings, sweeteners) may have cancer-promoting effects. It is correct to say
that other things can lower risk more effectively, but this does not give the client concrete
information about how to do so, and also does not answer the client’s question.
The nurse learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.)
a. Differentiated function
b. Large nucleus-to-cytoplasm ratio
c. Loose adherence
d. Nonmigratory
e. Specific morphology
f. Orderly and specific growth
ANS: A,D,E,F
Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and well-regulated growth.
The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.)
a. Exposure to carcinogens
b. Genetic predisposition
c. Immune function
d. Normal doubling time
e. State of euploidy
ANS: A,B,C
The three interacting factors needed for cancer development are exposure to carcinogens,
genetic predisposition, and immune function.
A nurse is participating in primary prevention efforts directed against cancer. In which activitiesisthisnursemostliakeblyitroben.gcagoe?m(S/etlectsaltlthatapply.)
a. Demonstrating breast self-examination methods to women
b. Instructing people on the use of chemoprevention
c. Providing vaccinations against certain cancers
d. Screening teenage girls for cervical cancer
e. Teaching teens the dangers of tanning booths
f. Educating adults about healthy eating habits
ANS: B,C,E,F
Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer.
Secondary prevention includes screening and early diagnosis. Primary prevention activities
include teaching people about chemoprevention, providing approved vaccinations to prevent
cancer, teaching teens the dangers of tanning beds, and educating adults on eating habits to
reduce the risk of getting cancer. Breast examinations and screening for cervical cancer are
secondary prevention methods.
A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.)
a. A sore that does not heal
b. Changes in menstrual patterns
c. Indigestion or trouble swallowing
d. Near-daily abdominal pain
e. Obvious change in a mole
f. Frequent indigestion
ANS: A,B,C,E,F
The seven warning signs for cancer can be remembered with the acronym CAUTION:
changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge,
thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign.
A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?
a. Call the client at home the next day to review teaching.
b. Give the client information about a cancer support group.
c. Provide all the preoperative instructions in writing.
d. Reassure the client that surgery will be over soon.
ANS: A
Clients are often overwhelmed at a sudden diagnosis of cancer and may be more
overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client’s ability to understand, retain, and recall information. The nurse would call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.
A nurse is caring for a client admitted for Non-Hodgkin’s lymphoma and chemotherapy. The client reports nausea, flank pain, and muscle cramps. What action by the nurse is most important?
a. Request an order for serum electrolytes and uric acid.
b. Increase the client’s IV infusion rate.
c. Instruct assistive personnel to strain all urine
d. Administer an IV antiemetic
ANS: A
This client’s reports are consistent with tumor lysis syndrome, for which he or she is at risk due to the diagnosis. Early symptoms of TSL stem from electrolyte imbalances and can include lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness, cramps, seizures, and altered mental status. The nurse would notify the primary health care provider and request
an order for serum electrolytes. Hydration is important in both preventing and managing this
syndrome, but the nurse would not just increase the IV rate. Assistive personnel may need to strain the client’s urine and the client may need an antiemetic, but first the nurse would assess the situation further by obtaining pertinent lab tests.
A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best?
a. Ensure the client is placed in protective isolation
b. Have pregnant visitors stay 6 feet away from the client
c. No special action is necessary to care for this client.
d. Read the policy on handling radioactive excreta.
ANS: D
This type of radioisotope is excreted in body fluids and excreta (urine and feces) and would not be handled directly. The nurse would read the facility’s policy for handling and disposing of this type of waste. The other actions are not warranted.
A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?
a. “Are you getting adequate rest and sleep each day?”
b. “It is normal to be fatigued even for months afterward.”
c. “This is not normal and I’ll let the primary health care provider know.”
d. “Try adding more vitamins B and C to your diet”
ANS: B
Radiation-induced fatigue can be debilitating and may last for months after treatment has
ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client
(and family) understands this is normal.
A client tells the oncology nurse about an upcoming vacation to the beach to celebrate
completing radiation treatments for cancer. What response by the nurse is most appropriate?
a. “Avoid getting salt water on the radiation site.”
b. “Do not expose the radiation area to direct sunlight.”
c. “Have a wonderful time and enjoy your vacation!”
d. “Remember you should not drink alcohol for a year.”
ANS: B
The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse would inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.
A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important?
a. Assessing the IV site and blood return every hour
b. Educating the client on side effects
c. Monitoring the client for nausea
d. Providing warm packs for comfort
ANS: A
Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse would check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side
effects such as nausea are important for all clients receiving chemotherapy. Warm packs may
be helpful for some drugs, whereas for others ice is more comfortable. would monitor the site
and check for blood return to prevent injury from infiltration or extravasation.
A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to
administer the client’s oral chemotherapy medications. What action by the nurse is most appropriate?
a. Crush the medications if the client cannot swallow them.
b. Give one medication at a time with a full glass of water.
c. No special precautions are needed for these medications.
d. Wear personal protective equipment when handling the medications.
ANS: D
During the administration of oral chemotherapy agents, nurses must take the same precautions
that are used when administering IV chemotherapy. This includes using personal protective
equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not
needed.
The nurse working with oncology clients understands that which age-related change increases the older client’s susceptibility to infection during chemotherapy?
a. Decreased immune function
b. Diminished nutritional stores
c. Existing cognitive deficits
d. Poor physical reserves
ANS: A
As people age, there is an age-related decrease in immune function, causing the older adult to
be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.
The nurse has educated a client on precautions to take with thrombocytopenia. What statement by the client indicates a need to review the information?
a. “I will be careful if I need enemas for constipation.”
b. “I will use an electric shaver instead of a razor.”
c. “ I should only eat soft food that is either cool or warm”
d. “I won’t be able to play sports with my grandkids.”
ANS: A
The thrombocytopenic client is at high risk for bleeding even from minor trauma. Due to the
risk of injuring rectal and anal tissue, the client should not use enemas or rectal thermometers.
This statement would indicate the client needs more information. The other statements are appropriate for the thrombocytopenic client
A client has a platelet count of 9800/mm3 (9800 × 109/L). What action by the nurse is most
appropriate?
a. Assess the client for calf pain, warmth, and redness.
b. Instruct the client to call for help to get out of bed.
c. Obtain cultures as per the facility’s standing policy.
d. Place the client on protective Isolation Precautions.
ANS: B
A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent
injury, the client would be instructed to call for help prior to getting out of bed. Calf pain,
warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.
A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL (61 mmol/L). The client is symptomatic but refuses blood transfusions. What medication does the nurse prepare to administer? a. Epoetin alfa b. Filgrastim c. Mesna d. Dexrazoxane
ANS: A
The client’s hemoglobin is very low, so the nurse prepares to administer epoetin alfa, a
colony-stimulating factor that increases production of red blood cells. Filgrastim is for
neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Dexrazoxane helps protect the heart from cardiotoxicity from other agents.
A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority?
a. Helping clients adjust to their appearance
b. Reassuring clients that this change is temporary
c. Referring clients to a reputable wig shop
d. Teaching measures to prevent scalp injury
ANS: D
All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse would first teach ways to prevent scalp injury.
A client is receiving retuximab. What assessment by the nurse takes priority?
a. Blood pressure
b. Temperature
c. Oral mucous membranes
d. Pain
ANS: A
Rituximab can cause infusion-related reactions, including hypotension, so monitoring blood
pressure is the priority. Other complications of this drug include fever with chills/rigors,
headache and abdominal pain, shortness of breath, bronchospasm, nausea and vomiting, and
rash. Assessing the client’s temperature and for pain are both pertinent assessments, but do
not take priority over the blood pressure. Oral mucus membrane assessment is important for
clients with cancer, but are not specific for this treatment.
A client is receiving rituximab and asks how it works. What response by the nurse is best?
a. “It causes rapid lysis of the cancer cell membranes”
b. “It destroys the enzymes needed to create cancer cells.”
c. “It prevents the start of cell division in the cancer cells.”
d. “It sensitizes certain cancer cells to chemotherapy.”
ANS: C
Rituximab prevents the initiation of cancer cell division. The other statements are not accurate.
Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would
the nurse assess first?
a. Dry, itchy, peeling skin
b. Serum calcium of 9.2 mg/dL (2.3 mmol/L)
c. Serum potassium of 2.8 mEq/L (2.8 mmol/L)
d. Weight gain of 0.5 lb (1.1 kg) in 1 day
ANS: C
TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse would
assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving cancer treatments, and the nurse would assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.
A nurse is assessing a female client who is taking hormone therapy for breast cancer. What assessment finding requires the nurse to notify the primary health care provider immediately?
a. Irregular menses
b. Edema in the lower extremities
c. Ongoing breast tenderness
d. Red, warm, swollen calf
ANS: D
Clients receiving hormone therapy are at risk for thromboembolism. A red, warm, swollen
calf is indicative of deep vein thrombosis and would be reported to the provider. Irregular
menses, edema in the lower extremities, and breast tenderness are not as urgent as the possible
thromboembolism.
A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important?
a. Assess the client’s gait and balance.
b. Ask the client about the ease of urine flow.
c. Document the report completely.
d. Inquire about the client’s job risks.
ANS: A
This client has symptoms of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is most important. Documentation would be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this would not be where the nurse starts investigating
The nurse has taught a client with cancer ways to prevent infection. What statement by the
client indicates that more teaching is needed?
a. “I should take my temperature daily and when I don’t feel well.”
b. “I will discard perishable liquids after sitting out for over an hour.”
c. “I won’t let anyone share any of my personal toiletries.”
d. “It’s alright for me to keep my pets and change the litter box.”
Clients should wash their hands after touching their pets and would not empty or scoop the cat
litter box. The other statements are appropriate for self-management.
A client with long-standing heart failure being treated for cancer has received a dose of
ondansetron for nausea. What action by the nurse is most important?
a. Assess the client for a headache or dizziness.
b. Request a prescription for cardiac monitoring
c. Instruct the client to change positions slowly.
d. Weigh the client daily before eating.
ANS: B
5-HT3 antagonists, such as ondansetron, can prolong the QT interval within the cardiac
conduction cycle. ECG monitoring is recommended in patients with electrolyte abnormalities
(e.g., hypokalemia or hypomagnesemia), heart failure, bradyarrhythmias or patients taking
other medications that can cause QT prolongation. The nurse would contact the primary
health care provider and request cardiac monitoring. The nurse would assess the client for any other reported changes, but this is not a critical safety factor. Weight is not related directly to
this drug.
A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem?
a. Assisting the client to pre-plan for this event
b. Reassuring the client that alopecia is temporary
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c. Teaching the client ways to protect the scalp
d. Telling the client that there are worse side effects
ANS: A
Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give
the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the client’s own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.
A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
a. Administer a dose of allopurinol.
b. Assess the client’s serum potassium level
c. Gently inquire about advance directives.
d. Prepare the client for emergency surgery.
ANS: C
Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized
and comfortable, the nurse would initiate a conversation about advance directives. Allopurinol
is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in
which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.
A client is having a catheter placed to deliver chemotherapy beads into a liver tumor via the femoral artery. What action by the nurse is most important?
a. Assessing the client’s abdomen beforehand
b. Ensuring that informed consent is on the chart
c. Marking the client’s bilateral pedal pulses
d. Reviewing client teaching done previously
ANS: B
This is an invasive procedure requiring informed consent. The nurse would ensure that consent is on the chart. The other actions are also appropriate but not as important as ensuring the client has given consent.
A nurse works on an oncology unit and delegates personal hygiene to assistive personnel
(AP). What action by the AP requires intervention from the nurse?
a. Allowing a very tired client to skip oral hygiene and sleep
b. Assisting clients with washing the perianal area every 12 hours
c. Helping the client use a soft-bristled toothbrush for oral care
d. Reminding the client to rinse the mouth with water or saline
ANS: A
Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The nurse would intervene and explain this to AP. The other options are all appropriate.
A client with cancer has anorexia and mucositis, and is losing weight. The client’s family members continually bring favorite foods to the client and are distressed when the client won’t eat them. What action by the nurse is best?
b. Help the family show other ways to demonstrate love and caring
c. Suggest foods and liquids the client might be willing to try to eat.
d. Tell the family the client isn’t able to eat now no matter what they bring.
ANS: B
Families often become distressed when their loved ones won’t eat. Providing food is a
universal sign of caring, and to some people the refusal to eat signifies worsening of the
condition. The best option for the nurse is to help the family find other ways to demonstrate
caring and love, because with treatment-related anorexia and mucositis, the client is not likely
to eat anything right now. Explaining the rationale for the problem is a good idea but does not
suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.
The nurse caring for clients who have cancer understands that the general consequences of
cancer include which client problems? (Select all that apply.)
a. Clotting abnormalities from thrombocythemia
b. Increased risk of infection from white blood cell deficits
c. Nutritional deficits such as early satiety and cachexia
d. Potential for reduced gas exchanged
e. Various motor and sensory deficits
f. Increased risk for bone fractures
ANS: A,B,C,D,E,F
The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).
A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. “Chemo” gloves b. Face mask c. Impervious gown d. N95 respirator e. Shoe covers f. Eye protection
ANS: A,B,C,F
The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses
Society have developed safety guidelines for those preparing or administering IV
chemotherapy. These include double gloves (or “chemo” gloves), eye protection, a face mask, and a gown. An N95 respirator and shoe covers are not required.
A client receiving radiation therapy reports severe skin itching and irritation. What actions does the nurse delegate to assistive personnel (AP)? (Select all that apply.)
a. Apply approved moisturizers to dry skin.
b. Apply steroid creams to the skin
c. Bathe the client using mild soap.
d. Help the client pat skin dry after a bath.
e. Teach the client to avoid sunlight.
f. Make sure no clothing is rubbing the site.
ANS: A,C,D,F
The nurse can delegate applying moisturizer approved by the radiation oncologist using mild soap for bathing, and helping the client pat wet skin dry after bathing. Any clothing worn over the site should be soft and not create friction. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function.
A client has thrombocytopenia. What actions does the nurse delegate to assistive personnel
(AP)? (Select all that apply.)
a. Apply the client’s shoes before getting the client out of bed.
b. Assist the client with ambulation.
c. Shave the client with a safety razor only.
d. Use a lift sheet to move the client up in bed.
e. Use a water pressure device be set on low for oral care.
ANS: A,B,D
Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. help prevent client injury. The nurse instructs the AP to put the client’s shoes on before getting the client out of bed,
assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care. All of these measures
A client has mucositis. What actions by the nurse will improve the client’s nutrition? (Select
all that apply.)
a. Assist with rinsing the mouth with saline frequently.
b. Encourage the client to eat room-temperature foods.
c. Give the client hot liquids to hold in the mouth.
d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal. f. Offer the client fluids to drink each hour.
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ANS: A,B,D,F
Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Drinking plenty of fluids (unless contraindicated for another condition) is another beneficial measure. Hot liquids would be painful for the client.
A client’s family members are concerned that telling the client about a new finding of cancer
will cause extreme emotional distress. They approach the nurse and ask if this can be kept
from the client. What actions by the nurse are most appropriate? (Select all that apply.)
a. Ask the family to describe their concerns more fully.
b. Consult with a social worker, chaplain, or ethics committee.
c. Explain the client’s right to know and ask for their assistance.
d. Have the unit manager take over the care of this client and family.
e. Tell the family that this secret will not be kept from the client.
ANS: A,B,C
The client’s right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone
understands them. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse would explain the client’s right to know and ask the family how best to proceed. Enlisting their help might reduce their reluctance for the client to be informed. The nurse would not abdicate responsibility for this difficult situation by
transferring care to another nurse. Simply telling the family that he or she will not keep this
secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not.
A client receiving chemotherapy has a white blood cell count of 1000/mm3 (1 × 109/L). What
actions by the nurse are most appropriate? (Select all that apply.)
a. Assess all mucous membranes every 4 to 8 hours.
b. Do not allow the client to eat meat or poultry.
c. Listen to lung sounds and monitor for cough.
d. Monitor the venous access device appearance hourly. e. Take and record vital signs every 4 to 8 hours.
f. Encourage activity the client can tolerate.
ANS: A,C,D,E
Depending on facility protocol, the nurse would assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device and recording vital signs. Assisting the client with mobilization will also help prevent infection. Eating meat and poultry is allowed.
A patient’s serum osmolality is 305 mOsm/kg. Which term describes this patient’s body fluid osmolality?
a. Iso-osmolar
b. Hypo-osmolar
c. Hyper-osmolar
d. Isotonic
ANS: C
Normal osmolality is 275 to 295 mOsm/kg. This patient is therefore hyper-osmolar.
A patient is admitted after experiencing vomiting and diarrhea for several days. The provider orders intravenous lactated Ringer’s solution. The nurse understands that this fluid is given for which purpose?
a. To increase interstitial and intracellular hydration
b. To maintain plasma volume over time
c. To pull water from the interstitial space into the extracellular fluid
d. To replace water and electrolytes
ANS: D
Lactated Ringer’s solution is an isotonic solution and is used to replace water and electrolytes and is often used to replace gastrointestinal losses. Hypotonic fluids increase interstitial and intracellular hydration. Colloidal solutions are used to maintain plasma volume over time. Hypertonic solutions pull water from the interstitial space into the extracellular fluid.
A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?
a. Decreased urine output
b. Improved blood oxygenation
c. Increased interstitial fluid
d. Stabilization of heart rate and blood pressure
ANS: D
6% Dextran 75 is a high–molecular-weight colloidal solution and is used to treat shock from hemorrhage, burns, or trauma. Colloids are plasma expanders, and the end result is an improvement in heart rate (decreased) and blood pressure (increased). Plasma expanders will result in an increase in urine output. Blood oxygenation is not affected, and colloids do not increase the amount of interstitial fluid.
