ONCOLOGY Flashcards
(35 cards)
The nurse is monitoing a child for bleeding after surgery for removal of a brain tumour. The nurse checks the head dressing for the presence of blood and notes a colourless drainage on the back of the dressing. Which intervention should be done immediately?
A/ Reinforce the dressing
B/ Notify the HCP
C/ Document the findings and continue to monitor
D/ Circle the area of drainage and continue to monitor
B/ Notify the HCP
Colourless drainage after a craniotomy indicates the presence of CSF and should be reported ASAP to the HCP.
Options 1,2,3 are not immediate nursing interventions
A child undergoes surgery to remove a brain tumour. During the post-op period, the nurse is monitoring the child and notes that the child is restless, tachycardic, and they are hypotensive compared to their baseline value. Nurse suspects the child is in shock, which is the most appropriate nursing action?
A/ Notify the HCP
B/ Place child in supine position
C/ Place child in Trendelenburg’s Position
D/ Increase the flow rate of the IV fluids
A/ Notify the HCP
In the event of shock, the HCP is notified immediately before the nurse intervenes.
After craniotomy, NEVER place anyone in a Trendelenburg’s position as this will significantly increase ICP!
The head of the bed should be elevated not lowered
Increasing IV fluids can increase ICP
Which of the following is incorrect in relation to osteosrcomas in children and adolescents?
A/ The femur is the most common site of this sarcoma
B/ The child dose not experience any pain at the site of the tumour
C/ Limping, if weight-bearing limb is affects is a clinical manifestation
D/ The symptoms of the disease in the early stage are almost always attributed to growing pains
B/ No pain
Most common bone cancer in kids and typically occurs in the metaphysis of long bones, especially in lower extremities (Femur mostly)
Manifested by progressive, insidious and intermittent pain at the tumour site.
Other options are all correct
The nurse analyzes the laboratory values of a child with leukaemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care?
A/ Initiate Bleeding precautions
B/ Monitor closely for signs of infection
C/ Administration of Anticoagulants q12h
D/ Initiate protective isolation precautions
A/ BLEEDING
Leukemia is a malignant increase in the number of leukocytes. Affecting bone marrow, causing anemia from decreased erythrocytes, infections from neutopenia, and bleeding from decreased platelet production.
A severely thrombocytopenic child has a platelet count of less than 20,000 cells/mm3, so bleeding precautions must be started.
They do not need anticoagulants.
The other options are more related to prevention of infection.
A 15-year old has been admitted to the hospital with Acute Lymphocytic leukaemia. Which signs and symptoms require the most immediate nursing intervention?
A/ Fatigue and Anorexia
B/ Fever and Petechiae
C/ Swollen lymph nodes in the neck and lethargy
D/ Enlarged liver and spleen
B/ Fever and Petechiae
This indicates a suppression of normal WBCs and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding.
Fatigue is a common symptom of Acute Lymphocytic leukaemia
Swollen glands and lethargy are uncomfortable, but do not require immediate attention. Enlarged liver and spleen require safety precautions that prevent injury to the abdomen, but this is not the priority
After teaching the parents of a child newly diagnosed with Leukaemia about the disease, which response from the parents indicates that they understand the nature of leukaemia?
A/ The disease is in infection resulting in increased white blood cell production
B/ The disease is a type of cancer than increases the amount of immature white blood cells
C/ The disease is an inflammation associated with enlargement of the lymph nodes
D/ The disease is a type of cancer that decreases the amount of white blood cells circulating in the lymphatic system
B/ Immature WBCs
Is a neoplastic/cancerous disorder that is characterized by the proliferation of immature WBCs.
It is not an infection or inflammation
Which medication prescription for a child with leukaemia should the nurse question? A/ Hydromorphone B/ Acetaminophen with codeine C/ Ibuprofen D/ Acetaminophen with hydrocodone
C/ Ibuprofen
Ibuprofen increases bleeding time and is contraindicated in clients with leukaemia. Non-narcotic drugs other than Ibuprofen and ASA, such as Tylenol, may be used to control pain and may be used in combination with narcotics like codeine or hydromorphone or hydrocodone.
Which signs and symptoms of leukaemia would the nurse suspect the client has developed thrombocytopenia? SELECT ALL THAT APPLY A/ Fever B/ Petechiae C/ Epistaxis D/ Anorexia E/ Bone Pain F/ Shortness of Breath
B/ Petechiae
C/ Epistaxis
Acute Lymphocytic leukaemia causes a decrease in platelets, RBCs, and WBCs due to the unrestricted proliferation of immature WBCs. Chemotherapy is used to treat leukaemia, however this increases thrombocytopenia, neutropenia, and anemia. Thus these patients are at an increased risk of bleeding; so petechiae (small red-purple bruises under the skin) and epistaxis (nosebleeds) are a clinical sign.
Fever is the result of neutropenia
Anorexia and shortness of breath is due to anemia
Bone pain is related to unrestricted proliferation of WBCs
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder?
A/ Increased calcium level
B/ Increased white blood cells
C/ Decreased blood urea nitrogen level
D/ Decreased number of plasma cells in the bone marrow
A/ Increased calcium level
Findings indicative of multiple myeloma are an INCREASED number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.
*read question carefully
The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? A/ Encouraging fluids B/ Providing frequent oral care C/ Coughing and deep breathing D/ Monitoring the red blood cell count
A/ Encouraging fluids
Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.
When caring for a client with an internal radiation implant, the nurse should observe which principles? SELECT ALL THAT APPLY
- Limiting the time with the client to 1 hour per shift.
- Keeping pregnant women out of the client’s room.
- Placing the client in a private room with a private bath.
- Wearing a lead shield when providing direct client care.
- Removing the dosimeter film badge when entering the client’s room.
- Allowing individuals younger than 16 years old in the room as long as they are 6 feet away
from the client.
- Keeping pregnant women out of the client’s room.
- Placing the client in a private room with a private bath.
- Wearing a lead shield when providing direct client care.
The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The client must be placed in a private room with a private bath. The nurse should wear a lead shield to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client’s room. Children younger than 16 years of age and pregnant women are not allowed in the client’s room.
While giving care to a client with an internal cervical radiation implant, the nurse finds the
implant in the bed. The nurse should take which initial action?
A/ Call the health care provider (HCP).
B/ Reinsert the implant into the vagina.
C/ Pick up the implant with gloved hands and flush it down the toilet.
D/ Pick up the implant with long-handled forceps and place it in a lead container.
D/ Pick up the implant with long-handled forceps and place it in a lead container.
In the event that a radiation source becomes dislodged, the nurse would first encourage the client to lie still until the radioactive source has been placed in a safe closed container. The nurse would use a long-handled forceps to place the source in the lead container that should be in the client’s room. The nurse should then call the radiation oncologist and then document the event and the actions taken. It is not within the scope of nursing practice to insert a radiation implant.
The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client’s pain should include which assessment?
A/ The client’s pain rating
B/ Nonverbal cues from the client
C/ The nurse’s impression of the client’s pain
D/ Pain relief after appropriate nursing intervention
A/ The client’s pain rating
The client’s self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure.
A client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment finding would the nurse expect to note specifically in the client? A/ Fatigue B/ Weakness C/ Weight gain D/ Enlarged lymph nodes
D/ Enlarged lymph nodes
Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.
During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? A/ Diarrhea B/ Hypermenorrhea C/ Abnormal bleeding D/ Abdominal distention
D/ Abdominal distention
Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumour and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the nurse recognize as indications of a possible oncological emergency? SELECT ALL THAT APPLY
- Facial edema in the morning
- Serum calcium level of 12 mg/dL
- Weight loss of 20 lb in 1 month
- Serum sodium level of 136 mg/dL
- Serum potassium level of 3.4 mg/dL
- Numbness and tingling of the lower extremities
- Facial edema in the morning
- Serum calcium level of 12 mg/dL
- Numbness and tingling of the lower extremities
Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL is a normal level.
A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?
A/ Altered red blood cell production
B/ Altered production of lymph nodes
C/ Malignant exacerbation in the number of leukocytes
D/ Malignant proliferation of plasma cells within the bone
D/ Malignant proliferation of plasma cells within the bone
Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3 describes the leukemic process.
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?
A/ Measure abdominal girth.
B/ Irrigate the nasogastric tube.
C/ Continue to monitor the drainage.
D/ Notify the health care provider (HCP).
D/ Notify the health care provider (HCP).
Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the HCP at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific HCP prescriptions to do so.
A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? SELECT ALL THAT APPLY
- Radiation
- Chemotherapy
- Increased fluid intake
- Decreased oral sodium intake
- Serum sodium level determination
- Medication that is antagonistic to antidiuretic hormone
- Radiation
- Chemotherapy
- Serum sodium level determination
- Medication that is antagonistic to antidiuretic hormone
Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment.
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? A/ Cyanosis B/ Arm edema C/ Periorbital edema D/ Mental status changes
C/ Periorbital edema
Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar.
A client is diagnosed as having a bowel tumour. The nurse should monitor the client for which complications of this type of tumour? SELECT ALL THAT APPLY
- Flatulence
- Peritonitis
- Hemorrhage
- Fistula formation
- Bowel perforation
- Lactose intolerance
- Peritonitis
- Hemorrhage
- Fistula formation
- Bowel perforation
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?
A/ Placing cool compresses on the affected arm
B/ Elevating the affected arm on a pillow above heart level
C/ Avoiding arm exercises in the immediate postoperative period
D/ Maintaining an intravenous site below the antecubital area on the affected side
B/ Elevating the affected arm on a pillow above heart level
Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.
A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? A/ Echocardiography B/ Electrocardiography C/ Cervical radiography D/ Pulmonary function studies
D/ Pulmonary function studies
Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs.
A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication? A/ Clotting time B/ Uric acid level C/ Potassium level D/ Blood glucose level
B/ Uric acid level
Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury.
