Oncology Nursing Exam and Rationale

ONCOLOGY 1. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor for cervical cancer, indicates a need for further teaching? a. Smoking b. Multiple sex partners c. First intercourse after age 20 d. Annual gynecological examinations Risk factors for cervical cancer include human papillomavirus (HPV) infection, active and passive cigarette smoking, certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, or male partners with multiple sex partners). Screening via regular gynecological exams and Papanicolaou smear (Pap test) with treatment of precancerous abnormalities decrease the incidence and mortality of cervical cancer. 2.

The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? a. Monitoring temperature b. Ambulation three times daily c. Monitoring the platelet count d. Monitoring for pathological fractures Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 1 relates to monitoring for infection, particularly if leukopenia is present. Options 2 and 4, although important in the plan of care, are not related directly to thrombocytopenia. 3.

The nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the white blood cell count is normal if which of the following results were present? a. 2000 to 5000 cells/mm b. 3000 to 8000 cells/mm c. 5000 to 10,000 cells/mm d. 7000 to 15,000 cells/mm

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The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination: a. At the onset of menstruation b. Every month during ovulation c. Weekly at the same time of day d. 1 week after menstruation begins The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue. 5.

The nurse is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client? a. Elevating the knee gatch on the bed b. Assisting with range-of-motion leg exercises c. Removal of antiembolism stockings twice daily d. Checking placement of pneumatic compression boots The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis. 6.

The client suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client? a. Eat a light breakfast only. b. Maintain an NPO status before the procedure. c. Wear comfortable clothing and shoes for the procedure. d. Drink six to eight glasses of water without voiding before the test. A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option 3 is unrelated to this specific procedure.

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The client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? a. Biopsy of the tumor b. Abdominal ultrasound c. Magnetic resonance imaging d. Computed tomography scan A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy. 8.

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 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. 9.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following 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 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. 10. 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 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. 11. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin’s disease. The nurse determines that further teaching is needed if a nursing staff member states that which of the following is a characteristic of the disease? a. Presence of Reed-Sternberg cells b. Occurs most often in the older client c. Prognosis depending on the stage of the disease d. Involvement of lymph nodes, spleen, and liver Hodgkin’s disease is a disorder of young adults. Options 1, 3, and 4 are characteristics of this disease. 12. The community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? a. Alopecia b. Back pain c. Painless testicular swelling d. Heavy sensation in the scrotum Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options 2, 3, and 4 are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

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13. The client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: a. Dyspnea b. Diarrhea c. Sore throat d. Constipation In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Options 2 and 4 may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement. 14. The nurse is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? a. Limit the time with the client to 1 hour per shift. b. Do not allow pregnant women into the client’s room. c. Remove the dosimeter badge when entering the client’s room. d. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client. 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 dosimeter 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. 15. A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? a. Bed rest b. Out of bed ad lib c. Out of bed in a chair only d. Ambulation to the bathroom only The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled. 16. The client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a. Call the physician. b. Reinsert the implant into the vagina immediately. 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. A lead container and long-handled forceps should be kept in the client’s room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it in the lead container. Options 1, 2, and 3 are inaccurate interventions. 17. The nurse is caring for a client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: a. Restrict all visitors. b. Restrict fluid intake. c. Teach the client and family about the need for hand hygiene. d. Insert an indwelling urinary catheter to prevent skin breakdown. In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections. 18. The nurse is reviewing the laboratory results of a client receiving chemotherapy whose platelet count is 10,000 cells/mm3. Based on this laboratory value, the priority nursing assessment is which of the following? a. Assess skin turgor. b. Assess temperature. c. Assess bowel sounds. d. Assess level of consciousness. A high risk of hemorrhage exists when the platelet count is less than 20,000 cells/mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000 cells/mm3. The client should be assessed for changes in level of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the

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white blood cell count is low and the client is at risk for an infection. Although options 1 and 3 are important to assess, they are not the priority in this situation. 19. The nurse is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client’s diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? a. Bowel sounds b. Ability to ambulate c. Incision appearance d. Urine specific gravity The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options 2, 3, and 4 are unrelated to the subject of the question. 20. The 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 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. 21. 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 Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor 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. 22. The nurse is reviewing the complications of conization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching? a. Infection b. Hemorrhage c. Cervical stenosis d. Ovarian perforation Conization procedure involves removal of a cone-shaped area of the cervix. Complications of the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is not a complication. 23. When assessing the laboratory results of the client with bladder cancer and bone metastasis, the nurse notes a calcium level of 12 mg/dL. The nurse recognizes that this is consistent with which oncological emergency? a. Hyperkalemia b. Hypercalcemia c. Spinal cord compression d. Superior vena cava syndrome Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients who have bone metastasis, and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. 24. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a. Lumps like that are normal; don’t worry. b. Let me know if it gets bigger next month. c. That could be cancer. I’ll ask the doctor to examine you. d. That’s important to report even though it might not be serious. Testicular cancer almost always occurs in only one testicle and is usually a pea-sized painless lump. The cancer is highly curable when found early. The finding should be reported to the physician.

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25. The nurse is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a. Pain at the incisional site b. Arm edema on the operative side c. Sanguineous drainage in the Jackson-Pratt drain d. Complaints of decreased sensation near the operative site Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options 1, 3, and 4 are expected occurrences following mastectomy and do not indicate a complication. 26. The nurse is admitting a client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer? a. Alcohol abuse b. Cigarette smoking c. Use of chewing tobacco d. Exposure to air pollutants The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of tobacco increase the risk. Another risk factor is exposure to environmental pollutants. 27. The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: a. Rupture of the bladder b. The development of a vesicovaginal fistula c. Extreme stress caused by the diagnosis of cancer d. Altered perineal sensation as a side effect of radiation therapy A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client’s complaint is not associated with options 1, 3, and 4. 28. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim) is prescribed for the client. The nurse tells the client that the purpose of the allopurinol is to prevent: a. Nausea b. Alopecia c. Vomiting d. Hyperuricemia Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs from the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting. 29. The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? a. Alcohol-based mouthwash b. Hydrogen peroxide mixture c. Lemon-flavored mouthwash d. Weak salt and bicarbonate mouth rinse An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of severe plaque, it should be a weak solution because it dries the mucous membranes. 30. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? a. Smoking b. A high-fat diet c. Foods containing nitrates d. A diet of smoked, highly salted, and spiced food A high-fat diet plays a role in the development of cancer of the pancreas. Options 1, 3, and 4 are risk factors related to gastric cancer.

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31. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a. Notify the physician. b. Measure abdominal girth. c. Irrigate the nasogastric tube. d. Continue to monitor the drainage. Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to 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 physician 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 physician orders to do so. 32. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? a. Age younger than 50 years b. History of colorectal polyps c. Family history of colorectal cancer d. Chronic inflammatory bowel disease Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease. 33. The nurse is performing an admission assessment on a client diagnosed with a right colon tumor. The nurse asks the client about which characteristic symptom of this type of a tumor? a. Rectal bleeding b. Flat, ribbon-like stools c. Crampy, colicky abdominal pain d. Alternating constipation and diarrhea Vague abdominal discomfort or crampy, colicky abdominal pain is a characteristic symptom of a right colon tumor. Options 1, 2, and 4 are symptoms associated with left colon tumors. 34. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? a. Notify the physician. b. Clamp the Penrose drain. c. Change the dressing as prescribed. d. Remove and replace the perineal packing. Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. The nurse does not need to notify the physician at this time. A Penrose drain should not be clamped because this action will cause the accumulation of drainage within the tissue. Penrose drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing. 35. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function? a. Absent bowel sounds b. The passage of flatus c. The client’s ability to tolerate food d. Bloody drainage from the colostomy Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy. 36. The nurse is caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer and is providing discharge instructions to the client. Which statement by the client indicates a need for further instructions? a. I will protect the stoma from water. • b. I need to keep powders and sprays away from the stoma site. • c. I need to use an air conditioner to provide cool air to assist in breathing. • d. I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking. •

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Air conditioners need to be avoided to protect from excessive coldness. A humidifier in the home should be used if excessive dryness is a problem. Options 1, 2, and 4 are appropriate interventions regarding stoma care following radical neck dissection and creation of a tracheotomy. 37. What is the purpose of cytoreductive ( debulking •) surgery for ovarian cancer? a. Cancer control by reducing the size of the tumor b. Cancer prevention by removal of precancerous tissue c. Cancer cure by removing all gross and microscopic tumor cells d. Cancer rehabilitation by improving the appearance of a previously treated body part Cytoreductive or debulking • surgery may be used if a large tumor cannot be completely removed as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or spread throughout the abdomen). When this occurs, as much tumor as possible is removed and adjuvant chemotherapy or radiation may be prescribed. 38. Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a. Increase testosterone levels. b. Increase prostaglandin levels. c. Limit the amount of circulating androgens. d. Increase the amount of circulating androgens. Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. 39. The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a. Avoid driving the car for 1 week. b. Restrict fluid intake to prevent incontinence. c. Avoid lifting objects heavier than 20 lb for at least 6 weeks. d. Notify the physician if small blood clots are noticed during urination. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Option 3 is an accurate discharge instruction following prostatectomy. 40. The oncology nurse is providing a teaching session to a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student indicates a need for further teaching? a. Bladder cancer most often occurs in women. • b. Using cigarettes and coffee drinking can increase the risk. • c. Bladder cancer generally is seen in clients older than age 40. • d. Environmental health hazards have been attributed as a cause. • The incidence of bladder cancer is greater in men than in women and affects the white population twice as often as blacks. Options 2, 3, and 4 are associated with the incidence of bladder cancer. 41. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? a. Dysuria b. Hematuria c. Urgency on urination d. Frequency of urination The most common symptom in clients with cancer of the bladder is hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. 42. The nurse is caring for a client following intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. Following the instillation, the nurse should instruct the client to: a. Urinate immediately. b. Maintain strict bed rest. c. Change position every 15 minutes. d. Retain the instillation fluid for 30 minutes. Normally, the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes

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from side to side and from supine to prone or resumes all activity immediately. The client then voids and is instructed to drink water to flush the bladder. 43. The nurse is assessing the stoma of a client following a ureterostomy. Which of the following should the nurse expect to note? a. A dry stoma b. A pale stoma c. A dark-colored stoma d. A red and moist stoma Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply. A dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may indicate a loss of vascular supply and must be reported immediately or necrosis can occur. 44. 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 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. 45. The nurse is preparing a client for a mammography. The nurse tells the client: a. That mammography takes about 1 hour b. That there is no discomfort associated with the procedure c. To maintain an NPO status on the day of the test d. To avoid the use of deodorants, powders, or creams on the day of the test Mammography takes about 15 to 30 minutes to complete. Some discomfort may be experienced because of the breast compression required to obtain a clear image. There is no reason to maintain an NPO status before the procedure. Option 4 is an accurate instruction. 46. A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a. Cyanosis b. Arm edema c. Periorbital edema d. Mental status changes 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. As the compression worsens the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs. 47. A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a. Headache b. Dysphagia c. Constipation d. Electrocardiographic changes Hypercalcemia is a late manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave. 48. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and selfcare during the period of the greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed when the client states: a. I should avoid blowing my nose. • b. I may need a platelet transfusion if my platelet count is too low. • c. I’m going to take aspirin for my headache as soon as I get home. • d. I will count the number of pads and tampons I use when menstruating. • During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells/mm3. Option 3 describes an incorrect statement by the client. Aspirin and nonsteroidal anti-inflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity,

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thus further teaching is needed. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding. 49. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply. 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Serum sodium levels 5. Decreased oral sodium intake 6. Medication that is antagonistic to antidiuretic hormone a. 1,2,3,4 b. 1,2,4,6 c. 1,2,5,6 d. 1,2,3,6 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 immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal. 50. The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which of the following laboratory values would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? a. Anemia b. Decreased platelet c. Increased ueic acid level d. Decereased Leukocyte count Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction

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