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A patient has the following laboratory values: white blood cell count 2100 mm3;
neutrophils, segmented 23%; neutrophils, band 6%; hemoglobin 8.9 g/dl; and,
platelets 100,000 mm 3. The nurse's initial patient teaching includes:
A. washing hands frequently.
B. using an electric razor.
C. avoiding trauma.
D. taking daily stool softeners. - ANSWER - A. washing hands frequently
There are many nonpharmacologic interventions for the prevention of infection.
Handwashing remains the single most important intervention to prevent
infection.
A patient is receiving the first dose of paclitaxel. The nurse should be prepared to
treat the patient for:
A. shaking chills.
B. projectile vomiting.
C. hypersensitivity reaction.
D. urinary retention. - ANSWER - C. hypersensitivity reaction
,A side effect associated with paclitaxel is hypersensitivity reaction.
Hypersensitivity is an exaggerated or inappropriate immune response that may be
localized or systemic. Pretreatment to prevent the reaction includes
administering cimetidine, diphenhydramine, and if not contraindicated,
dexamethasone.
A patient who completed treatment for malignant melanoma one year ago
complains of still feeling tired. The nurse anticipates an order for:
A. darbepoetin.
B. methylphenidate.
C. lorazepam.
D. pegfilgrastim. - ANSWER - B. methylphenidate
Psychostimulants such as methylphenidate have been tested in certain
populations including patients with malignant melanoma as well as in patients
with advanced cancer. Patients reported improvement in symptoms of cancer-
related fatigue with the use of methylphenidate but it remains an area where
more research is needed.
A patient receiving 10 mg of sustained-release oxycodone every 12 hours requires
5 mg of immediate-release oxycodone five to six times daily. The best adjustment
in the pain medication regimen is to request an order for:
A. 5 mg of immediate-release oxycodone every 3 hours.
B. 10 mg of immediate-release oxycodone every 6 hours.
C. 10 mg of sustained-release oxycodone every 8 hours.
,D. 30 mg of sustained-release oxycodone every 12 hours. - ANSWER - D. 30 mg of
sustained-release oxycodone every 12 hours
The first sign that an increase in opioid dose is needed is a decrease in the
duration of analgesia for a given opioid dose. Patients may report the need for an
increased number of rescue doses. Sustained release doses plus immediate-
release (rescue) doses should be calculated. When slight improvement in
analgesia is needed, a 25% increase in opioid dose may be sufficient; for a
moderate improvement, 50%; and for a strong effect, 100% increase may be
needed.
A patient with prostate cancer is taking oxycodone orally every four hours as
needed for pain. At a home visit, the nurse learns the patient is experiencing
constant, dull back pain and he has not moved his bowels for three days. These
symptoms most likely indicate:
A. ascites.
B. hypercalcemia.
C. impending spinal cord compression.
D. an adverse effect of the oxycodone. - ANSWER - C. impending spinal cord
compression
Spinal cord compression may result from tumor invasion into the vertebrae
causing a collapse on the spinal cord. Patients at high risk for cord compression
include those with prostate cancer. Dull back pain is an early symptom of spinal
cord compression.
Which terms are associated with malignant tumors originating in the epithelial
tissue?
, A. Osteo and chondra
B. Lympho and myelo
C. Adeno and squamous
D. Lipo and rhabdo - ANSWER - C. Adeno and squamous
Tumors are classified by the tissue of origin. The malignancies that arise from the
epithelium are squamous cell, adenocarcinoma, basal cell, and choriocarcinoma.
The severe pain associated with post-herpetic neuropathy is most effectively
treated by:
A. propoxyphene.
B. hydromorphone.
C. amitriptyline.
D. extra-strength acetaminophen. - ANSWER - C. amitriptyline.
Pain associated with herpes zoster is severe and can be debilitating. The pain is
described as continuous, deep and burning. Opioids are used to treat acute
herpes zoster. Tricyclic antidepressants are used to treat post-herpetic neuralgia.
An oncology nurse teaching a cancer biology class explains that a proto-
oncogene's role is to:
A. stimulate angiogenesis.
B. cause apoptosis.