,Arizona College NUR 445 Final Exam | Acute/Chronic
Health Disruptions Adults III (2026) Q&A
1. A nurse is caring for a client who was admitted for tumor lysis syndrome (TLS) with an
elevated uric acid level. The provider prescribes a large-volume IV fluid administration.
Which laboratory value indicates that the condition is improving?
A) Uric acid level decreasing toward normal range
B) Potassium level increasing from 4.5 to 5.5 mEq/L
C) Phosphorus level increasing from 4.0 to 5.5 mg/dL
D) Creatinine level increasing from 1.2 to 1.8 mg/dL
Correct Answer: Uric acid level decreasing toward normal range
Rationale: Tumor lysis syndrome results from rapid destruction of tumor cells, releasing
intracellular contents including uric acid, potassium, and phosphorus into the bloodstream.
Large-volume IV fluids promote renal excretion of these substances. A decreasing uric acid
level indicates improvement, while rising potassium, phosphorus, or creatinine levels
indicate worsening.
2. A nurse is caring for a client with superior vena cava syndrome. Which clinical
manifestation should the nurse expect?
A) Swelling of the face, neck, and upper extremities
B) Isolated swelling of the lower extremities
C) Dry, nonproductive cough with clear lung sounds
D) Hypotension with tachycardia
,Correct Answer: Swelling of the face, neck, and upper extremities
Rationale: Superior vena cava syndrome occurs when the superior vena cava is
compressed or obstructed, leading to venous congestion in the upper body. This results in
facial, neck, and upper extremity edema, distended neck veins, and dyspnea. Lower
extremity swelling suggests inferior vena cava obstruction.
3. A client with leukemia is admitted with leukostasis. Which finding requires immediate
intervention?
A) White blood cell count of 15,000/mm³
B) New-onset confusion and visual disturbances
C) Hemoglobin of 11 g/dL
D) Platelet count of 120,000/mm³
Correct Answer: New-onset confusion and visual disturbances
Rationale: Leukostasis occurs when extremely high white blood cell counts cause
sludging and occlusion of small blood vessels. Neurologic manifestations such as confusion,
visual disturbances, and headache indicate cerebral leukostasis and require immediate
intervention. A WBC of 15,000 is not high enough for leukostasis.
4. A client receiving chemotherapy has a neutrophil count of 400/mm³. Which nursing
intervention is most appropriate?
A) Implement neutropenic precautions including a private room
B) Encourage the client to eat raw fruits and vegetables
C) Administer live attenuated vaccines
D) Allow visitors with active infections to visit
, Correct Answer: Implement neutropenic precautions including a private room
Rationale: Neutropenia is defined as an absolute neutrophil count below 1,500/mm³,
with severe neutropenia below 500/mm³. Neutropenic precautions include a private room,
strict hand hygiene, avoiding fresh flowers and raw foods, and screening visitors for illness.
Live vaccines are contraindicated.
5. A client with cancer has a calcium level of 13.5 mg/dL. Which finding is most concerning?
A) Mild fatigue
B) Decreased deep tendon reflexes
C) Hyperactive bowel sounds
D) Polyuria and polydipsia
Correct Answer: Decreased deep tendon reflexes
Rationale: Hypercalcemia of malignancy is a life-threatening oncologic emergency.
Normal calcium is 9.0 to 10.5 mg/dL. Decreased deep tendon reflexes indicate
neuromuscular depression from severe hypercalcemia and require immediate intervention.
Polyuria and fatigue are early findings, and hyperactive bowel sounds are not associated
with hypercalcemia.
6. A client with metastatic cancer reports new-onset back pain and progressive lower
extremity weakness. Which condition should the nurse suspect?
A) Spinal cord compression
B) Peripheral neuropathy from chemotherapy
C) Muscle strain from immobility
Health Disruptions Adults III (2026) Q&A
1. A nurse is caring for a client who was admitted for tumor lysis syndrome (TLS) with an
elevated uric acid level. The provider prescribes a large-volume IV fluid administration.
Which laboratory value indicates that the condition is improving?
A) Uric acid level decreasing toward normal range
B) Potassium level increasing from 4.5 to 5.5 mEq/L
C) Phosphorus level increasing from 4.0 to 5.5 mg/dL
D) Creatinine level increasing from 1.2 to 1.8 mg/dL
Correct Answer: Uric acid level decreasing toward normal range
Rationale: Tumor lysis syndrome results from rapid destruction of tumor cells, releasing
intracellular contents including uric acid, potassium, and phosphorus into the bloodstream.
Large-volume IV fluids promote renal excretion of these substances. A decreasing uric acid
level indicates improvement, while rising potassium, phosphorus, or creatinine levels
indicate worsening.
2. A nurse is caring for a client with superior vena cava syndrome. Which clinical
manifestation should the nurse expect?
A) Swelling of the face, neck, and upper extremities
B) Isolated swelling of the lower extremities
C) Dry, nonproductive cough with clear lung sounds
D) Hypotension with tachycardia
,Correct Answer: Swelling of the face, neck, and upper extremities
Rationale: Superior vena cava syndrome occurs when the superior vena cava is
compressed or obstructed, leading to venous congestion in the upper body. This results in
facial, neck, and upper extremity edema, distended neck veins, and dyspnea. Lower
extremity swelling suggests inferior vena cava obstruction.
3. A client with leukemia is admitted with leukostasis. Which finding requires immediate
intervention?
A) White blood cell count of 15,000/mm³
B) New-onset confusion and visual disturbances
C) Hemoglobin of 11 g/dL
D) Platelet count of 120,000/mm³
Correct Answer: New-onset confusion and visual disturbances
Rationale: Leukostasis occurs when extremely high white blood cell counts cause
sludging and occlusion of small blood vessels. Neurologic manifestations such as confusion,
visual disturbances, and headache indicate cerebral leukostasis and require immediate
intervention. A WBC of 15,000 is not high enough for leukostasis.
4. A client receiving chemotherapy has a neutrophil count of 400/mm³. Which nursing
intervention is most appropriate?
A) Implement neutropenic precautions including a private room
B) Encourage the client to eat raw fruits and vegetables
C) Administer live attenuated vaccines
D) Allow visitors with active infections to visit
, Correct Answer: Implement neutropenic precautions including a private room
Rationale: Neutropenia is defined as an absolute neutrophil count below 1,500/mm³,
with severe neutropenia below 500/mm³. Neutropenic precautions include a private room,
strict hand hygiene, avoiding fresh flowers and raw foods, and screening visitors for illness.
Live vaccines are contraindicated.
5. A client with cancer has a calcium level of 13.5 mg/dL. Which finding is most concerning?
A) Mild fatigue
B) Decreased deep tendon reflexes
C) Hyperactive bowel sounds
D) Polyuria and polydipsia
Correct Answer: Decreased deep tendon reflexes
Rationale: Hypercalcemia of malignancy is a life-threatening oncologic emergency.
Normal calcium is 9.0 to 10.5 mg/dL. Decreased deep tendon reflexes indicate
neuromuscular depression from severe hypercalcemia and require immediate intervention.
Polyuria and fatigue are early findings, and hyperactive bowel sounds are not associated
with hypercalcemia.
6. A client with metastatic cancer reports new-onset back pain and progressive lower
extremity weakness. Which condition should the nurse suspect?
A) Spinal cord compression
B) Peripheral neuropathy from chemotherapy
C) Muscle strain from immobility
