N461 Exam 1 Med-surg Practice Questions

N461 Exam 1 Med-surg Practice Questions/N461 Exam 1 Med-surg Practice Questions N461 Exam 1 Practice Questions Chapter 14 Cancer 1. A patient shows the nurse a new sore on the forearm that has been increasing in size and will not heal. The nurse caring for this patient knows that which of the following signs could also point to a diagnosis of a malignant neoplasm? a. noncohesive, invasive, and invades and destroys surrounding tissues b. rapid growth, well-defined borders, and cohesiveness c. invasive, local, and does not stop at tissue border d. slow growth, well-defined borders, and encapsulated 2. After learning that he has a benign tumor in his abdomen, the patient is overheard telling his wife that he has cancer. Which of the following should the nurse say to the patient and spouse? a. “There is a growth in the abdomen but it is encapsulated and after being removed, will not recur.” b. “This type of cancer is easily treated.” c. “This type of cancer will not spread to other tissues.” d. “Even though this growth has invaded other tissues, it can be contained.” 3. A patient tells the nurse that he has a benign tumor that has spread into his lymph glands. With which of the following should the nurse respond to this patient? a. “Benign tumors do not spread.” b. “What did your doctor tell you about the tumor?” c. “That’s a good thing that the tumor is benign.” d. “Since it is benign are you going to have surgery to remove it?” 4. A patient with a history of cancer is surprised to learn that new cancer has been diagnosed in another body part. The nurse realizes that this patient is most likely experiencing which of the following? a. contact inhibition b. destructive force from a benign neoplasm c. metastasis d. a solid mass 5. A patient asks the nurse how his cancer developed. Which of the following statements would be incorrect for the nurse to respond with to this patient? a. “The theory of cellular mutation suggests that carcinogens cause mutations in cellular RNA.” b. “Oncogenes are genes that promote cell proliferation and are capable of triggering cancerous characteristics.” c. “Inherited cancers can become inactive by deletion or mutation.” d. “Known carcinogens include viruses, drugs, hormones, and chemical and physical agents.” 6. A patient with a history of smoking is diagnosed with cancer. If applying the cellular mutation theory of cancer to this patient’s diagnosis, the nurse realizes that smoking impacted which of the following stages? a. promotion b. initiation c. progression d. replication 7. A female patient asks the nurse why she needs a procedure to remove part of her cervix that was infected with a virus. With which of the following should the nurse explain to this patient? a. The medication to treat this virus is toxic to the body. b. If left untreated, it could spread to the liver. c. If left untreated, it could spread to the breast. d. Human papillomavirus can cause cervical cancer. 8. A patient with a history of using recreational cocaine tells the nurse that he would rather be addicted to cocaine that be diagnosed with cancer. With which of the following should the nurse respond with to this patient? a. “I guess if that’s what you would prefer.” b. “People who use cocaine do have a lower risk of developing cancer.” c. “As long as the cocaine is pure and not mixed with toxic chemicals.” d. “Cocaine has been linked to the development of cancer.” 9. A college student is diagnosed with Epstein-Barr virus. The student has a history of smoking and recreational cocaine use, and works for a floor refinishing company part-time. Which factors increase this student’s risk for developing cancer? Select all that apply. a. drug use b. occupation c. smoking d. viral infection e. age 10. Which of the following patients would be at a highest risk for developing cancer? a. an African American man b. a Native American woman c. an Hispanic man d. an Hispanic woman 11. The nurse is concerned that a patient is at increased risk for developing cancer when which of the following is assessed? a. aged 52, plays tennis twice a week, no alcohol intake, occasionally smokes a cigarette b. aged 45, premenopausal, not planning to use hormone replacement therapy c. aged 51, spouse deceased, downsized from employment, history of back and leg pain d. aged 50, employed as a computer technician, uses the fitness center five times a week 12. A female patient tells the nurse that she does not want to have annual mammograms because the x-rays can cause cancer. With which of the following should the nurse respond to this patient? a. “I don’t blame you. X-rays do cause cancer.” b. “Breast cancer is the number one type of cancer in females. The risk of developing cancer from the x-rays is considerably lower than the risk of having undiagnosed breast cancer.” c. “Be sure to do monthly breast exams.” d. “Contact your doctor if you notice any breast changes, feel any lumps, or develop breast pain since these are all symptoms of active breast cancer.” 13. The nurse is explaining the characteristics of malignant cells to a group of patients. Which statement by a patient demonstrates a good understanding of the information? a. “The work of malignant cells is simpler than that of normal cells.” b. “Malignant cells continue to perform cellular functions.” c. “Malignant cells can reverse into benign cells if treated promptly.” d. “Malignant cells rarely break away from the primary tissue site and travel to other locations.” 14. A patient, diagnosed with an 8 cm tumor in the ascending colon, asks the nurse how the tumor grew so large without any major symptoms. With which of the following should the nurse respond to this patient? a. “The pressure of the growing tumor caused the other tissue to reduce in size so the tumor could take over the space.” b. “The tumor cells bound to the tissue within the colon.” c. “The tumor cells are loosely held together so they can move about freely.” d. “The tumor cells secreted chemicals that stopped the body’s normal mechanism to remove foreign tissue.” 15. A patient is diagnosed with hyperplasia of lung tissue. The nurse realizes that this patient’s first course of treatment will most likely include which of the following? a. identification and removal of the irritant causing the hyperplasia b. antibiotic therapy c. chemotherapy d. radiation therapy 16. After a liver biopsy, a patient is diagnosed with anaplasia of liver cells. Which of the following will be indicated for this patient’s care? a. chemotherapy for liver cancer b. careful monitoring to ensure the cells do not develop into cancer c. monitoring for the onset of diabetes mellitus d. medication to reverse the anaplastic cells 17. The nurse is preparing to assess a patient who is newly diagnosed with cancer. Which of the following physical and psychologic symptoms should the nurse include in this assessment? a. altered taste and smell and increased leukocytes b. hypoglycemia and grief c. decreased intracranial pressure and acute pain d. hyperglycemia and body image concerns 18. A patient diagnosed with cancer is admitted with a weight loss of 25 lbs. over the last month with progressive anorexia. The nurse suspects this patient is experiencing which of the following physiological effects of cancer? a. anorexia-cachexia syndrome b. paraneoplastic syndrome c. infection d. esophageal obstruction 19. A patient, diagnosed with cancer, tells the nurse that he does not want to experience anymore pain. Which of the following can the nurse do to help this patient? a. Explain that every patient with cancer has pain. b. Discuss pain control options. c. Review ways to reduce pain without the use of medication. d. Instruct on why pain will continue throughout treatment. 20. A patient, diagnosed with cancer, has been receiving radiation treatments to shrink the tumor. After several weeks, the patient tells the nurse that he has not needed as much pain medication. Which of the following would explain why this patient’s pain has been reduced? a. The radiation treatments reduced the size of the tumor on adjacent tissues. b. The tumor is secreting pain-control chemicals initiated by the radiation. c. The patient is getting used to having pain. d. The patient is continuing to have pain but believes the radiation treatments are reducing the pain. 21. A patient is having a procedure, which is done by cutting through the skin, to diagnose a mass located in the left breast. This procedure is most likely which of the following? a. incisional biopsy b. fine-needle biopsy c. needle core biopsy d. excisional biopsy 22. A patient, diagnosed with neck cancer, is scheduled for a diagnostic test to determine the success of treatment. The test that would provide the best information regarding this patient’s treatment would be which of the following? a. magnetic resonance imaging b. computed tomography c. x-ray imaging d. ultrasonography 23. A male patient’s prostate specific antigen level was 2 ng/mL, however, the patient was diagnosed with prostate cancer. Which additional laboratory test was done to determine this diagnosis? a. albumin b. bilirubin c. calcium d. acid phosphatase 24. A patient’s carcinoembryonic antigen level was initially 16 ng/mL. The level is currently 6 ng/mL. The nurse realizes that this decreased level would indicate which of the following for the patient? a. The patient’s treatment for cancer is effective. b. The patient’s treatment for cancer is not effective. c. The patient has a new site of cancer. d. The patient’s cancer has metastasized. 25. The nurse is explaining the different types of chemotherapy to a patient recently diagnosed with cancer. Which of the following statements would be incorrect for the nurse to state to the patient? a. “The main hormones used in cancer therapy are the corticosteroids, which are phase specific.” b. “Mitotic inhibitors are drugs that act to prevent cell division during the M phase.” c. “Antitumor antibiotics disrupt RNA replication and DNA transcription.” d. “Alkylating agents basically act on preformed nucleic acids by creating defects in tumor DNA.” 26. A patient will be receiving busulfan (Myleran) as treatment for leukemia. Which of the following interventions would the nurse include in the plan of care for this patient? a. Assess for infection. b. Administer anti-emetic prior to chemotherapy. c. Assess oral mucous membranes. d. Check stool for occult blood. 27. A patient diagnosed with breast cancer is receiving 5-Fluorouracil (5-FU). Based on the knowledge of this medication, and anticipated adverse effects or side effects, which action should the nurse perform? a. Test stool for occult blood. b. Monitor ECG. c. Assess lung sounds. d. Encourage daily fluid intake of 2-3 liters. 28. Which of the following assessment findings would indicate to the nurse that a patient receiving vincristine is experiencing a toxic reaction? a. hypotension b. pain and motor weakness c. cardiac dysrhythmias d. stomatitis and alopecia 29. A nurse, caring for a patient undergoing brachytherapy, should implement which of the following precautions when caring for this patient? a. Wear a monitoring device to measure whole-body exposure. b. Care for this patient regardless of pregnancy status. c. Maintain the least possible distance form the patient. d. Avoid indirect exposure with radioisotopes containers. 30. A patient is scheduled for a nephrectomy for renal cancer. The nurse realizes that the goal of this surgery will be which of the following? a. remove the organ since the function of the organ can be replaced chemically b. to bypass an obstruction c. removing the kidney because the remaining kidney will maintain renal functioning d. decrease the tumor size 31. Which of the following should the nurse instruct a patient to do who is scheduled to receive a course of external radiation therapy for cancer treatment? a. Wash the radiation site with plain water and no soap. b. Shave the treated area with a straight razor. c. Apply ice packs to the treatment site to help reduce pain. d. Use a sunscreen for three months after the conclusion of the treatments. 32. A patient, diagnosed with cancer and scheduled to begin biotherapy, asks the nurse how the therapy will treat the cancer. With which of the following should the nurse respond to this patient? a. “It changes the body processes that caused the cancer by enhancing your own immunity.” b. “It uses radiation implanted into the organ with the cancer.” c. “It uses laser therapy to remove the cancer.” d. “It uses stem cells to treat the cancer.” 33. A patient, with a history of squamous cell lung cancer, is admitted to the hospital with arm and periorbital edema. After a few hours, the patient exhibits dyspnea, cyanosis, tachypnea, and an altered level of consciousness. Which action should the nurse take first? a. Call the physician. b. Monitor vital signs. c. Initiate seizure precautions. d. Administer oxygen. 34. The nurse suspects that a patient being treated for cancer is developing septic shock when which of the following is assessed? a. cardiac dysrhythmia and increased urine output b. hypertension and confusion c. high fever, peripheral edema, hypotension d. subnormal temperature and thirst 35. A patient with cancer is experiencing lower extremity numbness and loss of motor function. Which of the following should be done to assist this patient? a. Provide intravenous fluids. b. Assess for spinal cord compression. c. Administer oxygen. d. Turn and reposition every two hours. 36. A patient diagnosed with prostate cancer is demonstrating signs of renal failure. Which of the following does this assessment finding suggest to the nurse? a. obstructive uropathy b. spinal cord compression c. urethral strictures from radiation d. bladder irritation from chemotherapy 37. The nurse is providing instructions to a patient diagnosed with renal cancer regarding when to call for help after discharge. Which statement by the patient indicates that teaching has been successful? a. “I should call my physician if I experience new bleeding from any site.” b. “I should call my physician if I have an oral temperature higher than 100.5° F.” c. “I should call my physician if I have an episode of diarrhea.” d. “I should call my physician if I experience an occasional headache.” 38. A 34-year-old patient is being instructed on early screening for breast cancer. The patient has a sister and mother with a history of breast cancer. Which action by the patient demonstrates good screening techniques for someone with her family history? a. routine breast exams to begin after age 35 b. reporting of any changes in breast tissue to the healthcare provider at the next routine visit c. annual screening mammography staring at age 40 d. clinical breast examination every three years 39. A patient diagnosed with cancer contacted an attorney about a will and a church to arrange funeral and cemetery arrangements. Which of the following do this patient’s activities suggest to the nurse? a. The patient is participating in anticipatory grieving. b. The patient feels he is going to die soon. c. The patient’s family will not be willing to make funeral arrangements. d. The patient wants something to do while waiting for chemotherapy treatments. 40. The nurse has identified the diagnosis Risk for Infection for a patient receiving chemotherapy for cancer. Which of the following should be included in this patient’s plan of care? a. Teach the patient to avoid crowds. b. Encourage socialization with small children. c. Contact physician with a temperature elevation. d. Limit intake of protein and vitamin C. 41. The family of a patient with terminal metastatic cancer asks the nurse for guidelines regarding when to call for help when the patient is discharged to home. Which of the following would indicate this patient needs medical intervention? Select all that apply. a. oral temperature greater than 100° F b. difficulty breathing c. onset of bleeding d. resting comfortably, and reading e. extreme hunger 42. Which of the following descriptions is consistent with malignant neoplasms? Select all that apply. a. localized encapsulated growths b. growths demonstrating contact inhibition c. irregularly shaped growths d. neoplasms that cause bleeding and inflammation e. growths that remain stable in size 43. Which patient or patients’ cancer type, pathophysiology, and symptoms are consistent with oncological emergency of superior vena cava syndrome. a. Patient C b. Patient D c. Patient A only d. Patient A and B 44. Which of the patient diagnostic findings are consistent with the presence of a malignancy? Select all that apply. a. high levels of tumor markers b. positive biopsy results c. low levels of tumor markers d. decreased white blood cell count e. increased hemoglobin and hematocrit 45. Which of these interventions is appropriate care of the radiation site teaching for the patient receiving radiation therapy? Select all that apply. a. Clean radiation site with soap and water. b. Apply lotion daily to prevent scaling. c. Apply ice pack to radiation site if pain or itching occurs. d. If needed use an electric razor for shaving. e. Wear tight fighting clothing over the area to protect it. 46. Which of the following are causes of the malnutrition seen in patients with cancer? Select all that apply. a. decreases in metabolism resulting from increased cancer cell production b. decreased available nutrients due to the cancers parasitic activity c. loss of appetite due to side effects of chemotherapy d. decreased absorption in the gastrointestinal tract e. parenteral nutrition supplements administered via venous access devices 47. Which of the following interventions would be appropriate for the patient with cancer receiving chemotherapy who is at greater risk for infection? Select all that apply. a. Monitoring red blood cell counts monthly. b. Teaching the patient to avoid small children. c. Teaching the patient to apply lotion daily to clean skin to prevent drying. d. Encouraging the patient to consume a diet high in protein and vitamin C. e. Teaching the patient to report an oral temperature above 98° F. 48. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse about the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. “Benign tumors do not cause damage to other tissues.” b. “Benign tumors are likely to recur in the same location.” c. “Malignant tumors may spread to other tissues or organs.” d. “Malignant cells reproduce more rapidly than normal cells.” 49. A patient is receiving intravesical bladder chemotherapy. The nurse will monitor for a. nausea. b. alopecia. c. mucositis. d. hematuria. 50. The nurse in the outpatient clinic is caring for a 50-year-old who smokes heavily. To reduce the patient’s risk of dying from lung cancer, which action will be best for the nurse to take? a. Educate the patient about the seven warning signs of cancer. b. Plan to monitor the patient’s carcinoembryonic antigen (CEA) level. c. Discuss the risks associated with cigarettes during every patient encounter. d. Teach the patient about the use of annual chest x-rays for lung cancer screening. 51. After the nurse has finished teaching a patient who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the patient indicates that the teaching has been effective? a. Fresh fruit salad b. Roasted chicken c. Whole wheat toast d. Cream of potato soup 52. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Educate the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient. 53. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that a. the cancer is localized to the cervix. b. the cancer cells are well-differentiated. c. further testing is needed to determine the spread of the cancer. d. it is difficult to determine the original site of the cervical cancer. 54. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the nurse’s teaching about the purpose of the biopsy has been effective? a. “The biopsy will remove the cancer in my prostate gland.” b. “The biopsy will determine how much longer I have to live.” c. “The biopsy will help decide the treatment for my enlarged prostate.” d. “The biopsy will indicate whether the cancer has spread to other organs.” 55. The nurse is teaching a postmenopausal patient with stage III breast cancer about the expected outcomes of her cancer treatment. Which patient statement indicates that the teaching has been effective? a. “After cancer has not recurred for 5 years, it is considered cured.” b. “The cancer will be cured if the entire tumor is surgically removed.” c. “Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.” d. “I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.” 56. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is a. relief of pain by cutting sensory nerves in the stomach. b. control of the tumor growth by removal of malignant tissue. c. decrease in tumor size to improve the effects of other therapy. d. promotion of better nutrition by relieving the pressure in the stomach. 57. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to a. test all stools for the presence of blood. b. maintain a high-residue, high-fiber diet. c. clean the perianal area carefully after every bowel movement. d. inspect the mouth and throat daily for the appearance of thrush. 58. A patient with Hodgkin’s lymphoma who is undergoing external radiation therapy tells the nurse, “I am so tired I can hardly get out of bed in the morning.” An appropriate intervention for the nurse to plan with the patient is to a. minimize activity until the treatment is completed. b. exercise vigorously when fatigue is not as noticeable. c. establish a time to take a short walk almost every day. d. consult with a psychiatrist for treatment of depression. 59. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient has a history of dental caries. c. The patient eats frequently during the day. d. The patient showers with Dove soap daily. 60. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which patient statement indicates that the nurse’s teaching about management of the skin reaction has been effective? a. “I can buy some aloe vera gel to use on the area.” b. “I will expose the treatment area to a sun lamp daily.” c. “I can use ice packs to relieve itching in the treatment area.” d. “I will scrub the area with warm water to remove the scales.” 61. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. offer dry crackers and carbonated fluids during chemotherapy. d. administer prescribed antiemetics 1 hour before the treatments. 62. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. infuse the medication over a short period of time. b. stop the infusion if swelling is observed at the site. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available. 63. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient’s self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that the hair will grow back once the chemotherapy is complete. 64. A patient with ovarian cancer is distressed because her husband rarely visits and tells the nurse, “He just doesn’t care.” The husband indicates to the nurse that “I never know what to say to help her.” An appropriate nursing diagnosis is a. compromised family coping related to disruption in lifestyle. b. impaired home maintenance related to perceived role changes. c. risk for caregiver role strain related to burdens of caregiving responsibilities. d. dysfunctional family processes related to effect of illness on family members. 65. A patient receiving head and neck radiation has ulcerations over the oral mucosa and tongue and thick, ropey saliva. The nurse will teach the patient to a. remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. rinse the mouth before and after each meal and at bedtime with a saline solution. 66. Which nursing action will be most effective in improving oral intake for a patient with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide education about the importance of nutritional intake. d. Apply the ordered anesthetic gel to oral lesions before meals. 67. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic ovarian cancer. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a. “Why don’t we talk about the options you have for the care of your children?” b. “Perhaps your ex-husband will take the children when you can’t care for them.” c. “For now you need to concentrate on getting well, not worry about your children.” d. “Many patients with cancer live for a long time, so there is time to plan for your children.” 68. A patient who has severe pain associated with terminal liver cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. b. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. 69. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to a. enhance the patient’s immunologic response to tumor cells. b. stimulate malignant cells in the resting phase to enter mitosis. c. prevent the bone marrow depression caused by chemotherapy. d. protect normal cells from the harmful effects of chemotherapy. 70. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? a. “I have frequent muscle aches and pains.” b. “I rarely have the energy to get out of bed.” c. “I experience chills after I inject the interferon.” d. “I take acetaminophen (Tylenol) every 4 hours.” 71. A patient with leukemia is considering whether to have hematopoietic stem cell transplantation. Which information will be included in patient teaching? a. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone. b. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). 72. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Orange sherbet b. Fresh fruit salad c. Strawberry yogurt d. Cream cheese bagel 73. A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate? a. Add strained baby meats to foods such as casseroles. b. Teach the patient about foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Put extra spice in the foods that are served to the patient. 74. While teaching a patient who has a new diagnosis of acute leukemia about the complications associated with chemotherapy, the patient is restless and is looking away, never making eye contact. After the teaching, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment 75. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient ambulates several times a day in the room. b. The patient’s visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day. 76. A patient with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a. Uric acid level b. Serum potassium c. Serum phosphate d. Blood urea nitrogen 77. When assessing the need for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. “How long ago were you diagnosed with this cancer?” b. “Do you have any concerns about body image changes?” c. “Can you tell me what has been helpful to you in the past when coping with stressful events?” d. “Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?” 78. Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action by the nurse? a. Generalized muscle aches b. Complaints of nausea and anorexia c. Oral temperature of 100.6° F (38.1° C) d. Crackles heard at the lower scapular border 79. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of a need for a change in therapy? a. Poor oral intake b. Increase in CEA c. Frequent loose stools d. Complaints of nausea 80. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hematocrit of 30% b. Platelets of 95,000/µl c. Hemoglobin of 10 g/L d. WBC count of 1700/µl 81. When caring for a patient who is pancytopenic, which action by nursing assistive personnel (NAP) indicates a need for the RN to intervene? a. The NAP assists the patient to use dental floss after eating. b. The NAP adds baking soda to the patient’s saline oral rinses. c. The NAP puts fluoride toothpaste on the patient’s toothbrush. d. The NAP has the patient rinse after meals with a saline solution. 82. When caring for a patient with a temporary radioactive cervical implant, which action by nursing assistive personnel (NAP) indicates that the RN should intervene? a. The NAP flushes the toilet once after emptying the patient’s bedpan. b. The NAP stands by the patient’s bed for 30 minutes talking with the patient. c. The NAP places the patient’s bedding in the laundry container in the hallway. d. The NAP gives the patient an alcohol-containing mouthwash to use for oral care. 83. After receiving change-of-shift report, which of these patients should the nurse assess first? a. 35-year-old who has wet desquamation associated with abdominal radiation b. 42-year-old who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old who is receiving neck radiation and has blood oozing from the neck d. 56-year-old who has a new pericardial friction rub after receiving chest radiation 84. The nurse at the clinic is interviewing a 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening 85. The nurse is reviewing the American Cancer Society (ACS) recommendations for breast cancer screening with a 50-year-old female client. The nurse should emphasize the recommendation for a. breast examination by a health care professional semi-annually. b. breast self-examination (BSE) monthly. c. chest x-ray study yearly when the client is over age 40. d. mammography when a lump is detected. 86. The recommendation the nurse should share with a 22-year-old sexually active client who is seeking information on the prevention of cervical cancer is that a Pap smear a. is needed annually by all women over age 18. b. should be done annually until two tests are negative, then once every 2-3 years, in women over 30. c. should be done biannually for clients who have been sexually active for 3 years but not later than age 21. d. should be performed twice a year for all sexually active women over age 18. 87. After a client has a series of diagnostic tests, the studies confirm the presence of rectal cancer. The nurse’s primary intervention should be to a. assess the meaning and effect of cancer as perceived by the client. b. determine if the client is emotionally ready to deal with the diagnosis of cancer. c. reassure the client that many treatment modalities are available. d. support the physician when the client is informed of the diagnosis. 88. The nurse caring for a client with cancer of the thyroid gland has a tumor classified as T2, N1, M0. The nurse explains that the “T” in this classification schema represents a. number of years the tumor has been present. b. site of the tumor. c. size of the tumor. d. virulence of malignancy. 89. A 32-year-old client who has a history of familial polyposis but no manifestations still wants to explore the possibility of preventive surgery. The most appropriate response the nurse can make is a. “Cancer is not always hereditary, and you should change risk factors in your life.” b. “It is an overreaction to seek radical treatment before you develop symptoms.” c. “Monthly rectal smears may allay your anxiety without surgery.” d. “Subtotal colectomy is a procedure you might seek further information about.” 90. Yesterday a 28-year-old client was diagnosed with rectal cancer. The nurse has made the nursing diagnosis of Anxiety Related to Fear of the Unknown, as manifested by anger. The best approach for the nurse to take in relation to the client’s need for information is to a. offer suggestions to modify the client’s expressions of anger. b. provide the client with a detailed plan for future interventions. c. provide the client with simple explanations of proposed treatments. d. specifically discuss the scientific facts related to rectal cancer. 91. The nurse is administering medication in phase III trials to a client with lung cancer. Assessments made in this phase of the drug investigation involve a. determination of the maximum tolerated dose. b. evaluation of the drug’s general effectiveness. c. explanation of how the drug compares with standard treatments. d. description of the type and severity of side effects. 92. The client is receiving a drug in a phase I clinical trial. Regarding the type of malignancy for which the client is being treated, the nurse makes the assumption that the cancer a. and its treatment are not covered by the client’s insurance. b. is limited in size and virulence. c. is not following the expected disease course. d. will not respond to other known treatments for cancer. 93. The nurse caring for a client who has an implanted radiation source should reduce self-exposure by incorporating the strategy of a. limiting the time spent close to the client to 30 minutes per 8-hour shift. b. remaining 6 feet away from the client except for essential care. c. wearing a lead-shielded apron whenever entering the client’s room. d. wearing a radiation meter or film badge to measure exposure. 94. The nursing action that has the highest priority for a 32-year-old client with an implanted radiation source should focus on a. assessing the client’s reaction to the diagnosis and treatment. b. preventing skin problems related to radiation. c. promoting regular activity while confined to the room. d. safeguarding the client and others from unnecessary radiation exposure. 95. A client is receiving interleukin-2 (IL-2) as part of the therapeutic plan to manage malignant melanoma. The nurse should emphasize the ability of this agent to a. increase oxygenation to cells that are not malignant. b. physically dissolve the tumor mass. c. replace damaged and diseased cells from bone marrow. d. strengthen the client’s immune response. 96. The nurse administering granulocyte colony-stimulating factor (G-CSF; Neupogen) to a client who is also receiving chemotherapy should assess the client for a. a rash. b. bone pain. c. fatigue. d. muscle aches. 97. When there is extravasation of vincristine (Oncovin), the nurse should initially a. apply cold compresses to the site. b. apply manual pressure to delay further circulation. c. call the physician immediately. d. leave the cannula in place and aspirate. 98. When the client questions why the chemotherapeutic drug is being administered by intracavitary instillation, the nurse could best answer by explaining that this approach is a a. cost-effective and more rapidly-acting method of treatment. b. diffuse method of systemic administration that avoids side effects. c. means to allow high concentrations of drugs to be directed at the tumor. d. non-invasive method of administration. 99. When a client undergoing systemic chemotherapy reaches the nadir of treatment, priority care by the nurse should be directed toward a. assisting the client to eat an adequate amount of food to maintain nutrition. b. enhancing the effects of chemotherapy by encouraging mild activity. c. improving the mental state of the client by using mental imagery. d. protecting the client from infection and bleeding. 100. Before the specially trained nurse gives the prescribed dose of a chemotherapeutic agent, the nurse should a. collect an extra syringe and needle in case of contamination. b. cover the client with a water-resistant shield. c. explain the expected side effects of the drug to the client. d. verify dose, drug, and schedule with another nurse. 101. The nurse can best avoid catheter occlusion in a client with a recently inserted venous access device (VAD) by a. administering medications in small volumes. b. flushing the catheter per agency protocol. c. instructing the client to keep the arm extended during administration. d. using the catheter only for vesicant drugs. 102. The specially prepared nurse administering chemotherapeutic drugs should a. administer intravenous medications only through VADs. b. apply ice to the area after an intramuscular injection of chemotherapy. c. wear a mask during administration of the agent. d. wear gloves and a gown during preparation and administration of the drugs. 103. The nurse should closely assess a client undergoing chemotherapy for a tumor that is responding to the therapy for any indication of tumor lysis syndrome, which is marked by a. hypercalcemia. b. hyperkalemia. c. increase in antidiuretic hormone (ADH). d. platelet count below 20,000/mm3. 104. The nurse has assigned the nursing diagnosis Imbalanced Nutrition: Less than Body Requirements, Related to Anorexia for a client with colon cancer. Nursing goals include the maintenance of present body weight. To achieve this goal, the nurse should suggest a diet that is high in a. calories and low in cholesterol. b. fat and calories. c. fat and low in bulk. d. protein and calories. 105. The nurse caring for a neutropenic, 75-year-old man undergoing treatment for prostate cancer assesses an oral temperature of 100.4° F. The most appropriate interpretation of this finding is that the client a. is experiencing an expected, systemic chemotherapeutic effect. b. is experiencing the expected increase in metabolism that accompanies malignancy. c. may have a medical emergency and needs prompt further assessment. d. may have a urinary tract infection causing a low-grade fever. 106. The nurse caring for a client receiving chemotherapy assesses for indication of thrombocytopenia. Based on laboratory values, the client becomes at high risk for hemorrhage at the point when the platelet count is less than a. 60,000/mm3. b. 50,000/mm3. c. 25,000/mm3. d. 20,000/mm3. 107. A client undergoing a course of chemotherapy feels lonely and isolated and tells the nurse he wants to resume some normal activities. The precaution that the nurse should give the client when resuming activities is a. avoid crowds. b. do not eat outside the home. c. drink only bottled water. d. use only the client’s own bathroom. 108. The nurse is developing a long-term plan for a 45-year-old client with a malignancy. The factor that would disqualify this client from receiving hospice services is a. a life expectancy of less than 6 months. b. an annual income of more than $30,000. c. initiation of a course of curative chemotherapy. d. living alone in an apartment complex. 109. A 31-year-old male client who is to receive chemotherapy for treatment of lymphoma has expressed concern about the possible side effects of chemotherapy on reproduction and fertility. An appropriate response by the nurse to these concerns is to a. discuss pretreatment sperm banking as a reproductive alternative. b. reassure the client that sexual function will return to normal after treatments. c. review sexual functioning and discuss the previous pregnancy. d. suggest artificial insemination for the client’s wife. 110. The nurse assesses that the client most at risk for breast cancer is the a. 26-year-old multipara whose father died from lung cancer. b. 38-year-old primigravida who had menarche at age 9. c. 42-year-old multipara who had menarche at age 14. d. 68-year-old nullipara receiving treatment for osteoporosis. 111. The client whose father and uncle died of colorectal cancer asks the nurse how to modify a diet to reduce the risk of this cancer. The nurse can suggest a. decreasing consumption of alcohol. b. decreasing consumption of unrefined whole-grain products. c. increasing consumption of organ meats. d. increasing consumption of vitamin A. 112. A client with an advanced stage laryngeal cancer with widespread metastases is scheduled for surgery tomorrow morning. The nurse realizes that preoperative teaching has been effective when the client states a. “After the operation, how soon will I know if they got it all?” b. “I will be glad to have this tumor removed so I can breathe better.” c. “My family can’t wait for this to be over so we can travel to Europe.” d. “So what is the cure rate for this kind of cancer?” 113. A client with prostate cancer calls the clinic to ask for a physical therapy (PT) consult because his back has been hurting. Which action by the nurse is most appropriate? a. Advise the client to try a heating pad for 3 days before initiating a PT consult. b. Call in a prescription for nonsteroidal anti-inflammatory medications. c. Collaborate with the physician to arrange the physical therapy consult. d. Instruct the client to come in for a back x-ray immediately. 114. A client has the nursing diagnosis Hopelessness, related to concern over cancer diagnosis. The nurse can encourage hope in this client by (Select all that apply) a. affirming the client’s worth as a human. b. assisting with goal setting. c. providing symptom relief as needed by the client. d. reviewing mortality statistics for this type of cancer. 115. In planning programs for cancer prevention, the nurse should provide information about cancer as the _____ leading cause of death a. major b. second c. third d. fourth 116. After discussing the difference between benign and malignant tumors with a client, the nurse would know that the client understood the discussion when the client says a. “A benign tumor does not invade other tissue.” b. “Malignant tissue is not found far from the original site of the tumor.” c. “Malignant tumors do not respond well to chemotherapy.” d. “The control of growth is impaired only in malignant tissue.” 117. The number of new cancer cases diagnosed has increased steadily since 1900. The nurse explains to a client that one of the reasons for this increase is that a. cancer is related to most birth defects. b. many false-positive cancer results are reported. c. people who live longer are less prone to cancer. d. statistical analysis and reporting are more accurate. 118. A nurse is conducting a smoking cessation clinic. What information about smoking does the nurse include in the teaching component of the program? a. A pack-year history is the length of time, in years, a person has smoked. b. Smokeless tobacco is harmless because the carcinogens have been removed. c. Smoking causes more cancer in the United States than do all other causes combined. d. The risk of cancer for someone who stops smoking does not improve. 119. A client is considering having genetic testing for cancer that “runs in the family.” Vital information for the nurse to include in the teaching plan before the client has the testing includes telling the client that a. Genetic testing is simple and inexpensive and the client does not need to seek out a specialist to interpret the results. b. If a genetic test comes back positive for a gene related to cancer, the client will develop the cancer. c. There are so many genetically-based cancers that even genetic testing cannot possibly cover them all. d. There are specific state and federal laws to protect people who undergo genetic testing from insurance and job discrimination. 120. The nurse reviewing a research report recognizes that a discussion of oncogenes will address a. a chemotherapeutic agent that eradicates viruses that cause cancer. b. factors in the immune system protecting the client from malignant growths. c. risk factors in cancer development. d. segments of DNA that transform normal cells into malignant cells. 121. A nurse is conducting a wellness seminar in which the cancer-fighting actions of diet and physical activity are presented. A woman in the audience says, “I thought diet and exercise were related to heart disease.” The best response by the nurse is a. “In people who don’t smoke, diet and activity are the most important risk factors.” b. “They are important for both, but the diet to prevent cancer is totally different.” c. “They are important for heart disease too, but cancer is a bigger killer.” d. “You’re right; diet and activity are more important to prevent heart disease.” 122. A client has worked for 2 years installing insulation containing asbestos. The nurse will determine further assessment questions based on the understanding that occupational exposure to carcinogens represents _____% of all human cancers. a. <2 b. 2-8 c. 10-12 d. >12 123. A nurse is administering IV chemotherapy. What personal protective equipment (PPE) should the nurse use when doing this task? a. A gown and gloves b. Gloves and a mask c. No special PPE is needed d. Only gloves 124. After explaining how malignant cells differ from normal cells to a client with breast cancer, the nurse knows the client understands the characteristics of malignant cells when the client says “Malignant cells a. are larger than normal cells and have designated purposes.” b. cannot grow if inflammation is present.” c. develop chromosomal abnormalities as they mature.” d. develop the same antigens as normal cells do.” 125. A client angrily tells the nurse that he cannot understand why he has liver cancer when he started out with bladder cancer. The nurse would recognize that the client misunderstands how a malignant tumor metastasizes when he states that cancer can spread by a. attaching to white blood cells. b. direct extension into the lymphatic system. c. invasion into the blood vessels. d. new growths into internal body cavities. 126. The nurse assessing a client’s risk of cancer from cigarette smoking notes that the client has smoked one-half pack per day for 10 years. The nurse calculates that this client has a history of a. 2 pack-years. b. 5 pack-years. c. 10 pack-years. d. 20 pack-years. 127. A nurse preparing a teaching plan for a client recently diagnosed with cancer will include the fact about growth patterns of cancer that cancer cells a. exhibit contact inhibition. b. grow in adverse conditions, such as lack of nutrients. c. have a growth rate equal to or less than cell death rate. d. proliferate in response to specific stimuli. 128. A client has a benign tumor that has originated in adipose tissue. The nurse explains that this type of tumor is classified as a a. fibroma. b. lipoma. c. leiomyoma. d. carcinoma. Chapter 33 Nursing Care of Patients with Hematologic Disorders 1. Which of the following should the nurse do when a young female patient’s laboratory values indicate microcytic and hypochromic red blood cells? a. Enforce “nothing by mouth” in anticipation of emergency surgery. b. Insert an intravenous access line for fluids. c. Consult with the dietitian for a diet high in iron. d. Assess the past history for risks of bleeding or menstrual changes. 2. A middle-aged female is experiencing numbness and tingling in her lower extremities as well as difficulty ambulating. The patient’s recent complete blood count indicates large, oval-shaped macrocytic red blood cells with thin membranes. Which therapy would the nurse anticipate including in the discharge plan? a. a diet high in green, leafy vegetables; broccoli; wheat germ; and asparagus b. a daily multivitamin with extra iron c. instructions about subcutaneous injections of erythropoietin for a few weeks d. instructions about intramuscular parenteral injections of vitamin B12 for the rest of her life 3. A patient is admitted with the diagnosis of sickle-cell crisis. Which of the following would the nurse do first based upon the following clinical findings: temperature 102° F, O2 saturation of 89%, and complaints of severe abdominal pain? a. Give Tylenol (acetaminophen) grains X (650 mg). b. Administer oxygen c. Administer morphine sulfate intramuscular. d. Assess and document peripheral pulses. 4. After several doses of chemotherapy, a patient complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which NANDA nursing diagnosis would the nurse list as the first priority? a. Imbalanced Nutrition: Less than Body Requirements b. Activity Intolerance c. Powerlessness d. Ineffective Coping 5. The nurse would determine, after instructing a patient on dietary management of deficiency anemia, that which of the following statements would indicate a need for additional teaching? a. “I will eat more fruits, vegetables, especially green, leafy ones, to get more B12 in my diet.” b. “I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia.” c. “I will add food high in vitamin C to improve my absorption of iron in both my vitamins.” d. “I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads.” 6. A patient diagnosed with acute myeloid leukemia (AML) has an absolute neutrophil count of 200. What actions by the nurse would minimize the risk of complications from neutropenia? a. Strict aseptic technique should be used when performing all procedures. b. Additional nutrition should be spaced frequently throughout the day to increase caloric intake. c. Restrict fluids and salts to decrease edema. d. Regulate the thermostat for a cooler environment. 7. A patient recently diagnosed with chronic myeloid leukemia (CML) is discussing how he does not want to leave his wife alone with all of the household finances. Which response by the nurse would not be appropriate at this time? Select all that apply. a. “I would encourage you to discuss your feelings with your wife so that she can be a part of the decision making process.” b. “I would like to make a referral for you and your wife to a support group that may be helpful with some of the issues you are having.” c. “It must be very difficult for you to think of your wife having to be alone with the household decisions.” d. “You had better get your affairs in order now before it is too late.” 8. Which of the following would be the appropriate nursing intervention for the patient diagnosed with heparin-induced thrombocytopenia with the nursing diagnosis of Risk for Bleeding? a. Avoid invasive procedures, such as rectal temperatures, urinary catheterizations, and parenteral injections. b. Apply pressure to puncture sites for 3-5 minutes for arterial blood gases aspiration. c. Give enemas to avoid straining when having a bowel movement. d. Encourage patient to brush teeth thoroughly and rinse with alcohol-based mouthwash after each meal. 9. What would be the priority NANDA approved nursing diagnosis for a patient receiving a stem cell transplant? Select all that apply. a. Ineffective Coping b. Fatigue c. Interrupted Family Processes d. Risk for Infection e. Excess Fluid Imbalance 10. Upon analysis, a patient’s red blood cells (RBCs) appear microcytic and hypochromic. The nurse interprets this information to mean that this patient is demonstrating signs of which of the following? a. iron deficiency anemia b. acute blood loss anemia c. chronic blood loss anemia d. vitamin B12 deficiency anemia 11. A patient with chronic gastritis is experiencing “tingling” in his hands. The nurse realizes that this patient might be demonstrating signs of which of the following? a. iron deficiency anemia b. acute blood loss anemia c. folic acid deficiency anemia d. vitamin B12 deficiency anemia 12. A patient in sickle cell crisis is experiencing edema of the hands and feet. The nurse realizes that this edema is caused by which of the following? a. fluid overload b. poor venous return c. small vessel infarction d. dehydration 13. A patient is being treated for acquired hemolytic anemia. Which of the following assessment findings would suggest that the condition is severe? a. misshapen limbs due to pathological fractures b. enlarged spleen c. jaundice d. bradycardia 14. A patient with aplastic anemia is demonstrating signs of blood cell production. Which of the following should be done to support this patient? a. Continue with blood transfusions as prescribed. b. Report the finding. c. Plan to discontinue blood transfusions. d. Plan to administer fresh frozen plasma. 15. The nurse is providing dietary instructions to a vegetarian patient with iron deficiency anemia. Which of the following should be included in these instructions? a. Consider adding animal sources of iron and protein to the diet. b. Ensure an adequate intake of vitamin C when consuming non-animal-based proteins. c. Drink at least 12 glasses of water every day. d. Avoid exercise at least 30 minutes after completing a meal or snack. 16. A patient is prescribed an oral iron preparation. Which of the following would be appropriate for the nurse to instruct this patient about this medication? Select all that apply. a. Take with orange juice. b. Nausea is expected with this medication. c. Take with an antacid. d. Take two hours before a scheduled tetracycline dose. e. Take with vitamin E replacements. 17. The nurse is planning to instruct a patient with secondary polycythemia about ways to prevent blood stasis. Which of the following should be included in these instructions? a. Leg pain is normal. b. Elevate feet and legs when sitting. c. Restrict fluids. d. Black stools are to be expected. 18. A patient diagnosed with leukemia says, “If I have too many white blood cells and white blood cells fight infections, why do I have to be careful not to be exposed to germs?” An appropriate response for the nurse to make is which of the following? a. “Leukemia means you have the wrong kind of white blood cells.” b. “That’s not what leukemia is.” c. “The white blood cells with leukemia aren’t effective to fight infections.” d. “Your bone marrow can become infected.” 19. A 17-year-old patient with edematous lymph nodes and headaches is diagnosed with leukemia. The nurse suspects that this patient most likely has which of the following? a. acute lymphocytic leukemia (ALL) b. chronic lymphocytic leukemia (CLL) c. acute myeloid leukemia (AML) d. chronic myeloid leukemia (CML) 20. A patient who is undergoing treatment for leukemia is scheduled for a bone marrow transplant. The nurse determines that this patient is in which phase of treatment for the disorder? a. induction b. maintenance c. rehabilitative d. postremission 21. The nurse is preparing an analgesic for a patient with leukemia. Which of the following routes is preferred for this patient? a. intramuscular b. intravenous c. oral d. subcutaneous 22. A patient is diagnosed with stage II A Hodgkin’s lymphoma. The nurse interprets this information to mean that the extent of this disorder is limited to which of the following? a. a single lymph node with systemic symptoms b. two or more lymph nodes on the same side without systemic symptoms c. upper abdominal lymph nodes without systemic symptoms d. an extranodal site involvement with systemic symptoms 23. A college-age patient who is in the hospital for Hodgkin’s disease treatment is visited by friends who bring a pizza and cola to the patient’s room. Which of the following can the nurse do to ensure the patient’s comfort? a. Ask the visitors to leave. b. Ask the visitors to eat the pizza in the lounge. c. Encourage the patient to eat as much pizza as possible. d. Provide the patient with an antiemetic and suggest something else for the patient to eat with the visitors. 24. A patient with idiopathic thrombocytopenia purpura continues to experience symptoms of the disease after completing several courses of prednisone (Meticorten) therapy. The nurse anticipates that which of the following will most likely be indicated for this patient? a. life-long prednisone therapy b. splenectomy c. aspirin therapy d. weekly platelet transfusions 25. A patient with hemophilia is admitted with acute bleeding. Until the cause of the bleeding is determined, the nurse should be prepared to do which of the following interventions? a. Infuse packed red blood cells. b. Infuse normal saline. c. Infuse heparin. d. Infuse fresh-frozen plasma. 26. A patient with disseminated intravascular coagulation is not responding to infusions of fresh-frozen plasma and platelets. Which of the following interventions might be indicated for this patient? Select all that apply. a. Begin heparin injections. b. Begin heparin infusion. c. Give factor VIII infusion. d. Begin normal saline infusion. e. Prepare for a bone marrow biopsy. 27. A patient who is undergoing chemotherapy for lymphoma says, “I thought I was ugly before this all started. Now I know for sure I’m disgusting to look at.” Which of the following is this patient most at risk for developing related to her comments? a. changed body image perception b. reduced sexual response c. altered taste sensation d. inability to cope with the diagnosis and treatment 28. A patient who is being treated for malignant lymphoma is experiencing pruritis. Which of the following interventions would be appropriate for this patient? Select all that apply. a. Bathe with cool water. b. Vigorously rub the skin after bathing. c. Apply lavender-scented body lotion. d. Keep room temperature above normal. e. Cleanse bedding and clothing in mild detergent with a second rinse cycle. 29. The nurse is reviewing the patient’s the results from recent diagnostic tests and an assessment. Based on the information included in the chart above, which of the following would be consistent with the most likely diagnosis? a. The patient was just transported from the scene of a high-speed motorcycle accident. b. The patient was recently diagnosed with a chronic gastrointestinal bleed. c. The patient had a gastrectomy performed 22 years ago as a result of stomach cancer. d. The patient is an alcoholic. 30. The nurse is reviewing information about the patient who was admitted to the hospital three days ago with urosepsis. The nurse reviews the information regarding recent assessments and diagnostic testing that have been completed. Which of the following physician orders would be expected? a. Administer oxygen to keep oxygen saturation levels above or equal to 95%. b. Ambulate patient three times each day as tolerated. c. Apply hot compresses to painful joints. d. Consult physical therapy for active range of motion exercises. 31. The patient has developed multiple ecchymoses and there is the presence of occult blood in the patient’s stool. The patient’s factor assays are assessed and factor VIII is found to be decreased. Based on the nurse’s understanding of hematoligic disorders, which of the following are commonly associated with this patient’s condition? Select all that apply. Select all that apply. a. The patient’s platelet count is normal. b. The patient’s prothrombin time is elevated. c. The physician diagnoses the patient with hemophilia B. d. The nurse administers fresh-frozen plasma to the patient per physician’s orders. e. The patient’s bleeding time is within normal limits. 32. The patient was recently diagnosed with Hodgkin’s disease. The nurse provided education for the patient and the patient’s spouse. Which of the following statements made by the patient indicate the nee