ONCOLOGY EXAM

Oncology Exam A patient who is scheduled for a right breast biopsy asks the nurse 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." The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
 a. Nausea
 b. Alopecia
 c. Mucositis
 d. Hematuria The nurse is caring for a patient who smokes 2 packs/day. To reduce the patient's risk of lung cancer, which action by the nurse is best?
 a. Teach 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. The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer?
 a. Fresh fruit salad
 b. Roasted chicken
 c. Whole wheat toast
 d. Cream of potato soup During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?
 a. Teach 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. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is most appropriate? a. "The cancer involves only the cervix."
 b. "The cancer cells look almost like normal cells." 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." The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was 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." The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of 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." A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure?
 a. Pain will be relieved by cutting sensory nerves in the stomach.
 b. Relief of pressure in the stomach will promote better nutrition.
 c. Tumor growth will be controlled by the removal of malignant tissue.
 d. Tumor size will decrease and this will improve the effects of other therapy. External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?
 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. 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." Which intervention should the nurse add to the plan of care?
 a. Minimize activity until the treatment is completed.
 b. Establish time to take a short walk almost every day.
 c. Consult with a psychiatrist for treatment of depression.
 d. Arrange for delivery of a hospital bed to the patient's home. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about management of the skin reaction. Which statement, if made by the patient, indicates the teaching was 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." A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate?
 a. Have the patient eat large meals when nausea is not present.
 b. Offer dry crackers and carbonated fluids during chemotherapy.
 c. Administer prescribed antiemetics 1 hour before the treatments.
 d. Give the patient two ounces of a citrus fruit beverage during treatments. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?
 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 a small-bore catheter.
 d. Hold the medication unless a central venous line is available. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem?
 a. Tell the patient to 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. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss.
 d. Inform the patient that hair usually grows back once the chemotherapy is complete. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?
 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. A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?
 a. Offer the patient frequent small snacks between meals.
 b. Assist the patient to choose favorite foods from the menu.
 c. Provide teaching about the importance of nutritional intake.
 d. Apply the ordered anesthetic gel to oral lesions before meals. A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?
 a. "Why don't we talk about the options you have for the care of your children?"
 b. "I'm sure you have friends that will take the children when you can't care for them."
 c. "For now you need to concentrate on getting well and not worrying about your children."
 d. "Many patients with cancer live for a long time, so there is still time to plan for your children." A patient who has severe pain associated with terminal pancreatic 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 uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale).
 b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness.
 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. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?
 a. IL-2 enhances the immunologic response to tumor cells.
 b. IL-2 stimulates malignant cells in the resting phase to enter mitosis.
 c. IL-2 prevents the bone marrow depression caused by chemotherapy.
 d. IL-2 protects normal cells from the harmful effects of chemotherapy. The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?
 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." A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?
 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 stem cell transplant procedure is performed. 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. Lime sherbet
 b. Blueberry yogurt
 c. Cream cheese bagel
 d. Fresh strawberries and bananas During the teaching session for a patient who has a new diagnosis of acute leukemia the patient is restless and is looking away, never making eye contact. After teaching about the complications associated with chemotherapy, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most appropriate 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. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?
 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. The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon. When assessing the need for psychologic support, 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?" The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?
 a. Poor oral intake
 b. Frequent loose stools
 c. Complaints of nausea and vomiting
 d. Increase in carcinoembryonic antigen (CEA) The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result 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. White blood cell (WBC) count of 2700/µL When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?
 a. The UAP assists the patient to use dental floss after eating.
 b. The UAP adds baking soda to the patient's saline oral rinses.
 c. The UAP puts fluoride toothpaste on the patient's toothbrush.
 d. The UAP has the patient rinse after meals with a saline solution. The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?
 a. The UAP flushes the toilet once after emptying the patient's bedpan.
 b. The UAP stands by the patient's bed for 30 minutes talking with the patient.
 c. The UAP places the patient's bedding in the laundry container in the hallway.
 d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care. The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?
 a. 35-year-old patient who has wet desquamation associated with abdominal radiation
 b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer
 c. 24-year-old patient who received neck radiation and has blood oozing from the neck
 d. 56-year-old patient who developed a new pericardial friction rub after chest radiation The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?
 a. Shortness of breath
 b. Temperature 100.2° F (37.9° C)
 c. Shivering and complaint of chills
 d. Generalized muscle aches and pains A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?
 a. Give the patient the prescribed PRN opioid.
 b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms.
 d. Teach the patient how to use relaxation to reduce pain. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?
 a. Patient complains of severe fatigue.
 b. Patient needs to void every hour during the day.
 c. Patient takes only 50% of meals and refuses snacks.
 d. Patient has audible crackles to the midline posterior chest. After change-of-shift report on the oncology unit, which patient should the nurse assess first?
 a. Patient who has a platelet count of 82,000/µL after chemotherapy
 b. Patient who has xerostomia after receiving head and neck radiation
 c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)
 d. Patient who is worried about getting the prescribed long-acting opioid on time Know classifications of cancer (numbers, stages) • Grading: o Grade 1: cells differ slightly from normal cells and are well differentiated o Grade 2: cells are more abnormal and moderately differentiated o Grade 3: cells are very abnormal and poorly differentiated o Grade 4: cells are immature and primitive and undifferentiated; cell of origin is difficult to determine o Grade 5: grade cannot be assessed • Staging: o Stage 0: cancer in situ o Stage 1: tumor limited to the tissue to origin, localized tumor growth o Stage 2: limited local spread o Stage 3: extensive local and regional spread o Stage 4: metastasis Cervical cancer- how to classify • Stage 0: o In situ o Cervical conization, hysterectomy, cryosurgery, laser surgery • Stage 1: o Confinement to cervix o Radiation, radical hysterectomy • Stage 2: o Spread beyond cervix to upper two thirds of vagina but not to tissues around uterus o Radiation, cisplatin based chemo, radical hysterectomy • Stage 3: o Spread to pelvic wall, involvement of lower third vagina, and/or has caused kidney problems o Radiation, cisplatin based chemo • Stage 4: o Spread to other parts of the body such as bladder, rectum, liver, lungs, and bones o Radiation, surgery, cisplatin based chemo In severely anemic patients, the nurse would expect to find:
 A. dyspnea and tachycardia
 B. cyanosis and pulmonary edema
 C. cardiomegaly and pulmonary fibrosis
 D. ventricular dysrhythmia and wheezing When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about:
 A. folic acid intake
 B. dietary intake of iron
 C. a history of gastric surgery
 D. a history of sickle cell anemia A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include
 a. a hematocrit (Hct) of 38%.
 b. an RBC count of 4,500,000/L.
 c. normal red blood cell (RBC) indices.
 d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L). 2. Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia?
 a. Omelet and whole wheat toast
 b. Cantaloupe and cottage cheese
 c. Strawberry and banana fruit plate
 d. Cornmeal muffin and orange juice 3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
 a. iron.
 b. folic acid.
 c. cobalamin (vitamin B12).
 d. ascorbic acid (vitamin C). 4. A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I
 a. need to start eating more red meat and liver."
 b. will stop having a glass of wine with dinner."
 c. could choose nasal spray rather than injections of vitamin B12."
 d. will need to take a proton pump inhibitor like omeprazole (Prilosec)." 5. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to
 a. provide a diet high in vitamin K.
 b. alternate periods of rest and activity.
 c. teach the patient how to avoid injury.
 d. place the patient on protective isolation. 6. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?
 a. "I will call my health care provider if my stools turn black."
 b. "I will take a stool softener if I feel constipated occasionally."
 c. "I should take the iron with orange juice about an hour before eating."
 d. "I should increase my fluid and fiber intake while I am taking iron tablets." 7. Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?
 a. Potential complication: seizures
 b. Potential complication: infection
 c. Potential complication: neurogenic shock
 d. Potential complication: pulmonary edema 8. It is important for the nurse providing care for a patient with sickle cell crisis to
 a. limit the patient's intake of oral and IV fluids.
 b. evaluate the effectiveness of opioid analgesics.
 c. encourage the patient to ambulate as much as tolerated.
 d. teach the patient about high-protein, high-calorie foods. 9. Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?
 a. "Home oxygen therapy is frequently used to decrease sickling."
 b. "There are no effective medications that can help prevent sickling."
 c. "Routine continuous dosage narcotics are prescribed to prevent a crisis."
 d. "Risk for a crisis is decreased by having an annual influenza vaccination." 10. Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?
 a. Take a daily multivitamin with iron.
 b. Limit fluids to 2 to 3 quarts per day c. Avoid exposure to crowds when possible.
 d. Drink only two caffeinated beverages daily. 11. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the
 a. Schilling test.
 b. bilirubin level.
 c. stool occult blood test.
 d. gastric analysis testing. 12. A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?
 a. Use low-molecular-weight heparin (LMWH) only.
 b. Administer the warfarin (Coumadin) at the scheduled time.
 c. Teach the patient about the purpose of platelet transfusions.
 d. Discontinue heparin and flush intermittent IV lines using normal saline. 13. A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to
 a. place the patient on bed rest.
 b. administer iron supplements.
 c. avoid use of aspirin products.
 d. monitor fluid intake and output. 14. Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?
 a. Assign the patient to a private room.
 b. Avoid intramuscular (IM) injections.
 c. Use rinses rather than a soft toothbrush for oral care.
 d. Restrict activity to passive and active range of motion. 15. Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?
 a. Prothrombin time
 b. Erythrocyte count
 c. Fibrinogen degradation products
 d. Activated partial thromboplastin time 16. The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will
 a. immobilize the joint.
 b. apply heat to the knee.
 c. assist the patient with light weight bearing.
 d. perform passive range of motion to the knee. 17. A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the
 a. platelet count.
 b. bleeding time.
 c. thrombin time.
 d. prothrombin time. 18. A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about
 a. blood transfusion
 b. bone marrow biopsy.
 c. filgrastim (Neupogen) administration.
 d. erythropoietin (Epogen) administration. 19. Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic?
 a. Avoid any injections.
 b. Check temperature every 4 hours.
 c. Omit fruits or vegetables from the diet.
 d. Place a "No Visitors" sign on the door. 20. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
 a. Platelet count
 b. Reticulocyte count
 c. Total lymphocyte count
 d. Absolute neutrophil count 21. A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
 a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation."
 b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."
 c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do."
 d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly." 22. A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient?
 a. Infuse the PRBCs slowly over 4 hours.
 b. Transfuse only leukocyte-reduced PRBCs.
 c. Administer the scheduled diuretic before the transfusion.
 d. Give the PRN dose of antihistamine before the transfusion. 23. A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to
 a. emphasize the positive outcomes of a bone marrow transplant.
 b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT.
 d. explain that a cure is not possible with any other treatment except HSCT. 25. An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to
 a. check all stools for occult blood.
 b. encourage fluids to 3000 mL/day.
 c. provide oral hygiene every 2 hours.
 d. check the temperature every 4 hours. 26. A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?
 a. Discuss the need for hospital admission to treat the neutropenia.
 b. Teach the patient to administer filgrastim (Neupogen) injections.
 c. Plan to discontinue the chemotherapy until the neutropenia resolves.
 d. Order a high-efficiency particulate air (HEPA) filter for the patient's home. 27. Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?
 a. The platelet count is 52,000/µL.
 b. The patient is difficult to arouse.
 c. There are purpura on the oral mucosa.
 d. There are large bruises on the patient's back. 28. The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?
 a. Verify the patient identification (ID) according to hospital policy.
 b. Obtain the temperature, blood pressure, and pulse before the transfusion.
 c. Double-check the product numbers on the PRBCs with the patient ID band.
 d. Monitor the patient for shortness of breath or chest pain during the transfusion. 29. A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?
 a. Draw blood for a new crossmatch.
 b. Send a urine specimen to the laboratory.
 c. Administer PRN acetaminophen (Tylenol).
 d. Give the PRN diphenhydramine (Benadryl). 30. A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to
 a. administer oxygen therapy at a high flow rate.
 b. obtain a urine specimen to send to the laboratory.
 c. notify the health care provider about the symptoms.
 d. disconnect the transfusion and infuse normal saline. 31. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?
 a. A patient with chronic heart failure
 b. A patient who has viral pneumonia
 c. A patient who has right leg cellulitis
 d. A patient with multiple abdominal drains 32. Which patient requires the most rapid assessment and care by the emergency department nurse?
 a. The patient with hemochromatosis who reports abdominal pain
 b. The patient with neutropenia who has a temperature of 101.8° F
 c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours
 d. The patient with thrombocytopenia who has oozing after having a tooth extracted 33. A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?
 a. The platelet count is 42,000/L.
 b. Petechiae are present on the chest.
 c. Blood pressure (BP) is 94/56 mm Hg.
 d. Blood is oozing from the venipuncture site. 34. Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician?
 a. Leg bruises
 b. Tarry stools
 c. Skin abrasions
 d. Bleeding gums 35. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?
 a. Avoid venipunctures.
 b. Notify the patient's physician.
 c. Apply sterile dressings to the sites.
 d. Give prescribed proton-pump inhibitors. 36. A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first?
 a. Administer morphine sulfate 4 mg IV.
 b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes.
 d. Schedule complete blood count and coagulation studies. 37. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?
 a. Assessing the patient for signs and symptoms of infection
 b. Teaching the patient the purpose of neutropenic precautions
 c. Administering subcutaneous filgrastim (Neupogen) injection
 d. Developing a discharge teaching plan for the patient and family 38. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
 a. 44-year-old with sickle cell anemia who says "my eyes always look sort of yellow"
 b. 23-year-old with no previous health problems who has a nontender lump in the axilla
 c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
 d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement 39. After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?
 a. 56-year-old with frequent explosive diarrhea
 b. 33-year-old with a fever of 100.8° F (38.2° C)
 c. 66-year-old who has white pharyngeal lesions
 d. 23-year old who is complaining of severe fatigue 41. Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?
 a. Skin color
 b. Hematocrit
 c. Liver function
 d. Serum iron level 43. Following successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching?
 a. Potential impact of chemotherapy treatment on fertility
 b. Application of soothing lotions to treat residual pruritus
 c. Use of maintenance chemotherapy to maintain remission
 d. Need for follow-up appointments to screen for malignancy 45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?
 a. Serum calcium level is 15 mg/dL.
 b. Patient reports no stool for 5 days.
 c. Urine sample has Bence-Jones protein.
 d. Patient is complaining of severe back pain. 46. When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?
 a. Discourage deep breathing to reduce risk for splenic rupture.
 b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain.
 c. Schedule immunization with the pneumococcal vaccine (Pneumovax).
 d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery. 47. The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? a. Neutropenia
 b. Increasing fatigue
 c. Thrombocytopenia
 d. Frequent constipation