oncology
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the
nurse expect to note specifically in this disorder?
Increased calcium level
Increased white blood cells
Decreased blood urea nitrogen level
Decreased number of plasma cells in the bone marrow - ANSWER: Findings indicative of multiple myeloma are
an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of
calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white
blood cell count may or may not be present and is not related specifically to multiple myeloma.
The nurse is developing a plan of care for the client with multiple myeloma and includes which priority
intervention in the plan?
Encouraging fluids
Providing frequent oral care
Coughing and deep breathing
Monitoring the red blood cell count - ANSWER: Hypercalcemia caused by bone destruction is a priority
concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to
maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not
only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options
2, 3, and 4 may be components of the plan of care but are not the priority in this client.
A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding
would the nurse expect to note specifically in the client?
Fatigue
Weakness
Weight gain
Enlarged lymph nodes - ANSWER: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid
tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites,
such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are
not related significantly to the disease.
During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which
symptom as typical of the disease?
,Diarrhea
Hypermenorrhea
Abnormal bleeding
Abdominal distention - ANSWER: Clinical manifestations of ovarian cancer include abdominal distention,
urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing
tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately
general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the
nurse recognize as indications of a possible oncological emergency? Select all that apply.
Facial edema in the morning
Serum calcium level of 12 mg/dL
Weight loss of 20 lb in 1 month
Serum sodium level of 136 mg/dL
Serum potassium level of 3.4 mg/dL
Numbness and tingling of the lower extremities - ANSWER: Oncological emergencies include sepsis,
disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord
compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow
to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum
calcium level of 12 mg/dL indicates hypercalcemia. Numbness and tingling of the lower extremities could be a
sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium
level of 136 mg/dL is a normal level.
A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is
voiding through the vagina. The nurse interprets that the client may be experiencing which condition?
Rupture of the bladder
The development of a vesicovaginal fistula
Extreme stress caused by the diagnosis of cancer
Altered perineal sensation as a side effect of radiation therapy - ANSWER: A vesicovaginal fistula is a genital
fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two
body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's
complaint is not associated with options 1, 3, or 4.
A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases
the response on which description of this disorder?
,Altered red blood cell production
Altered production of lymph nodes
Malignant exacerbation in the number of leukocytes
Malignant proliferation of plasma cells within the bone - ANSWER: Multiple myeloma is a B-cell neoplastic
condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature
plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3
describes the leukemic process.
The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines
that further teaching is necessary related to colorectal cancer if the client identifies which item as an
associated risk factor?
Age younger than 50 years
History of colorectal polyps
Family history of colorectal cancer
Chronic inflammatory bowel disease - ANSWER: Colorectal cancer risk factors include age older than 50 years,
a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of
which most common symptom of this type of cancer?
Dysuria
Hematuria
Urgency on urination
Frequency of urination - ANSWER: The most common symptom in clients with cancer of the bladder is
hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and
dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of
urination are also signs of a bladder infection.
A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a
complication of the cancer. The nurse anticipates that the health care provider will request which
prescriptions? Select all that apply
Radiation
Chemotherapy
Increased fluid intake
Decreased oral sodium intake
, Serum sodium level determination
Medication that is antagonistic to antidiuretic hormone - ANSWER: Cancer is a common cause of syndrome of
inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the
kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum
sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and
cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of
action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because
hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer
therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone
synthesis and release processes return to normal.
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an
early sign of this oncological emergency?
Cyanosis
Arm edema
Periorbital edema
Mental status changes - ANSWER: Superior vena cava syndrome occurs when the superior vena cava is
compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and
include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse
collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental
status changes are late signs.
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client
with metastatic prostate cancer and tells the staff that which is a late sign of this oncological emergency?
Headache
Dysphagia
Constipation
Electrocardiographic changes - ANSWER: Hypercalcemia is a manifestation of bone metastasis in late-stage
cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the
process. Electrocardiogram changes include shortened ST segment and a widened T wave.
As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care
during the period of greatest bone marrow suppression (the nadir). The nurse understands that further
teaching is needed if the client makes which statement?
"I should avoid blowing my nose."
"I may need a platelet transfusion if my platelet count is too low."
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the
nurse expect to note specifically in this disorder?
Increased calcium level
Increased white blood cells
Decreased blood urea nitrogen level
Decreased number of plasma cells in the bone marrow - ANSWER: Findings indicative of multiple myeloma are
an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of
calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white
blood cell count may or may not be present and is not related specifically to multiple myeloma.
The nurse is developing a plan of care for the client with multiple myeloma and includes which priority
intervention in the plan?
Encouraging fluids
Providing frequent oral care
Coughing and deep breathing
Monitoring the red blood cell count - ANSWER: Hypercalcemia caused by bone destruction is a priority
concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to
maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not
only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options
2, 3, and 4 may be components of the plan of care but are not the priority in this client.
A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding
would the nurse expect to note specifically in the client?
Fatigue
Weakness
Weight gain
Enlarged lymph nodes - ANSWER: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid
tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites,
such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are
not related significantly to the disease.
During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which
symptom as typical of the disease?
,Diarrhea
Hypermenorrhea
Abnormal bleeding
Abdominal distention - ANSWER: Clinical manifestations of ovarian cancer include abdominal distention,
urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing
tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately
general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the
nurse recognize as indications of a possible oncological emergency? Select all that apply.
Facial edema in the morning
Serum calcium level of 12 mg/dL
Weight loss of 20 lb in 1 month
Serum sodium level of 136 mg/dL
Serum potassium level of 3.4 mg/dL
Numbness and tingling of the lower extremities - ANSWER: Oncological emergencies include sepsis,
disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord
compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow
to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum
calcium level of 12 mg/dL indicates hypercalcemia. Numbness and tingling of the lower extremities could be a
sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium
level of 136 mg/dL is a normal level.
A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is
voiding through the vagina. The nurse interprets that the client may be experiencing which condition?
Rupture of the bladder
The development of a vesicovaginal fistula
Extreme stress caused by the diagnosis of cancer
Altered perineal sensation as a side effect of radiation therapy - ANSWER: A vesicovaginal fistula is a genital
fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two
body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's
complaint is not associated with options 1, 3, or 4.
A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases
the response on which description of this disorder?
,Altered red blood cell production
Altered production of lymph nodes
Malignant exacerbation in the number of leukocytes
Malignant proliferation of plasma cells within the bone - ANSWER: Multiple myeloma is a B-cell neoplastic
condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature
plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3
describes the leukemic process.
The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines
that further teaching is necessary related to colorectal cancer if the client identifies which item as an
associated risk factor?
Age younger than 50 years
History of colorectal polyps
Family history of colorectal cancer
Chronic inflammatory bowel disease - ANSWER: Colorectal cancer risk factors include age older than 50 years,
a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of
which most common symptom of this type of cancer?
Dysuria
Hematuria
Urgency on urination
Frequency of urination - ANSWER: The most common symptom in clients with cancer of the bladder is
hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and
dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of
urination are also signs of a bladder infection.
A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a
complication of the cancer. The nurse anticipates that the health care provider will request which
prescriptions? Select all that apply
Radiation
Chemotherapy
Increased fluid intake
Decreased oral sodium intake
, Serum sodium level determination
Medication that is antagonistic to antidiuretic hormone - ANSWER: Cancer is a common cause of syndrome of
inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the
kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum
sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and
cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of
action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because
hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer
therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone
synthesis and release processes return to normal.
The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an
early sign of this oncological emergency?
Cyanosis
Arm edema
Periorbital edema
Mental status changes - ANSWER: Superior vena cava syndrome occurs when the superior vena cava is
compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and
include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse
collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental
status changes are late signs.
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client
with metastatic prostate cancer and tells the staff that which is a late sign of this oncological emergency?
Headache
Dysphagia
Constipation
Electrocardiographic changes - ANSWER: Hypercalcemia is a manifestation of bone metastasis in late-stage
cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the
process. Electrocardiogram changes include shortened ST segment and a widened T wave.
As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care
during the period of greatest bone marrow suppression (the nadir). The nurse understands that further
teaching is needed if the client makes which statement?
"I should avoid blowing my nose."
"I may need a platelet transfusion if my platelet count is too low."
