Question 1

A nurse working in the pediatric intensive care unit (PICU)is caring for a child with leukemia.What is the most common type of leukemia in children?
A) Chronic lymphocytic leukemia
B) Acute lymphocytic (lymphoblastic) leukemia
C) Acute myeloid (myeloblastic) leukemia
D) Chronic myeloid (myelogenous) leukemia.

Accepted Answer

A) Acute lymphoblastic leukemia is the most common type of leukemia in children and the most common cancer affecting children under 5 years of age. The other choices are also types of leukemia, but are incorrect choices.
B) Acute lymphoblastic leukemia is the most common type of leukemia in children and the most common cancer affecting children under 5 years of age. The other choices are also types of leukemia, but are incorrect choices.
C) Acute lymphoblastic leukemia is the most common type of leukemia in children and the most common cancer affecting children under 5 years of age. The other choices are also types of leukemia, but are incorrect choices.
D) Acute lymphoblastic leukemia is the most common type of leukemia in children and the most common cancer affecting children under 5 years of age. The other choices are also types of leukemia, but are incorrect choices.

Question 2

The nurse is caring for a client with leukemia who is experiencing neutropenia as a result of chemotherapy.Which action should the nurse include in the plan of care for this client?
A) Replace hand hygiene with gloves.
B) Restrict visitors with communicable illnesses.
C) Restrict fluid intake.
D) Insert an indwelling urinary catheter to prevent skin breakdown.

Accepted Answer

A) In the neutropenic client, visitors with communicable infections should be restricted. Fluid intake should be encouraged. Gloves may be appropriate but should never replace hand hygiene. Invasive procedures such as indwelling catheters should be avoided.
B) In the neutropenic client, visitors with communicable infections should be restricted. Fluid intake should be encouraged. Gloves may be appropriate but should never replace hand hygiene. Invasive procedures such as indwelling catheters should be avoided.
C) In the neutropenic client, visitors with communicable infections should be restricted. Fluid intake should be encouraged. Gloves may be appropriate but should never replace hand hygiene. Invasive procedures such as indwelling catheters should be avoided.
D) In the neutropenic client, visitors with communicable infections should be restricted. Fluid intake should be encouraged. Gloves may be appropriate but should never replace hand hygiene. Invasive procedures such as indwelling catheters should be avoided.

Question 3

The nurse is caring for a client who has just been diagnosed with chronic myeloid leukemia (CML).The client and the nurse are discussing the anticipatory grieving process.Which action by the nurse would be inappropriate at this time?
A) Make referrals for support or bereavement groups.
B) Identify family stress management strategies.
C) Encourage the client to see an attorney now to get affairs "in order" before it is too late.
D) Encourage the client to share feelings and discuss grieving.

Accepted Answer

A) Encouraging the client to get affairs "in order" now to avoid waiting until it is too late is not appropriate at this time: Although this topic is helpful to prepare for the actual death, this is not the time because this removes all hope. Establishing open communication and sharing of feelings to discuss grieving is appropriate at this time: The nurse should establish a rapport and use therapeutic communication to allow the client to express feelings and emotions about the new diagnosis of CML. Making referrals for support or bereavement groups is appropriate at this time: Offering information and resources about agencies that deal with grieving is an option to show the client that agencies can assist when the need is felt or when the client is ready to use them. In addition, this helps the client understand that anticipatory grieving is a normal process that occurs. Identifying family stress management strategies is appropriate at this time: Exploring possible stressors and strategies associated with the disease progression will give the client a realistic approach to understanding the disease process and its consequences. This also helps the client begin to share with the family to build a foundation for mutual understanding and trust.
B) Encouraging the client to get affairs "in order" now to avoid waiting until it is too late is not appropriate at this time: Although this topic is helpful to prepare for the actual death, this is not the time because this removes all hope. Establishing open communication and sharing of feelings to discuss grieving is appropriate at this time: The nurse should establish a rapport and use therapeutic communication to allow the client to express feelings and emotions about the new diagnosis of CML. Making referrals for support or bereavement groups is appropriate at this time: Offering information and resources about agencies that deal with grieving is an option to show the client that agencies can assist when the need is felt or when the client is ready to use them. In addition, this helps the client understand that anticipatory grieving is a normal process that occurs. Identifying family stress management strategies is appropriate at this time: Exploring possible stressors and strategies associated with the disease progression will give the client a realistic approach to understanding the disease process and its consequences. This also helps the client begin to share with the family to build a foundation for mutual understanding and trust.
C) Encouraging the client to get affairs "in order" now to avoid waiting until it is too late is not appropriate at this time: Although this topic is helpful to prepare for the actual death, this is not the time because this removes all hope. Establishing open communication and sharing of feelings to discuss grieving is appropriate at this time: The nurse should establish a rapport and use therapeutic communication to allow the client to express feelings and emotions about the new diagnosis of CML. Making referrals for support or bereavement groups is appropriate at this time: Offering information and resources about agencies that deal with grieving is an option to show the client that agencies can assist when the need is felt or when the client is ready to use them. In addition, this helps the client understand that anticipatory grieving is a normal process that occurs. Identifying family stress management strategies is appropriate at this time: Exploring possible stressors and strategies associated with the disease progression will give the client a realistic approach to understanding the disease process and its consequences. This also helps the client begin to share with the family to build a foundation for mutual understanding and trust.
D) Encouraging the client to get affairs "in order" now to avoid waiting until it is too late is not appropriate at this time: Although this topic is helpful to prepare for the actual death, this is not the time because this removes all hope. Establishing open communication and sharing of feelings to discuss grieving is appropriate at this time: The nurse should establish a rapport and use therapeutic communication to allow the client to express feelings and emotions about the new diagnosis of CML. Making referrals for support or bereavement groups is appropriate at this time: Offering information and resources about agencies that deal with grieving is an option to show the client that agencies can assist when the need is felt or when the client is ready to use them. In addition, this helps the client understand that anticipatory grieving is a normal process that occurs. Identifying family stress management strategies is appropriate at this time: Exploring possible stressors and strategies associated with the disease progression will give the client a realistic approach to understanding the disease process and its consequences. This also helps the client begin to share with the family to build a foundation for mutual understanding and trust.

Question 4

The nurse is caring for a school-aged child who had a bone marrow transplant for the treatment of leukemia several weeks ago.The child requires protective isolation.Which statement by the child's family indicates understanding of this type of isolation?
A) "We will encourage oral hygiene twice a day.
B) "We will encourage meticulous hand washing among all people in contact with our child."
C) "You will have to administer all medications by IM injection."
D) "It will be important to restrict all visitors."

Accepted Answer

A) A child on protective isolation will be at an increased risk for infection. It will be important to encourage meticulous hand washing among all people who come in contact with the child. Restrict only visitors with colds, flu, or infection. Medications by injection should be avoided. Oral hygiene should be encouraged after every meal.
B) A child on protective isolation will be at an increased risk for infection. It will be important to encourage meticulous hand washing among all people who come in contact with the child. Restrict only visitors with colds, flu, or infection. Medications by injection should be avoided. Oral hygiene should be encouraged after every meal.
C) A child on protective isolation will be at an increased risk for infection. It will be important to encourage meticulous hand washing among all people who come in contact with the child. Restrict only visitors with colds, flu, or infection. Medications by injection should be avoided. Oral hygiene should be encouraged after every meal.
D) A child on protective isolation will be at an increased risk for infection. It will be important to encourage meticulous hand washing among all people who come in contact with the child. Restrict only visitors with colds, flu, or infection. Medications by injection should be avoided. Oral hygiene should be encouraged after every meal.

Question 5

The nurse is caring for an older adult client who is very thin and emaciated.The client reports new onset of shortness of breath.A chest x-ray reveals a spot on the lungs that the physician believes is an inoperable lung cancer.Due to the client's poor nutritional status,chemotherapy is not an option.The health care provider also believes that the location of the cancer would make radiation therapy unsuccessful.In advocating for this client,what should the nurse encourage the healthcare team to do?
A) Provide palliative care to keep the client comfortable without diagnostic testing.
B) Perform any procedure necessary to diagnose the client properly.
C) Promote the use of blood tests to diagnose the suspected cancer.
D) Determine the client's and family's wishes regarding diagnostic testing.

Accepted Answer

A) An older adult emaciated client may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the client and family that should direct the plan of care and choices of diagnostic testing.
B) An older adult emaciated client may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the client and family that should direct the plan of care and choices of diagnostic testing.
C) An older adult emaciated client may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the client and family that should direct the plan of care and choices of diagnostic testing.
D) An older adult emaciated client may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the client and family that should direct the plan of care and choices of diagnostic testing.

Question 6

A pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL).When providing education to the child's parents regarding this disease,which topics should the nurse include? Select all that apply.
A) ALL is characterized by abnormal proliferation of all bone marrow elements.
B) This form of leukemia is the most common type among children and adolescents.
C) Most cases of ALL result from the malignant transformation of B cells.
D) This form of leukemia is very rarely seen in children.
E) The onset of ALL is usually gradual.

Accepted Answer

A) Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.
B) Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.
C) Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.
D) Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.
E) Acute lymphoblastic leukemia (ALL) is the most common type of leukemia among children and adolescents. Most cases of ALL result from the malignant transformation of B cells. The onset of ALL is usually acute and rapid. Chronic myeloid leukemia (CML) is characterized by abnormal proliferation of all bone marrow elements.

Question 7

A nurse is caring for a client with chronic myeloid leukemia (CML)who is neutropenic.Which interventions will the nurse implement to ensure this client's safety? Select all that apply.
A) Place client in reverse isolation.
B) Place patient in standard precaution isolation.
C) Administer granulocyte colony-stimulating factor (G-CSF) as ordered.
D) Administer neutrophil colony-stimulating factor (N-CSF) as ordered.
E) Administer a prophylactic gram-negative antibiotic.

Accepted Answer

A) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will place the client in reverse isolation, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. Standard precautions should be used for all clients and this does not ensure safety of the neutropenic client.
B) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will place the client in reverse isolation, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. Standard precautions should be used for all clients and this does not ensure safety of the neutropenic client.
C) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will place the client in reverse isolation, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. Standard precautions should be used for all clients and this does not ensure safety of the neutropenic client.
D) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will place the client in reverse isolation, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. Standard precautions should be used for all clients and this does not ensure safety of the neutropenic client.
E) A client who is neutropenic has a decrease in the level of white blood cells (WBCs) and is susceptible to infection and/or disease. To ensure the safety of the client with neutropenia, the nurse will place the client in reverse isolation, administer granulocyte colony-stimulating factor (G-CSF) as ordered, and administer a broad-spectrum antibiotic as ordered. Standard precautions should be used for all clients and this does not ensure safety of the neutropenic client.

Question 8

The student nurse is questioning the instructor about the different types of chemotherapeutic agents used to treat cancer.Which statement by the instructor best explains why lung cancers are less sensitive to antineoplastic agents than other types of cancers?
A) "Lung cancer cells have a low growth fraction, so they are less sensitive to antineoplastic agents."
B) "Lung cancer cells grow in a high-oxygen environment, so they are not very sensitive to antineoplastic agents."
C) "Lung cancer cells have been growing for a long time before detection, so they are less sensitive to antineoplastic agents."
D) "Lung cancer cells have a very erratic cell cycle, so they are not very sensitive to antineoplastic agents."

Accepted Answer

A) Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions. Lung cancer cells may grow for a long time before detection, but this is not the primary reason they are less susceptible to antineoplastic agents. A high-oxygen environment is not the reason why lung cancer cells are less sensitive to antineoplastic agents. Lung cancer cells do not have a very erratic cell cycle.
B) Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions. Lung cancer cells may grow for a long time before detection, but this is not the primary reason they are less susceptible to antineoplastic agents. A high-oxygen environment is not the reason why lung cancer cells are less sensitive to antineoplastic agents. Lung cancer cells do not have a very erratic cell cycle.
C) Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions. Lung cancer cells may grow for a long time before detection, but this is not the primary reason they are less susceptible to antineoplastic agents. A high-oxygen environment is not the reason why lung cancer cells are less sensitive to antineoplastic agents. Lung cancer cells do not have a very erratic cell cycle.
D) Growth fraction is a ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have low growth fractions. Lung cancer cells may grow for a long time before detection, but this is not the primary reason they are less susceptible to antineoplastic agents. A high-oxygen environment is not the reason why lung cancer cells are less sensitive to antineoplastic agents. Lung cancer cells do not have a very erratic cell cycle.

Question 9

A nurse is planning care for a client with leukemia.The nurse chooses "Risk for Bleeding" as the nursing diagnosis.Which interventions support this nursing diagnosis? Select all that apply.
A) Educate client in use of soft toothbrush for oral care.
B) Use non-electric razor when providing grooming for client.
C) Limit parenteral injections.
D) Apply pressure to arterial puncture sites for 5 minutes.
E) Encourage client to deep breathe and huff cough frequently.

Accepted Answer

A) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.
B) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.
C) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.
D) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.
E) The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.

Question 10

A young school-age male child is admitted with newly diagnosed acute lymphocytic leukemia.The multidisciplinary team is meeting to plan care for this child and family.Which statement by the parents should receive priority in the nursing planning process?
A) "His brother is upset about the amount of time we are away from home."
B) "Can we plan a trip out of town sometime this summer?"
C) "We are afraid that he will dislodge his central line at school."
D) "How do we get our parking validated?"

Accepted Answer

A) This is an imminent, potentially life-threatening concern. Financial worries, although a significant concern, would not take precedence over a potentially life-threatening concern. Questions about travel and other family matters should be addressed, but they are not acute issues. The impact of the illness on the client's brother is a realistic concern, but not acute or life-threatening.
B) This is an imminent, potentially life-threatening concern. Financial worries, although a significant concern, would not take precedence over a potentially life-threatening concern. Questions about travel and other family matters should be addressed, but they are not acute issues. The impact of the illness on the client's brother is a realistic concern, but not acute or life-threatening.
C) This is an imminent, potentially life-threatening concern. Financial worries, although a significant concern, would not take precedence over a potentially life-threatening concern. Questions about travel and other family matters should be addressed, but they are not acute issues. The impact of the illness on the client's brother is a realistic concern, but not acute or life-threatening.
D) This is an imminent, potentially life-threatening concern. Financial worries, although a significant concern, would not take precedence over a potentially life-threatening concern. Questions about travel and other family matters should be addressed, but they are not acute issues. The impact of the illness on the client's brother is a realistic concern, but not acute or life-threatening.

Question 11

The nurse is caring for a client in a community clinic who wishes to quit smoking.The client asks the nurse,"If I quit smoking,will my risk of lung cancer be the same as a nonsmoker?" Which is the best response by the nurse?
A) "No one knows for sure what the risk is for someone who quits smoking."
B) "Your risk of lung cancer will be equal to that of a non-smoker."
C) "Your risk of lung cancer will decline if you quit, but it will remain higher than a non-smoker's."
D) "Your risk of lung cancer will never drop because the damage has already been done."

Accepted Answer

A) While the client's risk for lung cancer will diminish sharply upon quitting smoking, it will not drop to the level of someone who never smoked. Another factor when calculating risk is the client's exposure to secondhand smoke, which also increases risk. Although damage has been done, the client's risk will drop dramatically upon quitting smoking. The risk for someone who quits is known to be dramatically less than for someone who continues to smoke.
B) While the client's risk for lung cancer will diminish sharply upon quitting smoking, it will not drop to the level of someone who never smoked. Another factor when calculating risk is the client's exposure to secondhand smoke, which also increases risk. Although damage has been done, the client's risk will drop dramatically upon quitting smoking. The risk for someone who quits is known to be dramatically less than for someone who continues to smoke.
C) While the client's risk for lung cancer will diminish sharply upon quitting smoking, it will not drop to the level of someone who never smoked. Another factor when calculating risk is the client's exposure to secondhand smoke, which also increases risk. Although damage has been done, the client's risk will drop dramatically upon quitting smoking. The risk for someone who quits is known to be dramatically less than for someone who continues to smoke.
D) While the client's risk for lung cancer will diminish sharply upon quitting smoking, it will not drop to the level of someone who never smoked. Another factor when calculating risk is the client's exposure to secondhand smoke, which also increases risk. Although damage has been done, the client's risk will drop dramatically upon quitting smoking. The risk for someone who quits is known to be dramatically less than for someone who continues to smoke.

Question 12

A nurse is caring for a client recovering from a wedge resection of the left lung for a tumor.What would be appropriate goals for the nursing diagnosis of ineffective airway clearance? Select all that apply.
A) Minimize accumulation of fluid.
B) Participation in care by the client
C) Maintain a patent airway.
D) Maintain current weight.
E) Express feelings and concerns.

Accepted Answer

A) All of the outcomes for this client are viable, but appropriate outcomes for the diagnosis of ineffective airway clearance are maintaining a patent airway and minimizing the accumulation of fluid.
B) All of the outcomes for this client are viable, but appropriate outcomes for the diagnosis of ineffective airway clearance are maintaining a patent airway and minimizing the accumulation of fluid.
C) All of the outcomes for this client are viable, but appropriate outcomes for the diagnosis of ineffective airway clearance are maintaining a patent airway and minimizing the accumulation of fluid.
D) All of the outcomes for this client are viable, but appropriate outcomes for the diagnosis of ineffective airway clearance are maintaining a patent airway and minimizing the accumulation of fluid.
E) All of the outcomes for this client are viable, but appropriate outcomes for the diagnosis of ineffective airway clearance are maintaining a patent airway and minimizing the accumulation of fluid.

Question 13

The nurse is teaching a class at a local community center about decreasing risk factors for cancer.Which risk factors should the nurse include in the teaching regarding leukemia? Select all that apply.
A) Alkylating agents
B) Diets low in fat
C) Exposure to infectious agents
D) Bloom syndrome
E) Decreased exercise

Accepted Answer

A) A higher incidence of leukemia associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.
B) A higher incidence of leukemia associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.
C) A higher incidence of leukemia associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.
D) A higher incidence of leukemia associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.
E) A higher incidence of leukemia associated with chromosomal defects such as Bloom syndrome, exposure to infectious agents, and chemical agents used to treat previous cancer, such as alkylating agents. Low-fat diets are not a risk factor for leukemia, and neither is lack of exercise.

Question 14

A pediatric client being treated for acute lymphocytic leukemia (ALL)has a white blood cell count of 1,000/mm3.Which nursing diagnosis would be a priority for this client?
A) Readiness for Enhanced Immunization Status
B) Impaired Gas Exchange
C) Risk for Infection
D) Activity Intolerance

Accepted Answer

A) In leukemia, the WBCs that are present are immature and incapable of fighting infection. The client with a WBC count of 500-1,000/mm3 is considered a moderate risk for infection. The client may or may not have activity intolerance, but it is not the priority nursing diagnosis. Impaired gas exchange is not evident in this client. Children with cancer would not be receiving immunizations during treatment.
B) In leukemia, the WBCs that are present are immature and incapable of fighting infection. The client with a WBC count of 500-1,000/mm3 is considered a moderate risk for infection. The client may or may not have activity intolerance, but it is not the priority nursing diagnosis. Impaired gas exchange is not evident in this client. Children with cancer would not be receiving immunizations during treatment.
C) In leukemia, the WBCs that are present are immature and incapable of fighting infection. The client with a WBC count of 500-1,000/mm3 is considered a moderate risk for infection. The client may or may not have activity intolerance, but it is not the priority nursing diagnosis. Impaired gas exchange is not evident in this client. Children with cancer would not be receiving immunizations during treatment.
D) In leukemia, the WBCs that are present are immature and incapable of fighting infection. The client with a WBC count of 500-1,000/mm3 is considered a moderate risk for infection. The client may or may not have activity intolerance, but it is not the priority nursing diagnosis. Impaired gas exchange is not evident in this client. Children with cancer would not be receiving immunizations during treatment.

Question 15

A child has recently been diagnosed with leukemia.The client's sibling is 6 years old and expressing feelings of anger and guilt.This reaction by the sibling is very upsetting to the parents.How should the nurse explain the sibling's behavior?
A) "This behavior is abnormal. I will have the physician refer you to a psychologist."
B) "This behavior is just the sibling's way to get attention."
C) "This is a normal response. Your other child is also affected by the diagnosis and anger and guilt are expected feelings for a 6-year-old."
D) "Your other child should not be so upset. The cancer is easily treated."

Accepted Answer

A) A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal. Although the sibling may want attention, this is not the best response by the nurse.
B) A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal. Although the sibling may want attention, this is not the best response by the nurse.
C) A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal. Although the sibling may want attention, this is not the best response by the nurse.
D) A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal. Although the sibling may want attention, this is not the best response by the nurse.

Question 16

The nurse is planning care to address ineffective airway clearance for a client with lung cancer.Which interventions should the nurse include in the client's plan of care? Select all that apply.
A) Increase fluid intake to 3000 mL per day.
B) Turn, cough, and deep breathe every 2 hours.
C) Chest percussion every 8 hours
D) Smoking cessation education
E) Administer pneumococcal vaccine.

Accepted Answer

A) An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.
B) An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.
C) An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.
D) An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.
E) An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.

Question 17

A male Hispanic client has had a lung biopsy.The results indicate a poor prognosis for the client.The family is at the client's bedside and begins to moan and cry loudly.The health care provider has told the nurse that he needs to have the consent form signed for surgery.The client has asked the nurse to allow the family private time.What should the nurse do at this time?
A) Ask the family to come back later.
B) Have the doctor get the consent with the family present.
C) Provide the client and family privacy.
D) Take the client to another room.

Accepted Answer

A) As the client advocate, the nurse would allow this family to bond according to their customs. Asking the family to leave may cause extreme stress to the client and family. It would not be appropriate for the doctor to try to explain the surgery while the family is grieving. Taking the client to another room would deprive the client from participating in his family's customs.
B) As the client advocate, the nurse would allow this family to bond according to their customs. Asking the family to leave may cause extreme stress to the client and family. It would not be appropriate for the doctor to try to explain the surgery while the family is grieving. Taking the client to another room would deprive the client from participating in his family's customs.
C) As the client advocate, the nurse would allow this family to bond according to their customs. Asking the family to leave may cause extreme stress to the client and family. It would not be appropriate for the doctor to try to explain the surgery while the family is grieving. Taking the client to another room would deprive the client from participating in his family's customs.
D) As the client advocate, the nurse would allow this family to bond according to their customs. Asking the family to leave may cause extreme stress to the client and family. It would not be appropriate for the doctor to try to explain the surgery while the family is grieving. Taking the client to another room would deprive the client from participating in his family's customs.

Question 18

The nurse is caring for a client who is undergoing diagnostic tests to rule out lung cancer.The client asks the nurse why a computed tomography (CT)scan was ordered.What is the best response by the nurse?
A) "The doctor prefers this test."
B) "To rule out the possibility that your problems are caused by pneumonia."
C) "It is more specific in diagnosing your condition."
D) "Why are you concerned about this test?"

Accepted Answer

A) Computed tomography (CT) is used to evaluate and localize tumors, particularly tumors in the lung parenchyma and pleura. It also is done before needle biopsy to localize the tumor. In addition, CT scanning can detect distant tumor metastasis and evaluate tumor response to treatment. A chest x-ray can be used to diagnose pneumonia. The client's question is valid and should not be minimized by asking why the client is having concerns about the test.
B) Computed tomography (CT) is used to evaluate and localize tumors, particularly tumors in the lung parenchyma and pleura. It also is done before needle biopsy to localize the tumor. In addition, CT scanning can detect distant tumor metastasis and evaluate tumor response to treatment. A chest x-ray can be used to diagnose pneumonia. The client's question is valid and should not be minimized by asking why the client is having concerns about the test.
C) Computed tomography (CT) is used to evaluate and localize tumors, particularly tumors in the lung parenchyma and pleura. It also is done before needle biopsy to localize the tumor. In addition, CT scanning can detect distant tumor metastasis and evaluate tumor response to treatment. A chest x-ray can be used to diagnose pneumonia. The client's question is valid and should not be minimized by asking why the client is having concerns about the test.
D) Computed tomography (CT) is used to evaluate and localize tumors, particularly tumors in the lung parenchyma and pleura. It also is done before needle biopsy to localize the tumor. In addition, CT scanning can detect distant tumor metastasis and evaluate tumor response to treatment. A chest x-ray can be used to diagnose pneumonia. The client's question is valid and should not be minimized by asking why the client is having concerns about the test.

Question 19

The nurse is assisting the healthcare provider with a bone marrow aspiration and biopsy on a client who has leukemia.The client also has thrombocytopenia.Upon completing of the test,which intervention is a priority for the nurse?
A) Dispose of the equipment used, and clean the area properly.
B) Label and refrigerate the specimen obtained by the physician.
C) Hold pressure on the wound for approximately 5 minutes.
D) Make certain the client understands the purpose of the test.

Accepted Answer

A) The most important task for the nurse is to prevent bleeding after the biopsy. Holding pressure on the wound for 5 minutes is effective. Dealing with the specimen is accomplished by a third party or after the nurse stabilizes the client. An explanation of the test is performed before the procedure is begun. Cleaning the area is completed after the client is stable and the specimen is sent to the laboratory.
B) The most important task for the nurse is to prevent bleeding after the biopsy. Holding pressure on the wound for 5 minutes is effective. Dealing with the specimen is accomplished by a third party or after the nurse stabilizes the client. An explanation of the test is performed before the procedure is begun. Cleaning the area is completed after the client is stable and the specimen is sent to the laboratory.
C) The most important task for the nurse is to prevent bleeding after the biopsy. Holding pressure on the wound for 5 minutes is effective. Dealing with the specimen is accomplished by a third party or after the nurse stabilizes the client. An explanation of the test is performed before the procedure is begun. Cleaning the area is completed after the client is stable and the specimen is sent to the laboratory.
D) The most important task for the nurse is to prevent bleeding after the biopsy. Holding pressure on the wound for 5 minutes is effective. Dealing with the specimen is accomplished by a third party or after the nurse stabilizes the client. An explanation of the test is performed before the procedure is begun. Cleaning the area is completed after the client is stable and the specimen is sent to the laboratory.

Question 20

The nurse is planning care for a client with acute myeloid leukemia (AML).Which diagnoses are priorities for this client to minimize the risk of complications associated with AML? Select all that apply.
A) Risk for Infection
B) Ineffective Thermoregulation
C) Imbalanced Nutrition
D) Fluid Volume Excess
E) Risk for Ineffective Protection (Bleeding)

Accepted Answer

A) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks include caution when moving or assisting the client to move, as well as strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary needs are not increased with AML. Restriction of fluids and salt are not needed. The client with AML does not have a problem with fluid shifts or edema that would require these restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of CML, not AML. CML has heat intolerance due to hypermetabolism state present with the condition.
B) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks include caution when moving or assisting the client to move, as well as strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary needs are not increased with AML. Restriction of fluids and salt are not needed. The client with AML does not have a problem with fluid shifts or edema that would require these restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of CML, not AML. CML has heat intolerance due to hypermetabolism state present with the condition.
C) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks include caution when moving or assisting the client to move, as well as strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary needs are not increased with AML. Restriction of fluids and salt are not needed. The client with AML does not have a problem with fluid shifts or edema that would require these restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of CML, not AML. CML has heat intolerance due to hypermetabolism state present with the condition.
D) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks include caution when moving or assisting the client to move, as well as strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary needs are not increased with AML. Restriction of fluids and salt are not needed. The client with AML does not have a problem with fluid shifts or edema that would require these restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of CML, not AML. CML has heat intolerance due to hypermetabolism state present with the condition.
E) AML results in neutropenia (decreased neutrophils = risk of infection) and thrombocytopenia (decreased platelets, which leads to increased risk of bleeding). Therefore, actions to minimize these risks include caution when moving or assisting the client to move, as well as strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary needs are not increased with AML. Restriction of fluids and salt are not needed. The client with AML does not have a problem with fluid shifts or edema that would require these restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of CML, not AML. CML has heat intolerance due to hypermetabolism state present with the condition.

Quiz 2: Cellular Regulation

A nurse working in the pediatric intensive care unit (PICU) is caring for a child with leukemia.What is the most common type of leukemia in children?

The nurse is caring for a client with leukemia who is experiencing neutropenia as a result of chemotherapy.Which action should the nurse include in the plan of care for this client?

The nurse is caring for a client who has just been diagnosed with chronic myeloid leukemia (CML) .The client and the nurse are discussing the anticipatory grieving process.Which action by the nurse would be inappropriate at this time?

The nurse is caring for a school-aged child who had a bone marrow transplant for the treatment of leukemia several weeks ago.The child requires protective isolation.Which statement by the child's family indicates understanding of this type of isolation?

A pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL) .When providing education to the child's parents regarding this disease,which topics should the nurse include? Select all that apply.

A nurse is caring for a client with chronic myeloid leukemia (CML) who is neutropenic.Which interventions will the nurse implement to ensure this client's safety? Select all that apply.

The student nurse is questioning the instructor about the different types of chemotherapeutic agents used to treat cancer.Which statement by the instructor best explains why lung cancers are less sensitive to antineoplastic agents than other types of cancers?

A nurse is planning care for a client with leukemia.The nurse chooses "Risk for Bleeding" as the nursing diagnosis.Which interventions support this nursing diagnosis? Select all that apply.

A young school-age male child is admitted with newly diagnosed acute lymphocytic leukemia.The multidisciplinary team is meeting to plan care for this child and family.Which statement by the parents should receive priority in the nursing planning process?

The nurse is caring for a client in a community clinic who wishes to quit smoking.The client asks the nurse,"If I quit smoking,will my risk of lung cancer be the same as a nonsmoker?" Which is the best response by the nurse?

A nurse is caring for a client recovering from a wedge resection of the left lung for a tumor.What would be appropriate goals for the nursing diagnosis of ineffective airway clearance? Select all that apply.

The nurse is teaching a class at a local community center about decreasing risk factors for cancer.Which risk factors should the nurse include in the teaching regarding leukemia? Select all that apply.

A pediatric client being treated for acute lymphocytic leukemia (ALL) has a white blood cell count of 1,000/mm3.Which nursing diagnosis would be a priority for this client?

A child has recently been diagnosed with leukemia.The client's sibling is 6 years old and expressing feelings of anger and guilt.This reaction by the sibling is very upsetting to the parents.How should the nurse explain the sibling's behavior?

The nurse is planning care to address ineffective airway clearance for a client with lung cancer.Which interventions should the nurse include in the client's plan of care? Select all that apply.

The nurse is caring for a client who is undergoing diagnostic tests to rule out lung cancer.The client asks the nurse why a computed tomography (CT) scan was ordered.What is the best response by the nurse?

The nurse is assisting the healthcare provider with a bone marrow aspiration and biopsy on a client who has leukemia.The client also has thrombocytopenia.Upon completing of the test,which intervention is a priority for the nurse?

The nurse is planning care for a client with acute myeloid leukemia (AML) .Which diagnoses are priorities for this client to minimize the risk of complications associated with AML? Select all that apply.