Nokea
The client is admitted with a diagnosis of colon cancer. Which finding in the client’s admission information should prompt the nurse to consider that the cancer may be located in the client’s descending colon?
- A. Pain in the lower abdomen
- B. Change in bowel habits
- C. Bright red blood in the stool
- D. Nausea and vomiting
Correct Answer: C
Rationale: A. Pain may be a symptom of a tumor located on the left side of the colon, but it is not exclusive and could be a symptom of a tumor elsewhere in the colon. B. Change of bowel habits may be a symptom of a tumor located on the left side of the colon, but this is not exclusive and could be a symptom of a tumor elsewhere in the colon. C. Bright red blood in the stool is a sign or symptom of a colorectal tumor located in the descending colon. D. Nausea and vomiting are not symptoms specific to colon cancer.
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The client is diagnosed with polycythemia vera. The nurse would prepare to perform which intervention?
- A. Type and crossmatch for a transfusion.
- B. Assess for petechiae and purpura.
- C. Perform phlebotomy of 500 mL of blood.
- D. Monitor for low hemoglobin and hematocrit.
Correct Answer: C
Rationale: Polycythemia vera requires phlebotomy (C) to reduce blood viscosity. Transfusions (A) worsen hyperviscosity, petechiae (B) are for thrombocytopenia, and Hb/Hct (D) are elevated.
The client with a primary diagnosis of liver cancer with metastases to the lung is hospitalized with severe dyspnea. The nurse is preparing the client for radiation of the upper chest. Which nursing conclusion about the purpose of radiation therapy for this client is correct?
- A. Radiation therapy is used to cure and control liver cancer.
- B. Radiation therapy is used to prevent future cancer development.
- C. Radiation therapy is used to cure and control lung cancer.
- D. Radiation therapy is used to prevent or relieve distressing symptoms.
Correct Answer: D
Rationale: A. Radiation of the upper chest would have no effect on the liver located in the abdominal cavity. B. Preventing future cancer development is not the intention of radiation therapy for this client. C. Radiation therapy reduces size of tumors but would not be expected to cure cancer in this client. D. Primary liver tumors commonly metastasize to the lung, which can cause obstructive symptoms. In this client, radiation therapy to the lung would be used as a palliative care modality to help relieve distressing symptoms such as dyspnea.
The client is diagnosed with severe iron-deficiency anemia. Which statement is the scientific rationale regarding oral replacement therapy?
- A. Iron supplements are well tolerated without side effects.
- B. There is no benefit from oral preparations; the best route is IV.
- C. Oral iron preparations cause diarrhea if not taken with food.
- D. Very little of the iron supplement will be absorbed by the body.
Correct Answer: D
Rationale: Oral iron has low absorption (D), requiring high doses. Side effects (A) include GI upset, IV (B) is for severe cases, and diarrhea (C) is not primary (constipation is common).
A client who receives a diagnosis of pernicious anemia asks why she must receive vitamin shots. What is the best answer for the nurse to give?
- A. Shots work faster than pills.'
- B. Your body cannot absorb vitamin B12 from foods.'
- C. Vitamins are necessary to make the blood cells.'
- D. You can get more vitamins in a shot than a pill.'
Correct Answer: B
Rationale: In pernicious anemia, the lack of intrinsic factor prevents absorption of vitamin B12 from foods, necessitating injections.
The client diagnosed with acute myeloid leukemia receives a bone marrow transplant. Which medication to prevent graft-versus-host disease (GVHD) should the nurse plan to administer?
- A. A cephalosporin antibiotic, such as ceftazidime
- B. An immunosuppressant, such as cyclosporine
- C. A chemotherapeutic agent, such as cisplatin
- D. Peginterferon alfa-2a for prevention and treatment of hepatitis
Correct Answer: B
Rationale: A. Antibiotics such as ceftazidime (Fortaz) are administered to prevent infection. B. GVHD occurs when the T lymphocytes proliferate from the transplanted donor marrow and mount an immune response against the recipient’s tissues. An immunosuppressant such as cyclosporine (Neoral) prevents the immune response. C. Cisplatin (Platinol AQ) is administered mainly to treat metastatic testicular, ovarian, and cervical carcinoma; advanced bladder cancer; and head and neck cancer. D. Interferons such as peginterferon alfa-2a (Pegasys) have antiviral activity, which decrease the progression of hepatic damage associated with hepatitis A and B. This would only be administered if the transplanted cells transmitted the disease. The biological agent interferon is used to treat follicular low-grade lymphomas.