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RN ONCOLOGY A RELIAS A LATEST ACTUAL EXAM
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RN ONCOLOGY A RELIAS A LATEST ACTUAL EXAM
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RN ONCOLOGY A RELIAS A LATEST ACTUAL EXAMThe 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."
"I'm going to take aspirin for my headache as soon as I get home."
"I will count the number of pads and tampons I use when menstruating." - ANSWER:
During the period of greatest bone marrow suppression (the nadir), the platelet
count may be low, less than 20,000 cells/mm3. The correct option describes an
incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs
and products that contain aspirin should be avoided because of their antiplatelet
activity. Options 1, 2, and 4 are correct statements by the client to prevent and
monitor bleeding.
A client is diagnosed as having a bowel tumor. The nurse should monitor the client
for which complications of this type of tumor? Select all that apply.
Flatulence
Peritonitis
Hemorrhage
Fistula formation
Bowel perforation
Lactose intolerance - ANSWER: Complications of bowel tumors include bowel
perforation, which can result in hemorrhage and peritonitis. Other complications
include bowel obstruction, and fistula formation. Flatulence can occur but is not a
complication; lactose intolerance also is not a complication of intestinal tumor.
The nurse is caring for a client following a mastectomy. Which nursing intervention
would assist in preventing lymphedema of the affected arm?
Placing cool compresses on the affected arm
Elevating the affected arm on a pillow above heart level
Avoiding arm exercises in the immediate postoperative period
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