BSN 2 - B8

NUR 145 – LECTURE

SESSION 31

1. The client diagnosed with leukemia has central nervous system involvement. Which instructions should the
nurse teach?

A. Sleep with the head of the bed elevated to prevent increased intracranial pressure.
B. Take an analgesic medication for pain only when the pain becomes severe.
C. Explain that radiation therapy to the head may result in permanent hair loss.
D. Discuss end-of-life decisions prior to cognitive deterioration.
ANSWER: C
RATIO: Radiation therapy to the head and scalp area is the treatment of choice for central nervous system
involvement of any cancer. Radiation therapy has longer lasting side effects than chemotherapy. If the radiation
therapy destroys the hair follicles, the hair will not grow back

2. The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse
notes that the platelet count is 20,000/ul. Based on the laboratory result, which intervention will the nurse
document in the plan of care?

A. Monitor closely for signs of infection

B. Monitor the temperature every 4hours
C. Initiate protective isolation precautions
D. Use soft small toothbrush for mouth care
ANSWER: D
RATIO: If a child is severely thrombocytopenic and has a platelet count less than 20,000/ul, bleeding
precautions need to be initiated because of increased risk of bleeding or hemorrhage. Options A ,B, C are
related to the prevention of infection rather than bleeding.

3. What nursing diagnosis is seen with acute lymphocytic leukemia and thrombocytopenia?

A. potential for injury

B. self-care deficit
C. potential for self-harm
D. alteration in comfort
ANSWER: A
RATIO: Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave with an
electric razor, use soft toothbrush, avoid SQ or IM meds and invasive procedures (urinary drainage catheter or a
nasogastric tube), side-rails up, remove sharp objects, frequently assess for signs of bleeding, bruising,
hemorrhage. "

4. Which of the following manifestations would be directly associated with Hodgkin's disease?

A. bone pain
B. generalized edema
C. petechiae and purpura
D. painless, enlarged lymph nodes
ANSWER: D
RATIO: Hodgkin's disease usually presents as painless enlarged lymph nodes. The diagnosis is made by lymph
node biopsy."

5. When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to:

A. Discourage the use of stool softeners

B. Assess temperature readings every six hours
C. Avoid invasive procedures
D. Encourage the use of a hard, brittle toothbrush
ANSWER: C
RATIO: Thrombocytopenia is a deficiency of platelets, and leaves the patient more prone to hemorrhage. For
this reason, avoiding invasive procedures will limit the risk of hemorrhage. Stool softeners should be
encouraged, while hard brittle toothbrushes should be avoided. Temperature is not the most important vital to
track in this patient"
6. Which statement is correct about the rate of cell growth in relation to chemotherapy?

A. Faster growing cells are less susceptible to chemotherapy.

B. Nondividing cells are more susceptible to chemotherapy.
C. Faster growing cells are more susceptible to chemotherapy.
D. Slower growing cells are more susceptible to chemotherapy.
ANSWER: C
RATIO: The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-
growing and nondividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used
to destroy nondividing cells as the begin active cell division."

7. An 18-year-old male with Hodgkin’s Lymphoma and engaged. Which of the following diagnoses would be a
priority for this client?

A. Fatigue related to chemotherapy

B. Sexual dysfunction related to radiation therapy
C. Tissue integrity related to prolonged bed rest
D. Anticipatory grieving related to terminal illness
ANSWER: B
RATIO: Radiation therapy often causes sterility in male clients and would be of primary importance to this
client. The psychosocial needs of the client are important to address in light of the age and life choices.
Hodgkin's disease, however, has a good prognosis when diagnosed early. Answers A, C, and D are incorrect
because they are of lesser priority

8. An 18-year-old female client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease.
Which assessment findings would the nurse expect to note specifically in the client?

A. Weakness
B. Enlarged lymph nodes
C. Fatigue
D. Weight gain
ANSWER: B
RATIO: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the
painless enlargement of lymph nodes with progression to extra lymphatic sites, such as the spleen and liver.

9. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin's disease. Which of the
following symptoms is typical of Hodgkin's disease?

A. Night sweats and fatigue

B. Weight gain
C. Nausea and vomiting
D. Painful cervical lymph nodes
ANSWER: A
RATIO: Night sweats and fatigue are the only correct symptoms of Hodkin’s disease. This occurs because the
lymphoma cells produce certain chemicals that can increase a person's body temperature.

10. You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation
for a client with Hodgkin's lymphoma who is receiving radiation to the groin area. Which nursing activity is
best delegated to a nursing assistant caring for the client?

A. Apply alcohol-free lotion to the area after cleaning.

B. Explain good skin care to the client and family.
C. Clean the skin over daily with a mild soap.
D. Check the skin for signs of redness or peeling.
ANSWER: C
RATIO: Skin care is included in nursing assistant education and job description. Assessment and client teaching
are more complex tasks that should be delegated to registered nurses. Use of lotions to the irradiated area is
usually avoided during radiation therapy.