A
A patient with lung cancer develops headaches; facial edema; periorbital edema; and distention of the veins in the head, neck, and chest. Which item will the nurse expect to be included in the patient's collaborative treatment plan? Select all that apply. One, some, or all responses may be correct.
Prepare the patient for radiation therapy.
Administer a narcotic and reassure the patient.
Administer a diuretic agent and reassure the patient.
Inform the patient that chemotherapy may be required.
Inform the patient that the symptoms are due to obstruction of a bronchus.
When a lung cancer patient presents with headaches; facial edema; periorbital edema; and distension of veins of the head, neck, and chest, it is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency; hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus.
The laboratory reports of a patient who is undergoing aggressive chemotherapy for cancer show increased blood levels of uric acid. Which interpretation would the nurse make from this finding?
Cardiac tamponade
Carotid artery rupture
Tumor lysis syndrome
Superior vena cava syndrome
Tumor lysis syndrome is caused by the destruction of cells due to chemotherapy. As cells are destroyed, intracellular components (potassium, phosphate, DNA, RNA) are metabolized to uric acid by the liver. Cardiac tamponade is a complication associated with an increase of fluid in the pericardial space. Carotid artery rupture is an infiltrative emergency that results in the blowout of blood from the ruptured artery. Superior vena cava syndrome involves an obstruction of the superior vena cava due to thrombosis.
Which complication of cancer treatment does the nurse suspect based on the following assessment findings?
Na 130 mEq/L; weight gain; Nausea; 1+ reflexes
Hypercalcemia
Third space syndrome
Superior vena cava syndrome
Syndrome of inappropriate antidiuretic hormone secretion
Syndrome of inappropriate antidiuretic hormone secretion resulting from a tumor causes the overproduction of antidiuretic hormone and manifests with water retention, hyponatremia, weight gain, oliguria, nausea, and decreased reflexes. Hypercalcemia from bone cancer or parathyroid malfunction results in a serum calcium higher than 12 mg/dL along with depression, fatigue, and muscle weakness. Third space syndrome results from the shifting of fluid from the vascular space to interstitial space, causing hypotension, tachycardia, low central venous pressure, and decreased urine output. Superior vena cava syndrome causes facial edema, periorbital edema, jugular venous distention, headache, and seizures from obstruction of the vena cava by tumor or thrombus.
A patient with breast cancer has tender vertebrae and intense back pain that gets worse with the Valsalva maneuver. Which complication would the nurse suspect?
Third space syndrome
Tumor lysis syndrome
Spinal cord compression
Superior vena cava syndrome
A patient with breast cancer who has tender vertebrae and intense back pain that gets worse with the Valsalva maneuver probably has spinal cord compression. Third space syndrome is an obstructive emergency that manifests as low central venous pressure, hypovolemia, and tachycardia. Tumor lysis syndrome is a metabolic complication associated with cell destruction after chemotherapy, resulting in hyperuricemia. Superior vena cava syndrome is an obstructive complication associated with thrombosis that manifests with facial and periorbital edema.
When a patient with Hodgkin lymphoma has mediastinal node involvement, the nurse will monitor for which complication?
Paraplegia
Liver dysfunction
Renal dysfunction
Superior vena cava syndrome
Enlarged intrathoracic lymph nodes may place pressure on the superior vena cava and cause superior vena cava syndrome. Paraplegia may occur with compression of the lower spinal cord by enlarged nodes. Liver dysfunction may occur with spread to the liver, which would occur more commonly with lymph node involvement below the diaphragm. Renal dysfunction can occur if enlarged nodes place pressure on urinary tract structures.
The nurse is caring for a patient diagnosed with superior vena cava syndrome. Which clinical manifestation would the nurse expect to find? Select all that apply. One, some, or all responses may be correct.
SeizuresCorrect answer
Periorbital edema
Reports of headache
Distention of head and neck veins
Bruit over bilateral carotid arteries
Clinical manifestations of superior vena cava syndrome are seizures; facial edema; periorbital edema; headache; distention of veins of head, neck, and chest; and a mediastinal mass observed on chest x-ray. A bruit is not a diagnostic related to this syndrome.
The nurse is assessing a patient who has prostate cancer with spinal cord compression. Which finding would indicate development of autonomic dysfunction?
Facial edema
Impaired bladder function
Distention of veins of the neck
Reduced central venous pressure
Damage to the spinal column can alter the function of the autonomic nervous system, causing impaired bladder function. Facial edema and distention of veins of the neck are manifestations of thrombosis or superior vena cava syndrome. Third space syndrome is a complication associated with visceral fluids that leads to a decreased central venous pressure.
When positron emission tomography (PET) for a patient with Hodgkin lymphoma shows enlarged mediastinal lymph nodes, the nurse will plan to assess for which complication?
Bone pain
Paraplegia
Renal failure
Superior vena cava syndrome
Enlarged mediastinal lymph nodes can lead to compression of the superior vena cava; the nurse will assess for neck vein distension, facial and upper extremity swelling, cough, and dyspnea. Bone pain may occur with Hodgkin lymphoma but is not necessarily associated with mediastinal node enlargement. Paraplegia may occur with spinal cord compression but would occur with nodal enlargement below the diaphragm. Renal failure may occur with hypercalcemia secondary to bone involvement but would not be typically associated with mediastinal lymphadenopathy.
A cancer patient has tumor lysis syndrome. For which other condition would the nurse monitor?
Acute kidney injury
Cardiac arrest
Venous thrombosis
Rheumatoid arthritis
Tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly due to chemotherapy. This cellular destruction is characterized by a rapid development of hyperuricemia and hyperphosphatemia, and can lead to acute kidney injury. Cardiac arrest and rheumatoid arthritis are not common complications with tumor lysis syndrome. Venous thrombosis would occur with a patient who has a tumor in the superior vena cava.
Which intervention would the nurse include in the discharge teaching for a patient with neutropenia? Select all that apply. One, some, or all responses may be correct.
Encourage the patient to eat raw eggs.
Encourage the patient to wash hands frequently.
Encourage the patient to frequent crowded areas.
Advise the patient to brush the teeth four times a day with a soft toothbrush.
Advise the patient to notify the health care provider if a fever develops.
Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the health care provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections and should be avoided.
A patient with cancer has neutropenia and a body temperature of 100.4°F (38°C). Which action would the nurse take?
Initiate parenteral fluids.
Give aspirin to the patient.
Administer pamidronate to the patient.
Notify the health care provider.
A patient with cancer who has neutropenia (low white blood cell count) is vulnerable to infection. A body temperature of 100.4°F (38°C) indicates hyperthermia. The nurse should immediately notify the health care provider in this situation. Hydration therapy with parenteral fluids will treat hypocalcemia, which is a complication of cancer and may cause nephrocalcinosis. Aspirin can reduce hyperthermia; however, it is not preferable for a patient with a low white blood cell count. Pamidronate is a bisphosphonate that inhibits serum calcium levels and helps to treat hypercalcemia effectively.
A patient undergoing chemotherapy has a low white blood cell (WBC) count. Which intervention would the nurse anticipate?
Monitor the respiratory rate of the patient.
Administer WBC growth factors.
Request that the chemotherapy dose be reduced.
Allow the patient to visit with family and friends.
Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low WBC counts. Low WBC count makes the patient prone to developing infections; therefore the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC. The chemotherapy dose need not be reduced because neutropenia is a common side effect. The number of visitors should be limited to prevent risk of infection.
Which teaching would the nurse provide to a patient with neutropenia secondary to chemotherapy treatments to reduce complications? Select all that apply. One, some, or all responses may be correct.
Can perform light gardening
Take temperature as directed by health care provider (HCP)
Use alcohol-based mouthwash
Avoid uncooked meats and eggs
Refrain from cleaning up after pets
A patient who is neutropenic is at high risk for infection. Therefore the nurse would instruct the patient to take their temperature as directed by their HCP and report fever >100.4°F. The patient should also avoid uncooked meats and eggs and refrain from cleaning up after their pets. Light gardening should be avoided as this can increase the risk for soil-based pathogens. Alcohol-based mouthwashes should be avoided in patients with stomatitis and neutropenia.
Which laboratory finding supports the nurse’s conclusion that a patient has an increased risk of infection?
Anemia
Neutropenia
Hyperkalemia
Hyponatremia
Neutropenia, or a decreased white blood cell count, indicates that the patient is at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has an increased risk of infection. Hyperkalemia and hyponatremia do not indicate a risk of infection.
The nurse and a student nurse are discussing a patient's complete blood count (CBC), which shows red blood cells (RBCs) 1.8 million6/uL, white blood cells (WBCs) 2,000/uL, and platelets 90,000/uL. Which response by the student indicates an understanding of the results?
"The laboratory results indicate leukopenia."
"The laboratory results indicate neutropenia."
"The laboratory results indicate pancytopenia."
"The laboratory results indicate thrombocytopenia."
The patient's complete blood count is suppressed. There is a marked decrease in the number of RBCs, WBCs, and platelets. This condition is called pancytopenia. Leukopenia is a condition in which the WBC count is less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. Thrombocytopenia is a condition in which platelet counts falls below 100,000/µL.
Which strategy is most important for a nurse to include when planning care for a patient who has neutropenia?
Restricting all visitors
Placing the patient in a private room
Advising the patient to use only an electric shaver
Wearing a gown and gloves when in direct contact with the patient
Neutropenia is the reduction in the number of neutrophils in the blood. This leaves a patient prone to infection. The risk of infection can be reduced by placing a patient in a private room. Restriction of all visitors is not necessary; however, visitors with signs and symptoms of infections, such as a cough or fever, should be restricted. Use of an electric shaver would be recommended for a patient taking anticoagulants but is not required for this condition. Wearing a gown and gloves when in direct contact with the patient is not necessary; however, meticulous hand hygiene is a must. If the patient is in protective isolation, a mask will need to be worn.
Which laboratory finding would reflect the presence of neutropenia in a patient undergoing treatment every three weeks with combination chemotherapy for breast cancer?
Hemoglobin 12.1 g/dL
Red blood cell (RBC) 4.2 cells/mm3
Platelet count 80,000 cells/mm3
White blood cell (WBC) 2.1 cells/mm3
Neutropenia is a decrease in the total WBC, which places the patient at risk for infection. A WBC 2.1 cells/mm3 indicates the patient is neutropenic. A hemoglobin 12.1 g/dL and an RBC 4.2 cells/mm3 reflect anemia. A platelet count of 80,000 cells/mm3 indicates thrombocytopenia.
After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?
Palpate lymph nodes for swelling.
Check temperature for elevation.
Inspect skin for bruising or petechiae.
Examine oral mucosa for ulceration.
ince thrombocytopenia increases the risk for bleeding, the nurse will inspect the skin for bruises or petechiae. Lymphadenopathy is a common symptom of some leukemias but does not cause thrombocytopenia. Although patients with leukemia do have an increased risk for infection and fever, a low platelet count would not cause fever. Ulcers of the oral mucosa can occur due to poor immune function in leukemia but are not caused by thrombocytopenia.
Which symptom is a clinical manifestation of sepsis?
Infection
Hypoglycemia
Normal body temperature
Systolic blood pressure (BP) of 100 mm Hg or higher
One clinical manifestation of sepsis is infection. Hypoglycemia, normal body temperature, and a systolic BP of 100 mm Hg or higher are not associated with sepsis. Rather, the nurse would expect hyperglycemia, fever, and hypotension as clinical manifestations of sepsis.
Which question would the nurse ask to determine the presence of bleeding in a patient suspected of having disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct.
"Do you get frequent headaches?"
"Has your appetite or weight changed?"
"Have you noticed changes in vision or dizziness?"
"Have you noticed changes in your urine or stools?"
"Are you experiencing breathing that is faster than normal?"
The patient with suspected DIC shows bleeding manifestations due to depletion of platelets and coagulation factors. Neurologic manifestations include headaches, changes in vision, and dizziness. Renal manifestations associated with this disorder include hematuria. Therefore the nurse should ask the patient questions regarding the occurrence of frequent headaches, changes in vision or dizziness, and changes in urine or stools. Tachypnea is a manifestation associated with DIC; the nurse should ask the patient about this symptom. The patient with DIC does not necessarily have changes in appetite or weight.
Which information would the nurse include when preparing to discuss the etiology and pathophysiology of disseminated intravascular coagulation (DIC)?
DIC is due to the depletion of hemolytic factors.
The coagulation pathway is overstimulated.
The coagulation pathway is genetically altered.
DIC is a secondary disease of clotting and hemorrhage.
DIC is an abnormal response of the normal clotting cascade stimulated by a disease process or disorder. It is a disorder in which the underlying disease depletes clotting factors in blood. DIC is a disorder in which tissue factor released at the site of injury leads to overstimulation of the coagulation process in the vasculature. The coagulation pathway is not genetically altered in DIC.
A patient with breast cancer has a fluid shift from the vascular space to the interstitial space. Which symptom would the nurse associate with the patient’s condition? Select all that apply. One, some, or all responses may be correct.
Bradycardia
Hypovolemia
Hypertension
Decreased urine output
Low central venous pressure
A shift of fluid from the vascular space to the interstitial space indicates third space syndrome. Because of this fluid imbalance, the patient may have hypovolemia, low urine output, and low central venous pressure. Hypovolemia is a condition caused by a serious decrease of fluid in the body. Urine output will decrease because of low fluids in the body. Central venous pressure is also reduced due to hypovolemia. Bradycardia and hypertension are not associated with third space syndrome.
A patient with advanced metastatic lung cancer experiences fatigue, weakness, nausea, and vomiting. The patient's blood report shows a high level of calcium in the blood. In which way would the nurse interpret this information?
The patient has cardiac tamponade.
The patient has a metabolic emergency.
The patient has third space syndrome.
The patient has spinal cord compression syndrome.
Advanced cancers may result in metastasis to the bones and cause increased levels of calcium in the blood. This may manifest as apathy, depression, fatigue, muscle weakness, electrocardiogram changes, polyuria and nocturia, anorexia, nausea, and vomiting. If untreated, these may result in nephrocalcinosis and irreversible renal failure. Cardiac tamponade manifests in a heavy feeling over the chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased level of consciousness, distant or muted heart sounds, and extreme anxiety. Third space syndrome manifests as low blood pressure, increased heart rate, low central venous pressure, and decreased urine output. Spinal cord compression syndrome manifests as intense, localized, and persistent back pain. The pain may be accompanied by vertebral tenderness
A nurse is caring for a patient with cancer of the neck. While assessing the patient, the nurse notices bleeding in the cancerous area. Which nursing action is a priority?
Start IV fluids.
Apply pressure on the site.
Inform the health care provider.
Obtain a prescription for a blood transfusion.
Carotid artery rupture is a common complication in cancers of the head and neck. The artery can rupture due to invasion of the blood vessel wall by the tumor. It can also be caused by erosion of the arterial wall following surgery or radiation therapy. In the case of bleeding at or near the carotid artery, the nurse should immediately apply pressure on the site to stop bleeding. IV fluids should be administered to maintain the intravascular volume; however, this intervention is not the priority. The health care provider should be informed after pressure is applied to the site of the bleeding. A blood transfusion may be necessary; however, it is not a priority.
Which cue would be noted in a patient experiencing cardiac tamponade?
Muffled heart sounds
Decreased hemoglobin
Asymmetric chest movement
Hyperresonance to percussion
A patient with cardiac tamponade will present with muffled, distant heart sounds due to constriction of the myocardium in the pericardial sac. Blood loss and a decreased hemoglobin would be noted in a patient with a hemothorax. A flail chest would cause asymmetric chest movement due to floating ribs. A pneumothorax would present with hyperresonance to percussion due to air in the pleural space.