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A client receiving chemotherapy has a white blood cell count of
1000/mm3 (1
× 109/L). What actions by the nurse are most appropriate? (Select all
that apply.)
a. Assess all mucous membranes every 4 to 8 hours.
b. Do not allow the client to eat meat or poultry.
c. Listen to lung sounds and monitor for cough.
d. Monitor the venous access device appearance hourly.
e. Take and record vital signs every 4 to 8 hours.
f. Encourage activity the client can tolerate - ANSWER-ANS: A, C, D, E
Depending on facility protocol, the nurse would assess this client for
infection every 4 to 8 hours by assessing all mucous
,membranes, listening to lung sounds, monitoring for cough, monitoring
the appearance of the venous access device, and recording vital signs.
Assisting the client with mobilization will also help prevent infection.
Eating meat and poultry is allowed A nurse learning about antibody-
mediated immunity learns that the cell with the most direct role in this
process begins development in which tissue or organ? a. Bone marrow
b. Spleen
c. Thymus
d. Tonsils - ANSWER-ANS: A The B-cell is the primary cell in
antibodymediated immunity and is released from the bone marrow.
These cells then travel to other organs and tissues, known as the
secondary lymphoid tissues for B-cells
. A nurse asks the staff development nurse what "apoptosis" means.
What response best? a. Growth by cells enlarging
b. Having the normal number of chromosomes
c. Inhibition of cell growth
d. Programmed cell death - ANSWER-ANS: D
Apoptosis is programmed cell death. With this characteristic, organs and
tissues function with cells that are at their peak of performance. Growth
by cells enlarging is hyperplasia.
Having the normal number of chromosomes is euploidy.
Inhibition of cell growth is contact inhibition.
,A younger woman from an unfamiliar culture is at high risk for breast
cancer and is considering a prophylactic mastectomy and oophorectomy.
What action by the nurse is most appropriate?
a. Discourage this surgery since the woman is still of
childbearing age.
b. Reassure the client that reconstructive surgery is as easy as
breast augmentation.
c. Inform the client that this surgery removes all mammary
tissue and cancer risk.
d. Offer to include support people, such as the male partner, in the
decision making - ANSWER-ANS: D The cultural aspects of decision
making need to be considered. In some cultures, the man often makes
the decisions for care of the female. The woman may want to make the
decision with other support people or by herself. The nurse must
maintain sensitivity to cultural, religious, and personal beliefs when it
comes to this personal decision. Women with a high risk for breast
cancer can consider prophylactic surgery. If reconstructive surgery is
considered, the procedure is more complex and will have more
complications compared to a breast augmentation. There is a small risk
that breast cancer can still develop in the remaining mammary tissue.
, Which statement about carcinogenesis is accurate?
a. An initiated cell will always become clinical cancer.
b. Cancer becomes a health problem once it is 1 cm in size.
c. Normal hormones and proteins do not promote cancer growth.
d. Tumor cells need to develop their own blood supply - ANSWER-ANS:
D Tumors need to develop their own blood supply through a process
called angiogenesis. An initiated cell needs a promoter to
continue its malignant path. Normal hormones and proteins in the body
can act as promoters. A 1-cm tumor is a detectable size, but other events
have to occur for it to become a health problem
The nurse caring for oncology clients knows that which form of
metastasis is the most common? a. Bloodborne b. Direct invasion
c. Lymphatic spread
d. Via bone marrow - ANSWER-ANS: A
Bloodborne metastasis is the most common way for cancer to metastasize.
Direct invasion and lymphatic spread are other methods. Bone marrow is
not a medium in which cancer spreads, although cancer can occur in the
bone marrow
The nurse is teaching a 45-year-old woman about her fibrocystic breast
changes. Which statement by the client indicates a lack of understanding?
a. "This condition will become malignant over time."