NCLEX Review: Cancer and Blood Disorders Quiz

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NCLEX Review: Cancer and Blood Disorders

1. The nurses assesses that the client with cancer is not ready for teaching when the client asks:
1. “Am I going to loose my hair?”
2. “Should I get a second opinion?”
3. “Will this make me really sick?”
4. “Will I have to stop exercising at the gym?”

2. Knowing that chemotherapy affects the taste buds, the nurse would have the client
1. Increase the amount of spices in the food.
2. Avoid red meats.
3. Medicate with Compazine before meals.
4. Eat foods that are hot in temperature.

3. In planning care for a client with a platelet count of 8000 and a WBC of 8000 the nurse can expect to:
1. Remove flowers from the room.
2. Encourage fruits and vegetables.
3. Use strict hand washing technique.
4. Take temperature frequently.

4. The nurse is teaching a client with a WBC of 2000. Which statement the client makes indicates an understanding of the teaching?
1. “I will eat fresh fruits and vegetables to avoid constipation.”
2. “I will stay away from my cat.”
3. “I will avoid crowded places.”
4. “I will wash all my fruits and vegetables before I eat them.”

5. In evaluating the client with cancer what best indicates that nutritional status is adequate?
1. Calorie intake
2. Weight is stable
3. Amount of nausea and vomiting
4. Serum protein levels

6. An adult client with newly diagnosed cancer says, “I’m really afraid of dying. Who’s going to take care of my children?” What is the best initial response for the nurse to make?
1. “What makes you think you are going to die?”
2. “How old are your children?”
3. “This must be a difficult time for you.”
4. “Most people with your kind of cancer live a long time.”

7. A client with terminal cancer yells at the nurse and says, “I don’t need your help. I can bathe myself.” Which stage of grief is the client most likely experiencing?
1. Projection
2. Denial
3. Anger
4. Depression

8. The nurse can expect a client with a platelet count of 8000 and WBC count of 8000 to be placed:
1. In a private room.
2. On protective isolation.
3. On bleeding precautions.
4. On neutropenic precautions.

9. Which statement the client makes indicates to the nurse that the client understands external radiation?
1. “I’ll stay away from small children since I am radioactive.”
2. “I won’t wash these marks off until after my therapy.”
3. “I’ll put lotion on my skin to keep it moist.”
4. “I will double flush the toilet each time I use the bathroom.”

10. When teaching and preparing a client for a bone marrow biopsy, the nurse would
1. Check for iodine allergy.
2. Position the client in fetal position with back curved.
3. Have the client sign the consent form.
4. Have the client remain NPO.

11. A 28-year-old woman is diagnosed as having iron deficiency anemia. Imferon IM is ordered. The nurse administers it using the Z track technique. The primary reason for administering Imferon via Z track is to:
1. Prolong the action of the drug.
2. Prevent staining of the skin.
3. Improve the absorption rate.
4. Increase the speed of onset of action

12. The nurse is discussing dietary sources of iron with a client who has iron deficiency anemia. The nurse knows the client can select a diet high in iron when she selects which menu?
1. Milkshake, hot dog, beets.
2. Beef steak, spinach, grape juice.
3. Chicken salad, green peas, coffee.
4. Macaroni and cheese, coleslaw, lemonade.

13. A client with iron deficiency anemia is to take ferrous sulfate. She returns to clinic in two weeks. Which assessment by the nurse indicates the client has NOT been taking iron as ordered?
1. The client’s cheeks are flushed.
2. The client reports having more energy.
3. The client complains of nausea.
4. The client’s stools are light brown.

14. A 66-year-old woman is being evaluated for pernicious anemia. What signs and symptoms would the nurse expect to assess in a client with pernicious anemia?
1. Easy bruising.
2. Beefy red tongue.
3. Fine red rash on the extremities.
4. Pruritus.

15. The nurse is caring for a client who is newly diagnosed with pernicious anemia. The client asks why she must receive vitamin shots. What is the best answer for the nurse to give?
1. “Shots work faster than pills.”
2. “Your body can not absorb Vitamin B12 from the stomach.”
3. “Vitamins are necessary to make the blood cells.”
4. “You can get more vitamins in a shot than a pill.”

16. A woman who has had pernicious anemia for several years is seen in the clinic. She tells the nurse that she has a tingling in her arms and legs. What question should the nurse ask initially?
1. “Has your activity level changed lately?”
2. “Has your diet changed recently?”
3. “Have you been sitting more than usual?”
4. “Have you been taking your medicine regularly?”

17. A one-year-old is admitted to the hospital with sickle cell anemia in crisis. Upon admission which therapy will assume priority?
1. Fluid administration.
2. Exchange transfusion.
3. Anticoagulant.
4. IM administration of iron and folic acid.

18. The nurse is caring for a 15-month-old child who is newly diagnosed with sickle cell anemia. The mother asks why the child has not had any symptoms before now. The nurse’s response is based on which knowledge?
1. Maternal antibodies have protected the child during the first year of life.
2. Breast milk is a deterrent to sickle cell anemia.
3. The disease does not manifest until the child begins to walk.
4. Elevated fetal hemoglobin levels prevent sickling of red cells.

19. Which statement is essential for the nurse to include in discharge teaching to the parents of a young child who has sickle cell anemia?
1. Do not let her bump into things. She will bruise easily.
2. Notify the physician immediately if she develops a fever.
3. She will need special help with feeding.
4. Observe her frequently for difficulty breathing.

20. The nurse has been teaching the mother of a child with hemophilia about the care he will need. Which statement the mother makes indicates a need for more instruction?
1. “If he needs something for pain or a fever, I will give him acetaminophen instead of aspirin.”
2. “I will take him to the dentist for regular checkups.”
3. “I will keep him in the house most of the time.”
4. “His medical identification bracelet arrived.”

21. A 19-year-old college student reports to the health service with a sore throat, malaise, and fever of four days duration. Examination shows cervical lymphadenopathy and splenomegaly. Temperature is 103oF. Blood is positive for heterophil antibody agglutination test. The nurse knows that infectious mononucleosis is caused by
1. Cytomegalovirus.
2. Beta hemolytic streptococcus.
3. Epstein-Barr virus.
4. Herpes simplex virus I.

22. A client who is diagnosed with infectious mononucleosis asks how he got this disease. The nurse’s response is based on the knowledge that the usual mode of transmission is through
1. Contact with an open wound in the skin.
2. Genital contact.
3. Contaminated water.
4. Intimate oral contact.

23. An 8-year-old is admitted to the unit with a diagnosis of acute lymphocytic leukemia. He was receiving a physical exam prior to playing Little League baseball. Numerous ecchymotic areas were noted on his body. His mother reported that he had been more tired than usual lately. The child’s mother says that he has had a cold for the last several weeks. She asks if this is related to his leukemia. The nurse’s response is based on the knowledge that
1. Leukemia causes a decrease in the number of normal white blood cells in the body.
2. A chronic infection such as he has had predisposes a child to the development of leukemia.
3. The virus responsible for colds has been implicated as a possible etiologic agent in leukemia.
4. Having an infection prior to the onset of leukemia is merely a coincidence.

24. A child who is receiving chemotherapy for leukemia has stomatitis. Which of the following nursing care measures is essential?
1. Using dental floss to clean the teeth.
2. Frequent cleaning of the mouth with an astringent mouthwash.
3. Use of an overbed cradle.
4. Swabbing the mouth with moistened cotton swabs.

25. A school age child is receiving chemotherapy for leukemia. Which statement he makes indicates the best understanding and acceptance of what is happening to him?
1. “I hope I won’t loose my hair like the other kids.”
2. “See my new red hat. I like to wear it.”
3. “I want to go see my friend Harold who is in the hospital with meningitis.”
4. “When I’m finished with the chemotherapy, the leukemia will be gone forever.”

26. An adult client has had a bone marrow aspiration. What should the nurse do immediately following this procedure?
1. Apply firm pressure to the site of the aspiration for at least 5 minutes.
2. Place a plain adhesive bandage directly over the aspiration site.
3. Apply a topical antibiotic on the aspiration site and leave open.
4. Apply an ice pack to the aspiration site for at least 10 minutes.

27. A five-year-old boy is admitted with a diagnosis of acute leukemia. The nurse is taking a nursing history from the child’s mother. Which statement she makes is least likely to be related to the diagnosis of acute leukemia?
1. “He has been so pale lately and has these little bruises and black and blue marks all over his skin.”
2. “He has bumps I can feel on the sides of his neck and in his groin.”
3. “He has sores in his mouth and feels so tired.”
4. “He is having difficulty holding a crayon and forgets things.”

28. The mother of a child with leukemia describes him as being pale and apathetic. The nurse interprets these symptoms as being an indication of
1. Anemia.
2. Poor nutrition.
3. Renal disease.
4. Infection.

29. The mother of a child newly diagnosed with leukemia reports that her son had a cold that persisted for several weeks. She is concerned that she did not take him to the doctor when his cold first appeared. She asks the nurse if taking him to the doctor would have prevented him from getting leukemia. What is the best reply for the nurse to make?
1. “It is too late to look back.”
2. “Perhaps you should discuss this with the doctor.”
3. “The delay did not have any effect on the course of the disease.”
4. “We’ll never know what could have happened if he had been treated sooner.”

30. The nurse is teaching person who has been diagnosed as HIV positive. Which comment by the person indicates a need for more instruction?
1. “My husband and I should have a child now before the condition gets worse.”
2. “I know several people who are HIV positive and they have not gotten sick yet.”
3. “I hope I can swallow all those pills every day.”
4. “I’m sorry I can’t donate blood any more.”

NCLEX Review: Cancer and Blood Disorders Answers and Rationales

1. (2) This indicates denial of his illness. The question states he has cancer. All of the other comments indicate an interest in what is going to happen to him.

2. (1) Because taste buds are affected, increasing spices will improve flavor.

3. (2) Fruits and vegetables will help the client to prevent constipation, which could cause bleeding. All of the other choices are appropriate for a low WBC but this WBC is normal. The problem for this client is a low platelet count.

4. (3) Crowded places predispose to infection. #1 is related to low platelet count. #4. The client should not eat fresh fruits and vegetables even if they are washed.

5. (2) Stable weight indicates adequate nutritional status.

6. (3) This empathetic response will open communication. #1 is really a “why” question which would put the client on the defensive. #2 and #4 do not focus on the client’s feelings.

7. (3) Yelling at the nurse would be typical of anger. Projection is putting his feelings on the nurse “You are angry at me.” Denial would be denying that he was terminally ill or that he had cancer. A client who is depressed would be apathetic and probably not have the energy to yell at the nurse.

8. (3) The platelet count is very low – normal is 150,000 – 500,000. Platelets clot blood. The client must be on bleeding precautions. A WBC of 8000 is within the normal range so neutropenic precautions and protective isolation and a private room are not indicated.

9. (2) It is important that the client not wash off the marks until after therapy is finished. The marks outline the tumor and show where the radiation should be concentrated. The client who is receiving external radiation is not radioactive and should not put anything on the skin. The person who had radioactive iodine to shrink the thyroid gland should double flush the toilet after each use. There is no radioactivity in the waste of a person who is receiving external radiation.

10. (3) Bone marrow biopsy is an invasive procedure that requires a legal consent form to be signed. No iodine dye is used. The usual site is the iliac crest; the client will not be placed in fetal position. That is the position for a lumbar puncture. There is no need for the client to be NPO. Only a local anesthetic is used.

11. (2) Imferon is black and stains the skin and stings. The Z track method of pulling the skin to one side before injecting the medications prevents staining of the skin. Z track also reduces pain. It does not prolong action or speed onset of action or improve absorption rate.

12. (2) Beef, spinach and grape juice contains iron. Milk contains no iron.

13. (4) Iron turns stool black. The other answers all indicate compliance with the medication regime.

14. (2) A beefy red tongue is characteristic of pernicious anemia. Easy bruising would be seen in a clotting disorder such as hemophilia, in leukemia or in bone marrow depression. Pruritus is characteristic of Hodgkin’s disease.

15. (2) Injections of Vit. B12 will be necessary because without intrinsic factor her body cannot absorb Vit. B12 from foods.

16. (4) Her symptoms suggest pernicious anemia. She would not develop these symptoms if she took her medications regularly.

17. (1) Dehydration causes sickling. Sickling causes clumping and pain. First priority of care upon admission should be the administration of fluids.

18. (4) Elevated fetal hemoglobin levels keep the oxygen tension high so sickling does not occur.

19. (2) Fevers cause dehydration and sickling.

20. (3) Parents of children with hemophilia tend to over protect them. A goal is to have the child lead as normal a life as possible. #1 is correct. He should not receive aspirin, as it is an anti-coagulant. #2 indicates good knowledge. Prophylactic dental care is important so he will not need dental work or extractions. #4 indicates good knowledge. He should always wear a medic Alert bracelet in case he is injured.

21. (3) The Epstein-Barr virus is the causative organism for infectious mononucleosis.

22. (4) The virus is spread through intimate oral contact. It is called the “kissing disease.” It can also be spread by sharing eating and drinking utensils.

23. (1) Leukemia causes a decrease in normal white cells. White blood cells are the infection fighting cells. Infections occur because of the decrease in normal WBCs due to leukemia. Infections do not cause leukemia.
24. (4) Stomatitis is a frequent complication of chemotherapy for leukemia. He has a tendency to bleed because of his decreased platelets. Dental floss might cause bleeding. An astringent mouthwash is too strong for his tender mouth. An overbed cradle does not relate to stomatitis. Moistened cotton swabs are a gentle means of cleaning the mouth.

25. (2) This answer indicates acceptance of hair loss a side effect of chemotherapy. Choice 1 indicates denial. Choice 2 indicates lack of understanding. He will be very susceptible to infections. Choice 4 is not correct. He may or may not go into remission.

26. (1) Bone marrow aspiration on adult clients is obtained from the sternum or iliac crest. Because there is a slight risk of hemorrhage, firm pressure is applied over the site of aspiration for approximately 5 minutes.

27. (4) Difficulty holding a crayon and forgetting things sounds like a neurological problem. He would be unlikely to exhibit these symptoms at this point in his illness. #1, #2, and #3 are all typically seen in the child with leukemia. Bruises are the result of platelet depression. Bumps on the sides of the neck and in the groin are probably swollen lymph nodes. Sores in the mouth are frequent and may be a result of decreased normal white cells. Fatigue is common and a result of decreased red blood cells.

28. (1) Pale and apathetic in a child who has leukemia is a result of the anemia or decrease in red cells that occurs in leukemia.

29. (3) Explaining that the delay did not have any effect upon the course of the disease is realistic. There is no way to predict that the child had leukemia when he first had a cold. The reason for the persistence of the cold was the leukemia. The cold did not cause leukemia to develop. Leukemia could not have been prevented by earlier treatment of the cold. The nurse should carefully explain this to the parents to reduce the guilt they may place upon themselves.

30. (1) In order to have a child, the husband would have to be exposed to the virus. This answer indicates a need for more instruction. The other responses all indicate understanding.

NCLEX Review: Cancer and Blood Disorders Quiz