Med Surg Test 1 H &N-H Lymphomas

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Brunner & Suddarth 14th Edition

The home health nurse is performing a home visit for an oncology
patient discharged 3 days ago aftercompleting treatment for
non-Hodgkin lymphoma. The nurses assessment should include
examinationfor the signs and symptoms of what
complication?A) Tumor lysis syndrome (TLS)B) Syndrome of
inappropriate antiduretic hormone (SIADH)C) Disseminated
intravascular coagulation (DIC)D) Hypercalcemia

Ans: AFeedback:TLS is a potentially fatal complication
that occurs spontaneously or more commonly followingradiation,
biotherapy, or chemotherapy-induced cell destruction of large or
rapidly growing cancers suchas leukemia, lymphoma, and small
cell lung cancer. DIC, SIADH and hypercalcemia are less
likelycomplications following this treatment and diagnosis.

An emergency department nurse is triaging a 77-year-old man who
presents with uncharacteristic fatigueas well as back and rib
pain. The patient denies any recent injuries. The nurse should
recognize the needfor this patient to be assessed for what
health problem?A) Hodgkin diseaseB) Non-Hodgkin
lymphomaC) Multiple myelomaD) Acute thrombocythemia

Ans: CFeedback:Back pain, which is often a presenting
symptom in multiple myeloma, should be closely investigated
inolder patients. The lymphomas and bleeding disorders do not
typically present with the primarysymptom of back pain or rib pain.

A nurse is caring for a patient with Hodgkin lymphoma at the oncology
clinic. The nurse should beaware of what main goal of
care?A) Cure of the diseaseB) Enhancing quality of
lifeC) Controlling symptomsD) Palliation

Ans: AFeedback:The goal in the treatment of Hodgkin
lymphoma is cure. Palliation is thus not normally
necessary.Quality of life and symptom control are vital, but the
overarching goal is the cure the disease.

An adult patient has presented to the health clinic with a complaint
of a firm, painless cervical lymphnode. The patient denies any
recent infectious diseases. What is the nurses most appropriate
response tothe patients complaint?A) Call 911.B)
Promptly refer the patient for medical assessment.C) Facilitate
a radiograph of the patients neck and have the results forwarded to
the patients primarycare provider.D) Encourage the patient
to track the size of the lymph node and seek care in 1 week.

Ans: BFeedback:Hodgkin lymphoma usually begins as an
enlargement of one or more lymph nodes on one side of theneck.
The individual nodes are painless and firm but not hard. Prompt
medical assessment is necessary ifa patient has this
presentation. However, there is no acute need to call 911. Delaying
care for 1 weekcould have serious consequences and x-rays are
not among the common diagnostic tests.

An adult patients abnormal complete blood count (CBC) and physical
assessment have prompted theprimary care provider to order a
diagnostic workup for Hodgkin lymphoma. The presence of
whatassessment finding is considered diagnostic of the
disease?A) Schwann cellsB) Reed-Sternberg cellsC)
Lewy bodiesD) Loops of Henle

Ans: BFeedback:The malignant cell of Hodgkin lymphoma is
the Reed-Sternberg cell, a gigantic tumor cell that
ismorphologically unique and thought to be of immature lymphoid
origin. It is the pathologic hallmarkand essential diagnostic
criterion. Schwann cells exist in the peripheral nervous system and
Lewy bodiesare markers of Parkinson disease. Loops of Henle
exist in nephrons.

A young adult patient has received the news that her treatment for
Hodgkin lymphoma has been deemedsuccessful and that no further
treatment is necessary at this time. The care team should ensure that
thepatient receives regular health assessments in the future due
to the risk of what complication?A) Iron-deficiency
anemiaB) HemophiliaTest Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 672C)
Hematologic cancersD) Genitourinary cancers

Ans: CFeedback:Survivors of Hodgkin lymphoma have a high
risk of second cancers, with hematologic cancers being themost
common. There is no consequent risk of anemia or hemophilia, and
hematologic cancers are muchmore common than GU cancers.

The clinical nurse educator is presenting health promotion education
to a patient who will be treated fornon-Hodgkin lymphoma on an
outpatient basis. The nurse should recommend which of the
followingactions?A) Avoiding direct sun exposure in excess
of 15 minutes dailyB) Avoiding grapefruit juice and fresh
grapefruitC) Avoiding highly crowded public placesD) Using
an electric shaver rather than a razor

Ans: CFeedback:The risk of infection is significant for
these patients, not only from treatment-related
myelosuppressionbut also from the defective immune response that
results from the disease itself. Limiting infectionexposure is
thus necessary. The need to avoid grapefruit is dependent on the
patients medicationregimen. Sun exposure and the use of razors
are not necessarily contraindicated.

The nurse is leading a workshop on sexual health for men. The nurse
should teach participants thatorganic causes of erectile
dysfunction include what? Select all that apply.A)
DiabetesB) Testosterone deficiencyTest Bank - Brunner
& Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle
2017) 1128C) AnxietyD) DepressionE) Parkinsonism

Ans: A, B, EFeedback:Organic causes of ED include
cardiovascular disease, endocrine disease (diabetes, pituitary
tumors,testosterone deficiency, hyperthyroidism, and
hypothyroidism), cirrhosis, chronic renal failure,genitourinary
conditions (radical pelvic surgery), hematologic conditions (Hodgkin
disease, leukemia),neurologic disorders (neuropathies,
parkinsonism, spinal cord injury, multiple sclerosis), trauma to
thepelvic or genital area, alcohol, smoking, medications, and
drug abuse. Anxiety and depression areconsidered to be
psychogenic causes.

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Ignataviticus Edition 7 & 9

The nurse is planning a cancer education event in an Asian community
center. The nurse plans to present information specifically on which
types of cancer?
Breast and colorectal
Skin and lymphoma
Liver and stomach
Uterine and ovarian

Asians have higher rates of breast, colorectal, prostate, lung,
and stomach cancers than are seen in the general population.
DIF: Cognitive Level: Application/Applying or higher REF: N/A
TOP: Client Needs Category: Physiological Integrity
(Physiological AdaptationPathophysiology)
MSC: Integrated Process: Nursing Process (Planning)

In preparing a cancer risk reduction pamphlet for African-American
clients, it is most important that the nurse include information on
prevention and early detection for which types of cancer?
Lung and prostate
Bone and leukemia
Skin and lymphoma
Stomach and esophageal

African Americans have higher incidences of lung, prostate,
breast, colorectal, and uterine cancers than are seen in the general population.
DIF: Cognitive Level: Application/Applying or higher REF: N/A
TOP: Client Needs Category: Physiological Integrity
(Physiological AdaptationPathophysiology)
MSC: Integrated Process: Nursing Process (Planning)

A client has Hodgkins lymphoma, Ann Arbor stage Ib. For what
manifestations should the nurse assess theclient? (Select all
that apply.)a. Headachesb. Night sweatsTest Bank -
Medical-Surgical Nursing: Concepts for Interprofessional Collaborative
Care 9e 339c. Persistent feverd. Urinary frequencye.
Weight loss

ANS: B, C, EIn this stage, the disease is located in a single
lymph node region or a single nonlymph node site. The
clientdisplays night sweats, persistent fever, and weight loss.
Headache and urinary problems are not related.DIF:
Understanding/Comprehension REF: 827KEY: Hematologic system|
lymphoma| nursing assessmentMSC: Integrated Process: Nursing
Process: AssessmentNOT: Client Needs Category: Physiological
Integrity: Reduction of Risk Potential

A nurse is caring for a young male client with lymphoma who is to
begin treatment. What teaching topic isa priority?a.
Genetic testingb. Infection preventionc. Sperm
bankingd. Treatment options

ANS: CAll teaching topics are important to the client with
lymphoma, but for a young male, sperm banking is ofparticular
concern if the client is going to have radiation to the lower abdomen
or pelvis.DIF: Understanding/Comprehension REF: 827KEY:
Lymphoma| hematologic system| caring| reproductive problemsMSC:
Integrated Process: Teaching/LearningNOT: Client Needs Category:
Health Promotion and Maintenance

A patient with Hodgkin�s lymphoma is undergoing external radiation
therapy on an outpatient basis. After 2 weeks of treatment, the
patient tells the nurse, �I am so tired I can hardly get out of bed in
the morning.� An appropriate intervention for the nurse to plan with
the patient is to
a. exercise vigorously when fatigue is not as noticeable.
b. consult with a psychiatrist for treatment of depression.
c. establish a time to take a short walk every day.
d. maintain bed rest until the treatment is completed.

Correct Answer: C

Rationale: Walking programs are used to keep the
patient active without excessive fatigue. Vigorous exercise when the
patient is less tired may lead to increased fatigue. Fatigue is
expected during treatment and is not an indication of depression. Bed
rest will lead to weakness and other complications of immobility.

Cognitive Level: Application Text
Reference: p. 297

Nursing Process: Planning NCLEX:
Physiological Integrity

A 32-year-old male patient is to undergo radiation therapy to the
pelvic area for Hodgkin�s lymphoma. He expresses concern to the nurse
about the effect of chemotherapy on his sexual function. The best
response by the nurse to the patient�s concerns is
�Radiation does not cause the problems with sexual functioning
that occur with chemotherapy or surgical procedures used to treat cancer.�
�It is possible you may have some changes in your sexual function,
and you may want to consider pretreatment harvesting of sperm if you
want children.�
�The radiation will make you sterile, but your ability to have
sexual intercourse will not be changed by the treatment.�
�You may have some temporary impotence during the course of the
radiation, but normal sexual function will return.�

Correct Answer: B

Rationale: The impact on sperm count and erectile
function depends on the patient�s pretreatment status and on the
amount of exposure to radiation. The patient should consider sperm
donation before radiation. Radiation (like chemotherapy or surgery)
may affect both sexual function and fertility either temporarily or permanently.

Cognitive Level: Application Text
Reference: p. 301

Nursing Process: Implementation
NCLEX: Physiological Integrity

The nurse assesses a patient with non-Hodgkin's lymphoma who is
receiving aninfusion of rituximab (Rituxan). Which assessment
finding would require the most rapid action bythe nurse?a.
Shortness of breathb. Temperature 100.2� F (37.9� C)c.
Shivering and complaint of chillsd. Generalized muscle aches and pains

ANS: ARituximab (Rituxan) is a monoclonal antibody. Shortness
of breath should be investigated rapidly becauseanaphylaxis is a
possible reaction to monoclonal antibody administration. The nurse
will need to rapidlytake actions such as stopping the infusion,
assessing the patient further, and notifying the health
careprovider. The other findings will also require action by the
nurse, but are not indicative of
life-threateningcomplications.DIF: Cognitive Level: Apply
(application) REF: 272-273OBJ: Special Questions: Prioritization
TOP: Nursing Process: AssessmentMSC: NCLEX: Physiological Integrity