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Exam 1 review

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  • Nursing considerations for potassium replacement include:
    replacement (PO or IV) if IV, preferably through a central line, administer through a PIV no more than 20mEq/hr, PO w/ food, cardiac monitor
  • Side effects of radiation include:
    Localized: Alopecia, cerebral edema, dermatitis, altered taste, anorexia, N/V, decreased bone density Systemic: lethargy, xerostomia,, bone marrow suppression
  • What is the normal lab values for calcium?
    9.0 -10.5 mg/dL
  • Common causes of hypocalcemia include:
    inadequate intake, malabsorption, inadequate vitamin d, hypoparathyroidism, thyroidectomy
  • The client admits to the emergency room. after passing out at the beach. Lab results show a serum Na level of 151mmol/L. What manifestations would the nurse likely observe in this client?
    agitation, confusion, muscle twitching, hypotension, and weak peripheral pulses.
  • The nurse recognizes that the patient is at increased risk for development of an infection post chemotherapy. What are the signs and symptoms that a patient has developed an infection?
    Elevated T, HR, RR, decreased BP, Decreased absolute neutrophil count
  • The client presents with <HR, muscle weakness, confusion, lethargy, constipation, and pain in the right calf, Doppler US shows a blood clot in the popliteal vein. The nurse suspects that these are symptoms of which electrolyte imbalance
    Hypercalcemia
  • What is the primary treatment for SVC Syndrome?
    High dose radiation, metal stent, thrombolytics.
  • A client asks the nurse why the radiation therapy did not make her feel as sick as the chemotherapy she received.. How would the nurse respond?
    Radiation destroys cancer cells with minimal damaging effects of surrounding normal cells, while chemotherapy can kill health cells as well as cancer cells.
  • Explain how ADH works to influence fluid balance.
    ADH (vasopressin) secreted by anterior pituitary in response to > osmolality - osmorecptors shrink - triggers ADH release - tells kidneys to conserve H2O
  • What is the purpose of chemotherapy and how does it work?
    Chemical cytotoxic agents (chemotherapy) destroys cancer cells by damaging DNA and interferes with cell division
  • Which oncological emergency is characterized by excess fluid, which leads to hemodilution of electrolytes such as sodium and calcium?
    SIADH
  • Which types of intravenous fluids are most often used for fluid resuscitation?
    Isotonic
  • What are the 3 types of oncological emergencies?
    Hematological, structural, and metabolic
  • Explain the difference in cell characteristics of benign versus malignant cells
    Specific morphology Differentiated function Nuclear-to-cytoplasmic ratio Adherence
  • The client asked the nurse to explain the difference between radiation dose and radiation exposure. How would the nurse respond?
    Radiation dose refers to the amount of radiation that is actually absorbed and radiation exposure is the amount of radiation delivered.
  • Common causes of hypercalcemia include:
    Excessive oral intake of calcium Excessive oral intake of vitamin D Kidney failure Use of thiazide diuretics, hyperparathyroidism, immobility, malignancies
  • List the possible causes for hypovolemia.
    Too little intake, blood loss, renal disease, diabetes, excessive sweating, vomiting, diarrhea, fever,
  • Manifestations of hypomagnesemia include:
    Hyperactive deep tendon reflexes Paresthesia Painful muscle contractions. + Chvostek and Trousseau Tetany Seizures, < GI motility
  • What is the normal lab value for potassium?
    3.5 - 5 mEq/L
  • Hypomagnesemia can be caused by a variety of conditions. These conditions include:
    Starvation Diarrhea Malnutrition Celiac disease Crohn’s disease Ethanol ingestion
  • A nurse is assessing a patient with a family history of colon cancer. What type of secondary prevention would the nurse suggest?
    A patient with a family history of colon cancer is encouraged to have a baseline colonoscopy
  • This electrolyte is critical for skeletal muscle contraction, carbohydrate metabolism, ATP formation, vitamin activation, cell growth
    Magnesium
  • A patient has been having frequent liquid diarrhea for the last 24 hours. The nurse should monitor the patient for which electrolyte imbalance?
    Hypokalemia
  • Explain how the RAAS system works to >BP
    <BP -Renin from JG cells - angiotensinogen changes angiotensin 1 to 2 - ADH and aldosterone secreted - vasoconstriction and Na/H2O resorption = >BP
  • In caner staging, what is meant by T3, N1, M1?
    Moderately large tumor, little lymph node involvement, has metastasized.
  • The nurse is providing education on ways to prevent exacerbation of CHF. What fluid imbalance is this patient at risk for and what should be included in the teaching?
    Take medications as directed. Limit salt intake, possible fluid restriction, daily weights
  • A client with colon cancer with bone metastasis presents with pain and leg include weakness, loss of of sensation, urinary retention, and constipation. The nurse recognizes this as which oncological emergency??
    Spinal cord compression
  • What is the normal lab values for Sodium?
    136 -145 mmol/L
  • True or false? Hospice care is appropriate for patients with life threatening illness and focuses on quality of life?
    False: Hospice care is appropriate for patients with life limiting disease who have less than 6 months to live and focuses on comfort.
  • A client with SIADH has a Na of 129. What manifestations would the nurse expect the client to exhibit?
    Decreased LOC Confusion Seizures Coma Death General muscle weakness <deep tendon reflexes N/V cramps Diarrhea, bounding pulse, >BP
  • The client asks the nurse about the the most serious side effects of chemotherapy. How should the nurse respond?
    Chemo can suppress your bone marrow resulting in low WBC, platelets, and red blood cells. This puts you at risk of infection, bleeding, and fatigue
  • What are the 3 stages of Malignant Transformation and explain them
    Initiation (cells become damaged) - promotion (begin to grow)- progression (grow larger and metastasize))
  • What are the normal lab values for Magnesium?
    1.8 - 2.6 mg/dL
  • The nurse is providing education to a group of nursing students about risk factors for development of cancer. What would be included in this teaching?
    Smoking, alcohol. excessive red meat, low fiber, older age, poor immunity, excessive sun exposure, work related carcinogens, family history, HPV, hepatitis
  • Nursing care of the patient who undergoes surgery to remove a tumor form the lung will focus on
    pain management, early mobility, prevention of post op infection including pneumonia – encourage TCDB, and nutritional support
  • When is the patient with acute leukemia at greatest risk of developing tumor lysis syndrome?
    It is most common in patients with large numbers of cancer cells in the body before treatment. It happens most often with the first cycle of chemotherapy.
  • The movement of water across a semi-permeable membrane from an area of lower concentration to an area of higher concentration?
    Osmosis
  • The client is scheduled to undergo external beam radiation. What education should the nurse provide?
    Reduce sun exposure after treatment, if dermatitis occurs, provide gentle skin care, no lotion, use artificial saliva for dry mouth, do not remove ink markings
  • True or false? Primary cancer prevention involve regular screening such as mammograms.
    False: Primary prevention includes avoidance of known carcinogens, modifying associated risk factors, removal of “at risk” tissue, chemoprevention, vaccination
  • Treatment for hyperkalemia includes:
    loop diuretics, limit intake, (salt substitutes), dialysis, insulin w/ glucose, stop K sparing diuretics t
  • True or false? The only surgical options for treatment of cancer are curative, prophylactic, and diagnostic.
    False; Curative, palliative, prophylactic, diagnostic, control
  • A client with renal failure presents with edema, SOB, HA, visual disturbances, and EKG shows peaked t-waves. Labs reveal K - 5.7, Na -150. What fluid and electrolyte imbalances is the client experiencing?
    Hypervolemia, hyperkalemia, hypernatremia
  • S/S of hypocalcemia include:
    Paresthesia, twitching, Cramps, Trousseau’s Chvostek’s, <HR, weak pulse , <BP, cardiac complications, >GI motility, osteoporosis,
  • True or false: appropriate treatment for hypovolemia is oral rehydration or hypotonic fluids
    False: oral rehydration is appropriate , however, hypotonic solutions can worsen dehydration because fluid shifts from ECF to ICF
  • Explain CAUTION as it relates to S/S of cancer.
    Changes in bowel or bladder A sore that doesn't heal Unusual bleeding Thickening or lump Indigestion Obvious change in mole Nagging cough
  • List the S/S of hypervolemia.
    peripheral and/or pulmonary edema, SOB, >RR, >HR, >BP, distended neck veins, wt gain, pale. cool skin, altered LOC, HA, visual disturburbances
  • A client presents to the ED with <BP, >HR, hot dry skin, dry mouth, sunken eyes, and extreme thirst. The nurse recognizes this as:
    Manifestations of hypovolemia/dehydration.
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