Hematology/Oncology

The 50-year-old previously healthy patient complains of shortness of breath, especially on exertion or when laying down to sleep. She takes over-the-counter allergy medicine for seasonal allergies and melatonin to help her sleep sometimes. Her vital signs are heart rate of 64 bpm, respirations 22, oxygen saturation 99%, and blood pressure 114/68 mmHg. Her assessment is notable for crackles over the bilateral lung bases and a moderate diastolic apical murmur. Her electrocardiogram is normal. Her echocardiogram shows normal function of the left ventricle and severe stenosis of the mitral valve. The nurse provides which information to the patient?  

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count reveals a megaloblastic anemia. Which statement by the nurse is most appropriate? 

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count revealed a hemoglobin of 10.2 mg/dL, white blood cell count of 9 x 10³ cells/µL, and a mean corpuscular volume of 110. Which information does the nurse provide to the patient?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. The nurse compiles information for the new parents about which procedure?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. Enucleation is performed and the diagnosis of retinoblastoma with clear tumor margins is confirmed. No chemotherapy or radiation is required. The infant is ready to be discharged home as a healthy baby. Which health screening information is most relevant to this family? 

The 59-year-old female reports vaginal bleeding. She experienced menarche at 12 years of age and menopause at 56. Endometrial carcinoma is found with endometrial biopsy. Further testing reveals no lymph node involvement or metastasis. The nurse prepares the patient for which initial therapy?  

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?  

The 20-year-old healthy soccer player is brought to the emergency department after collapsing at the end of a summer soccer game. The patient is lethargic and confused about the event. Upon assessment, the nurse notes flushed, dry skin that is warm to the touch. The oral mucosa is dry, as well. Vitals are as follows: temperature 40.7°C, heart rate 122 bpm, respiratory rate 20, and blood pressure 116/64 mmHg. Which lab studies does the nurse obtain? Select all that apply.  

The 49-year-old patient presented with a breast lump found during her monthly breast self-exam. This is confirmed on mammogram; the lump was biopsied and found to be an adenocarcinoma that is HER2/neu negative. The patient requests that interventions conserve as much of her breast tissue as possible. The nurse prepares the patient for which next step in management?  

The nurse is most suspicious of glucose-6-phosphate dehydrogenase (G6PD) deficiency in which patient who presents with jaundice and fatigue after receiving an antimalarial drug?  

The nurse is providing education to the parents of a child who was admitted with abdominal pain, fatigue, and yellow-tinged skin and sclera that was determined to be due to hemolysis. The liver dysfunction has resolved and the child is ready to be discharged, but the cause of the child’s hemolysis is still unknown at this time. Out of an abundance of caution, the nurse instructs on the list of medications/food the child must not receive to prevent possible recurrence. Which items are included on the list? Select all that apply.

The 2-year-old patient who has a history of drug-induced hemolysis, anemia, and hyperbilirubinemia presents to the clinic complaining of urinary urgency and dysuria. The patient has a fever and the urinalysis is positive for leukocyte esterase as well white blood cell casts. Which medications, if prescribed for the patient, prompt the nurse to clarify with the provider prior to administering them? Select all that apply.  

A 4-year-old child presents for a well-child visit. The parents report the child is doing well, has a good appetite, and has been meeting developmental milestones appropriately. Two months ago, the child was treated with antibiotics for an upper respiratory tract infection. Otherwise, the child is quite healthy. Upon assessment, the nurse notes a left-sided flank mass. The child denies urinary issues including pain or frequency, and the parents report that the child has had no incontinence episodes for a full year. The urinalysis is normal with the exception of 2+ blood. The nurse prepares to educate the family on which condition that most likely explains the child’s symptoms?  

The nurse is caring for the patient with prostate cancer that has metastasized to the bone. The physician has prescribed extended-release oxycodone to treat severe bone pain. The patient expresses to the nurse he is concerned he will become addicted to the opioid pain medication given what you see on television. Which response from the nurse is most appropriate?

The patient has been prescribed belatacept for transplant rejection. Which lab result is most important to evaluate prior to administration?

The patient who has received a heart transplant is prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) for Pneumocystis jiroveci pneumonia (PJP) prophylaxis. Which statements does the nurse provide to educate the patient about adverse effects of the TMP-SMZ? Select all that apply.

The neonate is found to have a hemoglobin of 26 g/dL on the first day of life. Which additional findings does the nurse anticipate in this patient? Select all that apply.