Cabahug, Jean Anne; Go, John Jeffrey; Magno, JC May; Mitzi Diane Manipis

Jigsaw Team no. 9

1. A child with neuroblastoma will be started on total parenteral nutrition (TPN) because
of cancer cachexia. The nurse would question which of the following newly written
physician orders?
a.
b.
c.
d.

Add 10 units NPH insulin to the TPN solution

Monitor blood glucose level every four hours
Daily intake and output
Regular diet

ANSWER: A
RATIONALE: Only regular insulin is administered in solutions administered by the IV route.
Monitoring blood glucose and I &O is appropriate. The child is usually anorexic but will be
allowed to eat any food that appeals to him or her.
2. The nurse reads in the medical record that a clients tumor is stage at T2, N0, M0. The
nurse concludes that this staging indicates which of the following about the clients
status?
a. There is an advanced tumor with metastasis
b. The client has measurable tumor with no indication of metastasis or involvement of
nodes
c. There is an advanced tumor with indication of lymph nodes but no indication of
metastasis
d. The client has an advanced tumor with indication of metastasis but no indication of
involvement of lymph nodes
ANSWER: B
RATIONALE: T2 indicates a measurable tumor, N0 indicates no regional node involvement,
and M0 indicates no evidence of distant metastasis. Options a, c, d are partially or totally
incorrect
3. A client with esophageal cancer arrives in the emergency department with shortness of
breath, tachycardia hypotension and cyanosis. The physician determines the client is
experiencing cardiac tamponade. Which of the following interventions would the nurse
expect to include in this clients care?
a.
b.
c.
d.

Administer vasodilator agent intravenously

Initiate oxygen and insert an intravenous catheter for IV access
Prepare to assist physician with thoracentesis
Prepare the client for radiation therapy

ANSWER: B

RATIONALE: oxygen and IV access are immediate interventions for the client with cardiac
tamponade. Vasopressor agents will be administered to manage hypotension. Option A, a
pericardiocentesis is performed not a thoracentesis; and radiation therapy in not indicated for
cardiac tamponade
4. A client with cancer who is receiving radiation therapy develops thrombocytopenia.
The priority nursing goal is to prevent which of the following?
a. Pain related to spontaneous bleeding episodes.
b. Altered nutrition related to anemia.
c. Injury related to the decreased platelet count.
d. Skin breakdown related to decreased tissue perfusion.
ANSWER: C.
RATIONALE: This client is at high risk for bleeding because of the decreased platelet count.
The priority nursing goal is to prevent injury to this client by preventing bleeding occurrences.
Spontaneous bleeding may cause pain but is not the priority. The client has a low platelet
count, but not a low hemoglobin count such as exists in anemia. Skin integrity is a risk but not
a priority.
5. A client who has been diagnosed with lung cancer complains of increasing shortness of
breath and difficulty swallowing. The client has facial swelling and engorged jugular
veins. The nurse assesses the client for which of the following?
a. Pulmonary emboli.
b. Cardiac tamponade.
c. Syndrome of inappropriate secretion of antidiuretic syndrome (SIADH).
d. Superior vena cava syndrome.
ANSWER: D.
RATIONALE: Superior vena cava syndrome is a syndrome in which the superior vena cava
is obstructed or compressed by tumor growth. Signs and symptoms result from a blockage of
venous blood flow from the head, neck, and upper trunk and include difficulty breathing or
swallowing, facial swelling, and jugular venous distention. The other selections do not refer to
superior vena cava syndrome.
6. A client had a colon resection yesterday. The clients hemoglobin was 14.1 g/dl
yesterday and todays hemoglobin level is 7.2 g/dl. The clients oxygen saturation is
87%. The nurse performs which of the following interventions first?
a. Assess the client.
b. Administer a 500 ml of normal saline intravenously.
c. Administer oxygen.
d. Administer two units PRBCs.
ANSWER: C.
RATIONALE: This client has decreased oxygen saturation and also decreased hemoglobin,

which puts the client at great risk for cardiac ischemia. The nurse administers oxygen
immediately.
The other interventions are appropriate, but not the priority at this time.
7. It is an act where a third party, usually implied to be a physician, terminates the life of
a person either passively or actively?
a. Euthanasia
b.medical futility
c.terminal sedation
d. End-of-life.
ANSWER: A
RATIONALE: euthanasia is an act where a third party, usually implied to be a physician,
terminates the life of a person- either passively or actively. The modern concept of euthanasia
is based on the fact that patients alive who are living in a situation that they consider to be
worse than death, are in a coma or are in a persistent vegetative state can be relieved from
their pain and misery
8. According to National Cancer Institute end of life care is, except?
a. When a patients health care team determines that the cancer can no longer be
controlled, medical testing and cancer treatment often stop.
b. either way, services are available to help patients and their families with the
medical, psychological, and spiritual issues surrounding dying
c. Promote independent decision making through treatment by encouraging clients
and family members to communicate openly with health care team
d. Each individual has a unique needs for information and support
ANSWER: C.
RATIONALE: Promote independent decision making through treatment by encouraging
clients and family members to communicate openly with health care team is a Role of the
Nurse in End of Life Care
9. A client has recently been told he has terminal cancer. As the nurse enters the room, he
yells, My eggs are cold, and Im tired of having my sleep interrupted by noisy nurses!
The nurse may interpret the clients behavior as:
a. an expression of the anger stage of dying
b. an expression of disenfranchised grief
c. the result of maturational loss
d. the result of previous losses
ANSWER: A.

RATIONALE: in the anger of Kubler-Rosss stages of dying, the individual resists tne loss
and may strike out everyone and everything, in this case, the nurse.
10. Contact of client on radiation therapy should be limited only to how many minutes to
promote safety of the therapy personnel.
A. 1 minute
B. 3 minutes
C. 5 minutes
D. 10 minutes
Rationale: C. Principles of Radiation Protection follows the DTS system. Distance (D), Time
(T), and Shielding (S). Distance atleast 3 feet should be maintained when a nurse is not
performing any nursing procedures. Time limit contact to 5 minutes each time. Shielding use
lead shield during contact.
11. Which of the following is the reason to perform a spinal tap on a client newly
diagnosed with leukemia?
A. To rule out meningitis
B. To decrease intracranial pressure
C. To aid in classification of the leukemia
D. To assess for Central Nervous System infitration
Rationale: D. Spinal tap is performed to assess for Central Nervous System infiltration. It
wouldn't be done to decrease Intracranial pressure nor does it aid in the classification of the
leukemia. Spinal tap can result in brain stem herniation in vases of Intracranial pressure. A
spinal tap can be done to rule out minigitis but it isn't indication for the test on a leukemia
client.
12. When caring for a client with Central Venous line, which of the following nursing
interventions should be implemented in the plan of care for chemotherapy
administration? Select all apply.
A. Inspect the insertion site for swelling, erythema, or drainage
B. Verifying patency of the line by with presence of a blood return at regular intervals
C. Administer cytotoxic agent to keep a regimen on schedule even if blood return is
not present.
D. If unable to aspirate blood, reposition the client and encourage the client to cough
E. Contact Helth Care Provider about verifying placement if the status is questionable
Rationale: A, B, D, E. A major concern with intravenous administration of the cytotoxic agent
is vessel irritation or extravasation. The Oncology Nursing Soceity and hospital guidelines
requirefrequent evaluation of blood return when administarting vesicant or nonvesicant
chemotherapy due to the risk of extravasation. There guidelines apply to peripheral and
central venous lines. In addition, central venous lines may be long term venous access devices.

Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or
may indicate the line has occlusion. Having a client coughor more position may indicate the
line has occlusion. Occlusion warrantes more thorough evaluation via X-ray study to verify
placement if the status is questionable and may require declotting rehimen.