Exam 2: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam Review| Complete Guide with Questions and Verified Answers| 100% Correct- Rasmussen

Exam 2: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam Review| Complete Guide with Questions and Verified Answers| 100% Correct- Rasmussen

Exam 2: NUR2392/ NUR 2392 (New 2023/
2024) Multidimensional Care II/ MDC 2
Exam Review| Complete Guide with
Questions and Verified Answers| 100%
Correct- Rasmussen
QUESTION
Hypercalcemia
Answer:
is associated with lung, kidney, breast and multiple myeloma cancers
QUESTION
early symptoms of hypercalcemia
Answer:
nonspecific,
skeletal pain,
kidney stones,
altered cognition,
loss of appetite,
constipation,
loss of deep tendon reflexes,
paralytic ileus,
ECG changes
Myalgia
Headache
QUESTION
Hypercalcemia Treatment
Answer:

IV hydration normal saline,
loop diuretics,
Inpatient monitoring
Phosphate replacement
I.V bisphosphates,
calcitonin,
oral glucocorticoids.
QUESTION
Hypercalcemia Intervention
Answer:
Assess s/s
Administer fluids
Monitor I&O
QUESTION
Hypervolemia (Excess fluid volume)
Answer:
Increased fluid in the extracellular space caused by the abnormal retention of water and sodium
in approximately the same proportions in which they normally exist in the ECF.
QUESTION
Causes of Excess fluid volume (hypervolemia)
Answer:
o Heart failure
o Excess fluid intake
o Renal failure
o Increased sodium intake
QUESTION
Hypervolemia s/s

Answer:
o Ascites.
o Aphasia,
o muscle twitching,
o tremors,
o seizures.
o Bounding pulses.
o lethargy,
o disorientation,
o confusion
o coma
o Crackles*
o Distended neck and peripheral veins.
o Edema variable from dependent
o Elevated central venous pressure.
o Extra heart sounds S3.
o Hypertension.
o Productive cough.
o Shortness of breath.
o Sudden weight gain
QUESTION
Hypovolemia (deficient fluid volume)
Answer:
occurs when loss of extracellular fluid exceeds the intake of fluid. Decreased fluid in ECF
QUESTION
Causes of hypovolemia
Answer:
o Burns
o Severe diarrhea
o Gastric intubation
o Hemorrhage
o Diabetic ketoacidosis (DKA)*
o Diabetes insipidus
o Diuretics

o Adrenal disease
o Recovery phase of acute renal failure*
QUESTION
Hypovolemia s/s
Answer:
o Abdominal distention.
o Fever
o Confusion, restlessness.
o Dark concentrated urine.
o Decreased urine volume.
o Decreased central venous pressure.
o Flattened neck veins.
o Hypotension.
o Pale, moist, clammy skin.
o Tachycardia.
o Tachypnea.
o Weak pulses.
QUESTION
Hyperkalemia
Answer:
is defined as serum potassium level above 5.0 mEq/L.
QUESTION
Hyperkalemia cause
Answer:
o Renal disease
o Renal failure
o Treatment side effects (NSAIDs,diuretics, and massive transfusion with banked blood)
o Metabolic acidosis
o Ketoacidosis
o Burns
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Benign cells
Normal cells growing in the wrong place or at the wrong time

Benign Cell Features
o Harmless
o Do not usually require intervention
o Slow growing
o Tight Adherence
o Specific morphology
o Small nuclear-to-cytoplasmic ratio
o Specific differentiated functions
o Tight adherence
o Orderly growth
o No migration
o Normal chromosomes

Benign cell looks similar to a
healthy cell

Examples of Benign cells
o Skin Tag
o Mole
o Nasal Polyp
o Uterine Fibroids
o Endometriosis

Malignant cells
indicates cancer and can be harmful to normal body tissues and result in death

Malignant cell features
o Large nucleus
o Migration
o Doesn’t stop and replicates (No contact inhibition)
o Loose adherence
o Rapid or continuous cell division
o Loss of cellular regulation
o Abnormal chromosomes (< or > 23)

Seven warning signs of cancer
o C-Change in bowel or bladder patterns
o A-A sore that doesn’t heal
o U-Unusual bleeding or d/c
o. T-Thickening or lump on breast or elsewhere
o I-Indigestion or difficulty swallowing
o O-Obvious change in wart or mole
o N-Nagging cough or hoarseness

Cancer development stages of malignancy
o Initiation
o Promotion
o Progression
o Metastasis

Initiation (Stage of malignancy)
Normal cells are damaged and irreversible

Promotion
Repeated exposure>Enhances growth of malignant cells

Progression
Increase in production of malignant cells

Metastasis
Cells move from primary site to the rest of the body

Carcinogenesis/oncogenesis
cancer development

Cancer classification
o Grading
o Ploidy
o Staging
o TNM
o Doubling time and mitotic index

Grading
Looking under microscope and determine level/degree of mutation of cancer cell from normal cells
o Ex. 1= No mutation
o 4= Severe mutation

Ploidy
Number of chromosomes

Staging
How large is the primary tumor and how far has it spread

TNM
o T-Tumor (How large is primary or 2nd)
o N- Node (Are regional lymph nodes invaded by cancer cell)
o M-Metastasis (0=None, 1=There is metastasis)

Doubling time and mitotic index
Period of time required for that quantity to double in size (Tells how aggressive cancer grows)
o Stage 1=Localized
o Stage 4= Spread across the body

Cancer prevention primary
o Sunscreen
o Avoid smoking
o Removal of “at risk” tissue (mole)
o Chemoprevention
o Vaccine (HPV)

Cancer prevention secondary
o Mammogram
o Pap smear
o Prostate test

Cancer prevention tertiary
People who are already affected and getting treatment (examples below)
o Chemo
o Radiation
o Surgery, etc.

Types of cancers
carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma

Carcinoma
malignant tumors of glandular (lining) tissues

Sarcoma
malignant tumor of connective (bone) tissues

Melanoma
pigment producing skin cancer

Lymphoma
malignant tumor of lymphoid tissue

Leukemia
white blood cell tumor

Blastoma
malignant tumors of less differentiated, embryonal tissue

Lab Diagnostic Tests
o CBC
o Blood protein testing
o Tumor marker test
o Circulation tumor cell tests

Imaging Diagnostic Tests
o CT Scans
o MRI
o X-ray
o Ultrasound
o Mammogram
o Nuclear medicine scans

Endoscopy Diagnostic Tests
o Bronchoscopy
o Colonoscopy
o Cystoscopy
o Laparoscopy
o Laryngoscopy
o Mediastinoscopy
o Thoracoscopy
o Upper Endoscopy

Biopsy Diagnostic Tests
o Breast biopsy
o Bone marrow biopsy
o Organ/tissue specific

Risk factors
o Older age.
o A personal or family history of cancer.
o Using tobacco.
o Obesity.
o Alcohol.
o Some types of viral infections(HPV)
o Specific chemicals.
o Exposure to radiation, including ultraviolet radiation from the sun.
o Alcohol

Types of therapy
surgery,
radiation,
chemotherapy,
radiation therapy,
immune therapy,
photodynamic therapy
hormonal therapy

Surgery
cells can escape during surgery sometimes, causing clients to have to deal with an altered appearance

Radiation
Destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain safe environment

Chemotherapy
Treatment of cancer with chemical agents. Used to cure and increase survival time.

Adjuvant therapy
= Chemotherapy + surgery or radiation. Cytotoxic effects exerted on healthy cells and cancer cells

Immunotherapy (biological response modifiers and targeted therapy)
-Modify patient’s biologic responses to tumor cells. Can have direct antitumor activity.

• Can interfere with cancer cell differentiation, transformation, metastasis.
  -Can improve immune function

Monoclonal antibodies(immunotherapy)
Bind to target antigens (often specific cell surface membrane proteins)
Prevents protein from functioning,

• prevents cell division. E.g- Rituximab (Rituxan)

Tyrosine Kinase Inhibitors(immunotherapy)
Inhibits activation of tyrosine kinase inhibitors- disrupt growth and cellular regulation of some types of cancer cells

Epidermal Growth Factor/ Receptor Inhibitors(immunotherapy)
Block epidermal growth factor from binding to cell surface receptor; prevents cancer cell division

Vascular Endothelial Growth Factor/Receptor Inhibitors(immunotherapy)
prevents binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels. Prevents formation of new blood vessels within the tumor

Multikinase Inhibitors (MKIs)(immunotherapy)
Inhibit activity of specific kinases in cancer cells and tumor blood vessels

Proteasome Inhibitor(immunotherapy)
Prevents formation of a large complex of proteins into cells; impair tumors cellular regulation ability

Angiogenesis inhibitors(immunotherapy)
Targets mammalian target of rapamycin; reduces concentration of vascular endothelial growth factor, disrupts cell division.

Photodynamic therapy
Selective destruction of cancer cells via chemical reaction triggered by types of light

Hormonal therapy
Changing usual hormone responses. Some hormones make hormone sensitive tumors grow more rapidly (Decreasing the hormone amounts to hormone sensitive tumors can slow cancer growth rate).
Steroids, steroid analogues, enzyme inhibitors

Surgical classification types
prophylaxis, diagnosis, cure, control, palliation,assessing therapy effectiveness and reconstruction

Prophylaxis(Surgical classification type)
remove cancerous tissue to prevent cancer development

Diagnosis(Surgical classification type)
removal for testing or examination to rule out cancer “biopsy”

Cure(Surgical classification type)
removes all cancerous tissue

Control(Surgical classification type)
removes part of tumor when removal of entire tumor is impossible

Palliation
surgery to provide symptom relief, is NOT curative

Assessing therapy effectiveness
(Surgical classification type)

Reconstruction(Surgical classification type)
increases function or appearance or both.

S/E of Surgery
removal can lead to changes in appearance, activity level, depression, grief, and decreased enjoyment of life

S/E of Radiation
Acute and long-term site-specific changes, vary according to site, Local skin changes and hair loss, altered taste sensations, Fatigue, Bone marrow suppression.

S/E of Chemotherapy
extravasation,
infection risk,
bone marrow suppression,
neutropenia,
anemia,
thrombocytopenia,
clotting risks,
chemotherapy-induced nausea and vomiting, mucositis,
alopecia,
cognitive changes,
chemotherapy-induced peripheral neuropathy.

S/E of Immunotherapy Monocle antibodies
allergic reactions,
skin,
mucous membranes,
GI tract

S/E of Immunotherapy Tyrosine kinase inhibitors
Fluid retention,
electrolyte imbalances,
bone marrow suppression

S/E of Immunotherapy EGFRI’s
skin reactions,
adverse effects on heart

S/E of Immunotherapy VEGF’s
hypertension,
impaired wound healing,
bone marrow suppression

S/E of Immunotherapy Multikinase inhibitors
hypertension,
GI distress,
mucositis,
mild neutropenia
thrombocytopenia

S/E of Immunotherapy Proteasome inhibitors
GI distress,
decreased taste sensation,
peripheral neuropathy

S/E of Immunotherapy Angiogenesis inhibitors
bone marrow suppression,
headache,
GI distress,
muscle pain
joint pain

S/E of Photodynamic therapy
avoid sunlight?

S/E of Hormonal manipulation
Masculinizing effects in women.
Feminizing effects in men (gynecomastia).
Fluid retention.
Acne.
Hypercalcemia.
Liver dysfunction.
Venous thromboembolism

Oncological emergency classification types
Sepsis,
Intravascular coagulation,
syndrome of inappropriate antidiuretic hormone, spinal cord compression,
hypercalcemia,
superior vena cava syndrome,
tumor lysis syndrome.

Sepsis (septicemia)
blood stream infection

Sepsis s/s
low grade fever

Sepsis treatment
IV antibiotics

Intravascular coagulation
extensive and abnormal clotting often caused by gram-negative sepsis

Intravascular coagulation s/s
bleeding from many sites
-pain
-ischemia
-strokes like symptoms

• dyspnea
  -tachycardia
  -reduced kidney function
  -bowel necrosis

Intravascular coagulation treatment
anticoagulants (depending on stage),
clotting factors if hemorrhaging,
IV antibiotics.

Syndrome of Inappropriate Antidiuretic Hormone

• excessive amounts of water that results in hyponatremia

SIAH S/S
Hyponatremia
Weakness
muscle cramps
Anorexia
Polyuria
Polydipsia
Myalgia (muscle pain & ache)
loss of appetite
fatigue
weight gain
confusion
Weakness
Coma
Seizure
death

SIAH Treatment
Fluid correction
Furosemide therapy
Correction of serum sodium imbalance

SIAH Intervention
Monitor I&O
Monitor lab values
Implement seizure precautions
Manage comfort

Spinal cord compression
Tumor compression of spinal cord

Spinal cord compression S/S
symptoms vary depending on location and severity of compression
Late paraplegia
Incontinence
Loss of sensory function
New onset backpain that worsens when laying dow
Constipation

Spinal cord compression Treatment
Radiation
Surgical intervention

Spinal cord compression Interventions
Assess for neurological defecits
Manage pain
Prevent skin breakdown

Spinal cord compression treatment/intervention
corticosteroids
-radiation
-surgery.

Hypercalcemia
is associated with lung, kidney, breast and multiple myeloma cancers

early symptoms of hypercalcemia
nonspecific,
skeletal pain,
kidney stones,
altered cognition,
loss of appetite,
constipation,
loss of deep tendon reflexes,
paralytic ileus,
ECG changes
Myalgia
Headache

Hypercalcemia Treatment
IV hydration normal saline,
loop diuretics,
Inpatient monitoring
Phosphate replacement
I.V bisphosphates,
calcitonin,
oral glucocorticoids.

Hypercalcemia Intervention
Assess s/s
Administer fluids
Monitor I&O

Superior vena cava syndrome(SVCS)
vena cava compressed by tumor or clots

SVCS S/S
edema in face and eyes
engorged blood vessels and erythema in the upper body,
edema in arms and hands
dyspnea,
stridor
Dysphagia
Cough

SVCS Treatment
Chemo
Metal stent
Radiation

SVCS Interventions
Maintain airway
Administer oxygen

Tumor lysis syndrome
large number of tumor cells are destroyed quickly and contents of those cells (potassium and purines) are released into the blood stream

Tumor lysis syndrome s/s
Hyperkalemia
Hypocalcemia
Hyperuricemia
Acute Renal failure*
Acidosis

Tumor lysis syndrome treatment
Inpatient monitoring
Fluid resuscitation
Correction of acidosis
Hemodialysis
Allopurinol or uricase therapy

Tumor lysis syndrome intervention
Maintain ABCs
Monitor vitals and cardiac rhythm
Manage electrolyte balance
Prepare patient for hemodialysis

Malignant pericardial effusion
Develops due to fluid accumulation around the pericardial sac

Malignant pericardial effusion s/s
Dyspnea
Fatigue
Distended neck veins
Distant heart sound
Tachycardia
Orthopnea

Malignant pericardial effusion Treatment
Radiation
Surgical Intervention

Malignant pericardial effusion nursing interventions
Assess for neurological deficits
Manage pain
Prevent skin breakdown

Hospice care
Model for quality, compassionate care for those facing life-limiting illness or injury
Usually less than 6 months to live

Palliative Care
Philosophy of care for those with life-threatening disease
Provided by physician, nurse practitioner, or team

Assessment findings
o Weakness
o Sleeping more
o Anorexia
o Changes in organ system function
o Cold, mottled, cyanotic extremities
o Changes in breathing pattern
o Decreased LOC

Interventions=responding
o Needs and preferences met
o Control of symptoms of distress
o Meaningful interactions with family
o Peaceful death

Managing Breathlessness/dyspnea
o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines
o Oxygen (for comfort)
o Electric fan for air circulation
o Reposition

Managing Nausea/vomiting
o Antiemetic agents,Prochlorperazine (Compazine),Ondansetron (Zofran),Dexamethasone (Decadron, Deronil, Dexasone) Metoclopramide (Reglan, Maxeran)
o Remove any source of odors
o Comfortable room temperature
o Aromatherapy

Managing Agitation/delirium
o Assess for pain, urinary retention, constipation, other reversible cause
o Pharmacologic agents
o Music therapy; aromatherapy

Managing Refractory symptoms of distress
o Proportionate palliative sedation

Lab values for normal ranges
o Sodium 136-145
o Potassium 3.5-5
o Calcium 9-10.5
o Chloride 98-106
o Magnesium 1.8-2.6

o What Three hormones control fluid and electrolyte imbalance?
Aldosterone (adrenal gland),
Antidiuretic hormone (vasopressin) (pituitary gland),
Natriuretic peptides (cells in the heart and ventricles)

Aldosterone (adrenal gland)
o Secreted when sodium levels in the extracellular fluid are low
o Prevents both water and sodium loss
o Triggers kidneys to reabsorb water and sodium from urine back into blood (increases blood osmolarity and blood volume
o Promotes kidney potassium excretion

Antidiuretic hormone (vasopressin) (pituitary gland)
o Released in response to change in blood osmolarity
o Retains only water> INDIRECTLY regulates electrolyte excretion and retention

Natriuretic peptides (cells in the heart and ventricles)
o Secreted in response to increased blood volume and pressure
o NP binds to receptors in nephrons, creates opposite effect of aldosterone
o Sodium reuptake is inhibited, urine output is increased (reduces BP/BV)

Renin angiotensin II pathway (urine output= indicator of perfusion)
o When kidneys sense blood pressure, volume, osmolarity, or oxygen levels are low, they secrete renin to RAISE them to normal levels
o Renin activates angiotensin 1 > angiotensin 1 is activated by the enzyme angiotensin converting enzyme (ACE) and converted to angiotensin 2

Angiotensin 2
constricts arteries and veins, lowers GFR rates to reduce urine output, signals kidneys to promote aldosterone

Hypervolemia (Excess fluid volume)
Increased fluid in the extracellular space caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF.

Causes of Excess fluid volume (hypervolemia)
o Heart failure
o Excess fluid intake
o Renal failure
o Increased sodium intake

Hypervolemia s/s
o Ascites.
o Aphasia,
o muscle twitching,
o tremors,
o seizures.
o Bounding pulses.
o lethargy,
o disorientation,
o confusion
o coma
o Crackles*
o Distended neck and peripheral veins.
o Edema variable from dependent
o Elevated central venous pressure.
o Extra heart sounds S3.
o Hypertension.
o Productive cough.
o Shortness of breath.
o Sudden weight gain

Hypovolemia (deficient fluid volume)
occurs when loss of extracellular fluid exceeds the intake of fluid. Decreased fluid in ECF

Causes of hypovolemia
o Burns
o Severe diarrhea
o Gastric intubation
o Hemorrhage
o Diabetic ketoacidosis (DKA)*
o Diabetes insipidus
o Diuretics
o Adrenal disease
o Recovery phase of acute renal failure*

Hypovolemia s/s
o Abdominal distention.
o Fever
o Confusion, restlessness.
o Dark concentrated urine.
o Decreased urine volume.
o Decreased central venous pressure.
o Flattened neck veins.
o Hypotension.
o Pale, moist, clammy skin.
o Tachycardia.
o Tachypnea.
o Weak pulses.

Hyperkalemia
is defined as serum potassium level above 5.0 mEq/L.

Hyperkalemia cause
o Renal disease
o Renal failure
o Treatment side effects (NSAIDs,diuretics, and massive transfusion with banked blood)
o Metabolic acidosis
o Ketoacidosis
o Burns
o Trauma
o Addison’s disease

Hyperkalemia s/s
o Bradycardia
o Hypotension
o Tall, peaked T waves
o Prolonged PR interval
o Wide QRS
o Asystole
o VFib
o Paresthesia
o Weakness
o Diarrhea
o Spastic colon
o Hyperactive bowel sounds

Hypokalemia
is defined as serum potassium level below 3.5 mEq/L.

Hypokalemia Causes
o Diabetic ketoacidosis
o Acute kidney failure
o Cushing’s syndrome
o Diuretics
o Beta blockers
o Laxatives
o Magnesium deficiency

Hypokalemia s/s
o Diarrhea
o Slows down heart*
o Cardiac standstill*
o Hypotension*
o Bradycardia*
o SEVERE V-fib (Ventricles quiver)*
o Shallow breathing
o Hyporeflexia
o Weakness
o Cardiovascular
o Thready weak pulse
o Dysrhythmia
o AMS
o Lethargy
o Hypoactive bowel sounds
o Constipation
o Nausea/vomiting

Potassium has a huge impact on the
heart (can be deadly)

Hypernatremia
Sodium levels greater than 149

Hypernatremia causes
o Dehydration
o Decreased water intake
o Excessive water loss
o Diabetes insipidus

Hypernatremia s/s
o Red flushed skin*
o Edema*
o Excess thirst (due to high sodium)*
o Swollen dry tongue*
o Lethargy
o Irritability
o Confusion
o Drowsy
o Stupor
o Twitching
o Muscle weakness
o Hypovolemia
o Hypotension
o Hypervolemia
o Bounding pulse
o Hypertension

Hyponatremia
Sodium levels below 130

Hyponatremia causes
o Excessive water intake
o SIADH*
o Increase in antidiuretic hormone
o Fluid volume depletion
o Profuse diaphoresis

Hyponatremia s/s
o Nausea
o Headache
o Fatigue
o Confusion*
o Weak thready pulse*
o HTN
o Cerebral edema
o Increased ICP
o Weakness
o Cramps
o Cardiovascular
o Hypovolemia
o Weak thready pulse
o Tachycardia*
o Hypotension
o Dizziness
o Hypervolemia
o Bounding pulse

Hypercalcemia
calcium greater than 10.9

Hypercalcemia causes
o Addison’s disease
o Paget’s disease
o Hyperthyroidism
o Sarcoidosis
o Lithium
o Tamoxifen
o Thiazide Diuretics

Hypercalcemia s/s
o Weakness
o ↓DTR
o Altered LOC
o Bradycardia
o Cyanosis
o Shortened QT
o ↑ DVT
o ↓ peristalsis
o Constipation
o N/V
o Hypoactive bowel sounds
o Abdominal pain

Hypocalcemia
Calcium level less than 8.5

Hypocalcemia cause
o Sepsis
o Hypoparathyroidism
o Lever disease
o Renal failure
o Hyperphosphatemia
o Vitamin D deficiency
o Magnesium deficiency

Hypocalcemia s/s
o Paresthesia ‘s
o Tetany
o Irregular heartbeat
o Hypotension
o Prolonged ST
o Prolonged QT
o Hyperactive bowel sounds GI/GU
o Diarrhea
o Osteporosis
o Chvostek’s Sign
o Trousseaus Sign

Hypermagnesemia
Magnesium level greater than 2.6

Hypermagnesemia cause
o Dehydration
o Addison’s disease
o Hyperparathyroidism
o Hypothyroidism
o Kidney failure
o Acidosis

Hypermagnesemia s/s
o Nausea
o Vomiting
o Flushing
o ↑DTR
o Numbness
o Painful contractions
o Muscle weakness
o Tetany
o Seizures

Hypomagnesemia
magnesium levels less than 1.8

Hypomagnesemia cause
o IBS
o Alcoholism
o Hypoparathyroidism
o Malnutrition
o Kidney disease
o Pancreatitis
o Diuretics
o Digoxin
o Cyclosporine

Hypomagnesemia s/s
o Muscle twitch
o Weakness
o Bradycardia
o Vasodila tion
o Hypotension
o Prolonged PR
o Widened QRS
o Neurologic
o Decreased LOC
o Decreased respiratory drive
o ↓DTR

Hypophosphatemia
Phosphorus level less than 2.5

Hypophosphatemia cause
o hyperparathyroidism.
o Cushing syndrome
o hypothyroidism.
o Vitamin D deficiency.
o hypomagnesemia
o hypokalemia.
o Theophylline intoxication.
o Long-term diuretic use.

Hypophosphatemia s/s
o Muscle dysfunction
o Weakness

Hyperphosphatemia
phosphorus level above 4.9

Hyperphosphatemia cause
o chronic kidney disease
o hypoparathyroidism
o metabolic or respiratory acidosis

Hyperphosphatemia s/s
o Calcium deposit in soft tissue
o Bone and joint pain
o muscle cramps,
o tetany
o perioral numbness or tingling

Hypochloremia
chloride levels below 95

Hypochloremia cause
o Loss of body fluids
o Diuretics
o Corticosteroids
o Laxative
o Bicarbonate

Hypochloremia s/s
o Excess diarrhea
o Vomiting
o Sweating
o Fever

Hyperchloremia
Chloride levels above 110

Hyperchloremia cause
o Loss of body fluids
o Kidney failure
o Kidney disease

Hyperchloermia s/s
o fatigue.
o muscle weakness.
o excessive thirst.
o dry mucous membranes.
o high blood pressure.

What are the steps in cancer cell development?
a. Initiation
b. Promotion
c. Progression
d. Metastasis

What sources affect cancer cell growth?

• Exposure to the carcinogens (tobacco, radiation, chemotherapy, hormone drugs, pollution)
• Genetic predisposition
• Immunity

Factors that cause cancer can be divided into two categories:

• External – chemical, physical, viral
• Personal – immunity, age, genetic risk

Why is it important to teach patients not to remove Radiation markings?
It allows the radiologist to know where to go, without the marker they won’t know

Oncology patients and risk for infection: what is the best way to prevent infections?
Hand hygiene

Why does someone have excess thirst with hypernatremia?
a. It’s due to the sodium being high;To boost water intake

What are the goals of hospice care?
maximize the quality of life for people in the last phases of a disease that cannot be cured

What are the goals of pallative care?
providing relief from the symptoms and stress of a serious illness

When is Hospice a necessary option?
a. When the patient will live for less than 6 months

Surgical post operative patients require what types of nursing interventions?
a. Assess for complications (bleeding,infection, pneumonia, and DVT/PE)
b. Encourage coughing and deep breathing
c. Use incentive spirometer
d. Ensure pt has DVT/PE prophylaxis ordered

Oncological Pain Management (Priority Nursing Interventions)
a. Assess level of pain frequently
b. Administer meds as prescribed

Cancer patient education
a. Type of procedure
b. Post-operative management to include any restrictions
c. Wound care
d. S/S of infection
e. Medication
f. F/U treatment
g. F/U appt

K+ (Potassium) normal range
3.5 to 5

Why is it important to use an IV pump when administering K+?
Because if it’s pushed the patient can go into cardiac arrest

What can happen to a patient when K+ levels change drastically?
it can cause cardiac dysrhythmias and cardiac arrest.

Ca(Calcium) normal range
9.0 to 10.5

Why would thyroid surgery cause changes in calcium levels?
They are temporarily damaged after surgery

Mg (Magnesium) normal range
1.3 to 2.1

What is a common cause of low magnesium?
a. Alcohol
b. Burns
c. Diarrhea
d. urination

Na(Sodium) normal range
136 to 145

What lab values would you expect to find with a patient experiencing hypovolemia?
a. Increased serum sodium
b. Increased blood urea nitrogen
c. Increased hematocrit
d. Increased urine S.G
e. Increased serum osmolality
f. Decreased serum potassium
g. Decreased urine sodium

Where sodium goes, water
follows

Hyponatremia can result in
seizures, coma and respiratory arrest

Chloride helps to control
Blood volume, BP and Ph balance

Thyrocalcitonin
Hormone produced by thyroid that lowers the level of calcium and phosphate in the blood and promotes the formation of bone.

Chloride follows
sodium

Fluid volume deficit(dehydration)
water loss alone without change in sodium

Fluid volume deficit(dehydration) s/s
a. Elevated HR
b. Low urine output
c. Alterations in mental state
d. Concentrated urine
e. Decreased skin turgor
f. Decreased urine output (less than 30mL/hr)
g. Decreased venous filling pressures (preload)
h. Dry mucous membranes
i. Hemoconcentration
j. Hypotension/orthostasis
k. Sudden weight loss
l. Tachycardia/weak, rapid HR
m. Thirst

Fluid Volume Overload (hypervolemia)
isotonic expansion of the ECF due to an increase in total body sodium content and an increase in total body water

Fluid Volume Overload (hypervolemia) s/s
a. Crackles in lungs*
b. Anxiety
c. Azotemia
d. BP changes
e. Change in mental status
f. Change in respiratory pattern
g. Decreased Hgb or Hct
h. Edema
i. Increased central venous pressure (CVP)
j. Increased pulmonary artery diastolic pressure
k. Intake exceeds output
l. Jugular vein distention
m. Oliguria
n. Restlessness
o. Specific gravity changes
p. Shortness of breath; orthopnea/dyspnea
q. Tachycardia
r. Third heart sound (S3)

Normal CBC
a. Hgb
i. Men 14-18 g/100 ml,
ii. Women 12-16 g/100 mL
b. Hct
i. Men 42-52%,
ii. Women 37-47%
c. WBC
i. 5,000-10,000/mm3

Benign Cells features

• Specific morphology – resemble the tissues they originated from
• A smaller nuclear-to-cytoplasmic ratio – similar to normal cells
• Specific differentiated function – contributes to the body function
• Tight adherence – bind closely together due to the production of fibronectin
• No migration – do not invade other tissues
• Orderly growth – rate of growth is normal by expansion
• Euploidy – normal chromosomes per cell

Malignant Cells features

• Anaplasia – loss of appearance of parent cell
• A larger nuclear-to-cytoplasmic ratio – larger nucleus
• Specific functions are lost – serve no purpose
• Loose adherence – loosely bound due to the lack of fibronectin production
• Migration – spread easily (metastasize)
• Contact inhibition does not occur – loss of cellular regulation
• Rapid or continuous cell division – loss of cellular regulation
• Aneuploidy – Abnormal chromosomes

Tall peaked T-waves, at P-waves, prolonged PR intervals and widened QRS complexes can
present in which of the following conditions?
A. Hypocalemia
B. Hypercalemia
C. Hypokalemia
D. Hyperkalemia
The answer is D: Hyperkalemia

Anaplasia

• loss of appearance of parent cell

A Larger Nuclear-to-Cytoplasmic Ratio

• larger nucleus

Specific functions are lost

• serve no purpose

Loose adherence

• loosely bound due to the lack of fibronectin production

Migration

• spread easily (metastasize)

Contact inhibition does not occur

• loss of cellular regulation

Rapid or continuous cell division

• loss of cellular regulation

Aneuploidy
Abnormal number of chromosomes.

Specific morphology
resemble the tissues they originated from

smaller nuclear to cytoplasmic ratio

• similar to normal cells

Specific differentiated function

• contributes to the body function

Tight adherence
bind closely together due to the production of fibronectin

No migration

• do not invade other tissues

Orderly growth

• rate of growth is normal by expansion

Euploidy

• normal chromosomes per cell

While monitoring a patient who has fluid overload, which assessment is most concerning to the nurse?
A. Bounding pulse
B. Neck vein distention
C. Pitting edema in the feet
D. Presence of crackles in the lungs
Presence of crackles in the lungs

A patient has been having frequent liquid diarrhea for the last 24 hours. A stool sample was sent to the laboratory to confirm possible Clostridium difficile infection. The nurse should monitor the patient for which electrolyte imbalance?
A. Dehydration
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Hypokalemia

Which of the following is NOT considered one of the seven warning signs of cancer?

• Changes in bowel or bladder
• Unusual bleeding or discharge
• Nagging cough or hoarseness
• Spots or blurry vision
  Spots or blurry vision

A patient has been vomiting for two days. Which electrolyte imbalance will the nurse most likely note?

• Hyponatremia
• Hyperkalemia
• Decreased urine specific gravity
• Dehydration
  Hyponatremia

The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered?

• Potassium chloride
• Allopurinol (Zyloprim)
• Recombinant erythropoietin(Procrit)
• Radioactive iodine 131
  Allopurinol (Zyloprim)

A patient has had a recurrence of her lymphoma and has decided not to restart treatment. The oncologist suggests she might have 2-3 months left to live. What services would be appropriate at this time?

• Hospice services
• Curative services
• Palliative services
• Rehabilitative services
  Hospice services

which of the following is NOT a characteristic of benign cell growth.

• Examples include moles, skin tags, nasal polyps
• Harmless
• Indicates cancer
• Usually does not require intervention
  Indicates cancer

TNM is a method for cancer reporting, which means:

• Thickness,Nodes,Metastasis
• Thorax nodes, Neck nodes, muscle involvement
• Tumor,Node, and Metastasis
• Time, Nuclear changes, Measurement
  Tumor, Node, and Metastasis

A patient is one week past their first round of chemotherapy for leukemia. The nurse should be on the lookout for all of the following EXCEPT:

• Increased energy
• Thrombocytopenia
• Neutropenia
• Metabolic Acidosis
  Increased energy

The nurse is taking care of a patient with cancer and metastasis throughout the body. Upon assessment, he notes dilated neck veins with a bluish tinge to the skin. This could be indicative of:

• Fluid overload
• Kidney failure
• Superior vena cava syndrome
• Tumor lysis syndrome
  Superior vena cava syndrome

Which of the following would be an example of primary cancer prevention?

• Mammogram
• MRI
• Vaccine
• Cervical cancer screening
  Vaccine

The diagnosis of a cancer should include

• Genetic testing
• MRI
• Biopsy
• Endoscopy
  Biopsy

What response by the nursing student accurately describes cancer grading?

• There are two grades: benign or malignant
• The degree of mutation of a cancer cell from the normal cells
• A letter assigned to the cancer; “D” being malignant
• The overall spread of cancer throughout the body
  The degree of mutation of a cancer cell from the normal cells

In the treatment of the patient admitted with Diabetic Ketoacidosis. When insulin is administered, what should the nurse be closely monitoring for

• Hyperkalemia
• Hypokalemia
• Hypercalcemia
• Hypocalcemia
  Hypokalemia

Which of the following would NOT be considered an oncologic emergency?

• Sepsis
• Intravascular coagulation
• Superior vena cava syndrome
• Nausea
  Nausea

Which electrolyte is in abundance inside the cell?

• Sodium
• Potassium
• Magnesium
• Water
  Potassium

Which cancers originate in the bones or soft tissues of the body?

• Leukemia
• Sarcoma
• Carcinoma
• Lymphomas
  Sarcoma

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is MOST important to communicate to the health care provider?

• “I am allergic to iodine”
• “I am incontinent when I cough”
• “My urinary stream is very weak”
• “My legs are numb and weak”
  “My legs are numb and weak”

A patient is on neutropenic precautions. What is the most effective intervention to protect the patient?

• Wearing a mask
• Wearing gloves
• Hand hygiene
• Negative air pressured room
  Hand hygiene

Which of the following would be included in the discharge education with a patient who has just completed chemotherapy. (Select all the apply)

• For nausea you can try ginger
• Try eating small frequent meals throughout the day versus large meals
• If you develop a fever, try OTC medications and if it doesn’t subside in two days call your provider.
• Some patients may develop mucositis or alopecia with this treatment
  For nausea you can try ginger
• Try eating small frequent meals throughout the day versus large meals
• Some patients may develop mucositis or alopecia with this treatment

A patient asks how does radiation work? The nurse responds by saying

• The radiologist oncologist targets the cancer and health tissue surrounding it
• At high doses, it kills cancer cells or slows their growth by damaging their DNA
• It kills cancer cells and other healthy cells like hair, bone marrow suppression, and the lining of the GI tract.
• It causes the cells to initiated a self destruct mechanism
  At high doses, it kills cancer cells or slows their growth by damaging their DNA

Which of the following lab values is abnormal?

• Na+ 138 mEq/L
• Blood sugar 75 mg/dL
• Ca++ 10.9mg/dL
• K+ 4.1 mEq/L
  Ca++ 10.9mg/dL

sources;

https://www.gcu.edu/
https://yaveni.com/