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The nurse is caring for a patient with stage IV metastatic breast cancer, who has metastasis to the bone.
During assessment, the patient appears severely weak, fatigued, confused, and continually repeats "I'm so thirsty!” What will the nurse implement in the patient's plan of care?

Notify the provider that the patient is exhibiting signs of hypercalcemia and draw blood to obtain ionized calcium level.

Notify the provider that the patient is exhibiting signs of tumor lysis syndrome and draw blood to obtain uric acid level.

Notify the provider that the patient is exhibiting signs of infection and request an order for blood cultures.

Notify the provider that the patient is exhibiting signs of bleeding and request an order for a packed red blood cell transfusion.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Hypercalcemia is common in patients with bone metastasis. Symptoms include weakness, fatigue, confusion, and excessive thirst. The nurse should notify the provider and draw blood to obtain the ionized calcium level for proper diagnosis and treatment.

Choice B rationale

Tumor lysis syndrome typically occurs in patients with rapidly proliferating tumors undergoing treatment, leading to the release of intracellular contents. Symptoms include hyperuricemia, not excessive thirst. This choice does not match the patient's presentation.

Choice C rationale

While infection can cause weakness and confusion, it does not typically cause extreme thirst. The patient's symptoms are more indicative of hypercalcemia, making this choice less relevant.

Choice D rationale

Bleeding can cause weakness and confusion due to anemia, but it does not cause extreme thirst. The symptoms of the patient are more aligned with hypercalcemia than bleeding.

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Correct Answer is D

Explanation

Choice A rationale

Tumor lysis syndrome (TLS) results from the rapid breakdown of cancer cells, leading to metabolic imbalances such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Symptoms can include nausea, vomiting, diarrhea, muscle cramps, and arrhythmias. TLS is a metabolic emergency seen in high-turnover cancers like leukemia or lymphoma and is not associated with symptoms like jugular venous distention or edema in the face, neck, and arms.

Choice B rationale

Hypercalcemia, often due to bone metastasis or certain paraneoplastic syndromes, presents with symptoms such as confusion, lethargy, constipation, nausea, polyuria, and polydipsia. It is not related to the symptoms described in the question, which are indicative of a different oncologic emergency.

Choice C rationale

Spinal cord compression occurs when a tumor compresses the spinal cord, leading to symptoms like severe back pain, weakness, sensory changes, and autonomic dysfunction. It does not explain the symptoms of jugular venous distention, facial, neck, and arm edema.

Choice D rationale

Superior vena cava syndrome (SVCS) occurs when a tumor compresses the superior vena cava, leading to decreased venous return from the upper body. Symptoms include shortness of breath, jugular venous distention, and edema of the face, neck, and arms due to impaired blood flow. This is an oncologic emergency requiring prompt intervention to reduce the obstruction.

A. Facial swelling and jugular vein distension (JVD). B. Muscle weakness, confusion, polyuria, and polydipsia. C. Flank pain, elevated uric acid, and cardiac monitor reveals an abnormal rhythm. D. Elevated liver function tests, jaundice, and blistering skin rash.

Correct Answer is C

Explanation

The correct answer is Choice C.

Choice A rationale

Facial swelling and jugular vein distension (JVD) are indicative of superior vena cava syndrome (SVCS), not tumor lysis syndrome (TLS). SVCS occurs when the superior vena cava, which carries blood from the head, neck, upper chest, and arms to the heart, is obstructed. This can lead to facial swelling, cyanosis, and distended neck veins due to increased venous pressure.

Choice B rationale

Muscle weakness, confusion, polyuria, and polydipsia are symptoms of hypercalcemia. Hypercalcemia is characterized by elevated levels of calcium in the blood, which can cause neuromuscular and cognitive symptoms, excessive urination, and increased thirst.

Choice C rationale

Tumor lysis syndrome (TLS) is characterized by rapid destruction of tumor cells, leading to elevated levels of uric acid, potassium, and phosphate. Symptoms include flank pain due to uric acid crystallization in the kidneys, and abnormal heart rhythms due to hyperkalemia.

Choice D rationale

Elevated liver function tests, jaundice, and blistering skin rash are symptoms of liver toxicity or hepatic dysfunction, possibly due to drug-induced liver injury. These symptoms are not related to tumor lysis syndrome (TLS).

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The nurse is caring for a patient with stage IV metastatic breast cancer, who has metastasis to the bone.During assessment, the patient appears severely weak, fatigued, confused, and continually repeats "I'm so thirsty!” What will the nurse implement in the patient's plan of care?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with lung cancer who suddenly develops shortness of breath, jugular venous distention, and edema in the face, neck, and arms.The nurse promptly notifies the healthcare provider that the patient is exhibiting signs of which oncologic emergency?

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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The nurse is caring for a patient with stage IV metastatic breast cancer, who has metastasis to the bone.
During assessment, the patient appears severely weak, fatigued, confused, and continually repeats "I'm so thirsty!” What will the nurse implement in the patient's plan of care?