MSN Exam for Hodgkin’s Disease

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1) A 22-year-old with stage I Hodgkin’s disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the client tells you, “Sometimes I am afraid of dying.” Which response is most appropriate at this time?

1. “Many individuals with this diagnosis have some fears.”
2. “Perhaps you should ask the doctor about medication.”
3. “Tell me a little bit more about your fear of dying.”
4. “Most people with stage I Hodgkin’s disease survive.”

2) After receiving the change-of-shift report, which client will you assess first?

1. A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit
2. A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge
3. A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of bed
4. A 60-year-old with non-Hodgkin’s lymphoma who is refusing the ordered chemotherapy regimen

3) The Hodgkin’s disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin’s disease were correct, which of the following cells would the pathologist expect to find?

1. Reed-Sternberg cells.
2. Lymphoblastic cells.
3. Gaucher’s cells.
4. Rieder’s cells

4) A male client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment findings would the nurse expect to note specifically in the client?

1. Fatigue
2. Weakness
3. Weight gain
4. Enlarged lymph nodes

5) A newly admitted client is diagnosed with Hodgkin’s disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure?

1. Vital signs
2. Incision site
3. Airway
4. Level of consciousness

6) Hodgkin lymphoma, named for Thomas Hodgkin, is an American physician who identified it in 1832.

1. True
2. False

7) Hodgkin lymphoma may be cured with chemotherapy with almost no incidence of secondary acute nonlymphocytic leukemia within 10 years.

1. True
2. False

Q.8) The nurse is aware that the following symptoms is most commonly an early indication of stage 1 Hodgkin’s disease?

1. Pericarditis
2. Night sweat
3. Splenomegaly
4. Persistent hypothermia

9) You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation for a client with Hodgkin’s lymphoma who is receiving radiation to the groin area. Which nursing activity is best delegated to a nursing assistant caring for the client?

1. Check the skin for signs of redness or peeling.
2. Apply alcohol-free lotion to the area after cleaning.
3. Explain good skin care to the client and family.
4. Clean the skin over daily with a mild soap.

10) The nurse understands that Hodgkin’s disease is suspected when a client presents with a painless, swollen lymph node. Hodgkin’s disease typically affects people in which age group?

1. Children (ages 6-12 years)
2. Teenagers (ages 13-20 years)
3. Young adults (ages 21-40 years)
4. Older adults (ages 41-50 years)

11) The two main groups of lymphoma in humans are Hodgkin lymphoma and the non-Hodgkin Lymphomas (NHL).

1. True
2. False

12) One of the symptoms for lymphatic disease is swelling of the lymph nodes; however, this symptom may be easily overlooked because the enlargement does not cause any pain.

1. True
2. False

13) A client admitted with newly diagnosed with Hodgkin’s disease. Which of the following would the nurse expect the client to report?

1. Lymph node pain
2. Weight gain
3. Night sweats
4. Headache

14) Non-Hodgkin lymphoma can spread to almost any part of the body, including the liver, bone marrow, and spleen.

1. True
2. False

15) Hodgkin lymphoma only occurs in a group of lymph nodes, not in a single lymph node or in other parts of the lymphatic system, such as the bone marrow and spleen.

1. True
2. False

Answers and Rationales

1. C. “Tell me a little bit more about your fear of dying.”Most assessment about what the client means is needed before any interventions can be planned or implemented. All of the other statements indicate a conclusion that the client is afraid of dying of Hodgkin’s disease. Focus: Prioritization
2. A. A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit . The newly admitted client should be assessed first, because the baseline assessment and plan of care need to be completed. The other clients also need assessments or interventions, but do not need immediate nursing care. Focus: Prioritization
3. A. Reed-Sternberg cells. A definitive diagnosis of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Gaucher’s cells are large storage cells found in patients with Gaucher’s disease. Rieder’s cells are myeloblasts found in patients with acute myelogenous leukemia.
4. D. Enlarged lymph nodes. Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.
5. C. Airway . Assessing for an open airway is the priority. The procedure involves the neck, the anesthesia may have affected the swallowing reflex or the inflammation may have closed in on the airway leading to ineffective air exchange.
6. B. False
7. B. False
8. B. Night sweat . In stage 1, symptoms include a single enlarged lymph node (usually), unexplained fever, night sweats, malaise, and generalized pruritis. Although splenomegaly may be present in some clients, night sweats are generally more prevalent. Pericarditis isn’t associated with Hodgkin’s disease, nor is hypothermia. Moreover, splenomegaly and pericarditis aren’t symptoms. Persistent hypothermia is associated with Hodgkin’s but isn’t an early sign of the disease.
9. D. Clean the skin over daily with a mild soap. Skin care is included in nursing assistant education and job description. Assessment and client teaching are more complex tasks that should be delegated to registered nurses. Use of lotions to the irradiated area is usually avoided during radiation therapy. Focus: Delegation
10. C. Young adults (ages 21-40 years) 
11. A. True 
12. A. True
13. C. Night sweats. Assessment of a client with Hodgkin’s disease most often reveals enlarged, painless lymph node, fever, malaise and night sweats.
14. A. True 
15. B. False
16. B. Night sweats and fatigue. Symptoms of Hodgkin’s disease include night sweats, fatigue, weakness, and tachycardia. The disease is characterized by painless, enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and vomiting are not typically symptoms of Hodgkin’s disease.
17. B. False
18. A. Sexual dysfunction related to radiation therapy. Radiation therapy often causes sterility in male clients and would be of primary importance to this client. The psychosocial needs of the client are important to address in light of the age and life choices. Hodgkin’s disease, however, has a good prognosis when diagnosed early.
19. A. True