Colon, Lung, Breast Cancer Quiz – Flashcards
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A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate? Select one: a. "Tell me what you know about the various treatments available." b. "Surgery is the treatment of choice for stage I lung cancer." c. "Did you have bad experiences with previous surgeries?" d. "Are you afraid that the surgery will be very painful?"
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a. "Tell me what you know about the various treatments available." Rationale: More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, "Surgery is the treatment of choice" is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery. Chemotherapy is the primary treatment for small cell lung cancer. In non-small cell lung cancer, chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery.
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After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all these changes. I don't want to look at the stoma." What is the best action by the nurse? a. Ask the patient about the concerns with stoma management. b. Postpone any teaching until the patient adjusts to the ileostomy. c. Develop a detailed written list of ostomy care tasks for the patient. d. Reassure the patient that ileostomy care will become easier.
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A. Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy
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Four hours after a bowel resection, a 74-year-old male patient with a nasogastric tube to suction complains of nausea and abdominal distention. The first action by the nurse should be to a. reposition the tube and check for placement. b. remove the tube and replace it with a new one. c. notify the patient's health care provider. d. auscultate for hypotonic bowel sounds.
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A. Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded.
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The nurse teaching a young women's community service group about breast self-examination (BSE) will include that a. BSE should be done daily while taking a bath or shower. b. annual mammograms should be scheduled in addition to BSE. c. BSE will reduce the risk of dying from breast cancer. d. performing BSE after the menstrual period is more comfortable.
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D. Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40, and newer guidelines suggest delaying them until age 50.
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A 58-year-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "It would not be appropriate for me to make a decision about your health." b. "There is no need to make a decision rapidly; you have time to think about this." c. "Tell me what you understand about the surgical options that are available." d. "I would have a lumpectomy, but you need to decide what is best for you."
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C. Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication
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A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Resume normal activities 2 to 3 days after the mammoplasty. b. Wear a loose-fitting bra to decrease irritation of the sutures. c. Check wound drains for excessive blood or a foul odor. d. Take aspirin every 4 hours to reduce inflammation.
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C. The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.
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A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing? a. Oncotype DX assay testing b. Estrogen receptor testing c. CA 15-3 level testing d. HER-2 receptor testing
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C. Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer.
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When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Discuss scheduling an annual clinical breast examination with a 22-year-old. b. Explain to a 60-year-old that mammography frequency can be reduced to every 3 years. c. Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI). d. Teach a healthy 30-year-old about the need for an annual mammogram.
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C. MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A young woman should have a clinical breast exam every 3 years. Annual mammograms are recommended for women over 50.
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Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Check blood pressure (BP) on both right and left arms. c. Keep the right arm at or below the level of the heart. d. Assist with application of a compression sleeve.
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D. Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position.
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The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a. The patient's white blood cell (WBC) count is 5000/µL. b. The patient's apical pulse is irregular. c. The patient complains of fatigue. d. The patient eats only 25% of meals.
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B. Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.
