NCLEX cancer – Flashcards
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The community health nurse is instructing a group of young female clients bout breast self-examination. The nurse should instruct the clients to perform the examination at which time? A. At the onset of menstruation B. Every month during ovulation C. Weekly at the same time of day D. 1 week after menstruation begins
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Answer: D Rationale: The breast self-examination should be performed monthly, 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
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The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? A. Placing cool compresses on the affected arm B. Elevating the affected arm on a pillow above heart level C. Avoiding arm exercises in the immediate post-operative period. D. Maintaining an intravenous site below the antecubital area of the affected side
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Answer: B Rationale: Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring
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While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors A. Do not cause damage to adjacent tissue. B. Do not spread to other tissues and organs. C. Are simply an overgrowth of normal cells. D. Frequently recur in the same site.
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Answer: B Rationale: The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. Both types of tumors may cause damage to adjacent tissues. The cells differ from normal in both benign and malignant tumors. Benign tumors usually do not recur.
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For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? A. "Client verbalizes feelings of anxiety." B. "Client doesn't guess at prognosis." C. "Client uses any effective method to reduce tension." D. "Client stops seeking information."
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Answer: A Rationale: Verbalizing feelings are the client's first step in coping with the situational crisis. It also helps the health care team gain insight into the client's feelings, helping guide psychosocial care. Suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Seeking information can help a client with cancer gain a sense of control over the crisis
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A patient has undergone a mastectomy. The nurse determines that the client is having the most difficulty adjusting to the loss of the breast if which behavior is observed? A. Performs arm exercises B. Refuses to look at the dressing C. Reads the post operative care booklet D. Requests pain medication when needed
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Answer: B Rationale: The patient demonstrated the most difficult adjustments to the loss if she refuses to look at the dressing. This indicates that the client is not ready or willing to begin to acknowledge and cope with the surgery. Performing arm exercises is an action oriented behavior on the part of the patient and is considered a positive sign of adjustment. Reading the post operative care booklet indicates an interest in self care and is a positive action oriented option that is helpful, although there is no direct connection to adjustment to the loss of the breast.
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A nurse is counseling the family of patient who has terminal breast cancer about palliative care. The nurse explains that which of the following are goals of palliative care? Select all that apply. A. Delays death B. Offers a support system C. Provides relief from pain D. Enhances the quality of life E. Focuses only on the patient not the family F. Manages symptoms of disease and therapies
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Answers: B, C, D, F Rationale: Palliative care is a philosophy of total care. Palliative care goals include the following: providing relief from pain and other distressing symptoms, affirming life and regarding dying as a normal process, neither hastening nor postponing death, integrating psychological and spiritual aspects of client care, offering a support system to help the client live as actively as possible until death, offering a support system to help families cope during the client's illness and their own bereavement, and enhancing the quality of life.
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The nurse is caring for a client admitted to the surgical unit following a right modified radical mastectomy. The nurse includes which of the following in the nursing plan of care? A. Take blood pressure in the right arm only. B. Draw serum laboratory samples from the right arm only. C. Position the client supine with the right arm elevated on a pillow. D. Check the right posterior axilla area when assessing the surgical dressing.
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Answer: D Rationale: If there is drainage or bleeding from the surgical site after a mastectomy, gravity will cause the drainage to seep down and soak the posterior axillary portion of the drainage first. The nurse checks this area to detect early bleeding. The patient should be positioned with the head of the bed in semi-Fowler's position and the arm elevated on pillows to decrease edema. Edema is likely to occur because lymph drainage channels have been resected during the surgical procedure. Blood pressure management, venipuncture, and intra-venous sites should not involve use of the operative arm.
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The nurse is caring for a young woman who is dying from breast cancer. The nurse determines that a defining characteristic of anticipatory grieving is present when the young woman: A. Discusses thoughts and feelings related to the loss. B. Has prolonged emotional reactions and outbursts. C. Verbalizes unrealistic goals and plans for the future. D. Ignores untreated medical conditions that require treatment.
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Answer: A Rationale: The nurse can determine the client's stage of grief by observing the client's behavior. This is important because the appropriate nursing diagnoses must be developed so that the plan of care is appropriate.
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A 58 year old female is concerned about her risk for developing breast cancer. She began menarche at age 14, had 3 children before the age of 35, went through menopause at age 50 with an associated weight gain of 20 lbs. Which of the risk factors would contribute to this client's risk of developing breast cancer? A. menarche at age 14 B. children before the age of 35 C. postmenopausal obesity D. menopause at age 50
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Answer: C Rationale: Postmenopausal obesity is a risk factor for developing breast cancer
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A nurse is teaching a group of women about the appropriate method for performing a breast self-exam (BSE). Which of the following statements regarding breast self-exam demonstrates correct comprehension of the material? A. "Breast exams should begin around age 30." B. "Breast exams should be done one week prior to the menstrual cycle." C. "Breast exams should incorporate both feeling and looking at the breasts." D. "Breast exams should be done during the middle of the menstrual cycle."
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Answer C Rationale: Breast exams should incorporate both feeling and looking at the breasts. Premenstrual swelling and tenderness of the breasts may be present one week prior. Breast self-examination should begin as early as possible, preferably when the individual is an adolescent.
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At a senior citizen program, the nurse who was invited to speak to the group is teaching them about detecting the early signs of cancer. Which of the following should the nurse include? A: Do not overexpose yourself to the sun B: Exercise for no more than 7 minutes a day C: Lower the amount of fats in your diet D: Do a monthly breast self-exam
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Answer: D: Do a monthly breast self-exam Rationale: Monthly breast exams aid in early detection of cancer. Changing the patients diet and limiting exposure to the sun may help with prevention but not detection.
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The nurse is caring for a 35-year old patient receiving radiation and chemotherapy. Which statement by the patient indicates that he is using a positive coping mechanism that is useful during treatments? A: I may miss my own hair, but I have chosen a nice wig to wear B: Losing my hair won't bother me at all C: I'm never going to leave the house if I am bald D: I will not lose my hair and I'll make sure of that
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Answer: A: I may miss my own hair, but I have chosen a nice wig to wear Rationale: Expressing personal feelings and positive interventions demonstrate positive coping mechanisms
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The nurse is visiting a patient receiving radiation therapy. Which of the following statements is incorrect and requires additional teaching? A: "I may lose the ability to sweat" B: "To keep the radiation from burning my skin, I will use lotion" C: "I need to check my mouth frequently for signs of irritation" D: "During radiation therapy, I may lose some of my hair and foods may not taste right"
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Answer: B: "To keep the radiation from burning my skin, I will use lotion" Rationale: Skin products must be prescribed by the physician because they can irritate the skin
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A client undergoing radiation therapy has a severely depressed WBC count. The nurse should include which priority nursing intervention in the plan of care? A: Place the client in a private room and maintain strict aseptic technique with all procedures B: Encourage the client to include fresh fruits and vegetables in the diet C: Educate the client to avoid shaving with a razor D: Encourage frequent visitors to reduce the client's feelings of isolation
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Answer: A: Place the client in a private room and maintain strict aseptic technique with all procedures Rationale: The immunosuppressed client is at a high risk for infection. A private room, maintaining aseptic technique, and limiting visitors will reduce exposure and risk.
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The nurse is making a home visit to a client receiving external radiation therapy on an outpatient basis. Further teaching is necessary when the nurse observes the client doing which of the following? A: Washing radiation site with plain water and patting skin dry B: Protecting skin with soft, loose clothing C: Applying lotion to irritated skin D: Inspecting skin for damage
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Answer: C: Applying lotion to irritated skin Rationale: Lotion, deodorant, and powders should not be applied to the radiation site during the treatment period to avoid further irritation to the skin.
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A hospitalized client with an internal radiation implant calls the nurse to the room to report the implant is dislodged and is lying in the bed. The nurse's actions would include which of the following? A: Apply gloves and place implant in a biohazard bag B: Use long-handled forceps to pick up the implant and place it into lead container C: Have client pick up the implant and place it into lead container D: Notify infection control personnel to dispose of implant
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Answer: B: Use long-handled forceps to pick up the implant and place it into lead container Rationale: Direct handling of the implant causes exposure to radiation and no one should directly touch the implant. Gloves and biohazard bags do not offer protection from radiation. Long-handled forceps should be used to pick up the implant and lead containers are necessary to prevent exposure to radiation.
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When teaching safety precautions to the client with internal radiation implant, the nurse would include which statement in explanations to the client? A: No precautions are necessary for internal radiation therapy implants B: The client poses a risk of radiation exposure to others C: The client must remain in solitary isolation for the entire hospitalization D: Visitors should maintain a distance of 30 feet from the client at all times
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Answer: B: The client poses a risk of radiation exposure to others Rationale: Internal radiation is emitted outward to people in close contact as long as the implant is in place. Therefore, certain precautions to protect others must be taken: The client should have a private room, and visitors should maintain a distance of 6 feet and limit visits to 10-30 minutes.
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A recently divorced male who has undergone radiation therapy for testicular cancer tells the nurse he is unable to achieve an erection. Which of the following nursing diagnoses is most appropriate? A: Ineffective coping related to the effects of radiation therapy B: Sexual dysfunction related to the effects of radiation therapy C: Disturbed body image related to the effects of radiation therapy D: Imbalanced nutrition: Less than body requirements related to radiation therapy
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Answer: B: Sexual dysfunction related to the effects of radiation therapy Rationale: Radiation may cause sexual dysfunction. Libido may only be temporarily affected, and the client should be provided with emotional support.
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Nausea and vomiting are common adverse effects of radiation. When should a nurse administer antiemetics? A: 30 minutes before the initiation of therapy B: With the administration of therapy C: Immediately after nausea begins D: When therapy is completed
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Answer: A: 30 minutes before the initiation of therapy Rationale: Antiemetics are most beneficial when given before the onset of nausea and vomiting. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.
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After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. It will be most important for the nurse to include information about which of the following in the client's teaching plan? A: Nutritional intake B: Management of alopecia C: Exercise and activity levels D: Access to community resources
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Answer: A: Nutritional intake Rationale: Clients who have had gastric surgery are prone to postoperative complications, such as dumping syndrome and postprandial hypoglycemia, which can affect nutritional intake. Vitamin absorption can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper gastrointestinal area also can affect nutritional intake by causing anorexia, nausea, and esophagitis. The client would not be expected to develop alopecia. Exercise and activity levels as well as access to community resources are important teaching areas, but nutritional intake is a priority need.
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Which of the following is correct about the rate of cell growth in relation to chemotherapy? A. Faster growing cells are less susceptible to chemotherapy B. Non dividing cells are more susceptible to chemotherapy C. Faster growing cells are more susceptible to chemotherapy D. Slower growing cells are more susceptible to chemotherapy
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ANSWER C The faster the cell grows the more susceptible it is to chemotherapy,
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During the administration of a chemotherapeutic drug, the nurse observes that there is a lack of blood return from the intravenous catheter. The priority action by the nurse would be to A. stop the administration of the drug immediately B. reposition the client's arm and continue with the administration of the drug C. apply a tourniquet to the patient's affected arm and notify the doctor D. continue to administer the drug and assess for edema at the IV site
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Answer A Chemotherapeutic agents are irritating to tissues. Lack of blood return from the IV catheter indicates that it is out of vein. Therefore, administration of the drug should be stopped immediately
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3) A nurse is instructing a client how to decrease nausea secondary to chemotherapy and radiation. The nurse understands that the client needs more teaching if the client states, "I will try A. eating small, frequent meals" B. Staying upright for at least on hour during meals" C. Avoiding a lot of liquids with my meals" D. Increasing the amount of unsaturated fats in my diet"
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Answer - D - increasing the amount of unsaturated fats in my diet"
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4) The nurse is developing a plan of care for a client being admitted to the hospital who is immunosuppressed and will be placed on neutropenic precautions. With regard to neutropenic precautions, which intervention is incorrect? A) admitting the client to a semi-private room B) placing a precaution sign on the door to the room C) placing a mask on the client if the client leaves the room D) removing a vase with fresh flowers left by a previous client
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Answer: A - admitting the client to a semiprivate room
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5) A nurse is caring for a client who was admitted to receive chemotherapy for treatment of ovarian cancer. The client vomited after each previous dose of chemotherapy. Which of the following actions should the nurse take to prevent vomiting? A. Speak to the provider about decreasing the chemotherapy dose B. Withhold food and fluids prior to and during treatment C. Provide the client with an emesis basin during treatment D. Administer and antiemetic prior to chemotherapy
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Answer: D - Administer an antiemetic prior to chemotherapy
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6) Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
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Answer: A - A bland, low-fiber diet
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7) The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia
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Answer: B - Hypocalcemia
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The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A) Increase intake of liquids at mealtime to stimulate appetite. B) Serve three large meals per day plus snacks between each meal C) Avoid the use of liquid protein supplements to encourage eating at mealtime D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods
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Answer: D - Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
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9) Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D.Risk for infection
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Answer: D - Risk for infection
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10. What would be most important for the nurse to teach the patient to protect themselves from infection? A) Avoiding crowds and taking antipyretics such as Aspirin TID to avoid a fever. B) Assessing their vital signs weekly and reporting a persistent fever of 102 degrees or greater. C) Bathing daily and washing their hands frequently, especially after using restroom or handling contaminated objects. D) Interacting only with individuals who have recently been vaccinated with live or attenuated vaccines.
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Answer: C - Bathing daily and washing their hands frequently, especially after using restroom or handling contaminated objects.
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1).The nurse is taking the social history of a client diagnosed with SCLC (Single Cell Lung Cancer).Which information is significant for this disease? 1. Worked with asbestos for a short time many years ago. 2. Has no family Hx of this type of lung cancer. 3. Has numerous tattoos on upper and lower arms. 4. Has smoked 2 packs of cigarettes/day for 20 years.
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Answer: 4- Has smoked 2 packs of cigarettes/day for 20 years. Rational: Smoking is greatest risk for LC.
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2). The client is 4 hours post-lobectomy for lung cancer. Which assessment data warrants immediate intervention by the nurse? 1. Intake of 1500 mL IV and output of 1000 mL. 2. 450 mL of bright red drainage in the chest tube. 3. Complaining of pain at a 10 on a 1-10 scale. 4. Absent lung sound on the side of surgery.
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Answer: 2- 450 mL of bright red drainage in the chest tube. Rational: This is about a pint of blood and could indicate a hemorrhage. HINT: Blood is always a priority.
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3). Which clinical manifestation would the nurse expect to find in newly diagnosed intrinsic LC? 1. Dysphagia 2. Foul smelling breath 3. Hoarseness 4. Weight loss
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Answer: 3- Hoarseness Rational: Hoarseness is an early sign.
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4). A 69-year-old patient was diagnosed with lung cancer. He is receiving chemotherapy and the nurse caring for him reviewed the laboratory results showing a platelet count is 18,000/mm3 and a pH of 7.36. Which of the following measures would the nurse implement based on the laboratory result? 1. Contact isolation 2. Reverse isolation 3. Respiratory isolation 4. Bleeding precautions
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Answer: 4- Bleeding precautions Rational: Normal platelet count is 150,000-400,000/mm3. Bleeding precautions should be implemented with a platelet count below 50,000/mm3. Patients receiving chemotherapy are at risk for thrombocytopenia. Bleeding precautions include avoiding anticoagulant and antiplatelet medications, using an electric razor, stool softeners to prevent straining, and avoiding dental floss.
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5). A 71-year-old patient diagnosed with lung cancer is receiving chemotherapy on an outpatient basis. The nurse must provide which of the following home care instructions to the patient? 1. During chemotherapy, use disposable plates and plastic utensils 2. All members of the family can share a bathroom 3. Do not consider urine and stool as contaminated 4. If necessary, contaminated linens should be washed separately and then washed a second time with other laundry.
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Answer: 4- If necessary, contaminated linens should be washed separately and then washed a second time with other laundry. Rational: Any contaminated linen or clothing should be washed separately and then washed a second time with other laundry to prevent exposure to chemotherapy in body fluids.
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6). A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Serum sodium levels 5. Decreased oral sodium intake 6. Medication that is antagonistic to antidiuretic hormone
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Answer: 1,2,4,6 Rational: Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.
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7). A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? 1. A seizure disorder 2. Chronic obstructive pulmonary disease (COPD) 3. Anemia 4. A bleeding disorder
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Answer: 4- A bleeding disorder Rational: A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis.
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8). A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further treatment? 1. "I'll use hats to protect my head from the sun when my hair falls out" 2. "If I get nauseous, I'll try to eat several small, bland meals each day" 3. "I'll allow myself plenty of time to rest between activities" 4. "Most of the adverse effects should go away shortly after my last radiation treatment"
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Answer: 1-"I'll use hats to protect my head from the sun when my hair falls out" Rational: The client requires additional teaching if he mentions that he will lose the hair on his head a result of radiation therapy. Alopecia as an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.
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9). A patient who smokes tells the nurse, "I want to have a yearly chest x-ray so that if I get cancer, it will be detected early." Which response by the nurse is most appropriate? 1. "Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." 2. "Annual x-rays will increase your risk for cancer because of exposure to radiation." 3. "Insurance companies do not authorize yearly x-rays just to detect early lung cancer." 4. "Frequent x-rays damage the lungs and make them more susceptible to cancer."
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Answer: 1-"Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." Rational: A tumor must be at least 1 cm large before it is detectable by an x-ray and may already have metastasized by that time. Radiographs have low doses of radiation, and an annual x-ray alone is not likely to increase lung cancer risk. Insurance companies do not usually authorize x-rays for this purpose, but it would not be appropriate for the nurse to give this as the reason for not doing an x-ray. A yearly x-ray is not a risk factor for lung cancer.
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10). Which of the following is the primary goal for surgical resection of lung cancer? 1. To remove the tumor and all surrounding tissue 2. To remove the tumor and as little surrounding tissue as possible 3. To remove the entire tumor and any collapsed alveoli in the same region 4. To remove as much of the tumor as possible, without removing any alveoli
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Answer: 2- To remove the tumor and as little surrounding tissue as possible Rational: The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.
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A female client has a mother who died from ovarian cancer and sister diagnosed with it. Which recommendations should the nurse make regarding early detection of ovarian cancer? A:The client should consider having a prophylactic bilateral oophorectomy B:The client should have a trans-vaginal ultrasound and a CA-125 lab test every 6 months C:The client should have yearly MRI scans D:The client should have a biannual gyn exam with flexible sigmoidoscopy
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Answer: B. The client should have a trans-vaginal ultrasound and a CA-125 lab test every 6 months Rationale: A trans-vaginal ultrasound is a sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sonogram, can provide info about ovarian cancer for early diagnosis.
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A 22 year old client asks about the purpose of the HPV vaccine (Gardasil). What is an appropriate nursing explanation? A. It is to lower the risk of contracting melanoma. B. It is a vaccine that prevents infection by all strains of HPV. C. The vaccine treats infections of HPV. D. The vaccine can lower the risk of cervical cancer.
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Answer: D. The vaccine can lower the risk of cervical cancer. Rationale: The HPV vaccine can prevent infection by certain strains of HPV, not all strains. It is useful in that it can lower the risk of developing cervical cancer. It does not treat preexisting infection, but can prevent infection by other types.
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In educating a client, what would the nurse NOT mention as a risk factor that increases the risk of developing endometrial cancer? A. Obesity B. Increased age C. Having had several children D. Diabetes
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Answer: C. Having had several children.
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Mina, who is suspected of an ovarian tumor, is scheduled for a pelvic ultrasound. The nurse provides which pre-procedure instruction to the client? A. Eat a light breakfast only B. Maintain an NPO status before the procedure C. Wear comfortable clothing and shoes for the procedure D. Drink six to eight glasses of water without voiding before the test
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Answer: D. Drink six to eight glasses of water without voiding before the test Rationale: A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure.
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The husband of a client with cervical cancer says to the nurse, "The doctor told my wife that her cancer is curable. Is he just trying to make us feel better?" Which would be the nurse's most accurate response? A. "When cervical cancer is detected early and treated aggressively, the cure rate is almost 100%" B. "The 5-year survival rate is about 75%, which makes the odds pretty good." C. "Saying a cancer is curable means that 50% of all women with the cancer survive at least 5 years." D. "Cancers of the female reproductive tract tend to be slow-growing and respond well to treatment."
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Answer: A. "When cervical cancer is detected early and treated aggressively , the cure rate is almost 100%" Rationale: When cervical cancer is detected early and treated aggressively, the cure rate approaches 100%. The incidence of cervical cancer has increased among African Americans, Native Americans, and Latinas, and these women often have a poorer prognosis because the cancer is not identified early. Papanicolaou (Pap) smears and colposcopy have the potential to decrease mortality from invasive carcinoma when these screening and treatment programs are utilized by women.
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A 50 year old female client complains of bloating and indigestion and tells the nurse she has gained two inches in her waist recently. Which question should the nurse ask the client? A:"What do you eat before you feel bloated?" B:"Have you had your ovaries removed?" C:"Are your stools darker in color lately?" D:"Is this indigestion worse when you lie down?"
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Answer: B. "Have you had your ovaries removed?" Rationale: Ovarian Cancer has vague symptoms of abdominal discomfort, but increasing abdominal girth is the most common symptom. If the client has had the ovaries removed, then the nurse could assess for another cause.
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When planning care for a client being treated for cervical cancer, it would be a priority for the nurse to include which of the following in the plan of care? A. Instruction on birth control methods. B. Vigorous fluid hydration. C. Assessment of sexual function. D. Daily weights.
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Answer: C. Assessment of sexual function. Rationale: Surgery and radiation therapy for cervical cancer often result in shortening of the vagina, vaginal dryness, and loss of libido due to emotional issues related to sexuality and femininity. Therefore, the client's feelings about sexuality and the partner's feelings should be assessed. If a client is not sexually active, instructions should be given in the use of a vaginal dilator and lubricant to prevent adhesion of the vaginal walls. While instruction about birth control methods may be needed for some clients, treatment for cervical cancer may include total abdominal hysterectomy, so that this would not be appropriate for all clients. Encouraging fluids and daily weights are not priorities for cervical cancer care.
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A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate scheduling the patient for A. endometrial biopsy. B. dilation and curettage (D&C). C. laser endometrial ablation. D. uterine balloon therapy.
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Answer: A. endometrial biopsy Rationale: A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient
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A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is A. "Why don't we talk about the options you have for the care of your children?" B. "Many patients with cancer live for a long time, so there is time to plan for your children." C. "For now you need to concentrate on getting well, not worry about your children." D. "Perhaps your ex-husband will take the children when you can't care for them."
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Answer: A. "Why don't we talk about the options you have for the care of your children?" Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.
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A woman tells the nurse that "there's been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer? A. Pain B. Leg edema C. Urinary and rectal symptoms D. Light bleeding or watery vaginal discharge
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Answer: D. Light bleeding or watery vaginal discharge. Rationale: In its early stages, cancer of the cervix is usually asymptomatic, which underscores the importance of regular Pap smears. A light bleeding or serosanguineous discharge may be apparent as the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late signs of cervical cancer.
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1. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors a. do not cause damage to adjacent tissue. b. do not spread to other tissues and organs. c. are simply an overgrowth of normal cells. d. frequently recur in the same site.
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B Rationale: The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. Both types of tumors may cause damage to adjacent tissues. The cells differ from normal in both benign and malignant tumors. Benign tumors usually do not recur.
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2. A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? a. "The cells in your tumor do not look very different from normal bowel cells." b. "The tumor cells have DNA that is different from your normal bowel cells." c. "Your tumor cells look more like immature fetal cells than normal bowel cells." d. "The cells in your tumor have mutated from the normal bowel cells."
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C Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue.
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3. A patient who smokes tells the nurse, "I want to have a yearly chest x-ray so that if I get cancer, it will be detected early." Which response by the nurse is most appropriate? a. "Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." b. "Annual x-rays will increase your risk for cancer because of exposure to radiation." c. "Insurance companies do not authorize yearly x-rays just to detect early lung cancer." d. "Frequent x-rays damage the lungs and make them more susceptible to cancer."
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A Rationale: A tumor must be at least 1 cm large before it is detectable by an x-ray and may already have metastasized by that time. Radiographs have low doses of radiation, and an annual x-ray alone is not likely to increase lung cancer risk. Insurance companies do not usually authorize x-rays for this purpose, but it would not be appropriate for the nurse to give this as the reason for not doing an x-ray. A yearly x-ray is not a risk factor for lung cancer.
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4. In teaching about cancer prevention to a community group, the nurse stresses promotion of exercise, normal body weight, and low-fat diet because a. most people are willing to make these changes to avoid cancer. b. dietary fat and obesity promote growth of many types of cancer. c. people who exercise and eat healthy will make other lifestyle changes. d. obesity and lack of exercise cause cancer in susceptible people.
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B Rationale: Obesity and dietary fat promote the growth of malignant cells, and decreasing these risk factors can reduce the chance of cancer development. Many people are not willing to make these changes. Good diet and exercise habits are not a guarantee that other healthy lifestyle changes will then occur. Obesity and lack of exercise do not cause cancer, but they promote the growth of altered cells.
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5. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. The nurse will plan to a. teach the patient about the need for a colonoscopy at age 50. b. ask the patient to bring in a stool specimen to test for occult blood. c. schedule a sigmoidoscopy to provide baseline data about the patient. d. have the patient ask the doctor about specific tests for colon cancer.
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D Rationale: The patient is at increased risk and should talk with the health care provider about needed tests, which will depend on factors such as the exact type of family history and any current symptoms. Colonoscopy at age 50 is used to screen for individuals without symptoms or increased risk, but earlier testing may be needed for this patient because of family history. For fecal occult blood testing, patients use a take-home multiple sample method rather than bring one specimen to the clinic. The health care provider will take multiple factors into consideration before determining whether a sigmoidoscopy is needed at age 30.
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6. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that a. the cancer cells are well-differentiated. b. it is difficult to determine the original site of the cervical cancer. c. further testing is needed to determine the spread of the cancer. d. the cancer is localized to the cervix.
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D Rationale: Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.
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7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy? a. "The biopsy will tell the doctor whether the cancer has spread to my other organs." b. "The biopsy will help the doctor decide what treatment to use for my enlarged prostate." c. "The biopsy will determine how much longer I have to live." d. "The biopsy will indicate the effect of the cancer on my life."
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B Rationale: A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life; the three remaining statements indicate a need for patient teaching.
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8. The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective when the patient says a. "After cancer has not recurred for 5 years, it is considered cured." b. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured." c. "Cancer is considered cured if the entire tumor is surgically removed." d. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." .
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B Rationale: The risk of recurrence varies by the type of cancer; for breast cancer in postmenopausal women, the patient needs at least 20 disease-free years to be considered cured. Some cancers (e.g., leukemia) are cured by nonsurgical therapies such as radiation and chemotherapy
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. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is a. control of the tumor growth by removal of malignant tissue. b. promotion of better nutrition by relieving the pressure in the stomach. c. relief of pain by cutting sensory nerves in the stomach. d. reduction of the tumor burden to enhance adjuvant therapy.
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D Rationale: A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.
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10. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to a. test all stools for the presence of blood. b. inspect the mouth and throat daily for the appearance of thrush. c. perform perianal care with sitz baths and meticulous cleaning. d. maintain a high-residue, high-fat diet.
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C Rationale: Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.
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11. Which action by a nursing assistant (NA) caring for a patient with a temporary radioactive cervical implant indicates that the RN should intervene? a. The NA places the patient's bedding in the laundry container in the hallway. b. The NA flushes the toilet once after emptying the patient's bedpan. c. The NA stands by the patient's bed for an hour talking with the patient. d. The NA gives the patient an alcohol-containing mouthwash for oral care. .
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C Rationale: Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated
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12. A patient with Hodgkin's lymphoma is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, "I am so tired I can hardly get out of bed in the morning." An appropriate intervention for the nurse to plan with the patient is to a. exercise vigorously when fatigue is not as noticeable. b. consult with a psychiatrist for treatment of depression. c. establish a time to take a short walk every day. d. maintain bed rest until the treatment is completed.
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C Rationale: Walking programs are used to keep the patient active without excessive fatigue. Vigorous exercise when the patient is less tired may lead to increased fatigue. Fatigue is expected during treatment and is not an indication of depression. Bed rest will lead to weakness and other complications of immobility.
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13. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient eats frequently during the day. c. The patient showers with Dove soap daily. d. The patient has a history of dental caries.
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A Rationale: The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change the habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.
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14. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse knows that teaching about management of the skin reaction has been effective when the patient says a. "I can use ice packs to relieve itching in the treatment area." b. "I can buy a steroid cream to use on the itching area." c. "I will expose the treatment area to a sun lamp daily." d. "I will scrub the area with warm water to remove the scales."
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B Rationale: Steroid (over-the-counter [OTC] hydrocortisone) cream may be used to reduce itching in the area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.
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15. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. administer prescribed antiemetics 1 hour before the treatments. d. offer dry crackers and carbonated fluids during chemotherapy.
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C Rationale: Treatment with antiemetics before chemotherapy may help to prevent anticipatory nausea. Although nausea may lead to poor nutrition, there is no indication that the patient needs instruction about nutrition. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea.
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16. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. stop the infusion if swelling is observed at the site. b. infuse the medication over a short period. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available.
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A Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication should generally be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.
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17. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that hair loss will not be permanent and that the hair will grow back.
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B Rationale: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.
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8. A patient with ovarian cancer tells the nurse, "I don't think my husband cares about me anymore. He rarely visits me." On one occasion when the husband was present, he told the nurse he just could not stand to see his wife so ill and never knew what to say to her. An appropriate nursing diagnosis in this situation is a. compromised family coping related to disruption in lifestyle and role changes. b. impaired home maintenance related to perceived role changes. c. risk for caregiver role strain related to burdens of caregiving responsibilities. d. interrupted family processes related to effect of illness on family members.
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D Rationale: The data indicate that this diagnosis is most appropriate because the family members are impacted differently by the patient's cancer diagnosis. There are no data to suggest a change in lifestyle or role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.
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19. A patient receiving head and neck radiation and systemic chemotherapy has ulcerations over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the nurse to teach the patient is to a. remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. rinse the mouth before and after each meal and at bedtime with a saline solution.
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D Rationale: The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.
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20. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider? a. Generalized aches b. Dyspnea c. Decreased appetite d. Insomnia
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B Rationale: Dyspnea may indicate capillary leak syndrome and pulmonary edema, which requires rapid treatment. The other symptoms are common with IL-2 therapy, and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.
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21. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is a. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." b. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." c. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." d. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return."
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B Rationale: The impact on sperm count and erectile function depends on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.
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22. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a. "Why don't we talk about the options you have for the care of your children?" b. "Many patients with cancer live for a long time, so there is time to plan for your children." c. "For now you need to concentrate on getting well, not worry about your children." d. "Perhaps your ex-husband will take the children when you can't care for them."
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A Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.
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23. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient a. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale. b. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. c. agrees to take the medications by the IV route to improve effectiveness. d. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
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D Rationale: For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the oral route is preferred.
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24. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to a. protect normal kidney cells from the damaging effects of chemotherapy. b. enhance the patient's immunologic response to tumor cells. c. stimulate malignant cells in the resting phase to enter mitosis. d. prevent the bone marrow depression caused by chemotherapy.
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B Rationale: IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.
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25. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I take acetaminophen (Tylenol) every 4 hours." d. "I experience chills after I inject the interferon."
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B Rationale: Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.
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26. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hemoglobin of 10 g/L b. WBC count of 1700/µl c. Platelets of 65,000/µl d. Serum creatinine level of 1.2 mg/dl .
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B Rationale: Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy
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27. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.
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A Rationale: The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.
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28. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Fresh fruit salad b. Orange sherbet c. Strawberry yogurt d. French fries
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C Rationale: Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.
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29. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to a. provide foods that are highly spiced to stimulate the taste buds. b. avoid presenting foods for which the patient has a strong dislike. c. add strained baby meats to foods such as soups and casseroles. d. teach the patient to eat whatever is nutritious since food is tasteless.
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B Rationale: The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.
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30. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Acute confusion related to infiltration of leukemia cells into the central nervous system b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
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C Rationale: The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.
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31. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient's visitors bring in some fresh peaches from home. b. The patient ambulates several times a day in the room. c. The patient uses soap and shampoo to shower every other day. d. The patient cleans with a warm washcloth after having a stool.
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A Rationale: Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.
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32. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? a. The NA assists the patient to use dental floss after eating. b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. c. The NA adds baking soda to the patient's saline oral rinses. d. The NA puts fluoride toothpaste on the patient's toothbrush.
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A Rationale: Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.
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33. A with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a. Blood urea nitrogen (BUN) b. Serum phosphate c. Serum potassium d. Uric acid level
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D Rationale: Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.
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34. When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" b. "How long ago were you diagnosed with this cancer?" c. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d. "How do you feel about having a possibly terminal illness?"
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A Rationale: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.
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MULTIPLE RESPONSE 1. A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.) a. Alcohol use b. Physical activity c. Body weight d. Colorectal screening e. Tobacco use f. Mammography g. Pap testing h. Sunscreen use
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D, F, G, H Rationale: The patient's age, gender, and history indicate a need for teaching about or screening or both for colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.
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Original Alphabetical The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."
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D. "I need to report the pain going down my legs to my health care provider." Pain in the back of the legs could indicate prostate cancer in an older man. Cigarette smoking is implicated in causing lung cancer and other types of cancer, but it does not always cause cancer. Investigation is ongoing about the efficacy of vitamins A and C in cancer prevention. Limiting alcohol to one drink per day is only one preventive measure.
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The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammogram every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A computed tomography (CT) scan will be done every year after I turn 50."
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A. "My mother and grandmother had breast cancer, so I am at risk." A strong family history of breast cancer indicates a risk for breast cancer. Annual rather than biannual screening may be indicated for a strong family history. An annual mammogram is performed after age 40 or in younger clients with a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. Annual CT breast scans after age 50 are not a current recommendation.
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A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles four times a week C. A history of cardiac disease D. Advancing age
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D. Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases. Diabetes is not known to cause lung cancer. Regular exercise is not a risk factor for lung cancer, nor does having cardiac disease predispose a person to lung cancer.
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The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."
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B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.
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The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements
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A. Testing of stool specimens for occult blood Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants. Client education is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care is best performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing personnel.
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The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.
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D. Do not smoke cigarettes. All of these actions are part of cancer prevention; however, tobacco is the single most important source of preventable carcinogenesis. Asbestos may be found in older homes and buildings. Most schools have been through an asbestos abatement program so should not pose a risk. It would be important to share with teens who may be involved in the construction industry during the summer to be aware of asbestos risks. Although asbestos may present a risk for lung cancer, it is not a likely exposure for teens. Lifetime exposure to the sun and the use of tanning beds will increase the risk for cancer, but not as much as tobacco use. The HPV vaccine will decrease the risk for cervical cancer, but will not have as much of an impact on cancer prevention as avoiding tobacco.
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The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? A. Vomiting B. Back pain C. Frequent urination D. Cyanosis of the toes
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B. Back pain Typical sites of breast cancer metastasis include bone (manifested by back pain), lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control, but not vomiting. Although frequent urination may be a sign of bladder cancer, incontinence is more indicative of spinal metastasis. Cyanosis of the toes indicates decreased tissue perfusion, often related to atherosclerotic disease.
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The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? A. Infection with hepatitis B virus B. Consuming a diet high in animal fat C. Exposure to radon D. Familial polyposis
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A. Infection with hepatitis B virus Hepatitis B and C are risk factors for primary liver cancer. Alcohol abuse is also a risk factor for the development of liver cancer. Consuming a diet high in animal fat may predispose a person to colon or breast cancer. Exposure to radon is a risk factor for lung cancer.
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Which type of cancer has been associated with Down syndrome? A. Breast cancer B. Colorectal cancer C. Malignant melanoma D. Leukemia
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D. Leukemia Leukemia is associated with Down syndrome and Turner syndrome. Breast cancer is often found clustered in families, not in association with Down syndrome. Colorectal cancer is associated with familial polyposis. Malignant melanoma is associated with familial clustering and sun exposure.
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The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound
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B. Dyspnea Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath, bloody sputum, arm or chest pain, and dysphagia. Easy bruising is a nonspecific finding. Night sweats is a symptom of the lymphomas. A chest wound is not specific to lung cancer.
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Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual Papanicolaou (Pap) smears
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B. Teaching a class on cancer prevention Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. Mammography is part of a secondary level of prevention, defined as screening for early detection. Chest x-ray is a method of detecting a cancer that is present—secondary prevention and early detection. A Pap smear is a means of detecting cervical cancer early—secondary prevention.
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A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? A. "Don't worry, most lumps are discovered by women during breast self-examination." B. "Does anyone in your family have breast cancer?" C. "Finding a cancer in the early stages increases the chance for cure." D. "Have you noticed a lump or thickening in your breast?"
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C. "Finding a cancer in the early stages increases the chance for cure." Providing truthful information addresses the client's concerns. Mammography can detect lumps smaller than those discovered by palpation. Asking about family history or symptoms is not therapeutic because it does not address the client's fear of cancer.
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Which information must the organ transplant nurse emphasize before a client is discharged? A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." B. "You are at increased risk for cancer when you reach 60 years of age." C. "Immunosuppressant medications will decrease your risk for developing cancers." D. "After 6 months, you may stop immunosuppressant medications, and your risk for cancer will be the same as that of the general population."
answer
A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." Use of immunosuppressant medications to prevent organ rejection increases the risk for cancer. Advanced age is a risk factor for all people, not just for organ transplant recipients. Immunosuppressant medications must be taken for the life of the organ; the risk for developing cancer remains.
question
The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team? A. Temperature of 96.6° F B. Reports of joint pain C. Pink and dry oral mucosa D. Palpable lump in the client's axilla
answer
D. Palpable lump in the client's axilla Clients taking immunosuppressive drugs to prevent rejection are at increased risk for the development of cancer; any lump should be reported to the physician. Fever should be reported to the physician, but this client's temperature is normal. It is not necessary to report joint pain to the transplant team; it is not a sign of rejection and is not a complication of transplant. A pink and dry oral mucosa may be a sign of dehydration, but it is not necessary to report this to the transplant team.
question
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? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."
answer
C. "My legs are numb and weak." Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur. Prostate cancer may frequently metastasize to the bone, specifically the spine. Allergy to iodine should be reported when contrast media will be used, but dye is not used in radiation therapy. A weak urinary stream and incontinence are common clinical manifestations of prostate cancer. Incontinence associated with coughing is typical of stress incontinence and is not a complication of cancer.
question
When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor? A. Tobacco use B. Ethnicity C. Gender D. Increased age
answer
A. Tobacco use Although all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change. Ethnicity, gender, and increasing age are associated with lung cancer, but they are not modifiable risks.
question
Which statement about the process of malignant transformation is correct? A. Mutation of genes is an irreversible event that always leads to cancer development in the initiation phase. B. Insulin and estrogen enhance the division of an initiated cell during the promotion phase. C. Tumors form when carcinogens invade the gene structure of the cell in the latency phase. D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage.
answer
D. Nutrition of cancer cells is provided by tumor angiogenesis factor (TAF) in the promotion stage. The promotion phase consists of progression when the blood supply changes from diffusion to TAF. Insulin and estrogen increase cell division. If cell division is halted, mutation of genes does not lead to cancer development in the initiation phase. In the initiation phase, carcinogens invade the DNA of the nucleus of a single cell. A 1-cm tumor consists of 1 billion cells. The latency phase occurs between initiation and tumor formation.
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A client has a glioblastoma. The nurse begins to plan care for this client with which type of cancer? A. Liver B. Smooth muscle C. Fatty tissue D. Brain .
answer
D. Brain The prefix "glio-" is used when cancers of the brain are named. The prefix "hepato-" is included when cancers of the liver are named. The prefix "leiomyo-" is included when cancers of smooth muscle are named. The prefix "lipo-" is included when cancers of fat or adipose tissue are named
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A client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? (Select all that apply.) A. Brain B. Bone C. Lymph nodes D. Kidneys E. Liver
answer
A, B, C, E Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Kidneys are not a typical site of lung cancer metastasis.
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The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? (Select all that apply.) A. Limit sodium intake. B. Avoid beef and processed meats. C. Increase consumption of whole grains. D. Eat "colorful fruits and vegetables," including greens. E. Avoid gas-producing vegetables such as cabbage.
answer
B, C, D Consuming bran and whole grains and avoiding red meat and processed foods such as lunchmeats can reduce cancer risk. Consuming foods high in vitamin A, including apricots, carrots, and leafy green and yellow vegetables, can also reduce cancer risk. Reducing sodium is helpful in the treatment of hypertension and heart and kidney failure; no evidence suggests that lowering of sodium intake decreases the incidence of cancer. Eating cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage may actually reduce cancer risk.
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What are the common cancers related to tobacco use? (Select all that apply.) A. Cardiac cancer B. Lung cancer C. Cancer of the tongue D. Skin cancer E. Cancer of the larynx
answer
B, C, E Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are the most likely to develop cancer. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.
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The nurse includes which factors in teaching regarding the typical warning signs of cancer? (Select all that apply.) A. Persistent constipation B. Scab present for 6 months C. Curdlike vaginal discharge D. Axillary swelling E. Headache
answer
A, B, D Change in bowel habits, a sore that does not heal, and a lump or thickening in the breast or elsewhere are all potential warning signs of cancer. Curdlike vaginal discharge represents a yeast infection. Headache is not a warning sign, but may be present with multiple problems.
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The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time
answer
B. Relief of symptoms or improved quality of life The focus of palliative surgery is to improve quality of life during the survival time. Curative surgery removes all cancer cells, visible and microscopic. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. Many therapies, such as surgery, chemotherapy, and biotherapy, increase the client's chance of cure and survival, but palliation improves quality of life.
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Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."
answer
C. "I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.
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When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? A. Drug toxicity B. Polycythemia C. Infection D. Dose-limiting side effects
answer
C. Infection The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction .
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The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? A. Veins of the legs B. Lung C. Heart D. Abdominal cavity
answer
D. Abdominal cavity Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.
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The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? A. Hemoglobin of 7.4 and hematocrit of 21.8 B. Potassium level of 2.9 mEq/L and diarrhea C. 250,000 platelets/mm3 D. 5000 white blood cells/mm3
answer
A. Hemoglobin of 7.4 and hematocrit of 21.8 Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 and hematocrit of 21.8 has anemia demonstrated by low hemoglobin and hematocrit. The client with diarrhea and a potassium level of 2.9 mEq/L has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 and the client with 5000 white blood cells/mm3 demonstrate normal values.
question
The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. The student scrubs the hub of IV tubing before administering an antibiotic. B. The nurse overhears the student explaining to the client the importance of handwashing. C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.
answer
C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia. Hygiene and perineal care help prevent infection and sepsis.
question
When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved
answer
C. Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition is important during cancer treatment; a local anesthetic may be prescribed for comfort.
question
A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Inform the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.
answer
D. Allow the client an opportunity to express her feelings. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.
question
Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Potential for injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction
answer
B. Potential for injury related to sensory and motor deficits The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.
question
The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills
answer
B. Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab). Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.
question
The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest
answer
C. Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.
question
When caring for the client with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order? A. Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine-131 (131I)
answer
B. Allopurinol (Zyloprim) TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; allopurinol decreases uric acid production and is indicated in TLS. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.
question
The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A. Monitor weight B. Trend red blood cells and hemoglobin and hematocrit C. Monitor platelets D. Observe for motor deficits
answer
A. Monitor weight Cachexia results in extreme body wasting and malnutrition; severe weight loss is expected. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.
question
Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day
answer
C. Change in mental status A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which is not related to thrombocytopenia. A large weight gain in a short period may be related to kidney or heart failure; bleeding is the major complication of thrombocytopenia.
question
Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug
answer
. C. Consume a diet high in fiber. A high-fiber diet will assist with constipation due to neuropathy. The client should bathe in warm water, not hotter than 96° F. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.
question
Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)
answer
B. Ondansetron (Zofran) Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Morphine is a narcotic analgesic or opiate; it may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only; lorazepam, another benzodiazepine, may be used for nausea.
question
A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr
answer
C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia. The clients with acute lymphocytic leukemia and chemotherapy-induced nausea are complex clients requiring a nurse certified in chemotherapy administration. The client with tumor lysis syndrome has complicated needs for assessment and care and should be cared for by an RN with more oncology experience.
question
The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast
answer
A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client with chemotherapy-induced neutropenia first. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.
question
An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light
answer
D. Reducing all direct and indirect sources of light Lighting of all types must be kept to a minimum with clients receiving photodynamic therapy; it can lead to burns of the skin and damage to the eyes because these clients' eyes are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties; drugs should be stored according to the recommendations, but this is not the primary concern for this client. Clothing must cover the skin to prevent burns from direct or indirect light; texture is not a concern for the client receiving this treatment. The client will be homebound for 1 to 3 months after the treatment and should not go outside.
question
Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain
answer
B. Edema of arms and hands Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly, but because it is an early manifestation, this is not the priority. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone; although this should be addressed, it is an early sign so it is not the priority.
question
Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? (Select all that apply.) A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing
answer
A, C, D, E Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific; the larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair; this does not normally occur with radiation therapy.
question
When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor
answer
A, C, D Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count. Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.
question
When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? (Select all that apply.) Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremor Na: 115, K: 4.2, Creatinine: 0.8 ondansetron (Zofran) cyclophosphamide (Cytoxan) A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness
answer
A, B, E Antidiuretic hormone (ADH) is secreted or produced ectopically, resulting in water retention and sodium dilution. Dilutional hyponatremia results from ADH secretion, causing confusion and changes in mental status. Weakness results from hyponatremia. Azotemia refers to buildup of nitrogenous waste products in the blood, typically from renal damage. Bradycardia is not part of the constellation of symptoms related to SIADH; tachycardia may result from fluid volume excess.
question
When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.) A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns.
answer
B, D, E Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication. Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.
question
The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? (Select all that apply.) A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta) - a biologic response modifier D. Do not permit fresh flowers or plants in the room. E. Do not allow the client's 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from the diet.
answer
A, C, D, F Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms. Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well; however, very small children, who may get frequent colds and viral infections, may pose a risk.
question
The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion? (Select all that apply.) A. Heavy menses B. Smooth facial skin C. Hyperkalemia D. Breast tenderness E. Weight loss F. Deep vein thrombosis
answer
D, F Breast tenderness and shrinking breast tissue may occur with antiestrogen therapy. Venous thromboembolism may also occur. Irregular menses or no menstrual period is the typical side effect of antiestrogen therapy. Acne may also develop. Hypercalcemia, not hyperkalemia, is typical. Fluid retention with weight gain may also occur.
question
The health education nurse reinforces instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse reinforce to the client?
answer
Use sunscreen when participating in outdoor activities. Wear a hat, opaque clothing, and sunglasses when in the sun. Examine your body monthly for any lesions that may be suspicious.
question
The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which is a priority nursing intervention for this client?
answer
Encouraging Fluids
question
The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines the need for further teaching if a community member states that which is a sign/symptom of testicular cancer?
answer
Alopecia
question
The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding would provide information about the massive cell destruction that occurs with the chemotherapy?
answer
Increased uric acid level
question
The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which is the most likely side/adverse effect of the external radiation?
answer
Sore throat
question
The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action?
answer
Apply pressure on the radiated area to prevent bleeding
question
The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle?
answer
Pregnant women are not allowed into the client's room
question
The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching?
answer
"I will limit sun exposure to 1 hour daily."
question
The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action?
answer
Pick up the implant with long-handled forceps and place into a lead container.
question
The nurse is assisting with developing a plan of care for a client who is experiencing hematological toxicity as a result of chemotherapy. The nurse should suggest including which in the plan of care?
answer
Restricting fresh fruits and vegetables in the diet
question
The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which may be prescribed to treat this complication?
answer
Radiation, Chemotherapy, Serum sodium blood levels, Medication that is antagonistic to antidiuretic hormone (ADH)
question
The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which finding should the nurse most likely expect to find documented in the client's record?
answer
Enlarged lymph nodes
question
When reviewing the health care record of a client with ovarian cancer, the nurse recognizes which sign/symptom as being a typical manifestation of the disease?
answer
Abdominal distention
question
The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication related to the surgery?
answer
Arm edema on the operative side
question
The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a prostatectomy. The nurse should reinforce which discharge instruction?
answer
Avoid lifting objects heavier than 20 pounds for at least 6 weeks
question
The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 cells/mm3. On the basis of this laboratory value, the nurse should collect which data as a priority?
answer
Level of consciousness
question
The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast?
answer
Under the left shoulder
question
The nurse is caring for a client dying of ovarian cancer. During care, the client states, "If I can just live long enough to attend my daughter's graduation, I'll be ready to die." Which phase of coping is this client experiencing?
answer
Bargaining
question
The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for further teaching if a member of the community group makes which statement regarding this type of cancer
answer
It most often occurs in women
question
The nurse is collecting data from a client with a history of bladder cancer. Which sign/symptom is the client most likely to report?
answer
Hematuria
question
The nurse is caring for a client after a mastectomy. Which nursing intervention should assist with preventing lymphedema of the affected arm?
answer
Elevating the affected arm on a pillow above heart level
question
The nurse is reinforcing instructions to a client on performing a testicular self-examination (TSE). Which instruction should the nurse provide to the client?
answer
The best time for the examination is after a shower
question
The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which as a risk factor associated with cancer?
answer
Low-fat and high-fiber diets
question
A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?
answer
Monitor the client for bleeding
question
A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?
answer
Malignant proliferation of plasma cells and tumors within the bone
question
The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis?
answer
Increased calcium level
question
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period the nurse notes bloody drainage from the nasogastric (NG) tube. Which action should the nurse take?
answer
continue to monitor drainage
question
The nurse is reviewing the medical history of a client admitted to the hospital with a diagnosis of colorectal cancer. The nurse understands that which information documented in the medical history is an unassociated risk factor of this type of cancer?
answer
Regular consumption of a high-fiber diet
question
A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which late symptom of this disease?
answer
Pelvic pain, anemia, and ascites
question
A client with ovarian cancer is scheduled to receive chemotherapy with cisplatin. The nurse assisting in caring for the client reviews the plan of care, expecting to note which intervention?
answer
Encourage fluids.
question
A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is appropriate?
answer
Encourage her to select a wig
question
A client has just been told by the health care provider about her diagnosis of breast cancer. The client responds, "Oh no, does this mean I'm going to die?" The nurse interprets which response as the client's initial reaction?
answer
Fear
question
The nurse should monitor for which laboratory result as indicating an adverse reaction in the client with endometrial cancer who is receiving chemotherapy?
answer
Platelet count 20,000 cells/mm3
question
The nurse determines that a client with which history is most at risk for endometrial cancer?
answer
Estrogen replacement therapy
question
A client with endometrial cancer is receiving doxorubicin (Adriamycin), an antineoplastic agent. The nurse should specifically collect data about which criterion?
answer
Hematological laboratory values
question
The nurse is caring for a client with cancer receiving chemotherapy who has developed stomatitis. The nurse plans to give mouth care by using oral care agents and devices that meet which additional criterion?
answer
Care will be based on the severity of stomatitis
question
A client with cancer has undergone a total abdominal hysterectomy and has a Foley catheter in place. The nurse should expect to note which type of urinary drainage immediately following this surgery?
answer
Blood tinged
