Chapter 15: Cancer

The nurse educates a patient who has undergone prostate surgery about health promotion measures to be followed at home. Which statement made by the patient indicates the need for further teaching? 1 "I am limiting fluid intake." 2 "I am limiting citrus juices." 3 "I am avoiding heavy lifting." 4 "I am avoiding sexual intercourse."

1 Limiting fluid intake can cause constipation and infection in a patient who has undergone prostate surgery; fluid intake should not be limited. The patient should limit citrus juices because they can cause urinary incontinence. Heavy lifting puts stress on stitches and can cause bleeding; that activity should be avoided. The patient should avoid intercourse for a few days to avoid straining the abdominal muscles.

Which instructions should the nurse give to a patient with a radiation skin care reaction? Select all that apply. 1 "Avoid swimming in saltwater." 2 "You may treat the area with a heating pad." 3 "You may use an ice pack on the treatment area." 4 "Use bleach to wash any clothing that covers the area." 5 "Avoid wearing tight-fitting clothing over the treatment field." 6 "Use an electric razor if you have to shave the treatment field."

1,5,6 The patient should avoid swimming in saltwater and wearing tight-fitting clothing over the treatment field. An electric razor should be used to shaving the treatment field. The patient should avoid exposing the treatment field to the extreme heat of a heating pad. The patient should wash clothing in gentle detergent and not bleach to avoid exacerbating the skin. The patient should avoid exposing the treatment field to the extreme cold of an ice pack.

The nurse is teaching a female patient who has undergone lymph node excision about measures to reduce lymphedema in the arm. Which action of the patient indicates the need for further teaching? 1 Pushing against the wall 2 Wearing clothing with loose fitting sleeves 3 Placing hands under the head while sleeping 4 Applying antibiotic ointment to the injury on the arm

2 Lymphedema is the accumulation of lymph in soft tissues. Patients with lymphedema in the arm should wear compression sleeves to provide a mechanical massage to the arm that facilitates the passage of lymph toward the heart. Pushing against an immovable object is an example of an isometric exercise. Isometric exercises help in relieving edema by causing drainage of the fluid from the arm. Placing hands under the head while sleeping will be beneficial, because the hands are at the level of the heart, therefore preventing fluid from pooling. Injury to the affected arm should be addressed carefully and the patient is encouraged to apply an antibiotic ointment to prevent the risk of spreading infection.

A nurse is explaining the mammography procedure to a patient. Which statement best describes the procedure? 1 A method of capturing ultrasonic images of the breast 2 A method to visualize the breast's internal structure using x-rays 3 A method that uses powerful magnetic and radio waves to create images of the breast 4 A method that involves inserting a small needle into the breast tissue to obtain a tissue sample

2 Mammography is a method used to visualize the breast's internal structure using x-rays. An ultrasound is used to capture ultrasonic images of the breast. Magnetic resonance imaging uses powerful magnetic and radio waves to create images of the breast. A fine needle aspiration biopsy is a technique that involves inserting a small needle into the breast tissue to obtain a tissue sample.

A patient with lung cancer presents with intense, localized, persistent back pain and motor and sensory disturbances. What nursing interventions would be helpful to this patient? Select all that apply. 1 Withhold narcotics. 2 Administer corticosteroids. 3 Prepare the patient for a laminectomy. 4 Prepare the patient for radiation therapy. 5 Encourage a graded increase in patient activity.

2,3,4 A lung cancer patient with symptoms of intense, persistent, and localized back pain associated with motor and sensory disturbances is suggestive of spinal cord compression. Therefore this patient would require administration of corticosteroids, radiation therapy, and surgical decompression (laminectomy). Corticosteroids help to prevent inflammation related to the spinal cord compression. Radiation therapy helps to control metastasis. Surgical decompression helps to relieve the pressure from the nerves and provide relief from symptoms. To provide symptomatic relief, the patient needs to be immobilized and administered pain killers.

A patient with a rectal tumor has undergone an abdominal-perineal resection (APR). The nurse should monitor the patient for what postoperative complications? Select all that apply. 1 Hepatotoxicity 2 Sexual dysfunction 3 Delayed wound healing 4 Persistent perineal sinus tracts 5 Upper respiratory tract infection

2,3,4 APR is a colorectal cancer surgery in which both the tumor and the entire rectum are removed, and the patient has a permanent colostomy. APR involves complications such as sexual dysfunction, delayed wound healing, and persistent perineal sinus tracts. Hepatotoxicity and upper respiratory tract infections are complications associated with immunomodulators.

What is the highest priority information to include in preoperative teaching for a patient scheduled for a colectomy? 1 How to care for the colostomy 2 Activity restrictions and bed rest requirements 3 Postoperative activities and pain management 4 Medications planned for use during the procedure

3Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of highest priority to teach the patient to cough and deep-breathe and to use pain medication. Otherwise, atelectasis and pneumonia could develop, delaying recovery from surgery and, as a result, hospital discharge. Caring for a colostomy and activity restrictions also can be discussed postoperatively. Medications for discharge should be discussed before discharge, not before surgery. To reduce the risk of adverse outcomes, the highest priority is pain control and early ambulation and activity.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected, with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? 1 Evaluate left arm lymphatic accumulation. 2 Maintain joint flexibility and left arm function. 3 Teach the patient about chemotherapy and radiation therapy. 4 Assess the patient's response to the diagnosis of breast cancer.

4 Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care for this patient. The approach for the care of the left arm and teaching the patient about further therapy will be based on this assessment.

The nurse recognizes that which treatment strategy is beneficial for patients with stage I colorectal tumors? 1 Resection 2 Reanastomosis 3 Chemotherapy 4 Laparoscopic surgery

4 Laparoscopic surgery is used to treat stage I colorectal tumors. Stage II colorectal tumors are treated with resection and reanastomosis. Chemotherapy is used to treat high-risk stage II, stage III, and stage IV colorectal tumors.

A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate? a. "The cancer involves only the cervix." b. "The cancer cells look like normal cells." c. "Further testing is needed to determine the spread of the cancer." d. "It is difficult to determine the original site of the cervical cancer."

A 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.

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates malignant cells in the resting phase to enter mitosis.

A 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.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem? a. Encourage the patient to purchase a wig or hat to wear when hair loss begins. b. Suggest that the patient limit social contacts until regrowth of the hair occurs. c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once chemotherapy is complete.

A 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 follicles 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.

A client with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? Have the patient eat large meals when nausea is not present. Offer dry crackers and carbonated fluids during chemotherapy. Administer prescribed antiemetic's 1 hour before the treatments. Give the patient two ounces of a citrus fruit beverage during treatments.

Administer prescribed antiemetic's 1 hour before the treatments.

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit of 32% b. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased breath sounds on left side

C The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma. The other findings also require intervention but are common in patients with lung cancer and not immediately life threatening.

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. Lime sherbet b. Blueberry yogurt c. Fresh strawberries d. Cream cheese bagel

B Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea b. Alopecia c. Hematuria d. Xerostomia

C Hematuria The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

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 the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? Hypokalemia Hypercalcemia Hyperuricemia Hypophosphatemia

Hyperuricemia Rationale: TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? The patient ambulates several times a day in the room. The patient's visitors bring in some fresh peaches from home. The patient cleans with a warm washcloth after having a stool. The patient uses soap and shampoo to shower every other day.

The patient's visitors bring in some fresh peaches from home.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? a. Poor oral intake b. Frequent loose stools c. Complaints of nausea and vomiting d. Increase in carcinoembryonic antigen (CEA)

d. Increase in carcinoembryonic antigen (CEA)

A client with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetic's 1 hour before the treatments. d. Give the patient two ounces of a citrus fruit beverage during treatments.

c. Administer prescribed antiemetic's 1 hour before the treatments.

You are monitoring your client who is at risk for spinal cord compression related to tumor growth. Which client statement is most likely to suggest early manifestation? "Last night my back really hurt, and I had trouble sleeping." "My leg has been giving out when I try to stand." "My bowels are just not moving like they usually do." "When I try to pass my urine, I have difficulty starting the stream

"Last night my back really hurt, and I had trouble sleeping."

The nurse is caring for an 18-yr-old patient with acute lymphocytic leukemia who is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? "I understand the transplant procedure has no dangerous side effects." "After the transplant, I will feel better and can go home in 5 to 7 days." "My brother will be a 100% match for the cells used during the transplant." "Before the transplant, I will have chemotherapy and possibly full-body radiation."

"Before the transplant, I will have chemotherapy and possibly full-body radiation." Rationale: Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

During the promotion stage of cancer development, which statement by the nurse most facilitates patient cancer prevention? "Exercise every day for 30 minutes." "Follow smoking cessation recommendations." "Following a vitamin regime is highly recommended." "I recommend excision of the cancer as soon as possible."

"Follow smoking cessation recommendations." Rationale: The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg, and it is getting worse. Which question would best determine treatment measures for the patient's pain? "Where is the pain?" "Is the pain getting worse?" "What does the pain feel like?" "Do you use medications to relieve the pain?

"What does the pain feel like?" Rationale: The UAP told the nurse the location of the patient's pain and the patient reports worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

A patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? "The cancer is found at the point of origin only." "Tumor cells have been identified in the cervical region." "The cancer has been identified in the cervix and the liver." "Your cancer was identified in the cervix and has limited local spread."

"Your cancer was identified in the cervix and has limited local spread." Rationale: Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

Which nursing action should be included in the plan of care for a client returning to the surgical unit following a left modified radical mastectomy with dissection of axillary lymph nodes? a. Obtain permanent breast prosthesis before the patient is discharged from the hospital. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Place a pink bracelet on the client warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.

. Place a pink bracelet on the client warning against venipunctures

When teaching patients with prostate cancer about brachytherapy, which information should the nurse include? Select all that apply. 1 Brachytherapy is a one-time outpatient procedure. 2 Brachytherapy can cause damage to the bladder and rectum. 3 Brachytherapy is best suited for patients with early stage disease. 4 Brachytherapy is advantageous because it preserves erectile function. 5 Brachytherapy has side effects that include urinary irritative or obstructive problems.

1,3,5 Brachytherapy is a one-time outpatient procedure, and the side effects include urinary irritative or obstructive problems. Brachytherapy is best suited for patients with early stage disease, because the procedure involves placing radioactive seed implants into the prostate gland, allowing higher radiation doses directly in the tissue while sparing the surrounding tissue. Brachytherapy is specifically designed to protect surrounding tissues such as the bladder and rectum. The procedure can, however, cause erectile dysfunction.

The nurse caring for a patient undergoing chemotherapy finds that the patient has a low white blood cell (WBC) count. Which is an appropriate intervention? 1 Monitor the respiratory rate of the patient. 2 Administer white blood cell growth factors. 3 Allow the patient to visit with family and friends. 4 Request that the chemotherapy dose be reduced.

2 Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low white blood cell counts. Low WBC count makes the patient prone to developing infections; therefore, the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, because neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC.

The nurse is reviewing the laboratory reports of a patient with cancer and anticipates that the patient is at an increased risk for infection. Which finding supports this conclusion? 1 Anemia 2 Neutropenia 3 Hyperkalemia 4 Hyponatremia

2 Neutropenia, or a decreased white blood cell count, indicates that the patient at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has infection. Hyperkalemia and hyponatremia also do not indicate infection.

The nurse is preparing education for a patient scheduled to begin radiation therapy and hormone manipulation for prostate cancer. What information is appropriate for the nurse to include? 1 Constipation is usually a problem; a high-fiber diet is recommended. 2 Sexual ability may be affected; discussion with the partner is recommended. 3 An intense daily exercise program will help prevent urinary dysfunction and fatigue. 4 Facial hair loss and a change in voice tone are expected side effects of hormone therapy.

2 Sexual function is usually affected by radiation therapy and hormone manipulation for the treatment of prostate cancer. Therefore it is important for the nurse to suggest options to assist the patient and his partner in adapting and coping with the changes in sexual function that may become permanent. Constipation is usually not a problem with a patient undergoing radiation therapy for prostate cancer. Instead, these patients usually experience diarrhea. Radiation therapy will cause urinary dysfunction and fatigue. Intense exercise in these patients will likely worsen these symptoms. Facial hair loss and change in voice tone are not expected side effects of hormone therapy.

A patient with cancer has third spacing and is on plasma protein replacement therapy. During the treatment, the nurse observes increased central venous pressure and shortness of breath. Which intervention would provide effective treatment? 1 Administering corticosteroids 2 Administering cyclophosphamide 3 Reducing rate of fluid administration 4 Administering potassium sparing diuretic

3 Although plasma protein replacement therapy will help to treat third spacing effectively, the patient may have hypervolemia, which leads to an increase in central venous pressure and shortness of breath. An effective treatment is to reduce fluid administration. Corticosteroids will help to reduce surgical spinal compression. Cyclophosphamide is an alkylating agent that increases antidiuretic hormone levels; the patient will have complications if this drug is administered. Potassium-sparing diuretics do not reduce the side effects of plasma protein replacement.

Which type of radiation therapy involves the oral administration of radioactive sources? 1 Particulate 2 Teletherapy 3 Brachytherapy 4 Radiopharmaceutical

4 Radiopharmaceutical therapy involves the oral administration of radioactive sources. Teletherapy involves exposing the patient to external radiation. A patient who undergoes brachytherapy is exposed to internal radiation. Particulate radiation is a type of ionizing radiation used to treat cancer.

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)

A Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications.

During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Obtain more information about the family history. b. Schedule a sigmoidoscopy to provide baseline data. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood.

A The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.

When assignments are being made for clients with alterations related to gastrointestinal (GI) cancer, which client would be the most appropriate to delegate to an LPN/LVN? A client with severe anemia secondary to GI bleeding. A client who needs enemas and antibiotics to control GI bacteria. A client who needs preoperative teaching for bowel resection surgery. A client who needs central line insertion for chemotherapy.

A client who needs enemas and antibiotics to control GI bacteria.

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? Morphine sulfate Ibuprofen (Advil) Ondansetron (Zofran) Acetaminophen (Tylenol)

Acetaminophen (Tylenol) Rationale: Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias.

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? Increase intake of liquids at mealtime to stimulate the appetite. Serve three large meals per day plus snacks between each meal. Avoid the use of liquid protein supplements to encourage eating at mealtimes. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. Rationale: The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about skin care? Use Dial soap to feel clean and fresh. Scented lotion can be used on the area. Avoid heat and cold to the treatment area. Wear the new bra to comfort and support the area

Avoid heat and cold to the treatment area. Rationale: Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Family history of colorectal cancer and consumes a high-fiber diet Limits fat consumption and has regular mammography and Pap screenings Exercises five times every week and does not consume alcoholic beverages

Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Rationale: Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? Cells are abnormal and moderately differentiated. Cells are very abnormal and poorly differentiated. Cells are immature, primitive, and undifferentiated. Cells differ slightly from normal cells and are well-differentiated.

Cells are abnormal and moderately differentiated. Rationale: Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? Cook food thoroughly before eating. Choose low calorie, low fiber foods. Avoid public transportation such as buses. Use rectal suppositories if needed for constipation. Talk to the oncologist before having any dental work

Cook food thoroughly before eating. Avoid public transportation such as buses. Talk to the oncologist before having any dental work

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply prescribed anesthetic gel to oral lesions before meals.

D Because the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? Bacteria Sun exposure Most chemicals Epstein-Barr virus

Epstein-Barr virus Rationale: Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

When caring for the patient with cancer, what does the nurse understand is the response of the immune system to antigens of the malignant cells? Metastasis Tumor angiogenesis Immunologic escape Immunologic surveillance

Immunologic surveillance Rationale: Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

The patient is told that an adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse's response be to the patient? It will recur. It has metastasized. It is probably benign. It is probably malignant

It is probably benign. Rationale: Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

After change-of-shift report on the oncology unit, which patient should the nurse assess first? Patient who has a platelet count of 82,000/µL after chemotherapy Patient who has xerostomia after receiving head and neck radiation Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) Patient who is worried about getting the prescribed long-acting opioid on time

Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that: BSE will reduce the risk of dying from breast cancer. BSE should be done daily while taking a bath or shower. Annual mammograms should be scheduled in addition to BSE. Performing BSE after the menstrual period is more comfortable.

Performing BSE after the menstrual period is more comfortable.

Which problem is of most concern for a patient with myelosuppression secondary to chemotherapy for cancer treatment? Acute pain Hypothermia Powerlessness Risk for infection

Risk for infection Rationale: Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible when patients undergo chemotherapy, but the threat of infection is paramount.

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? Weight gain of 6 lb Nausea and vomiting Urine specific gravity of 1.004 Serum sodium level of 118 mEq/L

Serum sodium level of 118 mEq/L Rationale: Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

Patients may reduce the risk of developing cancer using health promotion strategies. Identify modifiable strategies which can reduce the risk of developing cancer. (Select all that apply.) Stop smoking Use sunscreen Limit alcohol use Undergo genetic testing Maintain a healthy weight Receive appropriate immunizations

Stop smoking Use sunscreen Limit alcohol use Maintain a healthy weight Receive appropriate immunizations Rationale: Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Smoking can initiate or promote cancer development. Alcohol use combined with smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition to some cancers but is not modifiable.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? Infuse the medication over a short period of time. Stop the infusion if swelling is observed at the site. Administer the chemotherapy through a small-bore catheter. Hold the medication unless a central venous line is available.

Stop the infusion if swelling is observed at the site.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? The medications the patient is taking The nutritional supplements that will help the patient How much time is needed to provide the patient's care The time the nurse spends at what distance from the patien

The time the nurse spends at what distance from the patient Rationale: The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? Ask the patient if the site hurts. Turn off the chemotherapy infusion. Call the ordering health care provider. Administer sterile saline to the reddened area.

Turn off the chemotherapy infusion. Rationale: Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? Hematocrit 32% Platelets 148,000/μL Hemoglobin 11 g/L White blood cells (WBC) 2700/μL

White blood cells (WBC) 2700/μL

After change-of-shift report on the oncology unit, which patient should the nurse assess first? Patient who has a platelet count of 82,000/μL after chemotherapy Patient who has xerostomia after receiving head and neck radiation Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) Patient who is worried about getting the prescribed long-acting opioid on time

a temperature of 100.5° F (38.1° C) Patient who is worried about

You are monitoring your client who is at risk for spinal cord compression related to tumor growth. Which client statement is most likely to suggest early manifestation? a. "Last night my back really hurt, and I had trouble sleeping." b. "My leg has been giving out when I try to stand." c. "My bowels are just not moving like they usually do." d. "When I try to pass my urine, I have difficulty starting the stream."

a. "Last night my back really hurt, and I had trouble sleeping."

When assignments are being made for clients with alterations related to gastrointestinal (GI) cancer, which client would be the most appropriate to delegate to an LPN/LVN? a. A client with severe anemia secondary to GI bleeding. b. A client who needs enemas and antibiotics to control GI bacteria. c. A client who needs preoperative teaching for bowel resection surgery. d. A client who needs central line insertion for chemotherapy.

b. A client who needs enemas and antibiotics to control GI bacteria.

The nurse understands that the physician would need to be notified regarding a chemotherapy dose if the client experiences: a. Fatigue b. Nausea and vomiting c. Stomatitis d. Bone marrow suppression

d. Bone marrow suppression

The nurse is caring for a patient with cancer and is monitoring the albumin and prealbumin levels frequently. What condition does the nurse suspect the patient is at risk for? 1 Malnutrition 2 Cardiac tamponade 3 Tumor lysis syndrome 4 Third space syndrome

1 Altered albumin and prealbumin levels are indicators of malnutrition. Cardiac tamponade, tumor lysis syndrome, and third space syndrome are not associated with altered albumin and prealbumin levels.

When providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy, what would be most beneficial to teach the patient to use? Firm-bristle toothbrush Hydrogen peroxide rinse Alcohol-based mouthwash 1 tsp salt in 1 L water mouth rinse

1 tsp salt in 1 L water mouth rinse Rationale: A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

A 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.

Which patient is statistically and medically at the highest risk of developing cancer? A 68-yr-old white woman who has BRCA-1 gene and is obese A 56-yr-old black man with hepatitis C who drinks alcohol daily An 18-yr-old Hispanic man who eats fast food once per week and drinks alcohol An 80-yr-old Asian woman with coronary artery disease on blood pressure medication

A 56-yr-old black man with hepatitis C who drinks alcohol daily Rationale: The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. Most cancer cases are diagnosed in people older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in blacks, then whites, and then people from other cultures.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? It is delivered via an Ommaya reservoir and extension catheter. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. Rationale: Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work.

A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine and 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.

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."

C A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.

A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Relief of pressure in the stomach will promote better nutrition. c. Decreasing the tumor size will improve the effects of other therapy. d. Tumor growth will be controlled by the removal of malignant tissue.

C 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.

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I can buy aloe vera gel to use on my skin." d. "I will expose my skin to a sun lamp each day."

C Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. A 35-yr-old patient who has wet desquamation associated with abdominal radiation b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck d. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation

C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient voids every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has crackles up to the midline posterior chest.

D Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer or are receiving chemotherapy.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members

D The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

A patient who is receiving radiation to the head and neck as treatment for an invasive cancer reports mouth sores and pain. Which intervention should the nurse add to the plan of care? Provide ice chips to soothe the irritation. Weigh the patient every month to monitor for weight loss. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. Provide high-protein and high-calorie, soft foods every 2 hours.

Provide high-protein and high-calorie, soft foods every 2 hours. Rationale: A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

The client is diagnosed with laryngeal cancer and is scheduled for a laryngectomy next week. Which intervention would be priority for the clinic nurse? Assess the client's ability to swallow. Refer the client to a speech therapist. Order the client's preoperative lab work. Discuss the client's operative unit.

Refer the client to a speech therapist.

The client is diagnosed with laryngeal cancer and is scheduled for a laryngectomy next week. Which intervention would be priority for the clinic nurse? a. Assess the client's ability to swallow. b. Refer the client to a speech therapist. c. Order the client's preoperative lab work. d. Discuss the client's operative unit.

b. Refer the client to a speech therapist.

The nurse assesses a patient with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? "Have you had a fever?" "Have you lost any weight?" "Has diarrhea been a problem?" "Have you noticed any hair loss?"

"Have you had a fever?" Rationale: An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in patients with cancer. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? "When your hair grows back, it will be patchy." "Use your curling iron since that will slow down the loss." "You can get a wig now to match your hair so you will not look different." "You should contact "Look Good, Feel Better" to figure out what to do about this."

"You can get a wig now to match your hair so you will not look different." Rationale: The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back, it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

The nurse is caring for a patient who had a laparotomy one day ago and has a nasogastric tube in place. During suctioning of the nasogastric tube, the nurse finds that the nasogastric aspirate has become bright red in color. What action should the nurse take first? 1 Notify the surgeon. 2 Administer intravenous (IV) fluids. 3 Continue suctioning the aspirate. 4 Flush the nasogastric tube with normal saline.

1 Bright red color in the aspirate indicates ongoing hemorrhage. The surgeon should be notified immediately. Administering IV fluids and suctioning can be done once the surgeon is notified. Flushing the nasogastric tube with normal saline is not advised.

A nurse teaching a community group about ways to reduce the risk for colorectal cancer includes decreasing the dietary intake of: 1 Beef and pork 2 Fish and poultry 3 Fresh and dried fruits 4 Green leafy vegetables

1 Development of colorectal cancer has been associated with consumption of a high-fat diet. Of the foods listed, beef and pork are the highest in fat content. A diet that includes plenty of fresh fruits, vegetables, fish, and poultry is best for reducing the risk of colorectal and other forms of cancer.

A patient with breast cancer experiences a 3-kilogram weight loss over the course of a week. The nurse is evaluating the patient after teaching necessary interventions to reduce the risk of malnutrition. Which statement made by the patient indicates effective learning? Select all that apply. 1 "I can use packages of instant breakfast." 2 "I can add cheese to sandwiches or snacks." 3 "I can take low-calorie foods throughout the day." 4 "I can supplement puddings and cereals with Ensure." 5 "I can use raw milk when preparing milkshakes and sauc

1,2,4 A cancer patient who has lost 3 kilograms in a week is at a high risk of malnutrition. Instant breakfast packages can be sprinkled over puddings and sausages because they contain protein. Cheese contains protein and calories, which are essential for a patient suffering from weight loss. Ensure is a commercial nutritional supplement that provides adequate protein and fat for the patient. Low-calorie foods can further cause weight loss in the patient. Raw milk may contain bacteria, which would place the patient at a high risk of infection.

A nurse caring for a patient with breast cancer receiving chemotherapy has developed alopecia and is noticeably upset. Which nursing actions are appropriate for this patient? Select all that apply. 1 Suggest the patient use scarves and wigs. 2 Instruct the patient to use shampoo every day. 3 Suggest the patient cut long hair before therapy. 4 Instruct the patient to avoid the use of hair dryers. 5 Instruct the patient to brush and comb hair frequently.

1,3,4 Alopecia refers to loss of hair from the head or the body and is a common side effect of cancer treatment. The patient can use scarves and wigs to improve body image. Long hair should be cut before therapy, because it needs more care and is more prone to fall out. Hair dryers should be avoided because their use can worsen alopecia. Shampoos are chemicals that may harm the hair and should not be used daily. Brushing and combing should be done carefully and infrequently because excessive brushing and combing can worsen alopecia.

A patient has been diagnosed as BRCA1 and BRCA2 positive. The health care provider has suggested a prophylactic bilateral oophorectomy for this patient. What information should the nurse provide before this patient decides to undergo this procedure? Select all that apply. 1 This procedure will reduce the risk of acquiring breast cancer by 50%. 2 This procedure can decrease the patient's susceptibility to acquiring heart disease. 3 The patient will not be able to bear children naturally after this procedure. 4 This procedure will increase the patient's susceptibility to developing osteoporosis. 5 The patient will not have menstrual cycles after the surgery.

1,3,4,5 BRCA1 and 2 genes are tumor suppressor genes that inhibit tumor development when functioning normally. Estrogen hormone has been found to be a tumor promoter. In the case of BRCA1 and BRCA2 mutations, estrogen is able to work more effectively in the development of the breast tumor; therefore, a bilateral oophorectomy is indicated in these patients. If the ovaries are removed in premenopausal women, levels of estrogen come down significantly, and thus this procedure will be helpful in reducing the risk of acquiring breast cancer by 50%. Due to the removal of the ovaries, the normal menstrual cycle does not occur, and therefore the woman is unable to conceive. Estrogen is a bone-protective and cardioprotective hormone; therefore, its loss may increase the patient's susceptibility to developing osteoporosis and heart disease.

Which interventions will the nursing management of a patient with leukopenia include? Select all that apply. 1 Administering antiemetic drugs 2 Teaching the patient to avoid large crowds 3 Monitoring the patient's white blood cell count 4 Instructing the patient to take stool softeners as needed 5 Teaching the patient to report any temperature elevation 6 Monitoring the patient's hemoglobin and hematocrit levels 00:00:02 Question Answer Confidence Buttons

2,3,5 The nurse should monitor the white blood cell count, especially the neutrophils, of a patient with leukopenia because this patient is immunocompromised. In addition, the nurse should teach the patient to avoid large crowds and report temperature elevations because infections are the most frequent cause of morbidity and death in cancer patients. Patients with anemia should have their hemoglobin and hematocrit levels monitored. Antiemetics are administered prophylactically before chemotherapy and as needed. Stool softeners are used if a patient is constipated.

Previous administrations of chemotherapy agents to a patient with cancer have resulted in diarrhea. Which dietary modification should the nurse recommend? A bland, low-fiber diet A high-protein, high-calorie diet A diet high in fresh fruits and vegetables A diet emphasizing whole and organic foods

A bland, low-fiber diet Rationale: Patients with diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

A, C, D, E The patient's age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy.

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Crackles heard at the lung bases c. Complaints of nausea and anorexia d. Oral temperature of 100.6° F (38.1° C)

B Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

B Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should 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 are preferred.

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

B The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change 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.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.

B 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 or incision required.

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

B 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 friends will raise the children, more assessment information is needed before making plans.

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.

B Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

The nurse understands that the physician would need to be notified regarding a chemotherapy dose if the client experiences: Fatigue Nausea and vomiting Stomatitis Bone marrow suppression

Bone marrow suppression

A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

C 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 usually the oral route is preferred.

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful to you in the past when coping with stressful events?" d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

C 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. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

C Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. 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.

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action would address the cause of the patient problem? a. Add protein powder to foods such as casseroles. b. Tell the patient to eat foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add spices to enhance the flavor of foods that are served.

C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding protein powder does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition.

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

C The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.

C Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

C "Malignant tumors may spread to other tissues or organs." The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/μL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/μL

D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? 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.

D 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.

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.

D Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short or long term. There is no urgent need to report common chemotherapy side effects to the provider.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? Poor oral intake Frequent loose stools Complaints of nausea and vomiting Increase in carcinoembryonic antigen (CEA)

Increase in carcinoembryonic antigen (CEA) An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. Gastrointestinal adverse effects are common with chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. An elevated WBC may indicate infection but does not reflect the effectiveness of the colorectal cancer therapy.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? (Select all that apply.) Maintain hope. Exhibit a caring attitude. Plan realistic long-term goals. Give them antianxiety medications. Be available to listen to fears and concerns. Teach them about the type of cancers that could be diagnosed.

Maintain hope. Exhibit a caring attitude. Be available to listen to fears and concerns. Rationale: Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? Give the patient the prescribed PRN opioid. Assess for knowledge about cancer side effects. Notify the health care provider about the symptoms. Teach the patient how to use relaxation to reduce pain.

Notify the health care provider about the symptoms.

Which nursing action should be included in the plan of care for a client returning to the surgical unit following a left modified radical mastectomy with dissection of axillary lymph nodes? Obtain permanent breast prosthesis before the patient is discharged from the hospital. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. Place a pink bracelet on the client warning against venipunctures or blood pressures in the left arm. Insist that the patient examine the surgical incision when the initial dressings are removed.

Place a pink bracelet on the client warning against venipunctures or blood pressures in the left arm.

The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer? a. Fruit salad b. Baked chicken c. Creamed broccoli d. Toasted wheat bread

b. Baked chicken Protein is needed for wound healing. To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patient's visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

b. The patient's visitors bring in some fresh peaches from home.

After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time

c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)

The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarette smoking during each patient encounter.

d. Discuss risks associated with cigarette smoking during each patient encounter. Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk.

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that: a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. Annual mammograms should be scheduled in addition to BSE. d. Performing BSE after the menstrual period is more comfortable.

d. Performing BSE after the menstrual period is more comfortable.

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis

d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis 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.