chapter 22

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?

-Allow the client an opportunity to express her feelings.

A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

-Apply moisturizers to dry skin. -Bathe the client using mild soap.

A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

-Apply the clients shoes before getting the client out of bed. -Assist the client with ambulation. -Use a lift sheet to move the client up in bed.

A clients family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.)

-Ask the family to describe their concerns more fully. -Consult with a social worker, chaplain, or ethics committee. -Explain the clients right to know and ask for their assistance.

A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.)

-Assess all mucous membranes every 4 to 8 hours. -Listen to lung sounds and monitor for cough. -Monitor the venous access device appearance with vital signs. -Take and record vital signs every 4 to 8 hours.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement?

-Assess for fever. -Administer pegfilgrastim (Neulasta). -Do not permit fresh flowers or plants in the room. -Teach the client to omit raw fruits and vegetables from the diet.

A client has mucositis. What actions by the nurse will improve the clients nutrition? (Select all that apply.)

-Assist with rinsing the mouth with saline frequently. -Encourage the client to eat room-temperature foods. - local anesthetic medications to swish and spit. -Remind the client to brush teeth gently after each meal.

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?

-Breast tenderness -Deep vein thrombosis

When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider?

-Bruises -Petechiae -Epistaxis

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.)

-Chemo gloves - Facemask -Isolation gown

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?

-Encourage the client to participate in changing the ostomy. -Offer to have a person who is coping with a colostomy visit. -Encourage the client and family members to express their feelings and concerns.

Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer?

-Fatigue -Change in taste -Changes in skin of the neck -Difficulty swallowing

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? Physical Assessment FindingsDiagnostic FindingsMedicationsNeuro: Episodes of confusionCardiac: Pulse 88 and regularMusculoskeletal: Weakness, tremorsNa: 115K: 4.2Creatinine: 0.8ondansetron (Zofran)cyclophosphamide (Cytoxan)

-Hyponatremia -Mental status changes -Weakness

The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.)

-Increased risk of infection from white blood cell deficits -Nutritional deficits such as early satiety and cachexia -Potential for reduced gas exchange -Various motor and sensory deficits

The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?

-The student teaches the client that symptoms of neutropenia include fatigue and weakness.

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 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit)

A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem?

Assisting the client to pre-plan for this event

A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important?

Ensuring that informed consent is on the chart

A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important?

Assessing the IV site every hour

. A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important?

Assist the client in getting out of bed.

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?

Allergy

. A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse?

Allowing a very tired client to skip oral hygiene and sleep

A client in the emergency department reports difficulty breathing. The nurse assesses the clients appearance as depicted below: What action by the nurse is the priority?

Assess blood pressure and pulse.

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important?

Assess the clients gait and balance.

A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer?

Epoetin alfa (Epogen)

A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority?

Blood pressure

A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?

Call the client at home the next day to review teaching.

Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3?

Change in mental status

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first?

Client with a serum potassium of 2.8 mEq/L

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?

Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature

Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy?

Consume a diet high in fiber.

A nurse reads on a hospitalized clients chart that the client is receiving teletherapy. What action by the nurse is best?

Coordinate continuation of the therapy.

A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate?

Do not expose the radiation area to direct sunlight.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?

Monitor weight

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?

Edema of arms and hands

The nurse working with oncology clients understands that which age-related change increases the older clients susceptibility to infection during chemotherapy?

Decreased immune function

A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?

Gently inquire about advance directives.

A client with cancer has anorexia and mucositis, and is losing weight. The clients family members continually bring favorite foods to the client and are distressed when the client wont eat them. What action by the nurse is best?

Help the family show other ways to demonstrate love and caring.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?

Hemoglobin of 7.4 and hematocrit of 21.8

Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment plan?

I will have a radioactive device in my body for a short time."

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?

Infection

A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate?

Instruct the client to call for help to get out of bed.

A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?

It is normal to be fatigued even for years afterward.

A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best?

It prevents the start of cell division in the cancer cells.

The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed?

Its alright for me to keep my pets and change the litter box.

After receiving the hand-off report, which client should the oncology nurse see first?

Older client on chemotherapy with mental status changes

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?

Ondansetron (Zofran)

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?

Potential for injury related to sensory and motor deficits

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?

Providing oral care with a disposable mouth swab

. A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best?

Read the policy on handling radioactive excreta.

A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately?

Red, warm, swollen calf

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?

Relief of symptoms or improved quality of life

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority?

Teaching measures to prevent scalp injury

The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)?

Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client

A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the clients oral chemotherapy medications. What action by the nurse is most appropriate?

Wear personal protective equipment when handling the medications.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?

• Abdominal cavity

When caring for the client with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order?

• Allopurinol (Zyloprim)

An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?

• Reducing all direct and indirect sources of light