N300 Exam 2: Pancreatic Cancer
The client is diagnosed with cancer of the head of the pancreas. When assessing the patient, which signs and symptoms would the nurse expect to find? 1. Clay-colored stools and dark urine. 2. Night sweats and fever. 3. Left lower abdominal cramps and tenesmus. 4. Nausea and coffee-ground emesis.
**1. The client will have jaundice, clay-colored stools, and tea-colored urine resulting from blockage of the bile drainage. 2. Night sweats and fevers are associated with lymphoma. 3. Left lower abdominal cramps are associated with diverticulitis, and tenesmus is straining when defecating. 4. Nausea and coffee-ground emesis are symptoms of gastric ulcers. TEST-TAKING HINT: The test taker should remember anatomical placement of organs. This would eliminate answer options "3" and "4." The pancreas empties pancreatic enzymes into the small bowel to aid in the digestion of carbohydrates and fats in close proximity to where the common bile duct enters the intes- tine.
The nurse and an unlicensed nursing assistant are caring for clients on an oncology floor. Which intervention should the nurse delegate to the assistant? 1. Assist the client with abdominal pain to turn to the side and flex the knees. 2. Monitor the Jackson Pratt drainage tube to make sure it is draining properly. 3. Check to see if the client is sleeping after pain medication is given. 4. Empty the bedside commode of the client who has been having melena.
**1. The nursing assistant can help a client to turn to the side and assume the fetal position, which would decrease some abdominal pain. 2. This is a high-level nursing intervention that the unlicensed nursing assistant is not qualified to implement 3. Evaluation of the effectiveness of a PRN medication must be done by the nurse. 4. The nurse should empty the bedside commode to determine if the client is continuing to pass melena (blood in the stool). TEST-TAKING HINT: There are basic rules to delegation. The nurse cannot delegate assessment, evaluation, unstable clients, or situations requiring nursing judgment.
The nurse is assessing a client with complaints of vague upper abdominal pain that is worse at night but is relieved by sitting up and leaning forward. Which assessment question should the nurse ask next? 1. "Have you noticed a yellow haze when you look at things?" 2. "Does the pain get worse when you eat a meal or snack?" 3. "Have you had your amylase and lipase checked recently?" 4. "How much weight have you gained since you saw the HCP?"
1. A yellow haze is a sign of a toxic level of digoxin, with the client seeing through the yellow haze. Seeing a yellow haze is not the same as the client being jaundiced. In jaundice, the skin and sclera are yellow, signs of pancre- atic cancer **2. The abdominal pain is often made worse by eating and lying supine in clients diagnosed with cancer of the pancreas. 3. The client would not know these terms, and the HCP would be the one to check these laboratory values. 4. Clients diagnosed with cancer of the pancreas lose weight, not gain weight. TEST-TAKING HINT: The test taker could arrive at the correct answer by correlating words in the stem of the question and words in the answer options—the abdomen with eating and pain with pain.
The client diagnosed with cancer of the head of the pancreas is two (2) days post- pancreatoduodenectomy (Whipple's procedure). Which nursing problem has the highest priority? 1. Anticipatory grieving. 2. Fluid volume imbalance. 3. Acute incisional pain. 4. Altered nutrition.
1. Clients diagnosed with cancer of the pancreas have a poor prognosis, but this is not the priority problem at this time. **2. This is a major abdominal surgery, and there are massive fluid volume shifts that occur when this type of trauma is experienced by the body. Maintaining the circulatory system without overloading it requires extremely close monitoring. 3. Pain is a priority but not over fluid volume status. 4. Altered nutrition would be the next highest priority. The client will be NPO with a nasogastric tube to suction and will be receiving total parenteral nutrition. TEST-TAKING HINT: The nurse should identify all of the problems, but one—fluid volume imbalance—has the greatest priority because if not addressed promptly and correctly, it could lead to severe complications
The home health nurse is admitting a client diagnosed with cancer of the pancreas. Which information is the most important for the nurse to discuss with the client? 1. Determine the client's food preferences. 2. Ask the client if there is an advance directive. 3. Find out about insurance/Medicare reimbursement. 4. Explain that the client should eat as much as possible.
1. Food preferences are important for the care- giver to know because this will be the person preparing meals for the client. **2. Cancer of the pancreas has a poor prognosis for most clients, and the nurse should determine if the client has executed an advance directive regarding their wishes. 3. This is important because of payment issues, but it is not the highest priority. 4. Clients diagnosed with cancer frequently have anorexia, and explaining that the client should eat does not mean the client will eat. TEST-TAKING HINT: The test taker would need to know general information about the disease process to answer this question, but "2" is a good choice for many terminal diseases. Remember to read the questions carefully. The home health nurse is not arranging meals for the client.
The nurse is planning a program for clients at a health fair regarding the prevention and early detection of cancer of the pancreas. Which self-care activity should the nurse teach that is an example of primary nursing care? 1. Monitor for elevated blood glucose at random intervals. 2. Inspect the skin and sclera of the eyes for a yellow tint. 3. Limit meat in the diet and eat a diet that is low in fats. 4. Instruct the client with hyperglycemia about insulin injections.
1. Monitoring the blood glucose at random inter- vals, as would be done at a health fair, can pick up possible diabetes mellitus or the presence of a pancreatic tumor, but detecting a disease at an early stage is secondary screening, not primary prevention. 2. Inspecting the skin for jaundice would be a secondary nursing intervention. **3. Limiting the intake of meat and fats in the diet would be an example of primary interventions. Risk factors for the development of cancer of the pancreas are cigarette smoking and eating a high-fat diet that is high in animal protein. By changing these behaviors the client could possibly prevent the development of cancer of the pancreas. Other risk factors include genetic predisposition and exposure to industrial chemicals. 4. Instructing a client with hyperglycemia (diabetes mellitus) is an example of tertiary nursing care. TEST-TAKING HINT: Even if the test taker was not sure of the definition of primary, second- ary, or tertiary nursing care, primary means first. Only one answer option is preventive, and preventing something comes before treat- ing it.
The nurse caring for a client diagnosed with cancer of the pancreas writes the nursing diagnosis of "risk for altered skin integrity related to pruritus." Which interventions should the nurse implement? 1. Assess tissue turgor. 2. Apply antifungal creams. 3. Monitor bony prominences for breakdown. 4. Have the client keep the fingernails short.
1. The client is at risk for poor nutrition and malabsorption syndrome for which tissue turgor assessment is appropriate, but the client problem here is pruritus, or itching. 2. The itching is associated with the cancer and not a fungus. 3. The client should be monitored for skin break- down, but pruritus is itching and an intervention is needed to prevent skin problems from scratching. **4. Keeping the fingernails short will reduce the chance of breaks in the skin from scratching. TEST-TAKING HINT: The problem is "risk for skin breakdown." The etiology is "pruritus." Interventions address the etiology. Goals address the problem.
The client has had a total pancreatectomy and splenectomy for cancer of the body of the pancreas. Which discharge instructions should the nurse teach? Select all that apply. 1. Keep a careful record of intake and output. 2. Use a stool softener or bulk laxative regularly. 3. Use correct insulin injection technique. 4. Take the pain medication before the pain gets too bad. 5. Sleep with the head of the bed on blocks.
1. The client is being discharged. There is no need for the client to continue recording intake and outputs at home. **2. The client has undergone a radical and extensive surgery and will need to be administered narcotic pain medication, and a bowel regimen should be in place to prevent constipation. **3. Removal of the pancreas will create a dia- betic state for the client. The client will need insulin and pancreatic enzyme rep- lacement. **4. Client should not allow pain to reach above a "5" before taking pain medication or it will be more difficult to get the pain under control. 5. There is no reason for the client to sleep with the head of the bed elevated. TEST-TAKING HINT: The test taker might choose option "3" by remembering that the pancreas secretes insulin. Option "4" is taught to all clients in pain.
The client admitted to rule out pancreatic islet tumors complains of feeling weak, shaky, and sweaty. Which should be the first intervention implemented by the nurse? 1. Start an IV with D5W. 2. Notify the health-care provider. 3. Perform a bedside glucose check. 4. Give the client some orange juice.
1. The client may need IV medication, but in this case if it is needed, it would be 50% dextrose. 2. The HCP might be notified, but the nurse needs to assess the client first. **3. These are symptoms of an insulin reaction (hypoglycemia). A bedside glucose check should be done. Pancreatic islet tumors can produce hyperinsulinemia or hypoglycemia. 4. This would be done after the nurse knows the glucose reading. TEST-TAKING HINT: The test taker should remember the function of the pancreas. This would lead the test taker to look for interventions for hypoglycemia.
The client is being admitted to the outpatient department prior to an endoscopic retrograde cholangiopancreatogram (ERCP) to rule out cancer of the pancreas. Which pre-procedure instruction should the nurse teach? 1. Prepare to be admitted to the hospital after the procedure for observation. 2. If something happens during the procedure, then emergency surgery will be done. 3. Do not eat or drink anything after midnight the night before the test. 4. If done correctly, this procedure will correct the blockage of the stomach.
1. The client should stay in the outpatient department after the procedure for observation unless the HCP determines that a more extensive workup should be completed. 2. This is not the type of procedure where the results warrant an emergency surgery. A cardiac catheterization sometimes results in an emergency surgery and the client is prepared for this possibility, but this is not the case with an ERCP. **3. The client should be NPO after midnight to make sure the stomach is empty to reduce the risk of aspiration during the procedure. 4. The possible blockage would be of the duodenum, common bile duct, or pancreatic outlet. TEST-TAKING HINT: The nurse should never preface any instruction with "if done correctly" because this sets the nurse, HCP, and facility up for a lawsuit. The client is NPO for any procedure or surgery where the client will receive general or twilight sleep anesthesia.
The client diagnosed with cancer of the pancreas is being discharged to start chemo- therapy in the HCP's office. Which statement made by the client indicates the client understands the discharge instructions? 1. "I will have to see the HCP every day for six (6) weeks for my treatments." 2. "I should write down all my questions so I can ask them when I see the HCP." 3. "I am sure that this is not going to be a serious problem for me to deal with." 4. "The nurse will give me an injection in my leg and I will get to go home."
1. This would be the routine for radiation ther- apy, but chemotherapy is given one (1) to three (3) or four (4) days in a row and then a period of three (3) to four (4) weeks will elapse before the next treatment. This is called intermittent pulse therapy. **2. The most important person in the treat- ment of the cancer is the client. Research has proved that the more involved a client becomes in his or her care, the better the prognosis. Clients should have a chance to ask all the questions that they have. 3. Cancer of any kind is a serious problem. 4. Most antineoplastic medications are given intravenously. Many of the medications can cause severe complications if given intramuscularly. TEST-TAKING HINT: The test taker can eliminate option "3" on the basis that this statement is denial of the problem.
The nurse caring for a client diagnosed with cancer of the pancreas writes the collab- orative problem of "altered nutrition." Which intervention should the nurse include in the plan of care? 1. Continuous feedings via PEG tube. 2. Have the family bring in foods from home. 3. Assess for food preferences. 4. Refer to the dietitian.
1. Tube feedings are collaborative interventions, but the stem did not say the client had a feed- ing tube. 2. This is an independent intervention. 3. Assessment is an independent intervention and the first step in the nursing process. No one should have to tell the nurse to assess the client. **4. A collaborative intervention would be to refer to the nutrition expert, the dietitian. TEST-TAKING HINT: The key word in the stem is "collaborative." which means another health- care discipline must be involved. Only options "1" and "4" involve other members of the health-care team. The test taker could elimi- nate distracter "1" by rereading the stem and realizing that the stem did not say the client had a feeding tube.