Oncologic Disorders

A client seeks care for hoarseness that has lasted for 1 month. What is the most important question for the nurse to ask when assessing the client's health history?

"Do you smoke cigarettes, cigars, or a pipe?"

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning."

The nurse is teaching a client with abdominal cancer about taking medication to control the pain? What statement from the client indicates the need for additional teaching?

"I should skip doses periodically so I don't get hooked on my drugs."

The nurse is instructing a client on how to care for skin that has become dry after radiation therapy. Which statement by the client indicates that they understand the teaching?

"It's safe to apply a nonperfumed lotion to my skin."

A client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?

"Keep the stoma moist."

A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when the client says

"The advance directive allows me to state my healthcare wishes while I'm still able to do so."

A 70-year-old client asks the nurse if they need to have a mammogram. Which is the nurse's best response?

"The incidence of breast cancer increases with age."

On the third postoperative day after a radical mastectomy, a client's drainage tube is removed, and the dressings are changed. The client appears shocked when they see the operative area and exclaims, "I look horrible! Will it ever look better?" Which response by the nurse would be most appropriate?

"You're shocked by the sudden change in your appearance as a result of this surgery, aren't you?"

A client who will have the final chemotherapy cycle in 11 days becomes neutropenic. The client understands the condition by making which statement? Select all that apply.

-"I'll monitor my temperature frequently and go to the nearest emergency department if my temperature rises above 100.4° F (38° C)." -"I need to avoid going to the movies or eating out while receiving my cancer treatment." -"I will carry hand sanitizer with me and use it often."

A nurse is teaching a community program on breast self-examination (BSE). The nurse demonstrates the proper procedure for palpating each breast. In what sequence would the following actions be performed for proper self-examination? All options must be used.

-Lie down with one arm behind the head. -Place the hand over the breast to be examined (use the right hand for the left breast and vice versa). -Use the finger pads of the three middle fingers and touch the breast. -Use a circular motion to feel the breast tissue (with light, medium, and firm pressure). -Palpate the breast in a perpendicular motion, going across the breast from one side to another and top to bottom.

The nurse is administering atropine sulfate to a client undergoing a modified radical mastectomy. What is the expected outcome of this drug?

Inhibit oral and respiratory secretions.

Which client has the highest risk of ovarian cancer?

45-year-old woman who has never been pregnant

Which individual has the highest priority for receiving seasonal influenza vaccination?

50-year-old female client caring for a spouse with cancer

The nurse is teaching a client who had a mastectomy for breast cancer how to prevent lymphedema. What should the nurse teach the client to do?

Elevate the affected arm on a pillow.

After a client undergoes a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises. What is the expected outcome of these exercises?

Expand the alveoli, and increase the lung surface available for ventilation.

The nurse at the gynecologic clinic is teaching the client about the results of her Papanicolaou test, which demonstrated dysplasia. Which represents the nurse's best intervention?

Explain that the results show cervical changes that require follow up.

The nurse is teaching a group of unlicensed assistive personnel (UAP) to interact with a dying client and family. Which information will be most helpful to the UAPs?

When health care personnel do not understand their own feelings about death and dying, they often avoid the client.

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?

Inform the physician immediately.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?

It calls for a biopsy as soon as possible.

A client who is in the end stages of cancer is increasingly upset about receiving chemotherapy. Which approach by the nurse would likely be most helpful in gaining the client's cooperation?

Tell the client how the treatment can be expected to help.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

Testicular cancer is a highly curable type of cancer.

A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?

The client entered a clinical trial through the National Cancer Institute.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

a hemolytic allergic reaction caused by an antigen reaction

A client who is receiving chemotherapy is not eating well but otherwise feels healthy. What should the nurse suggest the client eat?

broiled chicken, green beans, and cottage cheese

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?

calcium level of 11.6 mg/dl (2.9 mmol/L)

A client with a nagging cough makes an appointment to see the healthcare provider. For what other signs or symptoms will the nurse assess as a priority?

change in voice and unexplained weight loss

The nurse is conducting an initial nursing history of a client who is experiencing pain related to bone cancer. What information is most important for the nurse to obtain?

client's self-reporting of the pain experience

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to

cryptorchidism

The nurse is caring for a client who is receiving external beam radiation therapy for the treatment of lung cancer. What should the nurse assess the client for while they are receiving radiation therapy?

dysphagia

The nurse is performing a breast examination on a client. Which findings most strongly suggest that a client has breast cancer?

fixed nodular mass, breast pain, dimpling of the skin

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?

injury related to the decreased platelet count

The nurse is planning care with a client with acute leukemia who has mucositis. What should the nurse advise the client to use for mouth care?

normal saline

The nurse is conducting a cancer risk assessment for a middle-age client. Which risk factor would the nurse focus on when engaging in motivational interviewing as an approach to risk reduction?

nutrition

A nurse is caring for a premenopausal client who had precancerous cells found during a routine Papanicolaou (Pap) test. At which time during the menstrual cycle would the nurse schedule a cervical biopsy?

one week after the end of the menstrual period

When conducting a focused assessment of the respiratory system, what should the nurse note as an early sign of laryngeal cancer?

persistent mild hoarseness

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?

pituitary carcinoma

The nurse is planning future care with a middle-age client who has undergone surgical resection for lung cancer. Which plan will best promote adaptation and rehabilitation?

planning a progressive activity regimen

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?

sigmoidoscopy

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

stage 3 pressure injury on the left heel

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. What is most important for the nurse to include in discharge teaching?

the need for continued breast self-examination on the right breast

A client at risk for lung cancer asks about the reason for having a computed tomography (CT) scan as part of the initial examination. What is the nurse's best response?

useful for distinguishing small differences in tissue density and detecting nodal involvement."

A nurse is caring for a client who is undergoing chemotherapy. The nurse is reviewing the client's current laboratory values that are noted on the medical record (see chart below). Which action would be most appropriate for the nurse to implement?

washing hands before and after entering the room

A nurse is caring for a terminally ill cancer client who is being transferred to hospice care. Which information regarding hospice care would the nurse include in the teaching plan? Select all that apply.

-The focus of care is on controlling symptoms and relieving pain. -A multidisciplinary team provides care. -Bereavement care is provided to the family.

The nurse has reinforced a pressure dressing on a client who is postoperative mastectomy and notes there is considerable sanguineous drainage in the Hemovac. Which assessments should the nurse report to the physician? Select all that apply.

-blood pressure 86/50 mm Hg; pulse weak and thready at 120 bpm -fever of 102 degrees F, no urine output for 2 hours

A client is receiving monthly doses of chemotherapy for the treatment of stage III colon cancer. Which laboratory result(s) should the nurse report to the oncologist before the next dose of chemotherapy is administered? Select all that apply.

-platelet count of 40,000/mm3 (40 × 109/L) -white blood cell count of 2300/mm3 (2.3 × 109/L) -temperature of 101.2°F (38.4°C)

A client diagnosed with leukemia is now experiencing neutropenia. Which assessment related to neutropenia is a priority for the nurse?

Breath sounds

The family of an older adult with terminal cancer asks about having hospice services. What should the nurse teach the family about hospice?

Hospice services provide supportive care for the client and family.

When the nurse is developing a plan of care to manage a client's pain from cancer, what should the nurse plan to do?

Individualize the pain medication regimen for the client.

A client with a suspected diagnosis of lung cancer has a bronchoscopy with biopsy. Following the procedure, what should the nurse do?

Monitor the client for signs of pneumothorax.

The client with acute lymphocytic leukemia (ALL) is at risk for infection. What action should the nurse take?

Place the client in a private room.

The nurse is planning care for a client with acute myeloid leukemia (AML). What is an appropriate goal for this client?

Prevent hemorrhage

A client is taking doxorubicin and is distressed about hair loss. What should the nurse do?

Provide resources for a wig selection before hair loss begins.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

Providing a solution of viscous lidocaine for use as a mouth rinse

A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

Refer the client to a community support program.

An adult recently diagnosed with Hodgkin's disease is admitted for staging by undergoing a bone marrow aspiration and biopsy. To obtain more information about the client's nutritional status, the nurse should review the results of which test?

albumin level

The client is advised by the health care provider to have mammography screening annually. Which measure improves adherence to mammography screening?

making sure that the individual barriers to screening are minimized

A medication nurse is preparing to administer 0900 medications to a client with liver cancer. Which consideration is the nurse's highest priority?

metabolism of the medication

The nurse is preparing a community presentation on oral cancer. Which is a primary risk factor for oral cancer that the nurse should emphasize in the presentation?

use of alcohol

A client had a right pneumonectomy for lung cancer yesterday and now has dyspnea. What position in bed will be best for this client?

head of the bed elevated

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

inspecting the skin for petechiae once every shift

A nurse is assessing a client with bone cancer pain. Which part of a thorough pain assessment is most significant for this client?

intensity

A woman tells the nurse, "There has been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer?

light bleeding or watery vaginal discharge

A client has an abnormal result on a Papanicolaou test. The client asks the nurse what dysplasia means. Which definition should the nurse provide?

alteration in the size, shape, and organization of differentiated cells

A client and their family have just received an initial diagnosis of colon cancer. In which way can the nurse act as an advocate?

listening carefully to their perceptions of what their needs are

A client with lung cancer is being cared for by their spouse at home. The client's pain is increasing in severity. The nurse recognizes that teaching has been effective when the spouse uses which pain relief strategy? Select all that apply.

-gives the client a long-acting or sustained-release oral pain medication regularly around the clock -uses an immediate-release medication (oxycodone) for breakthrough pain -uses music for distraction as well as heat or cold in combination with medications -has the client use a pain rating scale to measure the effectiveness of reaching their individual pain goal

A client with malignant pleural effusions has dyspnea and chest pain. In which order of priority from first to last should the nurse manage the client's care? All options must be used.

Apply oxygen at 2 L via nasal cannula. Administer morphine sulfate 2 mg IV. Coach the client on deep breathing exercise. Educate the client in anticipation of a thoracentesis.

he client who is in the end stages of cancer is requesting spiritual support. What should the nurse do next?

Ask the client what spiritual activities would be most helpful.

A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit the administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and their skin is warm and pale. The vital signs are blood pressure 80/30 mm Hg, pulse 132 bpm, respirations 28 breaths/min, temperature 103°F (39.4°C), and oxygen saturation 84%. The central line insertion site is inflamed. After the nurse calls the rapid response team, what should the nurse do next?

Insert a peripheral intravenous fluid line and infuse normal saline.

A 56-year-old woman is admitted for a modified radical mastectomy. The client appears anxious and asks many questions. How should the nurse respond to this client?

Tell the client as much as she wants to know and is able to understand.

A client is being treated with internal radium implants. The nurse should assess the client for which adverse effect associated with radiation therapy to the cervix?

nausea and a foul vaginal discharge

A client has malignant lymphoma. As part of their chemotherapy, the physician orders an alkylating drug. When caring for the client, the nurse teaches the client about adverse reactions to alkylating drugs. The nurse tells the client that they might begin to see adverse reactions

in 2 to 3 weeks.

A client is receiving methotrexate, 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?

leucovorin (citrovorum factor or folinic acid)

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/µl. What term should the nurse use to describe this low platelet count?

thrombocytopenia

After a gastric cancer resection for a malignant tumor, a client is scheduled to undergo radiation therapy. What is the most important information the nurse should include in the discharge teaching plan?

how to maintain adequate nutrition

A young female client is receiving chemotherapy and mentions to the nurse that they and their spouse are using a diaphragm for birth control. Which information is most important for the nurse to discuss?

infection control

A client with colon cancer is having a barium enema. The nurse should instruct the client to take which type of medication after the procedure is completed?

laxative

The nurse is assessing a client who is suspected of being in the early symptomatic stages of human immunodeficiency virus (HIV) infection. Which indication of infection should the nurse detect during this stage?

whitish-yellow patches in the mouth

The nurse is teaching a wellness class. Which person is at highest risk for colorectal cancer?

who has been treated for Crohn disease for 20 years

A client with suspected cervical cancer had a colposcopy with conization. What information should the nurse give the client about their menstrual periods after this surgery?

Their next two or three periods may be heavier and more prolonged than usual.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

avoiding using deodorant soap on the irradiated areas

A registered nurse(RN) on the oncology floor is busy with another client, so the RN delegates care of a client to a coworker, a licensed practical nurse (LPN). The client that the LPN begins caring for requires a three-hour chemotherapy infusion. Which statement is in accordance with the Nurse Practice Act?

A chemotherapy certified RN must begin the chemotherapy, then the LPN may monitor the client.

A client who has had a total laryngectomy appears withdrawn and depressed. The client keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client?

encouraging expression of feelings nonverbally and in writing

A client is scheduled for a total abdominal hysterectomy for cervical cancer. When discussing the potential impact of this procedure on the client's sexuality, the nurse should offer which response to the client?

"Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?"

The nurse is developing a care plan for a client who has leukemia. What instruction(s) should the nurse include in the plan? Select all that apply.

-Monitor temperature and report elevation. -Recognize signs and symptoms of infection. -Avoid crowds. -Maintain the integrity of skin and mucous membranes.

A client was discharged from the hospital for cancer-related pain. While the client was in the hospital, the pain was well controlled on patient-controlled administration (PCA) of intravenous (IV) morphine, and on discharge 2 days ago, the client was taking oral morphine. The client now reports pain as an 8 on a 10-point scale and is asking the nurse about using PCA for the morphine at home. Which explanation is the most likely for the client's reports of inadequate pain control?

undermedicated on the oral opioid.

A client diagnosed with testicular cancer expresses concerns about fertility. The client and their spouse desire to eventually have a family, and the nurse discusses the option of sperm banking. What should the nurse tell the couple about the best time to donate the sperm?

before treatment is started

A female client is currently receiving radiation therapy to the chest wall for recurrent breast cancer. They have pain while swallowing and burning and tightness in their chest. The nurse should further assess the client for indications of which health problem?

esophagitis

The nurse is explaining the long-term toxic effects of cancer treatments on the immune system to a client who is receiving chemotherapy and radiation therapy for colon cancer. What should the nurse tell the client?

The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment.

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?

Related to impaired balance

Which nursing intervention is most appropriate for a client with multiple myeloma?

preventing bone injury

The nurse is helping the spouse of a middle-age client in hospice care for end-stage pancreatic cancer prepare for the client's death. Which factor will most adversely impact the spouse's bereavement outcomes?

Spouse blames themself for the client's cancer.

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women

have a mammogram annually.

A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client receives busulfan until their white blood cell (WBC) count falls to between 10,000/mm3 and 25,000/mm3. Then the drug is stopped. When should treatment resume?

when the WBC count rises to 50,000/mm3

A client who is receiving chemotherapy develops stomatitis. What should the nurse instruct the client to do?

Use a soft-bristled toothbrush after each meal.

A client has a saline-only peripherally inserted central catheter (PICC). What should the nurse do to maintain the catheter?

Utilize a 10-mL saline flush to maintain line patency.

A client is to have radiation therapy after a modified radical mastectomy. What instruction should the nurse give the client about caring for the skin at the site of the radiation therapy?

Wash the area with water.

The nurse is providing discharge instructions about preventing infection to a client who had a modified radical mastectomy and will be pruning flowers when they return to work. To prevent infection, what should the nurse instruct the client to do?

Wear protective gloves when gardening.

In assessing a client in the early stage of chronic lymphocytic leukemia (CLL), the nurse should determine if the client has:

Unintentional weight loss.

A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include an irregular pulse of 120 bpm; blood pressure of 88/48 mm Hg; respiratory rate of 14 breaths/min; serum potassium level of 2.9 mEq/L (2.9 mmol/L); and arterial blood gas test results of pH 7.46, PaCO2 45 mm Hg (6.0 kPa), PaO2 95 mm Hg (12.6 kPa), and bicarbonate level 29 mEq/L (29 mmol/L). Which prescription should the nurse implement first?

5% dextrose in 0.45% normal saline with potassium chloride (KCl) 40 mEq/L at 125 mL per hour

Which client does the nurse determine has the highest risk for developing ovarian cancer?

60-year-old obese woman who has never been pregnant

A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?

7 to 14 days

A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Prior to surgery, what comment by the client indicates that the client understands the procedure?

"My urine will come out through an opening on my abdomen."

The nurse explains to the client with Hodgkin disease that a bone marrow biopsy will be taken after the aspiration. What should the nurse explain about the biopsy?

"You will feel a pressure sensation when the biopsy is taken but should not feel actual pain; if you do, tell the health care provider so that you can be given extra numbing medicine."

The nurse is teaching a group of clients about risk factors for the development of breast cancer. What should the nurse tell the group about risk factors?

early onset of menstruation

A client has just been diagnosed with cancer. During the initial stage of adaptation to the diagnosis and its treatment, the nurse can facilitate the client's adaptation by using which strategy?

encouraging the client to maintain their usual role

The nurse is conducting a wellness program for adults about cancer. The nurse should teach clients about which potential risk factor for the development of colon cancer?

history of inflammatory bowel disease

A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?

papillary carcinoma

A nurse is assessing a client and finds a crusted plaque on the client's forehead. The nurse suspects this is what type of skin cancer?

squamous cell carcinoma

In providing discharge teaching for the client after a modified radical mastectomy, the nurse should instruct the client to avoid:

working in her rose garden.

A client with a history of pancreatic cancer is revived following cardiac arrest but is determined to have suffered brain death. The family tells the nurse they want to donate any usable body organs so their loved one can live on in others. Which action by the nurse is appropriate?

Call the local organ procurement representative to meet with them.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include

chemotherapy exposure and risk factors.