oncology prepu
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
"I'm worried I'll expose my family members to radiation."
The client is diagnosed with benign fibrocystic breast disease. Interventions to reduce discomfort from this disease include teaching the client to:
avoid caffeine.
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
Interprofessional management of ovarian cancer includes which measures? Select all that apply.
bilateral salpingo-oophorectomy to remove diseased organsreferral to social services for supportive care
A client diagnosed with cancer is receiving chemotherapy. The nurses should assess which diagnostic value while the client is receiving chemotherapy?
bone marrow cells
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
After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to:
expand the alveoli and increase lung surface available for ventilation.
When reporting to the outpatient cancer center for their first chemotherapy treatment, a client appears anxious and apprehensive. Which statement by the nurse may help allay the client's anxiety?
"As a precaution, we wear gowns, goggles, and gloves to administer the medication."
The client who is in end stages of cancer is requesting spiritual support. The nurse should:
ask the client what spiritual activities would be most helpful.
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 the client understands the teaching?
"It is safe to apply a nonperfumed lotion to my skin."
A 70-year-old client asks the nurse if she needs to have a mammogram. Which is the nurse's best response?
"The incidence of breast cancer increases with age."
While doing a health history, a client tells the nurse that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be the nurse's best response?
"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is."
A client is ordered a dose of epoetin alfa to treat anemia related to chemotherapy. The recommended dose is 150 units/kg. The client weighs 60 kg. The vial is labeled 10,000 units/ml. How many milliliters of epoetin alfa would the nurse administer? Record your answer using one decimal place.
0.9
At what age is an individual most at risk for acquiring acute lymphocytic leukemia (ALL)?
4 to 12 years
During a breast examination, which finding most strongly suggests that a client has breast cancer?
A fixed nodular mass with dimpling of the overlying skin
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?
Allogeneic
A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which information should the nurse include in client teaching?
Apply deodorant only under the left arm.
A client diagnosed with terminal lung cancer expresses a desire to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client?
Ask who the client's spiritual advisor is and make the contact.
Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?
Biopsy of the axillary lymph nodes
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?
Blood studies
Which oncologic emergency involves the accumulation of fluid in the pericardial space?
Cardiac tamponade
A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next?
Check for availability of a liquid preparation.
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client?
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.
The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years?
Colonoscopy
A nurse is assessing an adult who has been receiving chemotherapy. The client has a platelet count of 22,000 cells/mm3 (22 × 109/L) and has petechiae on the lower extremities. What should the nurse should instruct the client to do?
Consult the health care provider.
While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to
Discontinue the intravenous medication.
A client receiving chemotherapy for cervical cancer indicates that she has an advance directive. She tells the nurse that she worries her children will not honor her wishes if her condition should worsen. In order to facilitate the honoring of the client's wishes, what should the nurse encourage the client to do?
Discuss her end-of-life wishes with her family.
You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?
Encourage cheese and sandwiches.
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.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation
A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared to be well controlled on the IV morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV morphine. Which explanation is the most likely for the client's reports of inadequate pain control?
He is undermedicated on the oral opioid.
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.
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
It lowers serum and uric acid levels.
A client is struggling with the decision whether or not to continue chemotherapy. The client tells the nurse, "It's making me so sick and ruining whatever time I have with my family." What is the nurse's role when caring for this client?
Listen to the client's concerns.
Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. What symptom would the nurse assess for in a patient at risk for thrombocytopenia?
Nose bleed
Which finding is an early indicator of bladder cancer?
Painless hematuria
You are admitting a client to your unit. While assessing the client, you find out that the client has had hoarseness of approximately 4 months duration. Why would you report this to the attending physician?
Persistent hoarseness is a warning sign of cancer
When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor?
Radiation can result in myelosuppression.
A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention?
Shallow breathing and increasing lethargy
A client had a total abdominal hysterectomy and bilateral oophorectomy for ovarian carcinoma yesterday. She received 2 mg of morphine sulfate IV by patient-controlled analgesia (PCA) 10 minutes ago. The nurse was assisting her from the bed to a chair when the client felt dizzy and fell into the chair. What should the nurse do next?
Take the client's blood pressure.
The nurse is providing discharge instructions about preventing infection to a client who had a modified radical mastectomy and will be pruning flowers when she returns to work. What is most important for the nurse to include in the teaching?
Wear protective gloves when gardening.
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain
A nurse is teaching an older adult who has had a left modified radical mastectomy with axillary node dissection about lymphedema. The nurse should tell the client that lymphedema occurs:
at any time after surgery.
After a mastectomy for breast cancer, the nurse teaches the client how to avoid the development of lymphedema. The nurse should teach the client to:
elevate the affected arm on a pillow.
The nurse is teaching the family of a client diagnosed with leukemia about ways to prevent infection. Which instruction has the most impact?
maintaining an intact skin integrity
When conducting a focused assessment of the respiratory system, what should the nurse note as an early sign of laryngeal cancer?
persistent mild hoarseness
A nurse is teaching a community class about how to decrease the risk of cancer. What is the best food for the nurse to recommend?
Oranges
Lifestyle influences that are considered risk factors for colorectal cancer include:
a high-fat, low-fiber diet.
A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend:
artificial saliva.
A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?
Sigmoidoscopy
An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful?
"I clean my teeth gently several times per day."
You are caring for a client who has just been told that they have stage IV colon cancer. The client asks you what "stage IV" means. What would be your best response?
"Stage IV means that the cancer has spread to other organs of the body."
On the third postoperative day after a radical mastectomy, the drainage tube is removed, and the dressings are changed. The client appears shocked when she sees the operative area and exclaims, "I look horrible! Will it ever look better?" Which response by the nurse would be most appropriate?
"You are shocked by the sudden change in your appearance as a result of this surgery, are you not?"
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following?
A normal reaction to the diagnosis of cancer.
A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client receives busulfan until his 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 has had a total laryngectomy appears withdrawn and depressed. He 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 him to express his feelings nonverbally and in writing
A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child?
fresh strawberries
According to the tumor-node-metastasis (TNM) classification system, T0 means there is
graft-versus-host disease.
A benign tumor of the blood vessels is a(n)
hemangioma
A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which information is most important for the nurse to discuss?
infection control
Atropine sulfate is included in the preoperative prescriptions for a client undergoing a modified radical mastectomy. The expected outcome is to:
inhibit oral and respiratory secretions.
A client has received several treatments of bleomycin. It is now important for the nurse to assess
lung sounds Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.
A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?
Nonmobile mass with irregular edges
A nurse is assessing a woman who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client's health history, the nurse should ask the client which question?
"Have you had nausea or vomiting?"
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."
A client states, "I don't want any more tests. Who cares what kind of leukemia I have? I just want to be treated now." Which is the nurse's best response?
"Your treatment can be more effective if it is based on more specific information about your disease."
A 17-year-old client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her parent, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I am pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which response would be effective for the nurse to make to the client?
"It seems there are some difficulties with being responsible for your medications that we need to address".
What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block?
"Remain supine for the time specified by the physician."
A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma voices concerns about the adverse effects of the treatment preventing the completion of the trial. What will the nurse tell the client to protect the principle of autonomy?
"You may withdraw at any time."
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 36-year-old female is scheduled to receive external radiation therapy and a cesium implant for cancer of the cervix and is asking about the effects of the radiation on sexual relations during and after the radiation therapy. The nurse should inform the client about which potential effect of radiation therapy on sexuality? Correct response: "You will have vaginal dryness after treatment is completed."
Correct response: "You will have vaginal dryness after treatment is completed."
A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. He has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client?
Decreasing environmental stimulation
A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic?
Genetic counseling
Which action should be included in the nursing care for a client with cervical cancer who has an internal radium implant in place?
Offer a low-residue diet.
An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an):
Platelet count of 60,000/mm3.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?
Progression
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?
Red, open sores on the oral mucosa
A decrease in circulating white blood cells is
leukopenia.
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include
testicular self-examination.
The charge nurse on a hematology/oncology unit is reviewing the policy for using abbreviations with the staff. The charge nurse should emphasize which information about why dangerous abbreviations need to be eliminated? Select all that apply.
to ensure efficient and accurate communicationto prevent medication errorsto ensure client safety
A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms?
Stomatitis
A nurse is administering daunorubicin to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen.
A 32-year-old woman 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 nutrition status, the nurse should review the results of which test?
albumin level
A client, who had intracavity radiation treatment for cervical cancer 1 month earlier, reports small amounts of vaginal bleeding. This finding most likely represents:
an expected effect of the radiation therapy.
A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and the 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 calling the rapid response team, what should the nurse do next?
Insert a peripheral intravenous fluid line and infuse normal saline.
On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:
should continue to perform breast self-examination on her right breast.
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 ulcer on the left heel
Following surgery for a radical neck dissection for laryngeal cancer, the priority for nursing care is:
suctioning the laryngectomy tube as often as needed.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?
Avoid spicy and fatty foods.
A patient with cancer who developed neutropenia several days ago has consequently been placed in a single-bed room that has positive pressure. His daughter has just come to visit her father after arriving from her home in another state and has asked you for his room number. You notice that the daughter has reddened eyes, sniffles, and a dry cough. What instruction should you provide to the daughter?
"Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now."
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?
"I will have to take vitamin B12 shots up to 1 year after surgery."
A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply.
"I will take acetaminophen for pain." "I will not be able to play basketball for the next 2 days." "I can apply an ice pack or a cold compress to the puncture site."
The nurse is evaluating if a client with Hodgkin's disease understands the monitoring that needs to be done at home between radiation treatments. Which statement would indicate that the client knows how to detect a major complication?
"I will take my temperature every day."
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?
"I'll play card games with my friends."
On the night before a 58-year-old wife and mother is to have a lobectomy for lung cancer, she remarks to the nurse, "I am so scared of this cancer. I should have quit smoking years ago. Now I have brought all this fear and sadness on myself and now my family." The nurse should tell the client:
"It is okay to be scared. What is it about cancer that you are afraid of?"
A 52-year-old 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 respond by saying:
"Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?"
A client with stage IV pancreatic cancer is admitted to hospice. The spouse breaks down crying, stating "I just don't know what I will do if he dies!" Which is the best response by the nurse?
"What has helped you cope with his illness so far?"
A client in the final stages of terminal cancer tells his nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." What is the nurse's best response?
"Would you like to meet with your family and your physician about this matter?"
A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer?
60-year-old mountain biker
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 client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis?
A bleeding disorder
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
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
Autologous
Which nursing goal is appropriate for the nurse to make with a client who has multiple myeloma?
Achieve effective management of bone pain.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?
Adjuvant therapy is likely.
The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain?
Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain.
Which is a sign or symptom of septic shock?
Altered mental status
A client with metastatic ovarian cancer is ordered cisplatin. Before administering the first dose, the nurse reviews the client's medication history for drugs that may interact with cisplatin. Which drug may cause significant interactions when given concomitantly with cisplatin?
An aminoglycoside
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Which occurs when fluid accumulates in the pericardial space and compresses the heart?
Cardiac tamponade
A 13-year-old girl is being evaluated for possible Crohn's disease. The nurse expects to prepare her for which diagnostic study?
Colonoscopy with biopsy
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression?
Decreased platelets and red blood cells
A hospitalized client with end-stage heart failure does not want to be resuscitated. The health care provider (HCP) has written the do-not-resuscitate (DNR) prescription on the client's record. The client has a cardiac arrest, and the wife tells the nurse she wants the client to be resuscitated and asks the nurse to "do something." What should the nurse do?
Discuss the DNR prescription with the wife.
A client receiving chemotherapy is nauseated and has lost 15 pounds (6.8 kg) in one month. Which nutritional instruction would the nurse include in the plan of care?
Eat frequent but small meals.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?
Encourage fluid intake to dilute the urine.
A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:
Encourage fluid intake, if possible, to dilute the urine.
When the client who has had a modified radical mastectomy returns from the operating room to the recovery room, what should the nurse do first?
Ensure that the client's airway is free of obstruction.
A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply.
Family members should stand about 6 feet from the patient.Lead aprons should be worn to buffer the exposure.Visitors may stay for 30 minutes or less.
What should a male client older than age 50 do to help ensure early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
A client requests his medication at 9 p.m. (2100) instead of 10 p.m. (2200) so that he can go to sleep earlier. Which type of nursing intervention is required?
Independent
When 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.
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 receiving chemotherapy for cancer has an elevated serum creatinine level. What should the nurse do next?
Notify the health care provider (HCP)
A client is receiving intravenous mannitol for treatment of a brain tumor. The client's intracranial pressure before administration of the mannitol was 14 mm Hg. Which assessment finding indicates that the medication is attaining a therapeutic effect?
Intracranial pressure of 10 mm Hg
As a nurse-manager of a medical-surgical unit reviews the month's risk-management data, she notices that a number of incident reports were completed because 6 p.m.(1800) medications were administered late. Dinner is served between 5:30 p.m. (1730) and 6 p.m. (1800). Staff take their dinner breaks between 5 p.m. (1700) and 6:30 p.m.(1830). Based on this information, which is the most appropriate action for the nurse-manager to take?
Investigate when medications are given, staff and client dinner times, the number of medications that must be given at 6 p.m. (1800), and staff availability between 5 p.m. (1700) and 6 p.m. (1800).
During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?
Kaposi's sarcoma
You are presenting a class on cancer for a local community group. You inform the attendees that chemical agents in the environment are believed to account for 75% of all cancers. Which organs are most susceptible to cancer caused by these chemical agents?
Lungs, liver, and kidneys
You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer?
Prophylactic surgery
What should the nurse do for a client who is receiving hormone replacement for prostate cancer? Select all that apply.
Provide the client the opportunity to communicate concerns and needs Utilize communication strategies that enable the client to gain some feeling of control.
After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond?
Provide the information requested.
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 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
The nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the information in the chart, what should the nurse do next?
Report the elevated calcium level immediately.
potassium = 4 sodium = 142 calcium = 12.4
Report the elevated calcium level immediately.
A middle-aged female with a history of breast-conserving surgery, axillary node dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen. Which action should the nurse suggest?
See the health care provider (HCP) immediately.
A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which assessment made after the procedure would indicate the development of a potential complication?
The client experiences a sudden increase in temperature.
A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up?
The client states he feels like he always has a lump in his throat.
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.
A client diagnosed with terminal lung cancer tells the nurse that he would like to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client?
The nurse could ask the client who his spiritual advisor is and make the contact.
A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem?
The patient requests that her family bring her makeup and wig.
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.
When explaining the long-term toxic effects of cancer treatments on the immune system, 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 metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy?
To prevent metastasis
The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation?
To prevent the formation of new cancer cells
A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL (80 g/L), and the health care provider (HCP) prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19-gauge needle. To administer the packed red blood cells, the nurse should:
attach the packed cells to the existing 19G IV of normal saline solution using Y tubing.
A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest?
bran muffin, skim milk, stir-fried broccoli
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.
A client is scheduled for cardiac catheterization the next morning. His physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:
sedatives reduce excitement; hypnotics induce sleep.
A nurse is teaching an older adult who has had a left modified radical mastectomy with axillary node dissection about lymphedema. The nurse should tell the client that lymphedema occurs:
sexual drive and libido are unchanged.
A right orchiectomy is performed on a client with a testicular malignancy. The client expresses concerns regarding his sexuality. What information should the nurse give the client to address his concerns?
should retain normal sexual drive and function.
After administering a prescribed medication to a client who becomes restless at night and has difficulty falling asleep, which nursing action is most appropriate?
sitting quietly with the client at the bedside until the medication takes effect
The client has been taking magnesium hydroxide to control hiatal hernia symptoms. The nurse should assess the client for which condition most commonly associated with the ongoing use of magnesium-based antacids?
diarrhea
Which guideline reflects the current American and Canadian Cancer Societies' recommendations for screening for colon cancer in individuals who are not at high risk?
Annual fecal testing for occult blood should begin at age 50.
What instructions should the nurse provide to a client who develops cellulitis in the right arm after a right modified radical mastectomy?
Antibiotics will need to be taken for 1 to 2 weeks.
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client?
Anticipatory grieving
After receiving an I.M. injection, a client complains of burning pain at the injection site. Which nursing action would be most appropriate at this time?
Applying a warm compress to dilate the blood vessels
A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as:
Moxifloxacin 400 mg daily.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a bone marrow transplant?
Monitor the client closely to prevent infection.
A client with a suspected diagnosis of lung cancer has a bronchoscopy with biopsy. Following the procedure, what nurse should the nurse do?
Monitor the client for signs of pneumothorax.
A client with advanced stomach cancer is scheduled for chemotherapy. As part of the chemotherapy regimen, the nurse expects the physician to order
Fluorouracil.
An adolescent in the terminal stage of leukemia cries out for more pain medicine. What is the best action for a nurse to take in caring for this dying adolescent?
Give him more pain medication to control his pain and suffering.
Which grade of tumor is also known as a well-differentiated tumor?
Grade I Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin).
What can the nurse do to meet the challenges in caring for a patient with cancer?
Identify own perception of cancer and set realistic goals.
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply.
Sloughing tissue Tissue necrosis Effectiveness of the antidote
A nurse is completing an admission interview of a client newly diagnosed with multiple myeloma. The client tells the nurse he is concerned that his insurance coverage and limited savings will not pay for all of his family's needs when he is not working. Based on this information, to whom would the nurse initiate a referral?
Social services
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 ulcer on the left heel
Prior to surgery for a modified radical mastectomy, the client is extremely anxious and asks many questions. Which approach offers the best guide for the nurse to answer these questions?
Tell the client as much as she wants to know and is able to understand.
A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client's family asks the nurse why the client has developed acute renal failure. The nurse should base the response on the knowledge that there was:
a decrease in the blood flow through the kidneys.
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.
Affected by light, temperature, social activities, and work routines, __________ rhythms
circadian
A client diagnosed with major depression has sleep and appetite disturbances, a flat affect and is withdrawn. The client has been taking fluvoxamine 50 mg twice daily for 5 days. Which client behavior is most important to report to the next shift?
client sleeping from 2300 hours to 0600 hours
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she
eats red meat such as steaks or hamburgers every day
A 56-year-old female is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The nurse should further assess the client for indications of:
esophagitis.
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife uses which pain relief strategies? Select all that apply.
gives her husband 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 her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal
The nurse should teach clients about which potential risk factor for the development of colon cancer?
history of inflammatory bowel disease
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 client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent:
lymphedema.
A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with
normal cellular processes during the S phase of the cell cycle.
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
After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. The nurse should include which information in the teaching plan?
nutritional intake
Which position would be best for a client's right arm when she returns to her room after a right modified radical mastectomy with multiple lymph node excisions?
on pillows, with her hand higher than her elbow and her elbow higher than her shoulder
The nurse is planning future care with a middle-aged woman who has undergone surgical resection for lung cancer. Which plan will best promote adaptation and rehabilitation?
planning a progressive activity regimen
Which nursing intervention is most appropriate for a client with multiple myeloma?
preventing bone injury
A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles (1,200 km) away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with:
support systems and coping strategies.
On a visit to the gynecologist, a client complains of urinary frequency, pelvic discomfort, and weight loss. After a complete physical examination, blood studies, and a pelvic examination with a Papanicolaou test, the physician diagnoses stage IV ovarian cancer. The nurse expects to prepare the client for which initial treatment?
surgical procedure
A client had a mastectomy followed by chemotherapy 6 months ago. She reports that she is now "unable to concentrate at her card game" and "it seems harder and harder to finish her errands because of exhaustion." Based on this information, the nurse should suggest that the client:
take frequent naps.
Which is a risk factor for testicular cancer?
undescended testes
A client is to have radiation therapy after a modified radical mastectomy. The nurse should teach the client to care for the skin at the site of therapy by:
washing the area with water.
A medication nurse is preparing to administer 9 a.m. medications to a client with liver cancer. Which consideration is the nurse's highest priority?
Metabolism of the medication
A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The laboratory report indicates a serum calcium level of [12.0 mg/dl (3.0 mmol/L)], a serum potassium level of [3.9 mEq/L (3.9 mmol/L)], a serum chloride level of [101 mEq/L (11 mmol/L)], and a serum sodium level of [140 mEq/L (140 mmol/L)]. Based on this information, the nurse determines that the client will likely need which of the following interventions?
Mithramycin 25 mcg/kg/day
An adult client with lymphoma reports cough, difficulty swallowing, and shortness of breath. On physical exam the client's face and neck are swollen and the upper extremities are cyanotic. What is the nurse's best course of action?
Monitor the respiratory pattern of the client continually.
A nurse is caring for a client with a prescription for morphine delivered by continuous intravenous infusion. Which intervention is most important to include in the plan of care?
Obtain baseline vital signs before initiating the infusion.
A nurse is screening participants at a health fair for cancer risk. Which of the following clients will the nurse refer for further evaluation? Select all that apply.
Older adult male with a history of smokingOlder adult female who works as a toll collectorMiddle-aged female with human papillomavirus (HPV)
A nurse is working with a dying client and the client's family. Which communication technique is most important to use?
Use active listening and silence when communicating.
An older adult woman who is usually meticulous about her appearance and dress arrives today for her 23rd day of radiation therapy. She appears disheveled and emotionally labile, and her responses to the usual questions are a little inappropriate. Her heart rate is 124 bpm, her respirations are 32 breaths/min, and her skin is cold and clammy. Based on these findings, the nurse should further assess the client for which condition?
delirium
The nurse is developing a care plan for a client who has leukemia. What instructions 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 integrity of skin and mucous membranes.
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 has been receiving chemotherapy for cancer treatment. The client is competent and has been actively involved in decisions regarding care; however, the client has now decided to refuse treatment. What should the nurse do when the client refuses the next dose of chemotherapy?
Document the client's choice and offer to discuss feelings about the chemotherapy.
Which statement indicates that the client needs further teaching about taking medication to control cancer pain?
I should skip doses periodically so I don't get hooked on my drugs."
The client with a laryngectomy does not want to be observed by the family because the opening in the throat is "disgusting." The nurse should:
explore why the client believed the stoma is "disgusting."
Cancer prevalence is defined as:
the number of persons with cancer at a given point in time.
The nurse is creating a presentation about early detection of colon cancer. Which symptom should the nurse encourage members of the audience to report to their health care providers? Select all that apply.
fatiguerectal bleedingbowel changespositive fecal occult blood testing
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife: Select all that apply.
gives her husband 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 her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal.
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 bed elevated
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 client asks the nurse to explain what it means that Hodgkin's disease is diagnosed at stage 1A. What should the nurse explain about the involvement of the disease?
involvement of a single lymph node
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 nurse is assessing a client with lymphoma who reports distress 9 days after chemotherapy. Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms?
low-grade fever, chills, tachycardia
At a public health fair, a nurse teaches a group of women about breast cancer awareness. What is most important for the nurse to include in teaching about the warning signs of breast cancer?
nipple discharge and a breast nodule
The nurse is conducting a cancer risk assessment for a middle-aged client. Which environmental factor increases the risk of cancer?
nutrition
A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. Which laboratory results 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 X 109/L)white blood cell count of 2,300/mm3 (2.3 X 109/L)temperature of 101.2° F (38.4° C)
Which client is at highest risk for colorectal cancer?
the client who has been treated for Crohn's disease for 20 years
A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This behavior may be caused by which factor?
uncertainty and an underlying fear of recurrence
The nurse is preparing a community presentation on oral cancer. Which is a primary risk factor for oral cancer that the nurse should include in the presentation?
use of alcohol
A nurse is caring for a client who is undergoing chemotherapy. Current laboratory values are noted on the medical record. Which action would be most appropriate for the nurse to implement?
washing hands before and after entering the room
The nurse is encouraging an unlicensed assistive personnel (UAP) to interact with a dying client and family. The nurse should help the UAP understand that:
when health care personnel do not understand their own feelings about death and dying, they often avoid the client.
The nurse is assessing a client who is suspected of being in the early symptomatic stages of human immunodeficiency virus (HIV) infection. Which indications of infection should the nurse detect during this stage?
whitish yellow patches in the mouth
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?
Liver