Cancer

The nurse admitting a patient who has a right frontal lobe tumor would expect the patient may have

impaired judgment The frontal lobe controls intellectual activities such as judgment. Speech is controlled in the parietal lobe. Weakness and hemiplegia occur on the contralateral side from the tumor. Swallowing is controlled by the brainstem.

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed?

"Mastectomy is the best choice to decrease the chance of cancer recurrence" The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable.

A 58-year-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best?

"Tell me what you understand about the surgical options that are available." Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly.

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective?

"The biopsy will help decide the treatment for my enlarged prostate" A biopsy is used to determine whether the prostate enlargement is benign or malignant, and determines the type of treatment that will be needed.

A patient with metastatic cancer of the colon experiences severe vomiting each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate?

Administer prescribed antiemetics 1 hours before the treatments Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcerations. Which nursing action will be most effective in improving oral intake?

Apply the ordered anesthetic gel to oral lesions before meals Because the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

Assess for sensation and strength in the legs Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the HCP.

A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing?

CA 15-3 level testing Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer.

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?

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

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the HCP?

Crackles heart at the lower scapular border Capillary leak syndrome and acute pulmonary edema are possible toxic effects of IL-2.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he never knows what to say to help his wife. Which nursing diagnosis is most appropriate for the nurse to add to the plan of care?

Dysfunctional family process related to effect of illness on family members The data indicates that this diagnosis is most appropriate because poor communication among the family members is affecting the family process.

A 51-year-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that

FNA is done in the outpatient clinic and results are available in 1 to 2 days FNA is done in outpatient settings and results are avaible in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative.

A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion?

HT decreases osteoporosis risk and increases the risk for cardiovascular and breast cancer Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures.

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?

Hematuria The adverse effects of intravesical chemotherapy are confined to the bladder.

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?

IL-2 enhances the immunologic response to tumor cells IL-2 enhances the ability of the patient's own immune response to suppress tumor cells.

During a routine health exam, a 40-year-old patient tells the nurse about a family history of color cancer. Which action should the nurse take next?

Obtain more information from the patient about the family history The patient may be at increased risk for colon cancer, by the nurse's first action should be further assessment.

After change-of-shift report on the oncology unit, which patient should the nurse assess first?

Patient who is neutropenic and has a temperature of 100.5°F (38.1°C) Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis.

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

Rinse the mouth before and after each meal and at bedtime with a saline solution The patient should rinse the mouth with a saline solution frequently.

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?

Shortness of breath Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the HCP.

Which patient in the women's health clinic will the nurse expect to teach about endometrial biopsy?

The 25-year-old patient who has a family history of hereditary nonpolyposis colorectal cancer Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer.

A patient who has severe pain associated with terminal pancreatic cancer is being care for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?

The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control.

The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the HCP?

The patient's apical pulse is irregular Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?

The patient's visitors bring in some fresh peaches from home Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present.

A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure?

Tumor size will decrease and this will improve the effects of other therapy A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries to not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

The nurse reviews the lab results of a patient who is receiving chemotherapy. Which lab result is most important to report to the HCP?

White blood cell (WBC) count of 2700/µL The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed.

A nursing diagnosis that is likely to be appropriate for a 67-year-old woman who has just been diagnosed with stage III ovarian cancer is

anxiety related to cancer diagnosis and need for treatment decisions The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used.

The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about

colonoscopy At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening.

The nurse will plan to teach a 34-year-old patient diagnosed with stage 0 cervical cancer about

conization Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

The nurse is caring for a patient who smokes 2 packs/day. To reduce the patient's risk of lung cancer, which action by the nurse is best?

discuss the risks associated with cigarettes during every patient encounter Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems.

When caring for a patient who has a radium implant for treatment of cancer of the cervix, the nurse will

encourage the patient to discuss the needs or concerns by telephone The nurse should spend minimal time in the patient's room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant, absolute bed rest is required.

A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to

monitor the tumor status after surgery CEA is used to monitor for cancer recurrence after surgery.

After a 48-year-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about

tamoxifen (Nolvadex) Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women.

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that

the patient should call if she notices ankle swelling Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure.

The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon. When assessing the need for psychologic support, which question by the nurse will provide the most information?

"Can you tell me what has been helpful to you in the past when coping with stressful events?" Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness.

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?

"I can buy some aloe vera gel to use on the area" Aloe vera gel or cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

The nurse will plan to teach the female patient with genital warts about the

importance of regular Pap tests Genital warts are caused by HPV and increase the risk for cervical cancer

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the HCP?

Increase in carcinoembryonic antigen (CEA) An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified.

The charge nurse observes an inexperienced staff nurse caring for a patient who has had a craniotomy for resection of a brain tumor. Which action by the inexperienced nurse requires the charge nurse to intervene?

The staff nurse suctions the patient routinely every 2 hours Suctioning increases intracranial pressure, and should only be done when the patient's respiratory condition indicates it is needed.

The home health care nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?

"I rarely have the energy to get out of bed" Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen q4h.

A patient who is scheduled for a right breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?

"malignant tumors may spread to other tissues or organs" The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize.

Which nursing actions can the nurse working in a women's health clinic delegate to UAP? Select all that apply

- Assist the HCP with performing a Pap test - Draw blood for CA-125 levels for a patient with ovarian cancer Assisting with a Pap test and drawing blood (if trained) are skills that require minimal critical thinking and judgment and can be safely delegated to UAP.

The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57kg). The patient has not seen a HCP for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk? Select all that apply

- Pap testing - Sunscreen use - Mammography - Colorectal screening The patient's age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen.

A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is most appropriate?

"The cancer involved only the cervix" Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.

To assess for functional deficits, which question will the nurse ask a patient who has been admitted for treatment of a benign occipital lobe tumor?

"Are you experiencing visual problems?" Because the occipital lobe is responsible for visual reception, the patient with a tumor in this area is likely to have problems with vision.

During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask?

"At what age did you start having menstrual periods?" Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs.

A 19-year-old visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed?

"Have you had sexual intercourse?" The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21.

The nurse teaches a post menopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective?

"I will need to have follow-up examinations for many years after I have treatment before I can be considered cured." The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?

"Why don't we talk about the options we have for the care of your children?" This response expresses the nurse's willingness to listen and recognizes the patient's concern.

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? Select all that apply

- Cook food thoroughly before eating - Avoid public transportation such as buses - Talk to the oncologist before having any dental work done Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

24-year-old patient who developed a new pericardial friction rub after chest radiation Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first?

50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue The patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first.

Which assessment finding in a 36-year-old patient is most indicative of a need for further evaluation?

A breast nodule that is 1 cm in size, nontender, and fixed Painless and fixed lumps suggest breast cancer.

A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?

Assess the perineal drainage and incision Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound.

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate?

Avoid giving the patient foods that are strongly disliked The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem?

Encourage the patient to purchase a wig or hat and wear it once hair loss begins The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats.

An older patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the HCP?

Patient has audible crackles to the midline posterior chest Rapid fluid infusions may cause heart failure, especially in older patients.

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care?

Establish time to take a short walk almost every day Walking programs are used to keep the patient active without excessive fatigue.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?

Hospitalization will be required for several weeks after the stem cell transplant procedure is performed The patient requires strict protective isolation to prevent infection for 2-4 weeks after HSCT while waiting for transplanted marrow to start producing cells.

A 31-year-old patient who has been diagnosed with HPV infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching?

Risk factors for cervical cancer Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking.

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and is looking away, never making eye contact. After teaching about complications associated with chemotherapy, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most appropriate for the patient?

Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information.

The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer?

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

A new 19-year-old male patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care?

Schedule the patient for yearly colonoscopy Patients with FAP should have annual colonoscopy starting at age 16 and usually have total colectomy by age 25 to avoid developing colorectal cancer.

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the HCP?

Serum sodium 126 mEq/L SIADH (and the resulting hyponatremia) is an oncologic metabolic emergency and will require rapid treatment in order to prevent complications such as seizures and coma.

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?

Suggest use of a daily planner and encourage adequate rest and sleep Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short- or long-term.

When the nurse is working in the women's health care clinic, which action is appropriate to take?

Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI) MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A young woman should have a clinical breast exam every 3 years. Annual mammograms are recommended for women over 50.

When caring for a patient who is pancytopenic, which action by the UAP indicates a need for the nurse to intervene?

The UAP assists the patient to use dental floss after eating Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by the UAP would require an intervention?

The UAP stands by the patient's bed for 30 minutes talking with the patient Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited.

A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide?

The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer Because HT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers.

Which information obtained by the nurse interviewing a 30-year-old male patient is most important to communicate to the HCP?

The patient has noticed blood in the stools Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the HCP.

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching?

The patient swims a mile 3 days a week The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

Stop the infusion if swelling is observed at the site Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of visecants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?

Blueberry yogurt Yogurt has high biologic value because of the protein and fat content.

Which action should the nurse taken when a 35-year-old patient has a result of minor cellular changes on her Pap test?

Schedule another Pap test in 4 months Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal.

A 56-year-old woman is concerned about having a moderate amount of vaginal bleeding after 4 years of menopause. The nurse will anticipate teaching the patient about

endometrial biopsy A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer.