Cancer NCLEX Questions New

A 62 year old patient is being treated with a sealed radiation source for cervical cancer. Which nurse should be assigned to provide personal care for this patient?

A 40 year old nurse who is efficient and experienced in caring for patients undergoing radioactive therapy. Aim to minimize the amount of time that the nurse is exposed

A patient is being evaluated for a suspicious lesion of the lung and asks why the doctor cannot just take it out instead of doing a bronchoscopy. The best response by the nurse is:

"It is necessary to examine and stage the disease along with excising the suspicious area" Clinincal staging is based on evidence acquired before treatment is obtained through a variety of testing procedures

A patient with radioactive implants for treatment of Graves' disease requests that she have the same nurse caring for her each day that she is scheduled for treatment. The charge nurse explains that

"Because there is limit to the amount of radiation the nurse is exposed to, one particular nurse cannot be assigned to your care each day." Nurses are rotated to limit the amount of exposure to radiation

Your client states she is fearful that her mammogram will be abnormal and that she may die of breast cancer. Your best response is:

"Death rates have declined and early detection is key"

A patient recently diagnosed with breast cancer states she is concerned about her treatment and asks the nurse why radiation is being done before surgery for the tumor removal. The best response by the nurse is"

"Radiation before the tumor removal shrinks the tumor and decreases the likelihood of tumor spread" Surgery is not always the first treatment. Tumor shrinkage and decreased possibility of micrometastasis are more likely to occur with chemotherapy and radiation before tumor removal.

Which comment by the client with lung cancer idicates a need for further teaching?

"The damage is done, why quit now?" More than 80% of lung cancers are directly attributed to tobacco use. Continuation of smoking will continue to damage and if treatment is successful the client is defeating the treatment

The nurse is assessing a 72 year old patient with end stage chronic obstructive pulmonary disease for admission into a palliative care program. The patient shared concerns about the effects of ending treatment and the possibility of increasing symptoms. What is the nurse's best response?

"Your sypmtoms can be managed and your quality time can be improved through palliative care" The goal of palliative care is to increase quality of life and relieve symptoms without aggressive or curative measures

When taking the health history for a client newly diagnosed with head and neck cancer it is important for the nurse to ask about which behaviors/

Alcohol and Tobacco use There is a synergistic effect of alcohol and tobacco use that increases the risk of head and neck cancer. Other high-risk behaviors are poor oral hygiene, long-term sun exposure, and occupational exposure-asbetos, tar, wood, leather work.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient needs to void every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has audible crackles to the midline posterior chest.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient needs to void every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has audible crackles to the midline posterior chest.

The client who has undergone colon resection with permanent colostomy for diagnosis of colon cancer refuses to engage in care of the ostomy. She states that she will never be able to go out in public again. An appropriate referral by the nurse is to:

An ostomy support volunteer Through communiciation and interaction with support volunteers, the patient can see that she will be able to engage in routine activities

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B. Administer antiemetic drugs before administering chemotherapy. Rationale: When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO. Reference: p. 422, Safe and Effective Care Environment

The nurse is teaching a client who is receiving an anti-estrogen drug about the side effects she may encounter. Which of these should the nurse include in the discussion? Select all that apply. A. Heavy menses B. Smooth facial skin C. Hyperkalemia D. Breast tenderness E. Weight loss F. Deep vein thrombosis (DVT)

D. Breast tenderness F. Deep vein thrombosis (DVT) Rationale Irregular menses or no menstrual period is the typical side effect.

What is a priority nursing diagnosis for a 46 year old patient undergoing chemotherapy for colorectal cancer who is experiencing chemotherapy-induced anemia?

Fatigue related to decreased cellular oxygenation Myelosuppressive effects of chemotherapy and inadequate production of RBC's and suppression of bone marrow production of RBC's by therapy result in impaired oxygen delivery, fatigue, pallor, headache, and dyspnea.

Which of the following should the client undergoing radiation therapy for diagnosis of squamous cell cancer of the head and neck be cautioned avoid?

Grapefruit Juice Mucositis, xerostomia, esophagitis, and dysphagia are all side effects of radiation - spicy and acidic foods/jucies should be avoided to prevent further irritation

During discussion of cancer prevention strategies with a group of community-dwelling independent adults, and individual asks for an example of secondary prevention. What example of secondary prevention would the nurse give?

Limiting exposure to unltraviolet rays Primary interventions activities are aimed at interventions before pathologic changes begin. Theses interventions reduce cancer risk through alteration of lifesytle behaviors. Secondary prevention would be behavior modifiers

A 63 year old pateint with acute lymphocytic leukemia has begun chemotherapy treatments and the nurse is giving discharge instructions to the patient and his wife. Which symptoms should be reported immediately?

Muscle Cramps and Twitching Tumor lysis syndrome causes rapid release of intracellular potassium, phosphorus, and nucleic acid into the circulation, causing electrolyte imbalances and acute renal failure usually 1 to 2 days after therapy begins

You are preparing a community education program about cancer prevention and early detection for a clinic serving a majority of African-American adults. Which types of cancer would be most important to include?

Prostate Both the incidence and death rates from prostate cancers for African-Americans are greater than for other racial groups, and the information for this population may have a great impact for reduction of risk and deaths. This population has the highest incidence of prostate cancer in the world.

A 46 year old patient with a diagnosis of breast cancer agrees to participate in a study involving potential noncytotoxic nutrients and pharmacologic chemoprotective agent. What is important for the patient to understand before participating in the study?

Side effects and adverse risks Individuals involved in studies of potential chemoprtective agents must be willing to accept the side effects and adverse risk agents.

A patient with ovarian cancer is being treated with cisplatin and taxotere and is receiving the second in a series of treatments. During the first hour of treatment, the patient complains of dizziness, urticaria, and chest pain. The first and priority intervention for the nurse to initiate is to:

Stop the infusion These symptoms indicate a hypersensitivity or anaphylactic reaction. Anaphylaxis is an emergency. After the infusion is d/c, vital signs should be obtained and the physician should be called. Antiaxiety agents are not needed.

A patient with colon cancer who has completed two rounds of chemotherapy has been admitted for acute cholecystistis and will undergo surgical cholecystectomy. Which of the following laboratory values would the nurse question and relate to the physician?

WBC 3.4 Individuals undergoing chemotherapy may be immunosuppressed and are at risk for developing infection. Usual manifestations of infection can be absent because of lack of neutrophils to produce adequate inflammatory response.

Your patient is recently diagnosed with colon cancer and is scheduled to begin chemotherapy and radiation after recovering from surgery for tumor removal. The patient states that he does not understand why he has to do both therapies and is fearful that he will be constantly sick during the treatment. The nurse's most appropriate response is

"survival is improved with a combination of these treatments because we know that tumors shed into the bloodstream and travel to other areas" The goal of combination therapy is to improve client survival

The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. A client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. A client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. A client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Rationale A. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first. B. The client can be assessed later; he is not currently nauseated. C. This client is not in distress and can be assessed later. D. The client with dry mouth can be assessed later, or the nurse can delegate mouth care to unlicensed assistant personnel.

The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.

A. Assess for fever. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. F. Teach the client to omit raw fruits and vegetables from his diet. Rationale Thrombocytopenia, or low platelet levels, cause bleeding, not low neutrophils (a type of white blood cell [WBC]).

Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply. A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A. Bruises C. Petechiae D. Epistaxis Rationale Fever is a sign of infection secondary to neutropenia.

The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression. A. Client with hemoglobin of 7.4 and hematocrit of 21.8 B. Client with diarrhea and potassium level of 2.9 mEq/L C. Client with 250,000 platelets D. Client with 5000 white blood cells/mm3

A. Client with hemoglobin of 7.4 and hematocrit of 21.8 Rationale A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit. B. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has hypokalemia and electrolyte imbalance. C. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has a normal platelet level. D. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has a normal white blood cell count.

Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing

A. Fatigue C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing Rationale Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair.

When caring for a client with suspected syndrome of inappropriate antidiuretic hormone secretions (SIADH), the nurse reviews the medical record to uncover which signs and symptoms consistent with this syndrome? Diagnostics Assessment Medications Na: 115 K: 4.2 Creatinine: 0.8 Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremors Ondansetron (Zofran) Cyclophosphamide (Cytoxan) A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness

A. Hyponatremia B. Mental status changes E. Weakness Rationale Azotemia refers to buildup of nitrogenous waste products in the blood, typically from renal damage.

When caring for a client with cachexia, the nurse expects to note which symptom? A. Weight loss B. Anemia C. Bleeding tendencies D. Motor deficits

A. Weight loss Rationale A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected. B. Anemia results from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. C. Bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. D. Motor deficits result from spinal cord compression.

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? a. "I can buy some aloe vera gel to use on the area." b. "I will expose the treatment area to a sun lamp daily." c. "I can use ice packs to relieve itching in the treatment area." d. "I will scrub the area with warm water to remove the scales."

ANS: A Aloe vera gel and 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. DIF: Cognitive Level: Apply (application) REF: 269 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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? a."The cancer involves only the cervix." b."The cancer cells look almost like normal cells." c."Further testing is needed to determine the spread of the cancer." d."It is difficult to determine the original site of the cervical cancer."

ANS: A Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread. DIF: Cognitive Level: Apply (application) REF: 254 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient. DIF: Cognitive Level: Apply (application) REF: 266 | 268 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider 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)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patient's age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy. DIF: Cognitive Level: Analyze (analysis) REF: 255 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

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)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work done.

ANS: A, C, E 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. DIF: Cognitive Level: Apply (application) REF: 265 | eTable 16-16 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated. DIF: Cognitive Level: Apply (application) REF: 264 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patient's visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection. DIF: Cognitive Level: Apply (application) REF: eTable 16-16 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

ANS: B 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 vesicants 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. DIF: Cognitive Level: Apply (application) REF: 259 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem? a. Tell the patient to limit social contacts until regrowth of the hair occurs. b. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once the chemotherapy is complete.

ANS: B The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

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? a. Lime sherbet b. Blueberry yogurt c. Cream cheese bagel d. Fresh strawberries and bananas

ANS: B Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein. DIF: Cognitive Level: Apply (application) REF: 276 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."

ANS: C 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 biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life. DIF: Cognitive Level: Apply (application) REF: 256 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. 35-year-old patient who has wet desquamation associated with abdominal radiation b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old patient who received neck radiation and has blood oozing from the neck d. 56-year-old patient who developed a new pericardial friction rub after chest radiation

ANS: C 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 diagnoses and clinical manifestations for the other patients are not immediately life threatening. DIF: Cognitive Level: Analyze (analysis) REF: 278-279 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning

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? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful to you in the past when coping with stressful events?" d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

ANS: C Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time. DIF: Cognitive Level: Apply (application) REF: 280 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time

ANS: C Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions, but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain. DIF: Cognitive Level: Analyze (analysis) REF: 277 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

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? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

ANS: C 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. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur. DIF: Cognitive Level: Understand (comprehension) REF: 253 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Teach the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.

ANS: C The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning. DIF: Cognitive Level: Apply (application) REF: 255-256 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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? a. Add strained baby meats to foods such as casseroles. b. Teach the patient about foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add extra spice to enhance the flavor of foods that are served.

ANS: C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition. DIF: Cognitive Level: Apply (application) REF: 277 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient two ounces of a citrus fruit beverage during treatments.

ANS: C 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. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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 health care provider? a. Poor oral intake b. Frequent loose stools c. Complaints of nausea and vomiting d. Increase in carcinoembryonic antigen (CEA)

ANS: D An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply the ordered anesthetic gel to oral lesions before meals.

ANS: D 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. The other actions might be helpful for other patients with impaired nutrition, but would not be as helpful for this patient. DIF: Cognitive Level: Apply (application) REF: 268-269 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

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? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members

ANS: D The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities. DIF: Cognitive Level: Apply (application) REF: 279-280 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit of 30% b. Platelets of 95,000/µL c. Hemoglobin of 10 g/L d. White blood cell (WBC) count of 2700/µL

ANS: D 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. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy. DIF: Cognitive Level: Apply (application) REF: 265 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." d. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."

ANS: D 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. DIF: Cognitive Level: Apply (application) REF: 257 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.

ANS: D 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. There is no urgent need to report common chemotherapy side effects to the provider. DIF: Cognitive Level: Apply (application) REF: 267 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills

B. Allergy Rationale A. Monoclonal antibody therapy does not cause alopecia. B. Allergy is the most common side effect. C. Although fever is a side effect of monoclonal antibody therapy, it would not take priority over an allergic response that could potentially involve the airway. D. Although chills are a side effect of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)? A. Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine 131

B. Allopurinol (Zyloprim) Rationale A. Tumor lysis syndrome results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; Procrit is used to increase red blood cell (RBC) production and is not a treatment for hyperuricemia. B. Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS. C. Tumor lysis syndrome results in hyperuricemia, hyperkalemia, and other electrolyte imbalances; administering additional potassium is dangerous. D. Radioactive iodine 131 is indicated in the treatment of thyroid cancer, not TLS.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain

B. Edema of arms and hands Rationale A. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly. Because it is an early manifestation, this is not the priority. B. Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention. C. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. D. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone. Although this should be addressed, it is an early sign; thus it is not the priority.

When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply. A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns.

B. Encourage the client to participate in changing the ostomy. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns. Rationale Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron (Zofran) Rationale A. Morphine is a narcotic analgesic or opiate; it may cause nausea. B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. C. Naloxone is a narcotic antagonist used for opiate overdose. D. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.

Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time

B. Relief of symptoms or improved quality of life Rationale A. Curative surgery removes all cancer cells, visible and microscopic. B. The focus of palliative surgery is to improve quality of life during the survival time. C. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. D. Many therapies such as surgery, chemotherapy, and biotherapy increase the client's chance of cure and survival. Palliation improves quality of life.

Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Risk for Injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction

B. Risk for Injury related to sensory and motor deficits Rationale A. Although this information may be helpful, the priority is the client's safety because of lack of sensation or innervation. B. The highest priority is safety. C. The nurse should address the client's coping, after providing for safety. D. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is the client's safety.

Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."

C. "I will have a radioactive device in my body for a short time." Rationale A. Side effects of radiation therapy are site specific. B. The client undergoing teletherapy (external beam radiation) must be positioned precisely in the same position each time. C. Brachytherapy refers to short-term insertion of a radiation source. D. The client who is receiving brachytherapy must be in a private room.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Encourage the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.

D. Allow the client an opportunity to express her feelings. Rationale A. Although evidence on this topic is not complete, the current thinking is that this process is usually temporary. B. The client is advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. C. The pharmacologic agents are implicated in central nervous system (CNS) function, not infection. D. Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.

A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) Rationale A. This is a complex client requiring a nurse certified in chemotherapy administration. B. This client is developing acute renal failure and requires complex assessment and treatment. C. A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow. D. This client has complicated needs for assessment and care and should be cared for by RNs with more oncology experience.

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2° C) to 100° F (37.8° C)

C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg Rationale Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.

Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds in 1 day

C. Change in mental status Rationale A. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. B. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which is not related to thrombocytopenia. C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. D. A large weight gain in a short period may be related to renal or heart failure; bleeding is the major complication of thrombocytopenia.

Which teaching is most appropriate for a client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.

C. Consume a diet high in fiber. Rationale A. The client should bathe in warm water, not greater than 96° F. B. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns. C. A high-fiber diet will assist with constipation due to neuropathy. D. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm

C. Examines the client's neck and chest for edema and engorged veins Rationale: The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.

The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period? A. Peak B. Trough C. Nadir D. Adjuvant

C. Nadir Rationale A. The peak of bone marrow function occurs when the client's blood levels are at their highest. B. Trough, which means low, is typically used in reference to drug levels. C. The lowest point of bone marrow function is referred to as the nadir. D. Adjuvant refers to use of radiation therapy or surgery along with chemotherapy in cancer treatment.

Which intervention will be most helpful for the client with mucositis? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Providing oral care with a disposable mouth swab Rationale A. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. B. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. C. Mouth swabs are soft and disposable and therefore clean. D. Keeping the client NPO is not necessary; nutrition is important during cancer treatment; a local anesthetic may be prescribed for comfort.

The nurse teaches the client that intraperitoneal chemotherapy will be delivered where? A. Into the veins of the legs B. Into the lung C. Into the heart D. Into the abdominal cavity

D. Into the abdominal cavity Rationale A. Intravenous drugs are delivered through veins. B. Chemotherapy delivered into the lungs is typically placed in the pleural space or is intrapleural. C. Chemotherapy is not typically delivered into the heart. D. Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.

Which precaution is most important for the nurse to teach a client receiving radiation therapy for head and neck cancer? A. Avoid eating red meat during treatment. B. Pace your leisure activities to prevent fatigue. C. See your dentist twice yearly for the rest of your life. D. Avoid using headphones or headsets until your hair grows back.

C. See your dentist twice yearly for the rest of your life. Rationale: Radiation therapy that is directed in or around the oral cavity has a variety of actions that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are affected, which changes the composition of the person's saliva and often causes "dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In addition, the radiation damages the integrity of the enamel and also damages some of the living cells in the tooth. All contribute to an increased risk for dental infections and cavities. Reference: p. 414, Health Promotion and Maintenance

The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. Rationale A. Asepsis with IV lines is an appropriate action; the student does not require correction. B. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia; the student does not require correction. C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. D. Hygiene and perineal care help prevent infection and sepsis; the student does not require correction.

Which intervention will be most helpful in preventing disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest

C. Using strict aseptic technique to prevent infection Rationale A. This intervention will help detect DIC but will not prevent it. B. Red blood cells are used for anemia, not for bleeding/coagulation disorders. C. Sepsis is a major cause of DIC, especially in the oncology client. D. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection." Rationale A. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Reference: p. 410, Health Promotion and Maintenance B. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. Reference: p. 410, Health Promotion and Maintenance C. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill. Reference: p. 410, Health Promotion and Maintenance D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Reference: p. 410, Health Promotion and Maintenance

The outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light

D. Reducing all direct and indirect sources of light Rationale A. Any drug that the client is prescribed should be considered for its photosensitivity properties. Drugs should be stored according to the recommendations, but this is not the primary concern for this client. B. Clothing must cover the skin to prevent burns from direct or indirect light. Texture is not a concern for the client receiving this treatment. C. The client will be homebound for 1 to 3 months after the treatment and should not go outside. D. Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light.

A 22 year old female patient has an abnormal pap smear. What is the most important question for the nurse to ask?

How many sexual partners have you been engaged with? Risk factors for cervical cancer are closely linked to sexual behavior and sexually transmitted infections. Early menarche is a risk factor for ovarian cancer.

What is the most important information that should be included in a breast cancer prevention program for college woman?

Women 20 years old and older should perform self-breast examinations monthly. American Cancer Society recommendations for self-breast examination begin at age 20