Exam 3

An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers. The nurse should know that these achieve a therapeutic effect by what means?

Altering the immunologic relationship between the tumor and the patient.

A nurse caring for a patient who has has surgery for oral cancer. When addressing the patient's long term needs, the nurse should prioritize interventions and referrals with what goal?

Enhancement of verbal communication

After contributing to the care of several patient's who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

Families needs for information and support often go unmet.

A patient is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the patient to first seek care?

Intermittent pain and bloody stool

An oncology patient will begin a course of chemo and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer from one place to another.

Invading healthy host tissue

A nurse who works in an oncology setting is assessing a patient who has arrived for a 2 month follow up appointment following chemo. the nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

LFT's

A 60 year old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high dose radiation. What safety measure should the nurse include in this patients subsequent plan of care?

Limit the time that visitors spend at the patient's bedside

A patient's most recent diagnostic imaging has revealed his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient's cancer cells spread?

Lymphatic circulation

A hospice nurse is caring for a 22 year old with a terminal diagnosis of leukemia. When updating this patient's plan of nursing care, what should the nurse prioritize?

Providing realistic emotional preparation for death

A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this patient?

Respiratory status and airway clearance

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action?

Stopping the administration of the drug immediately

Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention?

Teaching patient's to wear sunscreen

An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

The patient and family should be viewed as a single unit of care.

A patient with GERD has a diagnosis of Barrett's esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care?

The patient will require an upper endoscopy every 6 months to detect malignant changes

A patient just died following urosepsis that progressed to septic shock. The patient's spouse says "I knew this was coming but I feel so numb and hollow inside" The nurse should know that these statements are characteristic of what?

Uncomplicated grief and mourning

One aspect of the nurse's comprehensive assessment when caring for the terminally ill is the assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope. What would the nurse identify as a hope fostering category?

Uplifting memories.

A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?

High levels of alcohol consumption

A patient's daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA position Statement on assisted suicide, which clearly states that nursing participation in assisted suicide is a violation of the code for nurses. What does the position statement further stress?

Identifying patient and family concerns and fears

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?

Impaired nutritional status

The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problems?

Impaired wound healing

An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patient's wife has asked about the differences between normal cells and cancer cells. What characteristics of a cancer cell should the educator cite?

Malignant cells contain proteins called tumor-specific antigens

A patient has been diagnosed with a malignancy of the oral cavity and is undergoing oncologic treatment. The oncologic nurse is aware that the prognosis for recovery from head and neck cancers is often poor because of what characteristic of these malignancies?

Metastases are common and respond poorly to treatment

A community health nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?

Monthly administration of injections of vitamin B12

The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patient's death in imminent?

Mottling of the lower limbs

A patient newly diagnosed with cancer is scheduled to begin chemo treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?

Nausea and vomiting

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one What is the most important accomplishment available by attending a grief support group?

Normalization of feelings and experiences

A nurse is caring for a patient in the late stages of esophageal cancer. The nurse should plan to prevent or address what characteristics of this stage of the disease? Select all that apply.

Perforation of the mediastinum. Erosion into the great vessels. Obstruction of the esophagus.

A patient has undergone surgery for oral cancer and has just been extubated in post anesthetic recovery. What nursing action best promotes comfort and facilitates spontaneous breathing for this patient?

Placing the patient in Fowler's position

A patient on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life?

Poor communication between the family and the care team

A patient who underwent surgery for esophageal cancer is admitted to the critical care unit following post anesthetic recovery. Which of the following should be included in the patient's immediate post operative plan of care?

Positioning the patient to prevent gastric reflux

The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?

Presence of a painless sore with raised edges.

The nurse is caring for a 39 year old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?

Prophylactic surgery

A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection related death in oncology patients?

Provide skin care to maintain skin integrity

The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply.

Rate of growth. Ability to cause death. Ability to spread.

A 67 year old woman experienced the death of her husband from a sudden MI 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply.

Reinvesting in new relationships at the appropriate time. Reminiscing about the relationship she had with her husband. Relinquishing old attachments to her husband at the appropriate time.

A medical nurse is providing end of life care for a patient with metastatic bone cancer. The nurse notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

Request the physician to order analgesics by an alternative route.

The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer form occurring. What would be your response?

Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer.

The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is the priority nursing diagnosis for this patient?

Risk for infection related to altered immunologic response.

Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?

Rules concerning completion of all cure focused medical treatment

A public health nurse has formed an interdisciplinary team that is developing an education program entitled Cancer: the Risks and What you can do about them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

Secondary Prevention

A 62 year old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?

Sentinel node biopsy

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer death in North America?

Smoking Cessation

The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurse's rapid assessment reveals that the patient's jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

Superior Vena Cava Syndrome

The nurse is admitting a 52 year old father of four into hospice care. The patient has a diagnosis of Parkinson's disease, which is progressing rapidly. The patient has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care?

Supporting the patient's and family's values and choices

A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting the patient's nutritional needs?

TPN administration via a peripherally inserted central catheter

The hospice nurse is caring for a 45 year old mother of three young children in the patient's home. During the most recent visit the nurse has observed that the patient has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. What goal of nursing interventions should the nurse identify?

Teaching family members how to interact with, and ensure safety for, the patient with impaired cognition

A nurse is admitting a patient diagnosed with late stage gastric cancer. The patient's family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?

The early symptoms of gastric cancer are usually not alarming or highly unusual

A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy to her spine. At the completion of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this?

The patient has not achieved the desired learning outcomes.

A patient has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the patient's level of anxiety. Which of the following action is most likely to accomplish this?

The patient is encouraged to express fears openly

The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patient's strategy?

The patient may be trying to protect loved ones from the emotional effects of the illness.

A 16 year old female patient experiences alopecia resulting from chemo, prompting the nursing diagnosis 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 a wig.

The nurse is part of the health care team at an oncology center. A patient has been diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the bad news best be conveyed to the patient?

The prognosis should be delivered with the patient at eye level.

The clinic nurse is caring for a 42 year old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?

These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies.

A patient has just been told that her illness is terminal. The patient tearfully states "I cant believe I am going to die. Why me?" What is your best response?

This must be very difficult for you.

A medical nurse is providing palliative care to a patient with a diagnosis of end stage COPD. What is the primary goal of this nurse's care?

To improve the patient's and family's quality of life.

A patient's rapid cancer metastases have prompted a shift form active treatment to palliative care. When planning this patient's care, the nurse should identify what primary aim?

To prevent and relieve suffering

A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers Keflex to the patient and explain what rationale?

To reduce intestinal bacteria levels

The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurse's assessment should include examination for the signs and symptoms of what complication?

Tumor lysis syndrome

You are caring for an adult patient who has developed a mild oral yeast infection following chemo. What actions should you encourage the patient to perform? Select all that apply.

Use lip lubricant. Use dental floss every 24 hours. Rinse the mouth with normal saline.

The nurse has observed that an older adult patient with a diagnosis of end stage renal failure seems to prefer to have his eldest son make all of his health decisions. While the family is visiting, the patient explains to you that this is a cultural practice and very important to him. How should you respond?

Work with the team to negotiate informed consent.

A 58 year old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

You are anxious about the surgery. Do you see smoking as helping?

A nurse who provides care in an ambulatory clinic integrates basic cancer screening into admission assessments. What patient most likely faces the highest immediate risk of oral cancer?

A 65 year old man with alcoholism who smokes

A nurse is caring for an 87 year old Mexican American female patient who is in end stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?

A barrier to care for this patient

A 50 year old man diagnosed with leukemia will begin chemo. What would the nurse do to combat the most common adverse effects of chemo?

Administer an antiemetic.

A 66 year old patient in in a hospice receiving palliative care for lung cancer which has metastasized to the patient's liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relieve the dyspnea the patient is experiencing?

Administer bronchodilators and corticosteroids as ordered

You are caring for a 50 year old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?

Ask if he would like you to sit with him while he collects his thoughts

A nurse is assessing a patient who has just been admitted to the post surgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?

Assess for a patent airway

An oncology patient has just returned from the post anesthesia care unit after an open hemicolectomy. This patient's plan of nursing care should prioritize which of the following?

Assess the patient's wound for dehiscence every 4 hours.

The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds "research has shown that certain foods indeed appear to increase the risk of cancer." which of the following menu selections would be the best choice for potentially reducing the risks of cancer?

Baked apricot chicken and steamed brocolli

The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?

Care addresses the needs of the patient as well as the needs of the family.

A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common signs of possible colon cancer?

Change in bowel habits

The nurse is caring for a patient has just been given a 6 month prognosis following a diagnosis of extensive stage small cell lung cancer. The patient states the he would like to die at home, but the team believes that the patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?

Discuss a referral for hospice care.

The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antieoplastic agents, what action should the nurse emphasize?

Dispose of the antineoplastic waste in the hazardous waste receptacle.

A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation the following day. What information should the nurse emphasize to the patient's family and friends?

Do not visit if you've had a recent infection

In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?

Demographic changes in the population.

The nurse is assessing a 73 year old patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the patient is most likely in what stage of death and dying?

Depression

A 54 year old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states "they tell me my cancer is malignant, while my co-workers breast tumor was benign. I just don't understand at all" When preparing a response to this patient the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?

Different proteins in the cell membrane

A patient's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What in the nurses most appropriate response to this observation?

Acknowledge the patient's reluctance and initiate discussion of the factors underlying it

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide?

Administering a lethal dose of medication to a patient whose death is imminent.

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The child's mother has been unable to eat or sleep and can talk only about her impeding loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority?

Allowing the patient to express her feelings without judging her

A radial graft is planned in the treatment of a patients oropharyngeal cancer. In order to ensure that the surgery will be successful, the care team must perform what assessment prior to surgery?

Assessing the patency of the ulnar artery

As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died?

At a staff meeting

A pediatric nurse emotionally distraught by the death of a 9 year old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief?

Attend the patient's memorial serivce

An oncology patient has begun to experience skin reaction to radiation therapy, prompting the nurse to make the diagnosis of impaired skin integrity; erythmatous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?

Avoid rubbing or scratching the affected area

An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do?

Avoid using soap on the treatment area.

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.

Breast cancer. Esophageal cancer. Liver cancer.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.

Financial pressure on health care providers. Patient reluctance to accept this type of care. Advances in "curative" treatment in late stage illnesses

A patient with a diagnosis of colon cancer is 2 days post operative following bowel resection and anastomosis. The nurse has planned the patients care in the knowledge of potential complications. What assessment should the nurse prioritize?

Frequent abdominal auscultation

You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patient asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time?

Do you need more time to think about this?

You are caring for a patient, a 42 year old mother of two children, with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a spiritual assessment. What question would it have been most important for you to evaluate during this assessment?

Does she have a sense of peace of mind and a purpose to her life?

A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer?

Early diagnosis and treatment of GERD

A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the patient should adopt what dietary guidelines?

Eat small, frequent meals with high calorie and vitamin content

A hospice nurse is well aware of how difficult it is to deal with other's pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

Emotional Exhaustion

A patient has received treatment for oral cancer. The combination of medications and radiotherapy has resulted in leukopenia. Which of the following is an appropriate response to this change in health status?

Ensure that none of the patient's visitors has an infection

A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?

Epistaxis