Med Surg Chapter 15: Set 3

A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate? a. "The cancer involves only the cervix." b. "The cancer cells look 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."

a. "The cancer involves only the cervix." 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.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband tells the nurse that he does not know what to say to his wife. Which problem is appropriate for the nurse to address in the plan of care? a. Anxiety b. Death anxiety c. Difficulty coping d. Lack of knowledge

c. Difficulty coping The data indicate that difficulty coping with the situation may be present reflected by the poor communication among the family members. The data given does not suggest death anxiety, anxiety, or lack of knowledge as an etiology.

The MOST effectice method of administrating a chemotherapy agent that is a vesicant is to A. give it orally B. give it intraarterially C. use a Ommaya reservoir D. use a central venous access device

ANS:D If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

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? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates cancer cells in their resting phase to enter mitosis.

a. IL-2 enhances the body's immunologic response to tumor cells. IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate cancer cells to enter mitosis, or prevent bone marrow depression.

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

b. "I rarely have the energy to get out of bed." Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flu-like symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

A widowed mother of 4 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? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

b. "Would you like to talk about options for the care of your children?" This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's friends will raise the children, more assessment information is needed before making plans.

The nurse should suggest which food choice for a patient scheduled to receive external-beam radiation for abdominal cancer? a. Fruit salad b. Baked chicken c. Creamed broccoli d. Toasted wheat bread

b. Baked chicken Protein is needed for wound healing. To minimize the diarrhea that is 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 patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. What should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Decreasing the tumor size will improve the effects of other therapy. c. Relieving the pressure in the stomach will promote optimal nutrition. d. Tumor growth will be controlled by removing all the cancerous tissue.

b. Decreasing the tumor size 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 do 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.

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

b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. 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 follicles 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.

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? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.

b. Establish time to take a short walk almost every day. Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

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

b. Obtain more information about the patient's relatives. 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.

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.

b. 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 vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices are preferred.

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? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

b. The patient swims several days each week. The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

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. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

c. "I will need follow-up examinations for many years after 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 patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate? 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."

c. "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 do not 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.

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement 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."

c. "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 biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.

A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is 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 a glass of a citrus fruit beverage during treatments.

c. Administer prescribed antiemetics 1 hour 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 inadequate nutrition due 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. Apply prescribed anesthetic gel to oral lesions before meals. d. Teach the patient about the importance of nutritional intake.

c. Apply prescribed anesthetic gel to oral lesions before meals. Because the cause 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.

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? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

c. 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. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea b. Alopecia c. Hematuria d. Xerostomia

c. Hematuria The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used if the maximal dose of the opioid is reached without adequate pain relief.

c. 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. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and usually the oral route is preferred.

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I will expose my skin to a sun lamp each day." d. "I can buy some aloe vera gel to use on my skin."

d. "I can buy some aloe vera gel to use on my skin." 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.

The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarettes during each patient encounter.

d. Discuss risks associated with cigarettes during each 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. The other options may detect lung cancer that is already present but do not reduce the risk.

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.

d. 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. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

A 70-year old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complications of cacner is this MOST likely caused by? A. Hypercalcemia B. Tumor lysis syndrome C. Spinal cord compression D. Superior vena cava syndrome.

ANS: A Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

A patient has recently been diagnosed with early stages of breast cancer. What is the MOST appropriate for the nurse to focus on? A. Maintaining the patient's hope B. Preparing a wil land advance directives C. Discussing replacement child care for the patient's children D. Discussing the patient's past experiences with her grandmother's cancer.

ANS: A Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

The nurse explains to a patient undergoing brachytherapy of the cervix that she A. must undergo simulation to locate the treatment area B. requires the use of radioactive precautions during nursing care C. may experience desquamation of the skin on the abdomen and upper legs D. requires shielding of the ovaries during treatment to prevent ovarian damage.

ANS: B Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

To prevent fever and shivering during an infusion of rituximab (Rituxan) , the nurse should premedicate the patient with A. aspirin B. acetaminophen C. sodium bicarbonate D. meperidine (Demerol)

ANS: B Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

The nurse counsels the patient receiving radiation therapy or chemotherapy that A. effective birth control methods should be used for the rest of the patient's life B. if N/V occur during treatment, the treatment plan will be modified C. after successful treatment, a return to the person's previous functional level can be expected D. the cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity .

ANS: C Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over.

The goals of cancer treatment are based on the principal that A. surgery is the single most effective treatment for cancer B. initial treatment is always directed toward cure of the cancer C. a combination of treatment modalities is effective for controlling many cancers. D. Although cancer cure is rare, quality of life can be increased with treatment

ANS: C The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (i.e., chemotherapy).

A patient on chemo for 10 weeks had a starting weight of 121 lbs and is now 118 lbs and has no sense of taste. Which nursing intervention should be a priority? A. advise the patient to eat foods that are fatty, friend, or high in calories B. Discuss with the physician the need of parenteral or enteral feedings C. Advise the patient to drink a nutritional supplement beverage at least three times a day. D. Advise the patient to experiment with spices and seasonings to enhance food taste.

ANS: D Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Onion and pieces of ham may enhance the taste of vegetables.