Oncologic Disorders
A nurse is caring for a client who is receiving chemotherapy for lung cancer. During the hand-off report, the nurse from the previous shift states that the client has been placed on neutropenic precautions. Which laboratory value supports this nursing action?
A white blood cell count of 2200/mm3
A nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Polyps
A client who is in the end-stages of cancer is increasingly upset about receiving chemotherapy. Which approach by the nurse would likely be most helpful in gaining the client's cooperation?
Tell the client how the treatment can be expected to help
After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. The nurse should include which information in the teaching plan?
nutritional intake
A client with metastatic cancer of the liver tells the nurse about being concerned about the prognosis. The nurse should:
place emphasis on providing symptomatic and comfort measures.
The nurse is instructing a client on how to care for skin that has become dry after radiation therapy. Which statement by the client indicates that the client understands the teaching?
"It is safe to apply a nonperfumed lotion to my skin."
On an oncology unit, the nurse hears noises coming from a client's room. The client is found throwing objects at the walls and has just picked up the phone and is screaming, "How can God do this to me? It is the third type of cancer I have had. I have gone through all the treatment for nothing." In what order of priority from first to last should the nurse make the interventions? All options must be used.
-"Please put the telephone down so we can talk." -"I can hear how upset you are about the cancer." -"Tell me what you are feeling right now." -"I wonder if you would like to talk to a clergyman."
At what age is an individual most at risk for acquiring acute lymphocytic leukemia (ALL)?
4 to 12 years
Which client has the highest risk of ovarian cancer?
45-year-old woman who has never been pregnant
On the night before a 58-year-old wife and mother is to have a lobectomy for lung cancer, she remarks to the nurse, "I am so scared of this cancer. I should have quit smoking years ago. Now I have brought all this fear and sadness on myself and now my family." The nurse should tell the client:
"It is okay to be scared. What is it about cancer that you are afraid of?"
A client's husband expresses concern that his dying wife keeps saying, "I have to go to the store." Which statement by the nurse will be most effective in assisting the husband to understand the dying process?
"Comments related to going somewhere or leaving on a trip are common in dying clients."
A client's bone marrow report reveals normal stem cells and precursors of platelets (megakaryocytes) in the presence of decreased circulating platelets. The nurse recognizes a knowledge deficit when the client says
"I am glad that my report turned out normal."
When talking with the nurse, the brother of a client with leukemia says, "We used to play pretty rough games together. Maybe some of the bruises he got when I tackled him caused this." Which statement is the nurse's best response?
"I can see you are worried. Let us talk about how people get leukemia."
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?
"I floss my teeth every morning."
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife: Select all that apply.
-Gives her husband a long-acting or sustained-release oral pain medication regularly around the clock. -Uses an immediate-release medication (oxycodone) for breakthrough pain. -Uses music for distraction as well as heat or cold in combination with medications. -Has her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal.
A client with laryngeal cancer has undergone a laryngectomy and is now receiving radiation therapy to the head and neck. The nurse would monitor the client for which adverse effects of external radiation? Select all that apply.
-Xerostomia -Stomatitis -Mucositis
A client is ordered a dose of epoetin alfa to treat anemia related to chemotherapy. The recommended dose is 150 units/kg. The client weighs 60 kg. The vial is labeled 10,000 units/ml. How many milliliters of epoetin alfa would the nurse administer? Record your answer using one decimal place.
0.9
Which nurse should be assigned to a client receiving brachytherapy for the treatment of cervical cancer?
Female nurse with 3 years experience working in oncology
The nurse is planning care with a client with acute leukemia who has mucositis. The nurse should advise the client that after every meal and every four hours while awake the client should use:
a saline solution.
The nurse is preparing a community presentation on oral cancer. Which is a primary risk factor for oral cancer that the nurse should include in the presentation?
use of alcohol
Which nursing goal is appropriate for a client with multiple myeloma?
Achieve effective management of bone pain.
A client receiving 5-fluorouracil is experiencing nausea and vomiting. Which is the nurse's best course of action?
Administer odansetron prior to administering the 5-fluorouracil
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered
The nurse is working at the local family planning clinic completing family education. When devising a teaching plan, in which client group would the nurse stress the importance of an annual Papanicolaou test?
Clients infected with the human papillomavirus (HPV)
A client is diagnosed with esophageal cancer and presents with difficulty swallowing. Which intervention should receive the highest priority?
Establishing aspiration precautions
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift
A nurse attending to the discharge of two clients learns that she'll be caring for a client newly diagnosed with leukemia. She has limited time to evaluate the new client. What should be the nurse's priority consideration as she plans her time?
Performing basic care tasks before evaluating the new client
A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?
Related to impaired balance
A nurse is administering daunorubicin to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen.
A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up?
The client states he feels like he always has a lump in his throat
A client diagnosed with terminal lung cancer tells the nurse that he would like to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client?
The nurse could ask the client who his spiritual advisor is and make the contact.
A client recently diagnosed with lung cancer tells the nurse that she has been having difficulty sleeping and is often preoccupied with thoughts about how her life has changed. She says, "I wish my life could just go on the way it was." Which issue should the nurse discuss with the client first?
Understanding grief
A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
fine needle aspiration.
A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women:
have a mammogram annually.
The nurse is assessing a middle-aged client with cancer who has lost 1 lb (0.5 kg) in 4 weeks. The client is taking ondansetron for nausea and now has a temperature of 101° F (38.3° C). The fever is indicative of:
infection.
A client with cancer who is receiving radiation therapy develops thrombocytopenia. The priority nursing goal is to prevent:
injury related to the decreased platelet count.
A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This behavior may be caused by:
uncertainty and an underlying fear of recurrence.
The nurse is encouraging an unlicensed assistive personnel (UAP) to interact with a dying client and family. The nurse should help the UAP understand that:
when health care personnel do not understand their own feelings about death and dying, they often avoid the client.
A client with advanced Hodgkin's disease is admitted to hospice because death is imminent. The goal of nursing care at this time is to:
prevent feelings of isolation.
On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:
should continue to perform breast self-examination on her right breast.
A right orchiectomy is performed on a client with a testicular malignancy. The client expresses concerns regarding his sexuality. The nurse should base the response on the knowledge that the client:
should retain normal sexual drive and function.
A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL (80 g/L), and the health care provider (HCP) prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19-gauge needle. To administer the packed red blood cells, the nurse should:
attach the packed cells to the existing 19G IV of normal saline solution using Y tubing.
When a client and family receive the initial diagnosis of colon cancer, the nurse can act as an advocate by:
listening carefully to their perceptions of what their needs are.
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:
chemotherapy exposure and risk factors.
A woman tells the nurse, "There has been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer?
light bleeding or watery vaginal discharge
