Oncological Disorders (prep U)
A nurse is caring for a client with terminal liver cancer. The client states, "I want to control when and how I die. I want you to help me." Based on this information, the nurse determines that the client has requested: voluntary euthanasia. 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. uses music for distraction as well as heat or cold in combination with medications. gives her husband a long-acting or sustained-release oral pain medication regularly around the clock. has her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal. uses an immediate-release medication (oxycodone) for breakthrough pain. A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL (80 g/L), and the (HCP) prescribes a unit of PRBC's. 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 blood cells to the existing 22G IV of 5% dextrose using Y tubing. A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis? Sigmoidoscopy A client is receiving chemotherapy for the diagnosis of brain cancer. When teaching the client about contamination from excretion of the chemotherapy drugs w/in 48 hours, the nurse should instruct the client that: any contaminated linens should be washed separately and then washed a second time, if necessary. (x) After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond? Provide the information requested. (x) The nurse is conducting a cancer risk assessment for a middle-aged client. Which environmental factor increases the risk of cancer? nutrition (x) When conducting a focused assessment of the respiratory system, what should the nurse note as an early sign of laryngeal cancer? persistent mild hoarseness (x) A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? 7 to 14 days (x) A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and the skin is warm and pale. The vital signs are blood pressure 80/30 mm Hg, pulse 132 bpm, respirations 28 breaths/min, temperature 103° F (39.4° C), and oxygen saturation 84%. The central line insertion site is inflamed. After calling the rapid response team, what should the nurse do next? intravenous fluid line and infuse normal saline. (X)
level 5 to 6
The nurse is creating a presentation about early detection of colon cancer. Which symptom should the nurse encourage members of the audience to report to their health care providers? Select all that apply. bowel changes rectal bleeding fatigue positive fecal occult blood testing The nurse is evaluating if a client with Hodgkin's disease understands the monitoring that needs to be done at home between radiation treatments. Which statement would indicate that the client knows how to detect a major complication? "I will take my temperature every day." (x) A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? It calls for a biopsy as soon as possible. (x) 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. (x) A client receiving chemotherapy for cervical cancer indicates that she has an advance directive. She tells the nurse that she worries her children will not honor her wishes if her condition should worsen. In order to facilitate the honoring of the client's wishes, what should the nurse encourage the client to do? Discuss her end-of-life wishes with her family. (x)
Level 4 to 5
A client with cancer is uncertain about how to cope with all the issues that will arise. The nurse can best support the coping behaviors of a client with cancer by: assisting the client to prepare for adverse treatment effects. encouraging compliance with treatment regimens. relieving the client of decision making as much as possible. helping the client identify available resources. Which clinical manifestation does the nurse most likely observe in a client with Hodgkin's disease? painless, enlarged cervical lymph nodes (x) When the client who has had a modified radical mastectomy returns from the operating room to the recovery room, what should the nurse do first? Ensure that the client's airway is free of obstruction. (x) Which finding is an early indicator of bladder cancer? Painless hematuria (x) A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for the next 8 weeks. Which statement indicates that the client understands how to manage the urine as a biohazard? The client will: use a separate bathroom from the rest of the family for the next 8 weeks. (x) A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child? fresh strawberries (x) 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. (x) A nurse is assessing a client with metastatic lung cancer. The nurse should assess the client specifically for: hoarseness. (x) A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} (x) Blood pressure of 120/64 to 130/72 mm Hg Sodium level of [142 mEq/L (142 mmol/L)] Which information should be included in the teaching plan for a client with cancer who is experiencing thrombocytopenia? Select all that apply. Report bleeding, such as nosebleed, petechiae, or melena, to a health care professional (HCP). (x) Monitor temperature daily. Include an over-the-counter nonsteroidal anti-inflammatory (NSAID) daily for pain control. Avoid frequent flossing for oral care. (x) Use a soft-bristle toothbrush. (x) Use an electric razor. (x) A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? "Have you strained your voice recently?" "Do you eat spicy foods?" "Do you eat a lot of red meat?" "Do you smoke cigarettes, cigars, or a pipe?" (x) After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? Collection chamber Air-leak chamber Water-seal chamber (x) Suction control chamber 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?
LvL 1 to 2
A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? A seizure disorder A bleeding disorder (x) Chronic obstructive pulmonary disease (COPD) Anemia A 52-year-old client is scheduled for a total abdominal hysterectomy for cervical cancer. When discussing the potential impact of this procedure on the client's sexuality, the nurse should respond by saying: "All women experience sexual problems with this surgical procedure. Do you have any questions?" "When can I schedule an appointment with you and your partner to discuss any issues either of you may have regarding sexuality?" "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" (x) "Do you anticipate any problems with sex related to your scheduled hysterectomy?" 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? pain leg edema urinary and rectal symptoms light bleeding or watery vaginal discharge (x) 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 ml
LvL 2 to 3
The nurse could identify the name of the spiritual advisor from the client's admission history. The nurse could ask the client who his spiritual advisor is and make the contact. (x) The nurse could ask the client if he would like to talk to speak to her (the nurse). The nurse could contact the most available spiritual advisor such as clergy from another faith. The nurse is conducting a cancer risk assessment for a middle-aged client. Which environmental factor increases the risk of cancer? gender nutrition (x) immunologic status age When reporting to the outpatient cancer center for his first chemotherapy treatment, a client appears anxious and apprehensive. Which statement by the nurse may help allay the client's anxiety? "You may have a seat right over here." "We wear gowns and gloves to administer chemotherapy drugs because they're very dangerous." "You look anxious, don't worry you will get used to this place." "As a precaution, we wear gowns, goggles, and gloves to administer the medication." (x) The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain? Encourage the client to avoid intravenous pain medication until the condition has reached the terminal stage. Administer analgesics when the client's vital signs indicate that the severity of the pain is increasing. Keep the client sedated with tranquilizers to prevent awareness of pain sensations. Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain. (x) A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? Avoiding using deodorant soap on the irradiated areas (x) Applying talcum powder to the irradiated areas daily after bathing Wearing a lead apron during direct contact with the client Removing thoracic skin markings after each radiation treatment A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: hypoxemia. acute heart failure. chronic liver failure. pathologic bone fractures. (x) The nurse is conducting an initial nursing history of a client who is experiencing pain related to bone cancer. The most important information to gather in this initial assessment is the: amount of pain medication the client is taking. nurse's physical assessment of the client. client's self-reporting of the pain experience. (x) family's response to the client's illness. The nurse should teach the client with Addison's disease that the adverse effect of bronze-colored skin is thought to be caused by: hypersensitivity to sun exposure. adverse effects of the glucocorticoid therapy. increased serum bilirubin level. increased secretion of adrenocorticotropic hormone (ACTH). Which of the following symptomsmight indicate that a client wasdeveloping tetany after a subtotalthyroidectomy? -Pains in the joints of the hands and feet. - Tingling in the fingers. -Bleeding on the back of the dressing. -Tension on the suture line. A client who has undergone asubtotal thyroidectomy is subject tocomplications in the first 48 hours after surgery. The nurse should obtain andkeep at the bedside equipment to -Begin total parenteral nutrition. -Start a cutdown infusion -Administer tube feedings. - Perform a tracheostomy. Which of the following measures is most often recommended when preparing SSKI for administration? -Pour the solution over ice chips. -Mix the solution with an antacid. - Dilute the solution with water, milk, or fruit juice and have the client drink itwith a straw. -Disguise the solution in a pureed fruit or vegetable A client with Graves' disease is treated withradioactive iodine (RAI) in the form of sodium iodide. Which of the followingstatements by the nurse will explain to theclient how the drug works? -"The radioactive iodine stabilizes the thyroidhormone levels before a thyroidectomy." -"The radioactive iodine reduces uptake of thyroxine and thereby improves your condition." -"The radioactive iodine lowers the levels of thyroid hormones by slowing your body'sproduction of them." - "The radioactive iodine destroys thyroidtissue so that thyroid hormones are nolonger produced." Serum concentrations of thyroid hormones andthyroid-stimulating hormone (TSH) are testsordered for the client with thyrotoxicosis. Whichof the following laboratory values are indicativeof thyrotoxicosis? -Elevated thyroid hormone concentrations and normalTSH. -Elevated TSH and normal thyroid hormoneconcentrations. -Decreased thyroid hormone concentrations andelevated TSH. - Elevated thyroid hormone concentrations anddecreased TSH. The nurse is completing a healthassessment of a 42-year-old womanwith suspected Graves' disease. Thenurse should assess this client for -Anorexia. - Tachycardia. -Weight gain. -Cold skin. Propylthiouracil (PTU) is prescribedfor a client with Graves' disease todecrease circulating thyroid hormone.The nurse should teach the client toimmediately report which of thefollowing signs and symptoms? - Sore throat. - Painful, excessive menstruation. - Constipation. - Increased urine output. The nurse asks the client to state her name as soon as she regains consciousness postoperatively after a subtotal thyroidectomy and at each assessment. The nurse does this primarily to monitor for signs of which of the following? - Internal hemorrhage. - Decreasing level of consciousness. - Laryngeal nerve damage. - Upper airway obstruction. A client with a large goiter is scheduled for a subtotal thyroidectomy to treatthyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribedpreoperatively for the client. The primaryreason for using this drug is that it helps -Slow progression of exophthalmos. - Reduce the vascularityof the thyroid gland. -Decrease the body's ability to store thyroxine. -Increase the body's ability to excrete thyroxine. A client with thyrotoxicosis says to the nurse, "Iam so irritable. I am having problems at workbecause I lose my temper very easily." Whichof the following responses by the nurse wouldgive the client the most accurate explanation of her behavior? -"Your behavior is caused by temporary confusionbrought on by your illness." - "Your behavior is caused by the excess thyroidhormone in your system." -"Your behavior is caused by your worrying about theseriousness of your illness." -"Your behavior is caused by the stress of trying tomanage a career and cope with illness." The nurse should teach the client with Addison's disease that the adverse effect of bronze-colored skin is thought to be caused by: hypersensitivity to sun exposure. adverse effects of the glucocorticoid therapy. increased serum bilirubin level. increased secretion of adrenocorticotropic hormone (ACTH).
Lvl 2 to 3
After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to: decrease blood flow to the lungs for rest and increased surface alveoli ventilation. control the rate of air flow to the remaining lobe to decrease the risk of hyperinflation. elevate the diaphragm to enlarge the thorax so that the lung surface area available for gas exchange is increased. (x) expand the alveoli and increase lung surface available for ventilation.
level 3 to 4
A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma tells a nurse and physician that he's willing to start the trial, but doesn't know if adverse effects of the treatment will prevent him from completing it. To protect the ethical principle of autonomy, the nurse must tell the client: the risks and benefits associated with trial participation. how long the trial will last. the name of the company sponsoring the trial. that he may withdraw at any time. A young man with early-stage testicular cancer is scheduled for a unilateral orchiectomy. The client confides to the nurse that he is concerned about what effects the surgery will have on his sexual performance. Which response by the nurse provides accurate information about sexual performance after an orchiectomy? "Because your surgery does not involve other organs or tissues, you will likely not notice much change in your sexual performance." (x) A client with colon cancer is having a barium enema. The nurse should instruct the client to take which type of medication after the procedure is completed? laxative (x) A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? Red, open sores on the oral mucosa During the intravenous administration of a chemotherapeutic vesicant drug, the nurse observes that there is a lack of blood return from the intravenous catheter. The nurse should first: irrigate the catheter with normal saline. stop the administration of the drug. (x) continue to administer the drug and assess for edema at the IV site. reposition the client's arm and continue with administration of the drug.
level 6 to 7