Oncology

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.

A nurse is caring for a premenopausal client who had precancerous cells found during a routine papanicolaou (Pap) test. At which time during the menstrual cycle would the nurse schedule a cervical biopsy?

One week after the end of the menstrual period

A terminally ill client's husband tells the nurse, "I wish we had taken that trip to Europe last year. We just kept putting it off, and now I am furious that we did not go." The nurse interprets the husband's statement as indicating which stage of adaptation to dying?

anger

After a mastectomy for breast cancer, the nurse teaches the client how to avoid the development of lymphedema. The nurse should teach the client to:

elevate the affected arm on a pillow.

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

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?

"As a precaution, we wear gowns, goggles, and gloves to administer the medication."

A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply.

"I will take acetaminophen for pain." "I will not be able to play basketball for the next 2 days." "I can apply an ice pack or a cold compress to the puncture site."

A client who will have his last chemotherapy cycle in 11 days becomes neutropenic. The client understands his condition when he states which of the following. Select all that apply.

"I'll monitor my temperature frequently and go to the nearest emergency department if my temperature rises above 100.4° F (38° C )." "I need to avoid going to the movies or eating out while receiving my cancer treatment." "I will carry hand sanitizer with me and use it often."

A client with stage IV pancreatic cancer is admitted to hospice. The spouse breaks down crying, stating "I just don't know what I will do if he dies!" Which is the best response by the nurse?

"What has helped you cope with his illness so far?"

On the third postoperative day after a radical mastectomy, the drainage tube is removed, and the dressings are changed. The client appears shocked when she sees the operative area and exclaims, "I look horrible! Will it ever look better?" Which response by the nurse would be most appropriate? You Selected:

"You are shocked by the sudden change in your appearance as a result of this surgery, are you not?"

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

A nurse is caring for a terminally ill cancer client who is being transferred to hospice care. Which information regarding hospice care would the nurse include in the teaching plan? Select all that apply.

The focus of care is on controlling symptoms and relieving pain. A multidisciplinary team provides care. Bereavement care is provided to the family.

A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client?

encouraging him to express his feelings nonverbally and in writing

Which factor places a client at greatest risk for skin cancer?

fair skin and history of chronic sun exposure

A client has malignant lymphoma. As part of his chemotherapy, the physician orders an alkylating drug. When caring for the client, the nurse teaches him about adverse reactions to alkylating drugs. The nurse tells the client that he might begin to see adverse reactions:

in 2 to 3 weeks.

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.

The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with human immunodeficiency virus (HIV) infection is that it:

is an acquired immunodeficiency virus (AIDS)-defining illness.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:

pathologic bone fractures.

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 nurse is assessing a woman who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client's health history, the nurse should ask the client which question?

"Have you had nausea or vomiting?"

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 has been informed of a diagnosis of cancer. Which of the following client statements should the nurse address first?

"I need to end this before the cancer kills me."

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." Irradiated skin can become dry and irritated, resulting in itching and discomfort. The client should be instructed to clean the skin gently and apply nonperfumed, nonirritating lotions to help relieve dryness. Taking an antihistamine does not relieve the skin dryness that is causing the itching. Heat should not be applied to the area because it can cause further irritation. Medicated ointments should not be applied to the skin without the prescription of the radiation therapist.

A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when he says:

"The advance directive allows me to state my health care wishes while I'm still able to do so." The advance directive is a document that allows the client to give directions about future medical care or to designate another person to make medical decisions if and when the client loses decision-making capacity. The health care power of attorney is a legal document that enables the client to designate another person to act on the client's behalf if the client becomes disabled or incapacitated. The living will is a witnessed document indicating the client's desire to be allowed to die a natural death, rather than be kept alive by heroic life-sustaining measures. The living will applies to decisions that will be made after a terminally ill client is incompetent and has no reasonable possibility of recovery. The living will and health care power of attorney aren't the same.

Which nursing goal is appropriate for a client with multiple myeloma?

Achieve effective management of bone pain.

What instructions should the nurse provide to a client who develops cellulitis in the right arm after a right modified radical mastectomy?

Antibiotics will need to be taken for 1 to 2 weeks. Treatment for cellulitis includes oral or intravenous antibiotics for 1 to 2 weeks, elevation of the affected extremity, and application of warm, moist packs to the site. Arm exercises help to reduce swelling, but do not treat the infection.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client?

Anticipatory grieving

A client with malignant pleural effusions has dyspnea and chest pain. In which order of priority from first to last should the nurse manage the client's care? All options must be used.

Apply oxygen at 2 L via nasal cannula. Administer morphine sulfate 2 mg IV. Coach the client on deep breathing exercise. Educate the client in anticipation of a thoracentesis.

A client is diagnosed with esophageal cancer and presents with difficulty swallowing. Which intervention should receive the highest priority?

Establishing aspiration precautions

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?

Indigestion Indigestion is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

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.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?

Liver

The nurse is teaching the family of a client diagnosed with leukemia about ways to prevent infection. Which instruction has the most impact?

Maintaining an intact skin integrity

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

Nonmobile mass with irregular edges

A client is scheduled to receive methotrexate, 0.625 mg/kg P.O. daily, to treat malignant lymphoma. Before administering the drug, the nurse reviews the client's medication history. Which drug might interact with methotrexate?

Probenecid Probenecid inhibits methotrexate excretion, which increases the risk of methotrexate toxicity. Digoxin, theophylline, and famotidine aren't known to interact with methotrexate.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

Providing a solution of viscous lidocaine for use as a mouth rinse

A nurse is caring for a client with bronchogenic carcinoma. Which nursing intervention takes highest priority?

Removing pulmonary secretions

A middle-aged female with a history of breast-conserving surgery, axillary node dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen. Which action should the nurse suggest?

See the health care provider (HCP) immediately.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

Testicular cancer is a highly curable type of cancer.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/?l. What term should the nurse use to describe this low platelet count?

Thrombocytopenia

A hospitalized client with end-stage heart failure does not want to be resuscitated. The health care provider (HCP) has written the do-not-resuscitate (DNR) prescription on the client's record. The client has a cardiac arrest, and the wife tells the nurse she wants the client to be resuscitated and asks the nurse to "do something." The nurse should:

discuss the DNR prescription with the wife.

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:

client's self-reporting of the pain experience.

A client with pancreatic cancer has been receiving morphine via a subcutaneous pump for 2 weeks. The client is requiring an increased dose of the morphine to manage the pain. The nurse should document that the client is:

developing a tolerance for the medication.

After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to:

expand the alveoli and increase lung surface available for ventilation.

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:

helping the client identify available resources.

A client with suspected cervical cancer is undergoing a colposcopy with conization. The nurse gives instructions to the client about her menstrual periods, emphasizing that:

her next two or three periods may be heavier and more prolonged than usual.

The nurse is planning future care with a middle-aged woman who has undergone surgical resection for lung cancer. Which plan will best promote adaptation and rehabilitation?

planning a progressive activity regimen

A young adult with Hodgkin's disease has been readmitted to the hospital because of aggressive disease that is unresponsive to multiple therapies. Death appears imminent. A priority nursing goal for this client is to:

reduce feelings of isolation.

A 56-year-old woman is admitted for a modified radical mastectomy. The client appears anxious and asks many questions. The nurse's best course of action is to:

tell the client as much as she wants to know and is able to understand.