ONCOLOGY Exam 2- Emergencies, GYN, Breast, Prostate

Normal calcium level

8.5-10.5

A 40-year old woman is admitted to the hospital for a radiation implant therapy to treat recently diagnosed cervical cancer. The most important consideration when planning care is her a) level of anxiety b) loss of income due to inability to work c) support system d) energy level to perform ADL's

A - anxiety is the usual response to a change in life situation like undergoing treatment for cancer

Which of the following should the nurse include when providing health teachings for patients at risk of developing prostatic cancer? a) participate in smoking cessation program b) perform monthly self-testicular examination c) maintain daily walking exercise d) undergo monthly digital rectal examination

A - smoking increases risk for prostatic cancer. Choice B is done to detect cancer of the testes. Choice D, digital rectal examination is recommended annually, not monthly.

The community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? a) alopecia b) back pain c) painless testicular swelling d) heavy sensation in the scrotum

A'- Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

A community health nurse is preparing a poster for educational session for a group of women and will be discussing the risk factors associated with breast cancer. Select the risk factors for breast cancer that the nurse will list on the poster. Select all that apply. a) family history of breast cancer b) early menarche c) early menopause d) previous cancer of the breast, uterus, or ovaries e) multiparity f) high-dose radiation exposure to chest

A,B,D,F - Risk factors for breast cancer include family history of breast cancer, age older than 40 years, early menarche, late menopause, or both, previous cancer of the breast, uterus, or ovaries, nulliparity or first child born after age 30 years, and high-dose radiation exposure to chest.

The client has undergone mastectomy. The nurse interprets that the client is making the best adjustment to the loss of the breast if which of the following behaviors is observed? a ) participating in the care of the surgical drain b) reading the postoperative care booklet c) refusing to look at the wound d) asking for pain medication when needed

A- The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that would be in place for a short time after discharge. Asking for pain medication is also an action-oriented option, but it does not relate to acceptance of the loss of the breast. Reading the postoperative care booklet is useful, but is not the best of the options presented here. Refusing to look at the wound indicates no adaptation to the loss.

Who among these clients is at high risk to develop testicular cancer? a) the client has undescended testes at birth b) the client has human papilloma virus c) the client has recurrent urinary tract infection d) the client is uncircumcised

A- history of undescended testes at birth is strongly linked with testicular cancer.

What med is not to be used for pts with cardiac tamponade?

ASA/Anticoagulants

Which of the following questions should the nurse ask in a client who is at risk for breast cancer? a) does your family have a history of multiple gestation? b) does your family have a history of ovarian cancer? c) does your family have a history of early menopause? d) does your family have a history of late menarche?

B - history of cancer of the reproductive system (cancer of the uterus, cervix, and ovaries) increase risk for breast cancer.

A woman had been diagnosed to have breast cancer. Which of the following factors is most significant to her prognosis? a) she had her menarche at age 12 years b) her sister died of breast cancer 5 years ago c) she delivered her first born at age 25 years d) she had her menopause at age 50 years

B - positive family history plays vital role in the predisposition to cancer

Treatment most likely to be ordered for a client with cervical cancer. A. Oral chemotherapy B. Radiation therapy C. IV Chemotherapy D. Palliative Care

B. Cervical cancer has a poor response to chemotherapy. Chemotherapy may be used once there has been metastasis. Radiation is likely to be used. Radiation and hysterectomy are the two likely choices. They are both as effective. Options would be discussed with client to choose which is best for specific client

The community health nurse is conducting a breast cancer screening clinic in a local neighborhood and is providing sessions regarding breast self-examination (BSE). A postmenopausal woman arrives at the clinic for information on BSE. Which of the following information should the nurse give the client? a) it is not necessary to do BSE because you are postmenpausal b) you are not at risk for breast cancer because you are in the postmenopausal phase c) you need to perform BSE on the same day of every month d) mammograms performed every 5 years are sufficient in the postmenopausal phase

C - Women who are in the postmenopausal phase are taught to do BSE on the same day of every month. Before menopause, woman should do the procedure 7 days after the start of the menstrual cycle when the breasts are less tender. Options A, B, and D are incorrect regarding breast cancer and BSE in a woman who is postmenopausal.

When the nurse is discussing risk factors for cervical cancer, which of these women would be at greatest risk? a) a 25-year old woman with family history of cancer and using birth control pills b) a 50-year old woman who has several exposures to radiation and has chronic anemia c) a 19-year old woman who initiated sexual intercourse early with multiple partners d) a 60-year old woman who had smoked cigarettes for 5 years and used diaphragm for birth control

C - early sexual intercourse and having multiple sexual partners pose highest risk to cervical cancer.

Which of these findings in the breast of a patient who is suspected of having breast cancer would support the diagnosis? a) complaints of dull, achy, pain b) palpation of a mobile mass c) presence of an inverted nipple d) area of discoloration skin

C - inversion of nipple is one of the manifestations of breast cancer. A cancerous lesion is non-mobile

A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a) cyanosis b) arm edema c) periorbital edema d) mental status changes

C- Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

Cardiac tamponade often comes from what cancers?

Esophageal and breast

A female client with cancer is scheduled for radiation. The nurse knows that radiation at any treatment site may cause an adverse effects. The nurse should educate the client to be prepared to exect a. hair loss b. stomatitis c. fatigue d. vomiting

C. Regardless of the site radiation can cause fatigue, skin toxicities and anorexia. hair loss, stomatitis and vomiting are site specific

How is cervical cancer diagnosed?

Colposcopy and pap smear

Spinal Cord Compression early stages

Constipation/incontinence, worsens the longer it goes. Pain and muscle weakness

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a) diarrhea b) hypermenorrhea c) abnormal bleeding d) abdominal distention

D - Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination: a) at the onset of menstruation b) every month during ovulation c) weekly at the same time of day d) 1 week after menstruation begins

D - The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a) headache b) dysphagia c) constipation d) electrocardiographic changes

D- Hypercalcemia is a late manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

SVCS late signs

Decreased BP, hemorrhage, cyanosis, Dizziness, lethargy, syncope, MS change

What medication is used to treat sepsis in the clotting stage

Heparin because it has a short half life. Lovenox and coumadin effects can last days therefore once clotting stage is over and pt is into hemorrhagic stage, if lovenox and coumadin still in system- can increase hemorrhaging

SVCS early signs

Hoarseness, facial/neck swelling, NP cough, collar/neck feels tight, red face, broken capillaries, epistaxis, Increased BP/HR

Early sxs hypercalcemia

MS change, fatigue, weakness, lethargy, polyuria, anorexia, constipation

Anorexia/Cachexia

Once in cachexic stage pt cant eat more than 1-2 bites at a time. mortality is greatly increased. Prevention of cachexia from anorexia is key. TPN, Lipids, feeding tube can be used. Diagnosis- weekly wt, protein, prealbumin, albumin, h & h

TLS priority nsg intervention

PUSH FLUIDS. Needs to drink 3L to rid body of excess uric acid, K+, phosphorous

Prevention of hypercalcemia nsg intervention

Prevent immobility, exercise spaced with rest. immobility can cause osteoporosis- calcium released from bones into blood stream

What should a male client over age 52 do to help insure early identification of prostate cancer? a. have a digital rectal exam and PSA done yearly b. Have a transrectal ultrasound Q5Years c. Perform monthly testicular self-examinations, especially after 50 d. Have a CBC and BUN and creatinine levels yearly

a. the incidence of prostate cancer increases after 50. digital rectal exam identifies enlargement or irregularity of the prostate and the PSA is s tumor marker for prostate cancer. They both are effective diagnostic measures and should be done yearly.

late sxs hypercalcemia

SEVERE muscle weakness, loss of DTR's, ECG changes, paralytic ileus, coma, death

Spinal cord compression late stages

Weakness and paralysis

Which of the following would be inconsistent as a risk factor for breast cancer? a. multiparity b. late menopause c. increased age d. family hx breast ca

a

what is the purpose of cytoreductive ("debulking") surgery for ovarian cancer? a) cancer control by reducing the size of the tumor b) cancer prevention by removal of precancerous tissue c) cancer cure by removing all gross and microscopic tumor cells d) cancer rehabilitation by improving the appearance of a previously treated body part

a - Cytoreductive or "debulking" surgery may be used if a large tumor cannot be completely removed as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or spread throughout the abdomen). When this occurs, as much tumor as possible is removed and adjuvant chemotherapy or radiation may be prescribed.

the nurse is caring for a client following mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a) pain at the incisional site b) arm edema on the operative side c) sanguineous drainage in the Jackson-Pratt drain d) complaints of decreased sensation near the operative side

b - Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C and D are expected occurrences following mastectomy and do not indicate a complication.

When assessing the laboratory results of the client with bladder cancer and bone metastasis, the nurse notes a calcium level of 12 mg/dl. The nurse recognizes that this is consistent with which oncological emergency? a) hyperkalemia b) hypercalemia c) spinal cord compression d) superior vena cava syndrome

b - Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients who have bone metastasis, and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a) placing cool compresses on the affected arm b) elevating the affected arm on a pillow above heart level c) avoiding arm exercises in the immediate postoperative period d) maintaining an intravenous site below the antecubital area on the affected site

b - Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

The client is preparing for discharge from the hospital after radical vulvectomy. The nurse plans to teach this client that which of the following activities is acceptable after discharge because it will no precipitate complications? a) sexual activity b) walking c) sitting for lengthy periods d) driving a car

b - The client should resume activity slowly, but walking is a beneficial activity. The client should know to rest when fatigued. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged standing or sitting. Sexual activity is prohibited for 4 to 6 weeks after surgery.

The nurse has admitted a client to the clinical nursing unit following a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm in which of the following positions? a) elevated above shoulder level b) elevated on a pillow c) level with the right atrium d) dependent to the right atrium

b - The client's operative arm should be positioned so that it is elevated on a pillow, and not exceeding shoulder elevation. This promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option C) or dependent (option D), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

The nurse instructs the client in breast self-examination (BSE). The nurse tells the client to lie down and to examine the left breast. The nurse instructs the client that while examining the left breast, she should place a pillow under the : a) right shoulder b) left shoulder c) small of the back d) right scapula

b - The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the left breast is to be examined, the pillow would be placed under the left shoulder.

The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: a) to examine the testicles while lying down b) that the best time for the examination is after a shower c) to gently feel the testicles with one finger to feel for a growth d) that testicular self-examinations should be done at least every 6 months

b - The testicular-self examination is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.

A nurse teaches a female patient who is premenopausal to perform a breast self-examination at which time frame? a. with the onset of menstruation b. any time during the month c. on day 5 to 7, counting the first day of menses as day 1 c. on day 2 to 4 counting the first day of menses as day 1

c

Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a) increase testosterone levels b) increase prostaglandin levels c) limit the amount of circulating androgens d) increase the amount of circulating androgens

c - Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms.

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor to cervical cancer, indicates a need for further teaching? a) smoking b) multiple sex partners c) first intercourse after age 20 d) annual gynecological examinations

c - Risk factors for cervical cancer include human papillomavirus (HPV) infection, active and passive cigarette smoking, certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, or male partners with multiple sex partners). Screening via regular gynecological exams and Papanicolaou smear (Pap test) with treatment of precancerous abnormalities decrease the incidence and mortality of cervical cancer.

The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a) avoid driving the car for 1 week b) restrict fluid intake to prevent incontinence c) avoid lifting objects heavier than 20 lb for at least 6 weeks d) notify the physician if small blood clots are noticed during urination

c - Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Option C is an accurate discharge instruction following prostatectomy.

A nurse is assessing a client with metastatic breast cancer who reports nocturia, weakness, nausea and vomiting. The client's serum electrolytes include potassium 4.2 mEq/L, sodium 135 mEq/L, calcium 7.0 mEq/L, and magnesium 2.0 mEq/L. Based on the assessment findings, the priority action for the nurse is to: a) start client on fluid restriction b) administer calcium gluconate c) increase the client's IV fluids d) administer Allopurinol

c - nocturia, nausea and vomiting cause dehydration. Therefore, the correct nursing action is to increase the client's IV fluids.

Nurse April is teaching a client who suspects a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by a. breast self-examination b. mamography c. fine needle aspiration d. chest x-ray

c.

Which of the following is a characteristic of a breast cancer mass? a. occurs as disseminated masses b. symmetrical mass c. firm, hard, embedded in surrounding tissue d. tender upon palpation

c. also usually irregular shape, nontender and a single mass in one breast

late stages of sepsis

can turn into DIC- Clots then hemorrhage, will have elevated D-dimer

What treatment is not very effective with prostate cancer?

chemotherapy

High risk for HPV include

cigarette smokers, uncircumcised male, STD;s, multiple sex partners

The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a) lumps like that are normal, don't worry b) let me know if it gets bigger next month c) that could be cancer. I'll ask the doctor to examine you d) that's important to report even though it might not be serious

d - Testicular cancer almost always occurs in only one testicle and is usually a pea-sized painless lump. The cancer is highly curable when found early. The finding should be reported to the physician.

The nurse is preparing a client for a mammography. The nurse tells the client: a ) that mammography takes about 1 hour b) that there is no discomfort associated with the procedure c) to maintain an NPO status on the day of the test d) to avoid the use of deodorants, powders, or creams on the day of the test

d - Mammography takes about 15 to 30 minutes to complete. Some discomfort may be experienced because of the breast compression required to obtain a clear image. There is no reason to maintain an NPO status before the procedure. Option D is an accurate instruction.

Cardiac tamponade sxs

fatigue, cyanosis, cough, decreased cardiac output, weak pulses, rapid but thready HR, decreased BP, muffled heart sounds, friction rub, decreased urinary output due to decreased perfusion to kidneys

Sepsis sxs

fever, chills, n/v/d, lethargy

TLS signs

hyperkalemia, cardiac arrythmias, elevated uric acid level, gout, increased phosphorus

Pattern of metastasis from prostate cancer

lymph-bone-spine

Meds that affect Ca level

prednisone, diuretics, biphosphonates- calcitonin

What is the standard first treatment for breast cancer?

radiation

breast cancer can be treated with what?

radiation, chemo, surgery

Early sign of cervical cancer include

spotting between periods and after intercourse watery/blood tinged discharge, dark/foul smelling discharge

What are the two most common prognostic factors for breast cancer

tumor size, axillary lymph node involvement

What to assess for prior to administering guardasil?

yeast allergy