PCC3 Exam 4 Practice Qs

A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega)

a (The clients hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count.)

A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facility's standing policy. d. Place the client on protective isolation precautions.

b (A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.)

A nurse assesses a client who is dying. Which manifestation of a dying client should the nurse assess to determine whether the client is near death? a. Level of consciousness b. Respiratory rate c. Bowel sounds d. Pain level on a 0-to-10 scale

b (Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-Strokes respirations indicate death is near. As peripheral circulation decreases, the clients level of consciousness and bowel sounds decrease, and the client would be unable to provide a numeric number on a pain scale. Even with these other symptoms, the nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near.)

A client with prostate cancer is taking estrogen daily to control tumor growth. He reports that his left calf is swollen and painful. Which is the nurses best action? a. Instruct the client to keep the leg elevated. b. Measure and compare calf circumferences. c. Apply ice to the calf after massaging it. d. Document this expected response.

b (An adverse reaction to hormonal manipulation therapy is the development of thrombus formation. The nurse should measure both calf circumferences and compare them; the side with a thromboembolism will be larger. Elevation may be helpful, but first the nurse needs to assess the situation. Massaging a calf that is swollen and painful is never correct, because this action might break a clot to form an embolus, which could then travel to the lungs.)

When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death? a. The patient responds to noises. b. The patient's skin is mottled and waxlike. c. The heart rate and blood pressure increase. d. The patient is reviewing his life with his family.

b (When a patient is very near death, the skin will be waxlike, cold, clammy, and mottled or cyanotic. Although hearing is the last sense patients lose before death, it is unlikely that they will be responding to noises when very near death. Initially, the heart rate increases but later slows, and the blood pressure decreases. Near death, speaking may be slow and unusual and indicate confusion.)

A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this clients plan of care? a. Is your advance directive up to date and notarized? b. Do you want to be at home at the end of your life? c. Would you like a physical therapist to assist you with range-of-motion activities? d. Have your children discussed resuscitation with your health care provider?

b (When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the clients decision, not the family's decision.)

The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

b, c, d, e (The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).)

A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) a. Demonstrating breast self-examination methods to women b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers d. Screening teenage girls for cervical cancer e. Teaching teens the dangers of tanning booths

b, c, e (Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods.)

A hospice nurse is caring for a variety of clients who are dying. Which end-of-life and death ritual is paired with the correct religion? a. Roman Catholic: Autopsies are not allowed except under special circumstances. b. Christian: Upon death, a religious leader should perform rituals of bathing and wrapping the body in cloth. c. Judaism: A person who is extremely ill and dying should not be left alone. d. Islam: An ill or dying person should receive the Sacrament of the Sick.

c (According to Jewish law, a person who is extremely ill or dying should not be left alone. Orthodox Jews do not allow autopsies except under special circumstances. The Islamic faith requires a religious leader to perform rituals of bathing and wrapping the body in cloth upon death. A Catholic priest performs the Sacrament of the Sick for ill or dying people.)

An intensive care nurse discusses withdrawal of care with a clients family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond? a. I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia. b. You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support. c. I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death. d. There is no need to worry. Most religious organizations support the client's decision to stop medical treatment.

c (The nurse should validate the family's concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the clients family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.)

A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? a. Ensure the client is placed in protective isolation. b. Hand off a pregnant client to another nurse. c. No special action is necessary to care for this client. d. Read the policy on handling radioactive excreta.

d (This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled directly. The nurse should read the facility's policy for handling and disposing of this type of waste. The other actions are not warranted.)

Which statement about carcinogenesis is accurate? a. An initiated cell will always become clinical cancer. b. Cancer becomes a health problem once it is 1 cm in size. c. Normal hormones and proteins do not promote cancer growth. d. Tumor cells need to develop their own blood supply.

d (Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.)

A nurse teaches a client's family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? (Select all that apply.) a. Warm and flushed extremities b. Long periods of insomnia c. Increased respiratory rate d. Decreased appetite e. Congestion and gurgling

d, e (Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness.)

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. Chemo gloves b. Facemask c. Isolation gown d. N95 respirator e. Shoe covers

a, b, c (The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or chemo gloves), a facemask, and a gown. An N95 respirator and shoe covers are not required.)

A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply moisturizers to dry skin. b. Apply steroid creams to the skin. c. Bathe the client using mild soap. d. Help the client with a hot water bath. e. Teach the client to avoid sunlight.

a, c (The nurse can delegate applying unscented moisturizer and using mild soap for bathing. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function.)

A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects

a (Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the clients own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.)

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? a. "Have you had a fever?" b. "Have you lost any weight?" c. "Has diarrhea been a problem?" d. "Have you noticed any hair loss?"

a (An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.)

The nurse working with oncology clients understands that which age-related change increases the older clients susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves

a (As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.)

The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow

a (Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow.)

A patient admitted for pneumonia informs the nurse that no one is to attempt CPR. What is important for the nurse to verify in the medical record related to the patient's directive? a. The physician has written and signed the DNR order. b. The living will is signed by the patient and two witnesses. c. The patient's durable power of attorney agrees with the decision. d. There is an advance directive related to artificial nutrition and hydration.

a (CPR will be performed for respiratory or cardiac arrest unless a DNR (do not resuscitate) order is written and signed by the physician in the patient's medical record. The DNR order documents the patient's desire to avoid CPR.)

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings d. Exercises five times every week and does not consume alcoholic beverages

a (Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).)

A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon.

a (Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client's ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.)

A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline

a (Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate.)

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well-differentiated.

a (Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.)

A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies should the nurse incorporate in this clients pain management plan? (Select all that apply.) a. Play music that the client enjoys. b. Massage tissue that is tender from radiation therapy. c. Rub lavender lotion on the clients feet. d. Ambulate the client in the hall twice a day. e. Administer intravenous morphine.

a, c (Complementary therapies for pain management include massage therapy, music therapy, Therapeutic Touch, and aromatherapy. Nurses should not massage over sites of tissue damage from radiation therapy. Ambulation and intravenous morphine are not complementary therapies for pain management.)

A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort

a (Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.)

A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool

a (Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain. The other medications are appropriate for this client.)

A nurse discusses inpatient hospice with a client and the clients family. A family member expresses concern that her loved one will receive only custodial care. How should the nurse respond? a. The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left. b. Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop. c. A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given. d. Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility.

a (Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity.)

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods

a (Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.)

What is the priority problem for a client experiencing chemotherapy-induced anemia? a. Risk for injury related to fatigue b. Fatigue related to decreased oxygenation c. Body image problems related to skin color changes d. Inadequate nutrition related to anorexia

a (Safety is always a client priority. The client who is anemic will be fatigued and may need assistance with activity to prevent injury. The other problems may apply; however, they do not take priority over safety.)

A nurse reads on a hospitalized clients chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18.

a (The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary.)

A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse? a. "What are your feelings about being so sick and thinking you may die soon?" b. "None of us know when we are going to die. Is this a particularly difficult day?" c. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" d. "Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you."

a (The most appropriate response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. This option does both and is a helpful response that encourages further communication between the patient and nurse.)

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the client's gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the clients job risks.

a (This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.)

A nurse is caring for a client who is terminally ill. The clients spouse states, I am concerned because he does not want to eat. How should the nurse respond? a. Let him know that food is available if he wants it, but do not insist that he eat. b. A feeding tube can be placed in the nose to provide important nutrients. c. Force him to eat even if he does not feel hungry, or he will die sooner. d. He is getting all the nutrients he needs through his intravenous catheter.

a (When family members understand that the client is not suffering from hunger and is not starving to death, they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family.)

The nurse teaches a client with superior vena cava syndrome that improvement is characterized by which clinical manifestation? a. The clients hands are less swollen. b. Breath sounds are clear bilaterally. c. The clients back pain is relieved. d. Pedal edema is present.

a (With superior vena cava syndrome, blood flow through the vena cava is compromised as a result of tumor growth. Blood backs up into the periphery, and the client experiences upper body swelling, including the hands and feet. Compression of the superior vena cava has no effect on breath sounds. This would occur when blood is impeded from leaving the lungs, and with disorders that affect the left side of the heart. Back pain is not associated with this disorder.)

A client's family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the clients right to know and ask for their assistance. d. Have the unit manager take over the care of this client and family. e. Tell the family that this secret will not be kept from the client.

a, b, c (The clients right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the clients right to know and ask the family how best to proceed. The nurse should not abdicate responsibility for this difficult situation by transferring care to another nurse. Simply telling the family that he or she will not keep this secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not.)

The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.) a. Exposure to carcinogens b. Genetic predisposition c. Immune function d. Normal doubling time e. State of euploidy

a, b, c (The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function.)

Patients may reduce the risk of developing cancer using health promotion strategies.Identify strategies which can reduce the risk of developing cancer (select all that apply.). a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

a, b, c, d, e, f (Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.)

A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing d. Near-daily abdominal pain e. Obvious change in a mole

a, b, c, e (The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign.)

A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the clients shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care.

a, b, d (Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the clients shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care.)

A hospice nurse is caring for a dying client and her family members. Which interventions should the nurse implement? (Select all that apply.) a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. c. Assist family members by offering an explanation for their loss. d. Encourage reminiscence by both client and family members. e. Avoid spirituality because the clients and the nurses beliefs may not be congruent.

a, b, d (The nurse should teach family members about the physical signs of death, because family members often become upset when they see physiologic changes in their loved one. Palliative care includes management of symptoms so that the peaceful death of the client is facilitated. Reminiscence will help both the client and family members cope with the dying process. The nurse is not expected to explain why this is happening to the family's loved one. The nurse can encourage spirituality if the client is agreeable, regardless of whether the clients religion is the same.)

A client has mucositis. What actions by the nurse will improve the clients nutrition? (Select all that apply.) a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. c. Give the client hot liquids to hold in the mouth. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal.

a, b, d, e (Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Hot liquids would be painful for the client.)

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)? a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed.

a, b, e (Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.)

A nurse admits an older adult client to the hospital. Which criterion should the nurse use to determine if the client can make his own medical decisions? (Select all that apply.) a. Can communicate his treatment preferences b. Is able to read and write at an eighth-grade level c. Is oriented enough to understand information provided d. Can evaluate and deliberate information e. Has completed an advance directive

a, c, d (To have decision-making ability, a person must be able to perform three tasks: receive information (but not necessarily oriented 4); evaluate, deliberate, and mentally manipulate information; and communicate a treatment preference. The client does not have to read or write at a specific level. Education can be provided at the clients level so that he can make the necessary decisions. The client does not need to complete an advance directive to make his own medical decisions. An advance directive will be necessary if he wants to designate someone to make medical decisions when he is unable to.)

A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess all mucous membranes every 4 to 8 hours. b. Do not allow the client to eat meat or poultry. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours.

a, c, d, e (Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device, and recording vital signs. Eating meat and poultry is allowed.)

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply.)? a. Strong spiritual beliefs b. Advanced age of the patient c. Medical diagnosis of the patient d. Acceptance of the expected death of the patient e. Adequate time for the caregiver to prepare for the death

a, d, e (Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of the anticipatory grief of the caregiver.)

he nurse is planning care for a client with hypercalcemia secondary to bone metastasis. Which interventions are included in the plan? (Select all that apply.) a. Increase oral fluids. b. Place an oral airway at the bedside. c. Monitor for Chvosteks sign. d. Implement seizure precautions. e. Assess for hyperactive reflexes. f. Observe for muscle weakness.

a, f (Early manifestations of hypercalcemia include fatigue, loss of appetite, nausea, vomiting, constipation, and polyuria (increased urine output). More serious problems include severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, and electrocardiographic changes. An oral airway is not needed. Chvosteks sign is an assessment for hypocalcemia. Seizures and hyperactive reflexes do not occur with hypercalcemia.)

A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats.

b (Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the client's risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug.)

A patient near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms? a. Avoid administering pain medication until the patient is calm and alert. b. Stay physically close to the patient and use a soothing voice and soft touch. c. Turn on the television to provide a distraction and contact the hospital chaplain. d. Restrain the patient to prevent injury and ask family and visitors to leave the room.

b (Appropriate interventions for restlessness and confusion when a patient is near death include using soft touch and voice, staying physically close to the patient, and remaining calm. Use soothing music instead of the radio or television. Make referrals (e.g., hospital chaplain, spiritual leader) based on patient's spiritual and cultural preferences. Family visitors may provide comfort. Uncontrolled pain may be the cause of restlessness and confusion. Withholding pain medication or restraining the patient would be inappropriate and may cause more restlessness.)

A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this clients teaching? a. Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge. b. Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms. c. Hospice care will not help with your symptoms of depression. I will refer you to the facilitys counseling services instead. d. You seem to be experiencing some difficulty with this stage of the grieving process. Lets talk about your feelings.

b (As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.)

The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family? a. The patient will be incontinent of urine after frequent seizures. b. The skin will feel cold and clammy, with mottling on the extremities. c. The patient will have increased pain, and the sense of touch will be enhanced. d. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.

b (As death approaches, the following physical manifestations occur: cold, clammy skin; mottling on hands, feet, arms, and legs; jerking (not seizures), which occurs in patients on large amounts of opioids; bowel and bladder incontinence; decreased perception of pain and touch; loss of gag reflex; and Cheyne-Stokes respirations.)

A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss

b (Only symptoms that cause distress for a dying client should be treated. Such symptoms include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the clients comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they should be treated only if the client is distressed by their presence. The nurse should treat the client's pain first.)

A dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? a. Encourage more physical activity. b. Assess for pain, constipation, and urinary retention. c. Assess for spiritual distress and restrain in varying positions. d. Assess for quality, intensity, location, and contributing factors of discomfort.

b (Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult because weakness and fatigue are expected at the end of life. Keeping the skin clean and dry and preventing shearing forces will better avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.)

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.

b (Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.)

A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first? a. Call for emergency assistance so that resuscitation procedures can begin. b. Ask family members if they would like to spend time alone with the client. c. Ensure that a death certificate has been completed by the physician. d. Request family members to prepare the clients body for the funeral home.

b (Before moving the client's body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The clients family should not be expected to prepare the body for the funeral home.)

A client with cancer has anorexia and mucositis, and is losing weight. The clients family members continually bring favorite foods to the client and are distressed when the client wont eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isn't able to eat now no matter what they bring.

b (Families often become distressed when their loved ones won't eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.)

A client has small cell lung cancer. Which laboratory result requires immediate intervention by the nurse? a. Serum potassium of 5.1 mEq/L b. Serum sodium of 118 mEq/L c. Hematocrit of 45% d. Blood urea nitrogen (BUN) of 10 mg/dL

b (In the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), secretion of antidiuretic hormone (ADH) from the posterior pituitary gland is increased, causing the client to reabsorb water from the distal convoluted tubule and collecting duct. As a result, weight increases, and serum sodium and hematocrit levels are diluted. Blood urea nitrogen (BUN) and hematocrit are normal. Potassium is slightly high, but very low sodium places the client at risk for seizures and even death.)

A client's spouse reports that the last time the client received lorazepam (Ativan) before receiving chemotherapy, the client was extremely drowsy and didn't remember the trip home. Which is the nurses best action? a. Hold the dose of lorazepam for this round of chemotherapy. b. Explain that this is a normal response to the drug. c. Perform a Mini-Mental State Examination. d. Document the response in the clients chart.

b (Lorazepam, a benzodiazepine, induces sedation and amnesia, in addition to having antiemetic effects. Many clients have little if any memory about events occurring within a few hours after receiving lorazepam. This is an expected side effect and does not denote any permanent reduced cognition in the client. Both the client and the spouse should be aware of this effect so that the client is not at risk for injury. Driving, cooking, or operating mechanical equipment should not be performed until the drugs effects have worn off.)

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying clients anxiety and restlessness. Which statement made by the family member indicates understanding of the nurses teaching? a. Maybe we should just hire an around-the-clock sitter to stay with Grandmother. b. I have some of her favorite hymns on a CD that I could bring for music therapy. c. I don't think that she'll need pain medication along with her herbal treatments. d. I will burn therapeutic incense in the room so we can stop the anxiety pills.

b (Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client's inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the clients family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.)

After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today

b (Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward.)

A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. Are you getting adequate rest and sleep each day? b. It is normal to be fatigued even for years afterward. c. This is not normal and I'll let the provider know. d. Try adding more vitamins B and C to your diet.

b (Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.)

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d. Hypophosphatemia

b (TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.)

Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b.A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

b (The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.)

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? a. "Exercise every day for 30 minutes." b. "Follow smoking cessation recommendations." c. "Following a vitamin regime is highly recommended." d. "I recommend excision of the cancer as soon as possible."

b (The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.)

A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. Avoid getting salt water on the radiation site. b. Do not expose the radiation area to direct sunlight. c. Have a wonderful time and enjoy your vacation! d. Remember you should not drink alcohol for a year.

b (The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.)

The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. How would the nurse interpret the general prognosis of the patient? a. 3 months or less to live b. 6 months or less to live c. 12 months or less to live d. 18 months or less to live

b (There are two criteria to be eligible for hospice care. The first is that the patient wishes to receive hospice, not curative care, and the second is that the physician certifies that the patient has a prognosis of 6 months or less to live.)

A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the client's abdomen before hand b. Ensuring that informed consent is on the chart c. Marking the clients bilateral pedal pulses d. Reviewing client teaching done previously

b (This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority.)

In planning a teaching session for a client undergoing photodynamic therapy for lung cancer, the nurse includes which statements? (Select all that apply.) a. This is a palliative treatment that should decrease your pain. b. Avoid exposure to the sun for 1 to 3 months after the treatment. c. Do not eat or drink anything before your treatments. d. Do not remove skin markings between treatments. e. You need to wear sunglasses to protect your eyes after treatments. f. Make sure you keep your curtains closed at home afterward.

b, e, f (Phototherapy causes general sensitivity to light for up to 12 weeks. During this time, the client is at high risk for light sensitivity and eye pain. After the procedure, the client is taught to decrease exposure to sunlight (to the point of being homebound).)

When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue? a. Euthanasia b. Organ donor card c. Advance directives d. Do not resuscitate (DNR)

c (Advance directives are written documents that provide information about the patient's wishes for medical care and treatments and his or her designated spokesperson. Euthanasia is not a form; it is a deliberate act of hastening death. Organ donor cards only state that the patient wants to donate organs or their body for transplants or for scientific research. DNR or comfort measures is a written order from the physician that documents a patient's wishes to avoid CPR.)

A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. It causes rapid lysis of the cancer cell membranes. b. It destroys the enzymes needed to create cancer cells. c. It prevents the start of cell division in the cancer cells. d. It sensitizes certain cancer cells to chemotherapy.

c (Rituxan prevents the initiation of cancer cell division. The other statements are not accurate.)

After teaching a client about advance directives, a nurse assesses the client's understanding. Which statement indicates the client correctly understands the teaching? a. An advance directive will keep my children from selling my home when I'm old. b. An advance directive will be completed as soon as Im incapacitated and cant think for myself. c. An advance directive will specify what I want done when I can no longer make decisions about health care. d. An advance directive will allow me to keep my money out of the reach of my family.

c (An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the clients residence or financial matters.)

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.

c (Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.)

The nursing instructor explains the difference between normal cells and benign tumor cells. What information does the instructor provide about these cells? a. Benign tumors grow through invasion of other tissue. b. Benign tumors have lost their cellular regulation from contact inhibition. c. Growing in the wrong place or time is typical of benign tumors. d. The loss of characteristics of the parent cells is called anaplasia.

c (Benign tumors are basically normal cells growing in the wrong place or at the wrong time. Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells.)

A client is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurses first action when the client reports burning at the site? a. Check for a blood return. b. Slow the rate of infusion. c. Discontinue the infusion. d. Apply a cold compress.

c (Both irritants and vesicants can cause tissue damage. If the nurse suspects extravasation, he or she should immediately stop the infusion. Even if the IV has a good blood return, some of the chemotherapeutic agent can still be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent further leakage and damage. Applying a cold compress may or may not be the correct action, depending on the specific agent. However, the compress would be applied only after the infusion has been discontinued.)

The student nurse overhears several staff members referring to a client who is receiving chemotherapy as having chemo brain. The student asks the instructor what that means. Which response by the instructor is best? a. That is an awful thing to say and the staff should not call a client by that name. b. It refers to the clients brain as being irreversibly damaged by the chemotherapy. c. The client has reduced cognitive function that may last for several years. d. The client has delirium related to the toxic effects of the chemotherapy.

c (Chemo brain refers to the changes in concentration, memory, and learning that sometimes accompany chemotherapy. It usually is not present at 3 years after chemotherapy has been completed, so clients should be reassured that this is a temporary condition. Although the staff should be more sensitive, simply criticizing them does not help the student understand the situation.)

A patient died after a myocardial infarction experienced while performing yard work. What would indicate that his spouse is experiencing prolonged grief disorder? a. Initially, the spouse denied the death. b. Talking about the spouse extensively in year after the death c. Stating that the spouse will return on the anniversary of the death d. Crying uncontrollably and unpredictably in the weeks after the spouse's death

c (Denial of an individual's death that persists beyond 6 months is indicative of prolonged grief disorder. Strong emotions or denial immediately after the death are considered to be expected responses. Talking about the deceased loved one is not considered to be evidence of the disorder.)

How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient's life? a. Assess the individual patient's wishes. b. Call a pastor or priest for the family to help them cope. c. Assess the beliefs and preferences of the patient and family. d. Do not insult African Americans by suggesting hospice care.

c (Differences among spiritual and culture beliefs and values related to death and dying are innumerable. The individual patient and family must be assessed to avoid stereotyping individuals with different spiritual and cultural belief systems.)

During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness? a. Frustration with pain b. Anorexia and nausea c. Feelings of hopelessness d. Inability to carry out activities of daily living

c (Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness.)

A client who has just had a mastectomy is crying. When the nurse asks about her crying, the client responds, I know I shouldn't cry because this surgery may well save my life. What is the nurse's best response? a. It is all right to cry. Mourning this loss will help make you stronger. b. I know this is hard, but your chances of survival are better now. c. I can arrange for someone who had a mastectomy to come visit if you like. d. How have you coped with difficult situations in the past?

c (Often, cancer surgery involves the loss of a body part or a decrease in function. Mourning or grieving for a body image alteration is a healthy part of adapting or adjusting to a new image. Visiting with someone who has experienced the same situation as the client is very helpful in showing the client that many aspects of life can be the same afterward. If the opportunity to arrange this type of visit is available, this would be the nurses best response. The other options do not provide any assistance to the client in coping with her new body image and grieving for her loss.)

A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the client's serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery.

c (Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.)

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

c (TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.)

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."

c (The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.)

After a patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient? a. Maintain daily contact with the adolescent's family for the next 2 to 3 months. b. Request a prescription for an anxiolytic to aid in dealing with the death of this patient. c. Attend a debriefing session with interprofessional team to allow expression of feelings. d. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.

c (The nurse needs to express feelings of loss and grief. Interventions such as a peer support, professionally assisted groups, and informal discussion sessions are appropriate ways for the nurse to express feelings related to death and dying.)

A client is on chemotherapy and has a platelet count of 25,000. Which intervention is most important to teach this client? a. Eat a low-bacteria diet. b. Take your temperature daily. c. Use a soft-bristled toothbrush. d. Avoid alcohol-based mouthwashes.

c (This client has thrombocytopenia, which is a common side effect of chemotherapy. This increases the client's risk for prolonged bleeding in response to even minor injury, especially from highly vascular areas such as the gums. The client should be taught to use a soft toothbrush. A low-bacteria diet and daily temperature monitoring would be used in a client who is neutropenic. Alcohol-based mouthwashes will dry mucous membranes.)

A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? a. Foods high in vitamin A and vitamin C are important. b. I'll have to cut down on the amount of bacon I eat. c. I'm so glad I don't have to give up my juicy steaks. d. Vegetables, fruit, and high-fiber grains are important.

c (To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct.)

A nurse manager on an oncology nursing unit notes an increased incidence of infection and serious consequences for clients on the unit. Which action by the nursing manager is most beneficial in this situation? a. Review asepsis policies at a mandatory in-service for staff. b. Spot-check all staff for good handwashing practices. c. Develop standard protocols to identify and treat clients with infection. d. Institute protective precautions for all clients receiving chemotherapy.

c (Treatment delays have a serious negative impact on neutropenic clients with infection. Nursing units should have standardized protocols to obtain cultures and diagnostic tests, and to start antibiotics as soon as a client is suspected of having an infection. In-services and spot-checking for good handwashing practice are good ideas as part of a comprehensive infection control practice but are not as important as standard protocols that ensure rapid diagnosis and treatment. Not all clients on chemotherapy will need protective precautions.)

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? a. Provide ice chips to soothe the irritation. b. Weigh the patient every month to monitor for weight loss. c. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. d. Provide high-protein and high-calorie, soft foods every 2 hours.

d (A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.)

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? a. Firm-bristle toothbrush b. Hydrogen peroxide rinse c. Alcohol-based mouthwash d. 1 tsp salt in 1 L water mouth rinse

d (A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.)

A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf

d (All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.)

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

d (All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury.)

A client has late-stage colon cancer with metastasis to the spine and bones. Which nursing intervention does the nurse add to the care plan to address a priority problem? a. Provide six small meals and snacks daily. b. Offer the client prune juice twice a day. c. Ensure that the client gets adequate rest. d. Give the client pain medications around the clock.

d (Although all interventions might be appropriate, a client with late-stage cancer and bone metastases is at risk for severe pain. Giving the client pain medication around the clock is the best way to manage this type of pain.)

A patient has been receiving palliative care for the past several weeks in light of a worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse document that the patient is experiencing? a. Apnea b. Bradypnea c. Death rattle d. Cheyne-Stokes respirations

d (Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.)

The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. I should take my temperature daily and when I don't feel well. b. I will wash my toothbrush in the dishwasher once a week. c. I won't let anyone share any of my personal items or dishes. d. Its alright for me to keep my pets and change the litter box.

d (Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management.)

A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the clients oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications.

d (During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed.)

A client tells the nurse that, even though it has been 4 months since her sisters death, she frequently finds herself crying uncontrollably. How should the nurse respond? a. Most people move on within a few months. You should see a grief counselor. b. Whenever you start to cry, distract yourself from thoughts of your sister. c. You should try not to cry. Im sure your sister is in a better place now. d. Your feelings are completely normal and may continue for a long time.

d (Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client's response.)

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a. "I understand the transplant procedure has no dangerous side effects." b. "After the transplant, I will feel better and can go home in 5 to 7 days." c. "My brother will be a 100% match for the cells used during the transplant." d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

d (Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.)

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? a. Weight gain of 6 lb b. Nausea and vomiting c. Urine specific gravity of 1.004 d. Serum sodium level of 118 mEq/L

d (Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.)

A client receiving intravenous chemotherapy asks the nurse the reason for wearing a mask, gloves, and gown while administering drugs to the client. What is the nurse's best response? a. These coverings protect you from getting an infection from me. b. I am preventing the spread of infection from you to me or any other client here. c. The policy is for any nurse giving these drugs to wear a gown, gloves, and mask. d. The clothing protects me from accidentally absorbing these drugs.

d (Most chemotherapy drugs are absorbed through the skin and mucous membranes. As a result, health care workers who prepare or give these drugs, especially nurses and pharmacists, are at risk for absorbing them. Even at low doses, chronic exposure to chemotherapy drugs can affect health. The Oncology Nursing Society and the Occupational Safety and Health Administration (OSHA) have specific guidelines for using caution and wearing protective clothing whenever preparing, giving, or disposing of chemotherapy drugs.)

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? a. Acute pain b. Hypothermia c. Powerlessness d. Risk for infection

d (Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.)

A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the clients chart that the cancer classification is TISN0M0. What does the nurse conclude about this clients cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report.

d (TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis.)

A nurse is caring for a dying client. The clients spouse states, I think he is choking to death. How should the nurse respond? a. Do not worry. The choking sound is normal during the dying process. b. I will administer more morphine to keep your husband comfortable. c. I can ask the respiratory therapist to suction secretions out through his nose. d. I will have another nurse assist me to turn your husband on his side.

d (The choking sound or death rattle is common in dying clients. The nurse should acknowledge the spouses concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. The nurse should not minimize the spouses concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not appropriate in a dying client.)

After receiving change-of-shift report, which client does the nurse assess first? a. Client with leukemia who needs an antiemetic before chemotherapy b. Client with breast cancer scheduled for external beam radiation c. Client with xerostomia associated with laryngeal cancer d. Client with neutropenia who has just been admitted with a possible infection

d (The most complex, potentially unstable client is the one with neutropenia with suspected infection. Because the onset of infection is insidious in clients with neutropenia, this client is at risk for sepsis. All other clients are stable.)

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

d (The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.)

The nurse is evaluating whether a hospice referral is appropriate for a patient with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program? a. The hospice medical director certifies admission to the program. b. The physician guarantees the patient has less than 6 months to live. c. The patient has completed both advance directives and a living will. d. The patient wants hospice care and agrees to terminate curative care.

d (There are two criteria for admission to a hospice program. The first criterion is the patient must desire the services and agree in writing that only hospice care (and not curative care) can be used to treat the terminal illness. The second criterion is that the patient must be considered eligible for hospice. Two physicians must certify that the patient's prognosis is terminal with less than 6 months to live.)