Peritonitis

The male client has had a radial neck dissection for cancer of the larynx. Which action by the client indicates a disturbance in body image? 1. The client requests a consultation by the speech therapist. 2. The client has a towel placed over the mirror. 3. The client is attempting to shave himself. 4. The client practices neck and shoulder exercises

2. Placing a towel over the mirror indicates the client is having difficulty looking at his reflection, a body-image problem.

The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach? 1. The test will confirm the results of the MRI. 2. The client can eat and drink immediately after the test. 3. The HCP can do a biopsy of the tumor through the scope. 4. There is no discomfort associated with this procedure.

3

A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? SATA A. permit visitors to stay with the clients 30 minutes at a time B. place the client on bed rest C. wear a dosimeter when in the clients room D. placed soiled dressings in a biohazard bag before discarding in the regular trash E. dispose soiled linens in the hamper outside the clients room

A,B,C

While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for nursing actions related to a. diarrhea. b. grieving. c. risk for infection. d. nutritional intake

. c. The nadir is the point of the lowest blood counts after chemotherapy is started, and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated, but they are not the priority.

The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the first thing the nurse should do for this patient? a. Administer a nonsteroidal anti inflammatory drug. b. Assess the patient's vital signs and behavior to determine the medication to use. c. Have the patient keep a pain diary to better assess the patient's potential addiction. d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain.

. d. The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management. Vital signs and behavior are not reliable indicators with the chronic pain of cancer. A pain diary identifies pain management.

The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply. 1. Apply O2 via nasal cannula. 2. Have the dietitian plan for six (6) small meals per day. 3. Place the client in respiratory isolation. 4. Assess vital signs for fever. 5. Listen to lung sounds every shift

1,2,4,5; impaired O2 levels should warrant the use of supplemental oxygen, 6 meals a day are appropriate because pts. with lung cancer tend not to eat d/t poor appetite; assess for fever because cancer patients are susceptible to infection and listening to lung sounds every hour should be implemented every shift

The charge nurse is assigning clients for the shift. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with cancer of the lung who has chest tubes. 2. The client diagnosed with laryngeal spasms who has stridor. 3. The client diagnosed with laryngeal cancer who has multiple fistulas. 4. The client who is two (2) hours post-partial laryngectomy

1. Chest tubes are part of the nursing education curriculum. The new graduate should be capable of caring for this client or at least knowing when to get assistance

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a surgical floor. Which information provided by the UAP requires immediate intervention by the nurse? 1. There is a small, continuous amount of bright-red drainage coming out from under the dressing of the client who had a radical neck dissection. 2. The client who has had a right upper lobectomy is complaining that the patient-controlled analgesia (PCA) pump is not providing any relief. 3. The client diagnosed with cancer of the lung is complaining of being tired and short of breath. 4. The client admitted with chronic obstructive pulmonary disease is making a whistling sound with every breath

1. The most serious complication resulting from a radical neck dissection is rupture of the carotid artery. Continuous bright-red drainage indicates bleeding and this client should be assessed immediately

The HCP has recommended a total laryngectomy for a male client diagnosed with cancer of the larynx but the client refuses. Which intervention by the nurse illustrates the ethical principle of nonmalfeasance? 1. The nurse listens to the client explain why he is refusing surgery. 2. The nurse and significant other insist that the client have the surgery. 3. The nurse refers the client to a counselor for help with the decision. 4. The nurse asks a cancer survivor to come and discuss the surgery with the client.

1. This is an example of nonmalfeasance, where the nurse "does no harm." In attempting to discuss the client's refusal, the nurse is not trying to influence the client; the nurse is merely attempting to listen therapeutically

445. When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply. 1. Limiting the time with the client to 1 hour per shift. 2. Keeping pregnant women out of the client's room. 3. Placing the client in a private room with a private bath. 4. Wearing a lead shield when providing direct client care. 5. Removing the dosimeter film badge when entering the client's room. 6. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client.

2, 3, 4 Rationale: The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per shift. The client must be placed in a private room with a private bath. Lead shielding can be used to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room.

The client who has undergone a radical neck dissection and tracheostomy for cancer of the larynx is being discharged. Which discharge instructions should the nurse teach? Select all that apply. 1. The client will be able to speak again after the surgery area has healed. 2. The client should wear a protective covering over the stoma when showering. 3. The client should clean the stoma and then apply a petroleum-based ointment. 4. The client should use a humidifier in the room. 5. The client can get a special telephone for communication

2. The client breathes through a stoma in the neck. Care should be taken not to allow water to enter the stoma, 4. The client has lost the use of the nasal passages to humidify the inhaled air, and artificial humidification is useful until the client's body adapts to the change. 5. Special equipment is available for clients who cannot hear or speak

The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse? 1. The client has an intake of 1,500 mL IV and an output of 1,000 mL. 2. The client has 450 mL of bright-red drainage in the chest tube. 3. The client is complaining of pain at a "10" on a 1-to-10 scale. 4. The client has absent lung sounds on the side of the surgery.

2; 450mL is equivalent to a pint of blood, so this finding may implicate that the patient is hemorrhaging

The nurse is writing a care plan for a client newly diagnosed with cancer of the larynx. Which problem is the highest priority? 1. Wound infection. 2. Hemorrhage. 3. Respiratory distress. 4. Knowledge deficit

3. Respiratory distress is the highest priority. Hemorrhaging and infection are serious problems, but airway is priority

The client has had a total laryngectomy. Which referral is specific for this surgery? 1. CanSurmount. 2. Dialogue. 3. Lost Chord Club. 4. SmokEnders

3. The Lost Chord Club is an American Cancer Society-sponsored group of survivors of larynx cancer. These clients are able to discuss the feelings and needs of clients who have had laryngectomies because they have all had this particular surgery.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

4. Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen 1332 level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? 1. The client worked with asbestos for a short time many years ago. 2. The client has no family history for this type of lung cancer. 3. The client has numerous tattoos covering both upper and lower arms. 4. The client has smoked two (2) packs of cigarettes a day for 20 years.

4. Option 1 is incorrect because asbestos is associated with mesothelioma of the lung not small cell cancer of the lung

The nurse is preparing the client diagnosed with laryngeal cancer for a laryngectomy in the morning. Which intervention is the nurse's priority? 1. Take the client to the intensive care unit for a visit. 2. Explain that the client will need to ask for pain medication. 3. Demonstrate the use of an antiembolism hose. 4. Find out if the client can read and write

4. The client is having the vocal cords removed and will be unable to speak. Communication is a high priority for this client. If the client is able to read and write, a Magic Slate or pad of paper should be provided. If the client is illiterate, the nurse and the client should develop a method of communication using pictures

The client diagnosed with cancer of the larynx has had four (4) weeks of radiation therapy to the neck. The client is complaining of severe pain when swallowing. Which scientific rationale explains the pain? 1. The cancer has grown to obstruct the esophagus. 2. The treatments are working on the cancer and the throat is edematous. 3. Cancers are painful and this is expected. 4. The treatments are also affecting the esophagus, causing ulcerations.

4. The esophagus is extremely radiosensitive, and esophageal ulcerations are common. The pain can become so severe the client cannot swallow saliva. This is a situation in which the client will be admitted to the hospital for IV narcotic pain medication and possibly total parenteral nutrition.

A nurse is reviewing the medical record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2-N3-MX. Which of the following findings should the nurse identify as a supporting diagnosis? A. the tumor is moderate in size B. no lymph nodes contain cancer cells C. the tumor is receptive to chemotherapy D. the cancer has metastasized to other areas of the body

A. A T2 designation describes the size and extent of the ovarian tumor using the TNM scale

A nurse is planning care for a client who has a platelet count of less than 10,000/mm. Which of the following interventions should the nurse include in the plan of care? A. apply prolonged pressure to puncture site after blood sampling B. Administer epoetin alfa as prescribed C. Place the client in a private room D. Have the client use an oral topical anesthetic before meals

A. This indicates the patient has thrombocytopenia therefore bleeding precautions should be implicated

457. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? 1. Age younger than 50 years 2. History of colorectal polyps 3. Family history of colorectal cancer 4. Chronic inflammatory bowel disease

Answer: 1 Rationale: Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease

444. The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

Answer: 1 Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client

448. The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. The client's pain rating 2. Nonverbal cues from the client 3. The nurse's impression of the client's pain 4. Pain relief after appropriate nursing intervention

Answer: 1 Rationale: The client's self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Assessing pain relief is an important measure, but this option is not related to the subject of the

465. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. "I should avoid blowing my nose." 2. "I may need a platelet transfusion if my platelet count is too low." 3. "I'm going to take aspirin for my headache as soon as I get home." 4. "I will count the number of pads and tampons I use when menstruating.

Answer: 3 Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 10 9 /L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided because of their anti-platelet activity

447. The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors. 2. Restrict fluid intake. 3. Teach the client and family about the need for hand hygiene. 4. Insert an indwelling urinary catheter to prevent skin breakdown

Answer: 3 Rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections

A patient undergoing chemotherapy is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (SATA) A. Encourage a high-fiber diet B. Eliminate standing water in the room C. Have the client specific equipment remain in the room D. Eliminate raw foods from the clients diet

B,C,D

A nurse is collecting information from a client in a providers office. Which of the following findings should the nurse identify as an indication of possible cancer? SATA a. Temperature of 102 for more than 48hrs b. sore that does not heal c. difficulty swallowing d. unusual discharge e. weight gain 4lbs in 2 weeks

B,C,D,E

A nurse is caring for a client who is undergoing chemotherapy and frequently complains of nausea. Which of the following statements should the nurse make? A. Your nausea will lessen with each course of chemotherapy B. Hot food is better tolerated due to the aroma C. Try eating several small meals throughout the day D. Increase your intake of red meat as tolerated

C. Several small meals per day are usually better tolerated by the client who has nausea

A nurse is caring for a client who is receiving chemotherapy and has mucositis. Which of the following actions should the nurse take? A. Use a glycerin-soaked mouth swab to clean the clients teeth B. Encourage the intake of orange juice C. Obtain a culture of the lesions C. provide an alcohol-based mouthwash for oral hygiene

C. obtain a culture first to identify pathogens and determine appropriate treatment

A nurse is reviewing the plan of care for a client who has leukemia and developed thrombocytopenia. Which of the following actions should the nurse take? A. Instruct the client to rest B. Encourage the client to reposition in bed every 2 hours C. Check the temperature every 4 hours D. Monitor PLT count

D

Which factors will help a patient in coping positively with having cancer (select all that apply)? a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. Easier adaptability of a young person f. Not having had to cope with previous stressful events

a, b, d, e. Feeling in control, having a strong support system, and the potential of cure or control of the cancer will have a positive effect on coping with the diagnosis. The other options will make coping more difficult for the patient

To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program. b. Ignore the fatigue as much as possible. c. Do the most stressful activities when fatigue is tolerable. d. Schedule rest periods throughout the day whether fatigue is present or not.

a. Walking programs, or activity the patient enjoys, scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves, stimulate appetite, enhance functional capacity, and help combat the depression caused by inactivity

The nurse uses many precautions during IV administration of vesicant chemotherapy agents primarily to prevent a. septicemia. b. extravasation. c. catheter occlusion. d. anaphylactic shock

b. One of the major concerns with the IV administration of vesicant chemotherapy agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local tissue breakdown, and necrosis

When teaching the patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about side effects of the drugs to prevent anticipatory anxiety. b. Assure the patient that side effects from chemotherapy are uncomfortable but not life threatening. c. Explain that antiemetics, antidiarrheals, and analgesics will be given as needed to control side effects. d. Tell the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong use of wigs.

c. Patients should always be taught what to expect during a course of chemotherapy, including side effects and expected outcome. Side effects of chemotherapy are serious, but it is important that patients be informed about what measures can be taken to help them cope with the side effects of therapy. Hair loss related to chemotherapy is usually reversible and wigs, scarves, or turbans can be used during and following chemotherapy until the hair grows back.

The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Keep the area shaved of hair. b. Keep the area covered if it is sore. c. Dry the skin thoroughly after cleansing. d. Avoid extreme temperatures to the area.

d. Avoiding sources of excessive heat and cold will prevent damage to the skin. Only an electric razor is used if shaving is necessary in the treatment field. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended